Surgical Treatment of Periarticular Distal Radius Fracture in Elderly: A Systematic Review

Abstract

Background/Objectives: The treatment of periarticular distal radius fractures remains challenging. Different surgical treatment options have been proposed as alternatives to conservative treatment. This systematic review aims to compare the functional outcomes, radiological outcomes, and complications among volar locking plates (VLPs), Kirschner-wire fixations, and external fixations (EFs) for distal radius fractures in patients aged 60 years and older. Methods: We conducted a comprehensive search of PubMed, Cochrane, and Science Direct databases assessing the effects of VLP, EF, and K-wire treatments for distal radius fractures in patients aged 60 years and over. The primary outcome was the evaluation of the range of motion (ROM) degrees after three surgical procedures, trying to assess the best treatment option. The secondary outcome included evaluation of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, quick-DASH score, Patient-Rated Wrist Evaluation (PRWE) score, Visual Analog Scale (VAS) score, grip strength, radiographic assessment, and complications comparing VLPs, EFs and K-wires. Results: A total of 23 studies were included, comparing VLP, EF, and K-wire fixation. The overall population comprised 5618 patients, with 4690 females and 1015 males, of which 4468 patients were treated with VLP, 503 with EF, and 647 with K-wire. The most common complications among the VLP group were complex regional pain syndrome (7.5%) and carpal tunnel syndrome (6.8%); for the EF group, infections (9.8%) and carpal tunnel syndrome (6.8%); and for the K-wire group, carpal tunnel syndrome (7.5%) and infections (6.9%). Conclusions: VLP showed better clinical outcomes in the first few months after treatment. However, these differences decreased over time and became similar after one year. EF and K-wire fixations remain easier to manage during surgery.

Keywords: DRF; K-wires; ORIF; aging fracture; distal radius fracture; elderly; external fixation; osteoporosis; plate; surgical treatment.

Figure 1

PRISMA 2020 flow diagram for new systematic reviews. * Unsuitable due to unassessable abstracts or inability to access the full text. ** Unsuitable according to the search criteria.

Figure 2

Histogram of the DASH scores, considering all available data. The vertical lines represent the standard deviations. Eight studies reported DASH score data for a VLP group, two studies for an EF group, and one study for a K-wire group.

Figure 3

Histogram of the quickDASH scores, considering all available data. The vertical lines represent the standard deviation. Seven studies reported quickDASH score data for a VLP group, two studies for an EF group, and one study for a K-wire group.

Figure 4

Histogram of the VAS score, considering all available data. The vertical lines represent the standard deviation. Five studies reported VAS score data for a VLP group, two studies for an EF group, and two studies for a K-wire group.

Figure 5

(A) Pie diagram representing complications arising from surgery with VLP. (B) Pie diagram representing complications arising from surgery with EF. (C) Pie diagram representing complications arising from surgery with K-wire.

Figure 5

(A) Pie diagram representing complications arising from surgery with VLP. (B) Pie diagram representing complications arising from surgery with EF. (C) Pie diagram representing complications arising from surgery with K-wire.