Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial
Abstract Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study prese...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-05-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-022-05394-7 |
| _version_ | 1811253200750116864 |
|---|---|
| author | Hanna Südow Sara Severin Maria Wilcke Jenny Saving Olof Sköldenberg Cecilia Mellstrand Navarro |
| author_facet | Hanna Südow Sara Severin Maria Wilcke Jenny Saving Olof Sköldenberg Cecilia Mellstrand Navarro |
| author_sort | Hanna Südow |
| collection | DOAJ |
| description | Abstract Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study presents a clinical and radiographic follow up at an average of 3 years after treatment in the context of a randomized clinical trial comparing outcomes in patients aged ≥70 years, with a dorsally displaced distal radius fracture treated either surgically with volar locking plate or non-operatively. Methods Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional 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 radiological results. Results Sixty six patients were available for a 3 year follow-up, 33 in the non-operatively treated group and 33 in the VLP-group. The mean age at injury was 77 years. At 3 years the median PRWE was better (0 points) in the VLP-group than in the non-operative treatment group (9 points) p-value: 0.027. No statistically significant difference was found in Disabilities of the Arm, Hand, and Shoulder (DASH), EuroQol 5 Dimensions (EQ-5D) or grip strength. Total arc of range of motion was larger in the operatively treated group. No significant difference in osteoarthritis was found. Both groups had regained grip strength. The complication rate was similar. Outcomes improved from the 1 year to the 3 year follow-up. Conclusions Surgery with volar locking plate gave less long-term disability compared to non-operative treatment for severely displaced distal radius fractures in patients aged ≥70 years. Our findings were statistically significant but in the lower range of clinical importance. Trial registration The study was registered at : NCT02154620 03/06/2014 and NCT01268397 30/12/2010. Ethical approval was obtained from Ethical Committee in Stockholm, Sweden (2009/37–31/3, 2013/105–31/2, 2014/1041–32, 2017/611–32). |
| first_indexed | 2024-04-12T16:46:20Z |
| format | Article |
| id | doaj.art-b62bfbad94dc4a109003d24ad5453cc3 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-12T16:46:20Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-b62bfbad94dc4a109003d24ad5453cc32022-12-22T03:24:33ZengBMCBMC Musculoskeletal Disorders1471-24742022-05-0123111310.1186/s12891-022-05394-7Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trialHanna Südow0Sara Severin1Maria Wilcke2Jenny Saving3Olof Sköldenberg4Cecilia Mellstrand Navarro5Department of Clinical Science and Education, Karolinska InstituteKarolinska Institute, Department of Clinical Science, Danderyd HospitalDepartment of Clinical Science and Education, Karolinska InstituteDepartment of Clinical Science and Education, Karolinska InstituteKarolinska Institute, Department of Clinical Science, Danderyd HospitalDepartment of Clinical Science and Education, Karolinska InstituteAbstract Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study presents a clinical and radiographic follow up at an average of 3 years after treatment in the context of a randomized clinical trial comparing outcomes in patients aged ≥70 years, with a dorsally displaced distal radius fracture treated either surgically with volar locking plate or non-operatively. Methods Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional 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 radiological results. Results Sixty six patients were available for a 3 year follow-up, 33 in the non-operatively treated group and 33 in the VLP-group. The mean age at injury was 77 years. At 3 years the median PRWE was better (0 points) in the VLP-group than in the non-operative treatment group (9 points) p-value: 0.027. No statistically significant difference was found in Disabilities of the Arm, Hand, and Shoulder (DASH), EuroQol 5 Dimensions (EQ-5D) or grip strength. Total arc of range of motion was larger in the operatively treated group. No significant difference in osteoarthritis was found. Both groups had regained grip strength. The complication rate was similar. Outcomes improved from the 1 year to the 3 year follow-up. Conclusions Surgery with volar locking plate gave less long-term disability compared to non-operative treatment for severely displaced distal radius fractures in patients aged ≥70 years. Our findings were statistically significant but in the lower range of clinical importance. Trial registration The study was registered at : NCT02154620 03/06/2014 and NCT01268397 30/12/2010. Ethical approval was obtained from Ethical Committee in Stockholm, Sweden (2009/37–31/3, 2013/105–31/2, 2014/1041–32, 2017/611–32).https://doi.org/10.1186/s12891-022-05394-7Distal radius fractureGeriatric fractureVolar locking plateNon-operative treatmentFracture fixationAged |
| spellingShingle | Hanna Südow Sara Severin Maria Wilcke Jenny Saving Olof Sköldenberg Cecilia Mellstrand Navarro Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial BMC Musculoskeletal Disorders Distal radius fracture Geriatric fracture Volar locking plate Non-operative treatment Fracture fixation Aged |
| title | Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial |
| title_full | Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial |
| title_fullStr | Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial |
| title_full_unstemmed | Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial |
| title_short | Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years – a three year follow-up of a randomized controlled trial |
| title_sort | non operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years a three year follow up of a randomized controlled trial |
| topic | Distal radius fracture Geriatric fracture Volar locking plate Non-operative treatment Fracture fixation Aged |
| url | https://doi.org/10.1186/s12891-022-05394-7 |
| work_keys_str_mv | AT hannasudow nonoperativetreatmentorvolarlockingplatefixationfordorsallydisplaceddistalradiusfracturesinpatientsover70yearsathreeyearfollowupofarandomizedcontrolledtrial AT saraseverin nonoperativetreatmentorvolarlockingplatefixationfordorsallydisplaceddistalradiusfracturesinpatientsover70yearsathreeyearfollowupofarandomizedcontrolledtrial AT mariawilcke nonoperativetreatmentorvolarlockingplatefixationfordorsallydisplaceddistalradiusfracturesinpatientsover70yearsathreeyearfollowupofarandomizedcontrolledtrial AT jennysaving nonoperativetreatmentorvolarlockingplatefixationfordorsallydisplaceddistalradiusfracturesinpatientsover70yearsathreeyearfollowupofarandomizedcontrolledtrial AT olofskoldenberg nonoperativetreatmentorvolarlockingplatefixationfordorsallydisplaceddistalradiusfracturesinpatientsover70yearsathreeyearfollowupofarandomizedcontrolledtrial AT ceciliamellstrandnavarro nonoperativetreatmentorvolarlockingplatefixationfordorsallydisplaceddistalradiusfracturesinpatientsover70yearsathreeyearfollowupofarandomizedcontrolledtrial |