955 Is Non-Operative Management Equal to or Superior to Operative Management of Distal Radius Fractures for Patients Over 60?

Le résumé fourni par la source

Abstract Aim Distal radius fractures are managed operatively with the implantation of a fixation device or conservatively with casting. However, most studies on distal radius fracture management focus on younger populations, and there is inconclusive evidence regarding the optimal management of elderly populations. This study evaluates current evidence to determine whether operative or non-operative management is superior for elderly distal radius fractures. Method A literature search was performed on Medline and EMBASE for papers from the year 2000 onwards. Level I-III studies that compared operative to non-operative management of distal radius fractures in patients aged 60 and above were included in this study. Data was analyzed using the Cochrane ROBINS-I and RoB 2 risk of bias tools and then formulated into forest plots and a double bar graph. Results 13 heterogeneous studies involving 1,371 elderly patients with distal radius fractures were included. Significant bias was present in these studies, mainly with the non-comparability of treatment groups. At one year follow-up, operative management demonstrated significantly superior results in grip strength, radiographic outcome, and patient-reported outcome measures. Non-operative management demonstrated significantly lower complication rates and costs. Pain and time to union demonstrated a negligible difference between managements. Conclusions There is some evidence suggesting operative management provides better functional outcomes to elderly patients with distal radius fractures. Therefore, treatment should be guided by whether the patient’s functional needs outweigh the risk of complications with surgery. Additionally, intra-articular fractures were associated with osteoarthritis and high redisplacement when managed nonoperatively, potentially making operative management preferred with these patients.

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