Session IV - Geriatrics
*Internal Fixation for Unstable Distal Radius Fractures in the Elderly Patient
Jorge L. Orbay, MD1 (d-Hand Innovations, Inc.);Alejandro Badia, MD1 (d-Hand Innovations, Inc.); Igor R. Indriago, MD1; Roger K. Khouri, MD1; Eduardo Gonzalez, MD1 (d-Hand Innovations, Inc.); Diego L. Fernandez, MD2;
Introduction: Increased incidence of falls and osteoporosis combines to make distal radius fractures a major cause of morbidity for the elderly patient. We present our experience treating distal radius fractures in this population by using fixed-angle internal fixation.
Methods: We retrospectively reviewed records of all patients more than 75 years of age treated between January 1998 and August 2002 at our centers for unstable distal radius fractures by using fixed-angle implants. Postoperative management included immediate finger motion, early functional use of the hand, and a wrist splint used for an average of 3 weeks. Standard radiographic fracture parameters were measured, and final functional results were assessed by measuring digital motion, wrist motion, and grip strength.
Results: Of 31 patients that fit the inclusion criteria, we were able to observe 27 patients with 28 unstable distal radius fractures for an average of 57 weeks. One patient died of unrelated causes and three were lost to follow-up. Twenty seven patients were treated as outpatients, all under regional anesthesia. Four were treated as inpatients; three were discharged in less than 23 hours and one patient (associated pelvic fracture) stayed 14 days in a rehabilitation unit. Final volar tilt averaged 8°, radial tilt 20°, and radial shortening averaged less than 1 mm. The average final dorsiflexion was 60°, volar flexion 50°, pronation 82°, and supination was 78°. Grip strength was 79% of the contralateral side. There were no plate failures or significant loss of reduction, although there was some settling of the distal fragment in three patients (1 to 3 mm).
Conclusion: It is possible to treat distal radius fractures in the elderly patient by using fixed-angle fixation. The implant must be placed immediately below the subchondral bone to provide stable fixation. Anesthetic risks must be considered. Early return to function, satisfactory final results, and few complications were observed.