Treatment for Wrist Fractures in Older AdultsYou might think that a broken bone is a simple affair: set it, put a cast around it, wait six weeks and it's healed. But that isn't always the case. Sometimes fractures separate and the two ends have to be brought back together and held in place until the bone heals.
Surgeons are always trying to figure out the best way to treat displaced (separated) fractures. There are all kinds of factors to consider like the patient's age, location of the fracture (does it include the joint?), and severity of the break.
In this study, adults between 60 and 85 years of age with displaced distal radial fractures were treated in one of two ways. Distal radial fractures occur in the wrist at the end of the lower arm. The two groups were followed for at least one year and the results compared.
Group one was treated with closed reduction and a plaster cast up to (but not including) the elbow. Closed reduction means the two ends of the bone could be put back together without an open incision and surgery.
Group two had open surgery to line the bones back up and then were placed in an external fixator. The type of external fixator used had two pins through the radius (forearm bone) and two more pins through the bones of the hand. The pins were attached at both ends to a metal rod outside the arm.
The goal was to see which type of treatment might be better for low energy trauma wrist (radial) fractures in older adults. Bone breaks from low energy trauma refer to fractures that occur when the person falls from a standing position. They could have tripped over something on the floor or lost their balance and fallen.
Four main measures were used to compare the results: pain, range of motion, function, and grip strength. Since this was an older group of retired adults, function was defined as doing ordinary, every day activities. This could include carrying groceries, shoveling snow, cleaning house, or lifting a heavy pot or pan while cooking.
It turns out that there was no difference in outcomes between the two treatment groups. For this older age group, it didn't matter whether they were treated with a plaster cast or external fixation. At least that was true when using the four measures mentioned.
There were some differences between the two treatment groups when comparing complication rates. For example, skin or wound infections (at the pin sites) were more common in the external fixation group. Patients in the external fixation group were also more likely to develop nerve damage or carpal tunnel syndrome.
Patients in the plaster cast group had more cases of fracture redisplacement (i.e., bones separate again). This problem suggests that the plaster cast doesn't stabilize the displaced fracture as well as external fixation does.
Other studies have taken a look at types of fractures and differences in fixation devices (e.g., interlocking plates, internal pins, external pins). Results have had some wide ranging differences leaving some doubt as to whether those differences were age related or based on treatment chosen or both.
The results of this study make it easy to see that at least for simple but displaced distal radial fractures, immobilization technique (cast vs. external fixation) doesn't yield different results.
The authors pointed out one other significant finding in both groups: grip strength and range of motion were still problems a year after treatment. Likewise, wrist stiffness and mild pain were persistent symptoms reported in both groups. It's possible that with a different method of fixation, these lingering symptoms could be reduced. Further study is needed to find out for sure.
Zoltan FÃ¶ldhazy and Leif Ahrengart. External Fixation Versus Closed Treatment of Displaced Distal Radial Fractures in Elderly Patients: A Randomized Controlled Trial. In Current Orthopaedic Practice. May/June 2010. Vol. 21. No. 3. Pp. 288-295.
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