HIGH RATES OF REDUCTION IN CONSERVATIVE TREATMENT OF GERIATRIC DISTAL RADIUS FRACTURES

Öz

Objective: The aim of this study is to evaluate the early reduction results in conservative treatment of distal radial fractures in geriatric patients.

Material and Methods: Patients aged over 60 years with displaced distal radius fractures who were treated with conservative treatment were included in the study. Follow-up X-rays of the patients at the 1st week were evaluated. Patients’ data were obtained from hospital information management system. We evaluated the patient's age, sex, fracture side, the mechanism of injury, type of AO/OTA classification, loss of reduction, and treatment methods.

Results: One hundred and nineteen patients of 132 geriatric patients with distal radius fracture were elligible for the inclusion criteria. 97.6% of patients with AO type 2R3A fracture were found to be within acceptable degrees of reduction in the 1st week of conservative treatment. Seven patients had a loss of reduction. Six had a high degree of dorsal angulation, and one had over 2mm step off. There was no significant difference in terms of conservative treatment success between extra-articular fractures and partial and complete intra-articular fractures (p=0.584).

Conclusion: We demonstrated that initial closed reduction and cast immobilization is an effective treatment method in the management of elderly patients with AO type 2R3A, 2R3B, and 2R3C distal radius fractures.

Anahtar Kelimeler

• conservative management
• distal radius fractures
• closed reduction
• geriatric fractures

Geriatrik Distal Radius Kırıklarının Konservatif Tedavisinde Yüksek Redüksiyon Oranları

Öz

Amaç: Bu çalışmanın amacı, geriatrik hastalarda radius distal uç kırıklarının konservatif tedavisinde erken redüksiyon sonuçlarını değerlendirmektir.

Gereç ve Yöntemler: Radius distal uç kırığı olan 132 geriatrik hastanın 119’u çalışmaya dahil edilmiştir. Yer değiştirmiş radius distal uç kırığı olan ve konservatif olarak tedavi edilen 60 yaş üstü hastalar çalışmaya alındı. Hastaların birinci haftadaki takip röntgenleri değerlendirildi. Hasta verileri hastane bilgi yönetim sisteminden elde edildi. Hastaların yaşı, cinsiyeti, kırık tarafı, yaralanma mekanizması, AO/OTA sınıflandırması tipi, redüksiyon kaybı ve tedavi yöntemleri taranmıştır.

Bulgular: AO tip 2R3A kırığı olan hastaların %97,6’sında konservatif tedavinin birinci haftasında kabul edilebilir bir redüksiyon derecesi elde edilmiştir. Yedi hastada redüksiyon kaybı vardı. Altı hastada yüksek derecede dorsal açılanma ve bir hastada ise 2 mm’nin üzerinde bir basamaklanma mevcuttu. Eklem dışı kırıklar ile kısmi ve tam eklem içi kırıklar arasında konservatif tedavi başarısı açısından anlamlı fark yoktu (p=0.584).

Sonuç: AO tip 2R3A, 2R3B VE 2R3C radius distal uç kırığı olan yaşlı hastaların ilk tedavisinde kapalı redüksiyon ve alçı immobilizasyonunun etkili bir tedavi yöntemi olduğunu gösterdik.

Anahtar Kelimeler

• konservatif tedavi
• Radius distal uç kırıkları
• geriatrik kırıklar
• kapalı redüksiyon

Kaynakça

1. 1. Karl JW, Olson PR, Rosenwasser MP. The Epidemiology of Upper Extremity Fractures in the United States, 2009. J Orthop Trauma. 2015;29(8):242-4.
2. 2. Padegimas EM, Ilyas AM. Distal radius fractures: emergency department evaluation and management. Orthop Clin North Am. 2015;46(2):259-70.
3. 3. Walenkamp MM, Rosenwasser MP, Goslings JC, Schep NW. A multicentre cross-sectional study to examine physicians' ability to rule out a distal radius fracture based on clinical findings. Eur J Trauma Emerg Surg. 2016;42(2):185-90.
4. 4. Mauck BM, Swigler CW. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am. 2018;49(2):211-22.
5. 5. Wei DH, Raizman NM, Bottino CJ, Jobin CM, Strauch RJ, Rosenwasser MP. Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate. A prospective randomized trial. J Bone Joint Surg Am. 2009;91(7):1568-77.
6. 6. Koval K, Haidukewych GJ, Service B, Zirgibel BJ. Controversies in the management of distal radius fractures. J Am Acad Orthop Surg. 2014;22(9):566-75.
7. 7. Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am. 2009;91(8):1868-73.
8. 8. Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am. 2011;36(5):824-35.

9. 9. Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg Am. 2014;39(7):1280-6.
10. 10. Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am. 2010;92(9):1851-7.
11. 11. Levin LS, Rozell JC, Pulos N. Distal Radius Fractures in the Elderly. J Am Acad Orthop Surg. 2017;25(3):179-87.
12. 12. Murray J, Gross L. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2013;21(8):502-5.
13. 13. Perugia D, Guzzini M, Civitenga C, Guidi M, Dominedo C, Fontana D et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures? Injury. 2014;45:21-6.
14. 14. Cooney WP. Management of Colles' fractures. J Hand Surg Br. 1989;14(2):137-9.
15. 15. Wu YS, Yang J, Xie LZ, Zhang JY, Yu XB, Hu W et al. Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly. ANZ J Surg. 2019;89(10):428-32.
16. 16. Kong L, Kou N, Wang Y, Lu J, Tian D, Zhang B. The Necessity of Restoration of Radiologic Parameters by Closed Reduction in Elderly Patients with Distal Radius Fractures. Med Sci Monit. 2019;25:6598-604.