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#Grand Rounds

Is Surgical Reduction Following Wrist Fracture in Older Adults Necessary to Improve Functional Outcomes?

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BACKGROUND AND PURPOSE:

  • Distal radius fractures (DRFs) are common in older adults
  • Precise anatomic reduction usually not done under the assumption that total return to function may not be necessary compared to younger patients
  • Chung et al. (JAMA Network Open Surgery, 2020) looked at whether precise anatomic reduction impacts function in older adults with DRF

METHODS:

  • Secondary analysis of a multicenter RCT
    • Data came from the Wrist and Radius Injury Surgical Trial (WRIST)
  • Participants
    • Adults ≥60 years with DRF  
    • Completed 12-month assessments
  • Randomized to the following interventions
    • Volar locking plate
    • Percutaneous pinning
    • External fixation
    • If patient did not opt for surgical anatomic reduction, they obtained casts
  • Study design
    • Multivariable regression modeling to address covariates and confounding  
  • Primary outcomes 12 months following treatment
    • Hand grip strength
    • Wrist arc of motion
    • Radial and ulnar deviation
    • Michigan Hand Outcomes Questionnaire (MHQ) total score, MHQ function score, and MHQ activities of daily living score (MHQ ADL)

RESULTS:

  • 166 WRIST participants were included
    • 86.7% women | Mean age: 70.9 years
  • Overall, radiographic measures were not associated with outcomes
  • For patients ≥70 years
    • Every degree increase in radial inclination away from normal (22°), grip strength in the injured hand was 1.1 kg weaker than the uninjured hand
      • 95% CI, 0.38 to 1.76; P = 0.004
    • Each millimeter increase toward normal (0 mm) in ulnar variance was associated with a 10.4-point improvement in MHQ ADL score
      • 95% CI, −16.84 to −3.86; P = 0.003
  • Neither of these radiographic parameters impacted function scores

CONCLUSION:

  • Precise restoration of wrist anatomy is not associated with better patient outcomes
  • The authors state

In the treatment decision-making process, surgeons can prioritize patient preferences over the need to achieve exact realignment.

Learn More – Primary Sources:

Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults: A Secondary Analysis of a Randomized Clinical Trial

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Related ObG Topics:

Is Physical Activity Associated with Lower Risk of Fractures in Older Women?
Hip Fractures in Older Women: Who is at Risk and Would Benefit Most from Treatment?
Does Combined Vitamin D and Calcium Supplementation Reduce Risk of Fracture?

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