Sat., 10/6/12 Upper Extremity Injuries, PAPER #94, 11:53 am OTA-2012
The Correlation of Age and Short-Term Outcomes in Patients Who Have Undergone Operative Fixation of Distal Radius Fractures
John W. Karl, MD, MPH; Patrick R. Olson, MD, MS, MPH; Melvin P. Rosenwasser, MD;
Columbia University Medical Center, Department of Orthopedics, New York, New York, USA
Purpose: There is considerable controversy regarding the optimal treatment of distal radius fractures, particularly in the elderly, despite national trends suggesting significant increases in operative fixation. Our aim was to report on the outcomes, as correlated by age, of these patients in our prospective cohort study of operatively treated distal radius fractures.
Methods: The Distal Radius Study Group (DRSG) is a prospectively studied group of patients with distal radius fractures of all types and all ages who presented to our institution. Using these data, 223 unstable distal radius fracture patients treated with surgical fixation with a mean age of 55.6 years (range, 18-85 years) were followed prospectively for a mean of 6 months. Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH), wrist range of motion (pronation, supination, wrist flexion, extension), and pinch and grip strength. Pain was assessed by resting visual analog scale (VAS), active VAS, and resting and active verbalized pain on a scale from 0 to 10. Linear regression models were used to identify correlations of age and outcomes.
Results: In this prospective cohort study of operatively treated distal radius fractures, as patient age increased, physical function decreased, as measured by DASH scores (coef. = 0.231, P = 0.018, R2 = 0.025). Similarly, older patients experienced more pain compared with their younger peers, as measured by verbalized resting pain (coef. = 0.040, P = 0.014, R2 = 0.083). These correlations remained when controlling for length of follow-up. There were no differences, however, between age groups when assessing resting VAS, active VAS, or verbalized pain with activity, pronation, supination, wrist flexion, extension, and grip and pinch strength.
Conclusion: In this prospective cohort study of patients who have undergone operative fixation of distal radius fractures, more mature patients demonstrate worse functional outcomes (as measured by DASH score) and verbalized more resting pain compared with their younger peers. Understanding these outcomes as they pertain to age is critical, especially considering recent research demonstrating no marked benefit to operative fixation of distal radius fractures in the elderly compared with nonoperative management.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.