Grand Rounds

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

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

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)

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

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.

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