Partially Healed Malaligned Distal Radius Fracture. Surgical Treatment in Patients older than 70 Years

Abstract

Introduction Management of distal radius fractures remains controversial despite their high frequency. Elderly patients specifically present a high rate of secondary displacement, sometimes requiring a complex reconstructive surgery. The surgical treatment of displaced fractures evolving for several weeks in elderly patients has not been clearly reflected in the literature. This study aims to show clinical and radiological outcomes from this particular situation.

Material and Methods Retrospective study of 31 cases of distal radius fractures with more than 2 weeks of evolution. Fractures were graded according to the Fernández's classification. Pre- and postoperative radiological studies were carried out to evaluate the degree of correction achieved. A clinical evaluation was performed using the Mayo Wrist Score. Data on arthroscopy and bone substitutes use, specific surgical tips and complications were also collected.

Results Thirty-one patients with a mean age of 76 years old were operated for distal radius fracture with a delay in surgical treatment of 22 days. The most frequent fracture pattern was Fernández type III (38.7%). The clinical outcome according to the Mayo Wrist Score was 81.94 points with no relationship to fracture pattern or arthroscopic assistance. A statistically significant improvement was achieved for the correction of radial inclination, joint gap and ulnar variance. No statistically significant improvement was achieved in volar tilt correction. Complications were observed in 12.9% of the cases.

Conclusions Delayed surgical treatment of distal radius fracture in elderly patients provides similar results to those observed in other age groups and time of evolution. Despite not being the ideal scenario for the surgeon, it should be considered to avoid functional deterioration in this fragile age group.

Keywords

distal radius fracture - malunion - reconstructive surgery

• References

• 1 Instituto Nacional de Estadística (España). https://www.ine.es/welcome.shtml (Consulta: Diciembre 2019
• 2 Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma 2009; 23 (04) 237-242
• 3 Fernandez DL. Distal radius fracture: the rationale of a classification. Chir Main 2001; 20 (06) 411-425
• 4 Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know?. Radiology 1992; 184 (01) 15-24
• 5 Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney III WP, Linscheid RL. Scaphoid malunion. J Hand Surg Am 1989; 14 (04) 679-687
• 6 Jupiter JB, Ring D, Weitzel PP. Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg Am 2002; 27 (04) 714-723
• 7 Wijffels MME, Orbay JL, Indriago I, Ring D. The extended flexor carpi radialis approach for partially healed malaligned fractures of the distal radius. Injury 2012; 43 (07) 1204-1208
• 8 Rapley JH, Kearny JP, Schrayer A, Viegas SF. Ulnar translation, a commonly overlooked, unrecognized deformity of distal radius fractures: techniques to correct the malalignment. Tech Hand Up Extrem Surg 2008; 12 (03) 166-169
• 9 Porter M, Stockley I. Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res 1987; (220) 241-252
• 10 McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function?. J Bone Joint Surg Br 1988; 70 (04) 649-651
• 11 Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 2000; 25 (01) 19-28
• 12 Brogren E, Wagner P, Petranek M, Atroshi I. Distal radius malunion increases risk of persistent disability 2 years after fracture: A prospective cohort study hand. Clin Orthop Relat Res ••• 38 (03) 526-531
• 13 Gehrmann SV, Windolf J, Kaufmann RA. Distal radius fracture management in elderly patients: a literature review. J Hand Surg Am 2008; 33 (03) 421-429
• 14 Thompson GH, Grant TT. Barton's fractures-reverse Barton's fractures. Confusing eponyms. Clin Orthop Relat Res 1977; (122) 210-221
• 15 Weil YA, Mosheiff R, Firman S, Liebergall M, Khoury A. Outcome of delayed primary internal fixation of distal radius fractures: a comparative study. Injury 2014; 45 (06) 960-964
• 16 Del Piñal F, Clune J. Arthroscopic Management of Intra-articular Malunion in Fractures of the Distal Radius. Hand Clin 2017; 33 (04) 669-675
• 17 Huber FX, Hillmeier J, Herzog L, McArthur N, Kock HJ, Meeder PJ. Open reduction and palmar plate-osteosynthesis in combination with a nanocrystalline hydroxyapatite spacer in the treatment of comminuted fractures of the distal radius. J Hand Surg [Br] 2006; 31 (03) 298-303
• 18 Schupp A, Tuttlies C, Möhlig T, Siebert HR. [Distal radius fractures. 2.4 mm locking compression plates. Are they worth the effort?]. Chirurg 2003; 74 (11) 1009-1017
• 19 Pritchett JW. External fixation or closed medullary pinning for unstable Colles fractures?. J Bone Joint Surg Br 1995; 77 (02) 267-269
• 20 Cannegieter DM, Juttmann JW. Cancellous grafting and external fixation for unstable Colles' fractures. J Bone Joint Surg Br 1997; 79 (03) 428-432