Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years

Abstract

Purpose: Despite the high prevalence and impact of distal radius fractures (DRFs) on older patients, the currently available literature regarding DRFs in older adults lacks adequate comparative treatment data. The purpose of this prospective, controlled outcomes study is to compare outcomes using the volar locking plating system (VLPS) for DRFs in both older and younger adults and to assert the eligibility of older patients for surgical management with the VLPS.

Methods: Consecutive, eligible patients were enrolled into our prospective study over a 2-year period on the basis of strict inclusion and exclusion criteria. Subjects were entered into 2 cohorts based on age: 20-40 years and >60 years. Patient outcomes and complication rates were evaluated at 3, 6, and 12 months after surgery. Outcome measures included the Michigan Hand Outcomes Questionnaire (MHQ), grip strength, active wrist and forearm range of motion, the Jebsen-Taylor test, and radiographic parameters.

Results: Fifty-five patients (30 young and 25 older adults) with unilateral, inadequately reduced DRFs were enrolled and received surgical treatment with the VLPS. We observed no statistically significant difference in any of the outcomes for all 3 follow-up periods, except the Jebsen-Taylor test, which displayed a trend toward a worse outcome in the older-age cohort. Whereas older patients continued to improve throughout their 12-month postoperative visits, younger patients achieved their maximum recovery during the 6-month follow-up period, suggesting different recovery patterns. At the 12-month assessment, older patients were able to achieve a higher mean MHQ score than their younger counterparts (normalized mean: 85% and 82%, respectively). Complication rates were similar between the 2 groups for all 3 time periods, with most occurring on or before the 3-month postoperative visit.

Conclusions: This study indicates that the VLPS is successful in managing DRFs in older patients without increased complications compared to younger patients. For older patients without prohibitive surgical risks, internal fixation using the VLPS yields comparable outcomes to younger patients. However, these conclusions do not necessarily apply to other surgical techniques used to manage DRFs in older adults.

Type of study/level of evidence: Therapeutic II.

Figure 1. Michigan Hand Outcomes Questionnaire over Time by Two Age Cohorts This figure demonstrates the overall score for the Michigan Hand Outcomes Questionnaire for each cohort over time

Connecting lines are based on locally weighted smoothing to illustrate patterns over time. The red line represents the older cohort (>=60) and the black dashed line represents the younger cohort (20–40). The black “x” marks represent individual patient outcomes for the older cohort and the red “o” marks represent individual patient outcomes for the younger cohort for each follow-up period (3,6, and 12 months).