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Dr. Tomaino's Blog

Distal Radius Fracture Treatment Update: If you are 65 years and older, is surgery or a cast better?

March 10th, 2012
In the December 2011 issue of the Journal of Bone and Joint Surgery, this exact question was addressed in a report entitled “A Prospective Randomized Trial Comparing Nonoperative Treatment with Volar Locking Plate Fixation for Displaced and Unstable Distal Radius Fractures in Patients Sixty-five Years of Age and Older.”

This study design provided the highest level of evidence, and showed, at 12 months, that pain level, range of motion and global satisfaction scores were NOT different between the operative and nonoperative groups. However, patients in the operative group had better grip strength through the entire time period. Obtaining a “proper looking x-ray” did not result in better range of motion or improved ability to perform daily living activities. Early on in the follow-up period, patients in the operative group had better wrist extension.

So what does this mean? Well---firstly, it appears that the case FOR surgery is not necessarily made based on the “evidence”, although better extension early on, and better grip strength at 1 year did “favor” operative treatment. Another advantage of operative treatment is the opportunity to come out of a cast earlier---at 7-10 days as opposed to 5-6 weeks.
The take home message is that a recommendation for or against surgery may involve more than simply “outcome considerations.” So it’s important that you have a good understanding of why one or the other option is being advised in your case.


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