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Operative Treatment of Distal Radius Fractures in Elderly Patients is Associated with Beneficial Mental Health Outcomes in Elderly Patients Compared to Nonoperative Management: A Retrospective Cohort Analysis
Cameron Bowers, BS
1, Jad Lawand, MS
2, Patrick Tansey, MD
1, Umar M. Ghilzai, MD
3; John Faillace, MD
1(1)University of Texas Medical Branch, Galveston, TX, (2)UTMB, Galvestone, TX, (3)Baylor College of Medicine, Houston, TX
Introduction: Previous research has compared functional outcomes in elderly patients receiving operative versus nonoperative management of distal radius fractures. These studies have identified that patients with either treatment approach have had similar outcomes regarding postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores, making the decision to operate or not on these patients controversial. However, there remains a gap in the literature in how these different methods of care impact the mental wellbeing of patients. This study aims to explore these mental health outcomes in elderly patients undergoing these different treatment options within a 1-year post-fracture period.
Methods: A retrospective query of the TriNetX database was performed to identify patients who were 65 years of age or older with a distal radius fracture, and within a month of diagnosis underwent open reduction internal fixation (ORIF) using International Classification of Diseases, 10
th Revision (ICD-10) and Current Procedural Terminology (CPT) codes. Patients in the ORIF of distal radius fractures cohort were 1:1 propensity score matched to a cohort that received nonoperative treatment for demographic factors such as age, sex, race, and ethnicity and other variables such as polytrauma, yielding 18,489 patients per group. Mental health outcomes were evaluated in a period within 1-year post-fracture management using ICD-10 codes. Patients that did not have a minimum of 1 year of follow-up post-fracture were excluded from analysis. Risk percentages, risk ratios (RR), 95% confidence intervals (CI), and
p values were calculated.
Results: Patients undergoing ORIF of distal radius fractures were associated with having a significantly lower risk of diagnosis of major depressive disorder (MDD) (1.9% vs. 2.3%; RR 0.828; 95% CI 0.710, 0.966;
p = 0.017), depressive episodes (2.9% vs. 3.3%; RR 0.865; 95% CI 0.760, 0.984;
p = 0.028), selective serotonin reuptake inhibitor (SSRI) use ( 3.2% vs. 3.6%l RR 0.882; 95% CI 0.780, 0.998), and opioid dependence (0.1% vs. 0.2%; RR 0.566; 95% CI 0.331, 0.966;
p = 0.034) compared to the nonoperative management cohort within 1-year post-fracture.
Conclusion: In elderly patients with distal radius fractures, undergoing ORIF was associated with significantly reduced risk of MDD, depressive episodes, SSRI use, and opioid dependence compared to nonoperative treatment within 1-year post-fracture. While previous studies have identified that these patients have similar functional outcomes sparking debate over the indications for surgical management, these findings contribute to another important aspect that may be considered in the management of distal radius fractures.
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