Published results showed volar locking plate fixation may not be superior to closed reduction for subjective wrist function in patients aged 60 years or older with displaced distal radius fractures.
“Surgical treatment of wrist fractures in older patients does not offer any advantage over nonsurgical treatment in the long term,” Andrew Lawson, MPH, told Healio. “Our findings should encourage health practitioners to carefully consider the indications for surgical treatment in these patients.”
Lawson and colleagues randomly assigned 166 patients aged 60 years or older with displaced distal radius fractures to either undergo open reduction and internal fixation using a volar locking plate or nonsurgical treatment consisting of closed reduction and cast immobilization. Researchers included 134 patients who declined randomization in a parallel observational group with the same treatment options and follow-up, which was performed by an assessor who was blinded to treatment at 3, 12 and 24 months.
Researchers considered patient-reported function using the patient-rated wrist evaluation questionnaire as the primary outcome and health-related quality of life, wrist pain, patient-reported treatment success, patient-rated bother with appearance and posttreatment complications as the secondary outcomes.
Overall, 91% of patient in the randomized cohort and 88.1% of patients in the observational cohort had follow-up data at 24 months. Researchers found no clinically important differences in mean patient-rated wrist evaluation scores at 24 months in the randomized controlled trial. Except for patient-reported treatment success, which favored the volar locking plate group, results showed no between-group differences in all other outcomes. Researchers noted the surgical and nonsurgical groups had low and similar rates of posttreatment complications, including deep infection and complex regional pain syndrome. Results showed consistency between the 12-month outcomes, outcomes from the observational group and 24-month outcomes.