Non-Operative Treatment versus Volar Locking Plate Fixation for Unstable Dorsally Displaced Distal Radius Fractures in patients over 70 years - A 3 Year Follow-Up of a Randomized Controlled Trial
Hanna Südow, MD1, Sara Severin, MD2, Maria Wilcke, PhD3, Olof Sköldenberg, Associate Professor2, Jenny Saving, MD, PhD3 and Cecilia Mellstrand Navarro, MD, Associate Professor3, (1)Karolinska Institutet, Stockhom, Sweden, (2)Karolinska Institute, Danderyd, Sweden, (3)Karolinska Institute, Stockholm, Sweden
Background: Surgical treatment of displaced distal radius fracture (DRF) in older patients with volar locking plates has increased despite lacking evidence of its superiority over non-operative treatment. How the choice of treatment affects these patients beyond 12 months remains unknown. The aim of this three-year follow-up of a randomized clinical trial was to compare surgery with volar locking plate with non-operative treatment in patients 70 years or older 3 years after a dorsally displaced distal radius fracture.
Methods: 2009-2017 140 patients over the age of 70 years with unstable DRF were randomized to non-operative treatment or surgery with volar locking plate (VLP). Three years after inclusion the participants were invited to an new follow-up. The primary outcome was Patient Rated Wrist Evaluation (PRWE). Secondary outcomes included additional Patient Reported Outcome Measures (PROM), grip strength, range of motion, complications, and radiology.
Results: 66 patients were available for a three-year follow-up, 33 in the non-operatively treated group and 33 in the VLP-group. The mean age of injury was 77 years. At three years the median PRWE was lower (0p) in the VLP-group than in the non-operative treatment group (9p). No statistically significant difference was found in the other PROM nor in grip strength. No significant difference in osteoarthritis was found. The complication rate was similar. Both groups had regained grip strength compared to the non-injured side.
Conclusions: There is a benefit for surgery with volar locking plate compared to non-operative treatment for severely displaced distal radius fractures in patient over 70 years. The clinical importance of the benefit may be questioned.
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