This meta-analysis compared anterior locking plate and non-operative treatment for distal radial fractures and assessed if the age of the patients is associated with the treatment effect. We searched the MEDLINE, Embase and CENTRAL databases and included 12 studies with 1366 patients. Compared with non-operative care, anterior locking plate treatment does not seem to provide clinically important benefits in mean DASH score, mean pain or their mean quality of life at 12 to 24 months if the patients’ ages are not considered (moderate to low certainty evidence). However, the younger the patients, the larger the benefit for surgery. Meta-regression with the DASH score suggested that while people over 70 likely experience no clinically relevant benefit from surgery, the mean effects cannot be generalized to people under 60. The evidence regarding the risk of adverse events is too uncertain to make firm conclusions.
AbbaszadeganHJonssonUvon SiversK.Prediction of instability of Colles’ fractures. Acta Orthop Scand. 1989,
60: 646–50.
2.
AroraRLutzMDemlCKrappingerDHaugLGablM.A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am. 2011,
93: 2146–53.
3.
BartlCStengelDBrucknerTGebhardF.The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arztebl Int. 2014,
111: 77987.
4.
BrogrenEPetranekMAtroshiI.Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007,
8: 48.
5.
DehghaniMRavanbodHArdakaniMPNodushanMHTDehghaniSRahmaniM.Surgical versus conservative management of distal radius fracture with coronal shift; a randomized controlled trial. Int J Burns Trauma. 2022,
12: 66–72.
6.
Del PiñalFJupiterJBRozentalTDAroraRNakamuraTBainGI.Distal radius fractures. J Hand Surg Eur. 2022,
47: 12–23.
7.
DengZBWuJPTangKY, et al.
In adults, early mobilization may be beneficial for distal radius fractures treated with open reduction and internal fixation: a systematic review and meta-analysis. J Orthop Surg Res. 2021,
16: 691.
8.
FlinkkiläTSirniöKHippiM, et al.
Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011,
22: 2307–12.
9.
Hao Q, Devji T, Zeraatkar D, et al. Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform a BMJ Rapid Recommendation. BMJ Open. 2019, 9: e028777.
10.
HassellundSSWilliksenJHLaaneMM, et al.
Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. Bone Joint J. 2021,
103-B: 247–55.
11.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Updated March 2011, Cochrane Collab. 2011. www.handbook.cochrane.org (accessed 20 November 2021).
12.
KhoslaSMeltonLJDekutoskiMBAchenbachSJObergALRiggsBL.Incidence of childhood distal forearm fractures over 30 years: a population-based study. J Am Med Assoc. 2003,
290: 1479–85.
13.
KumarSPenematsaSSadriMDeshmukhSC.Can radiological results be surrogate markers of functional outcome in distal radial extra-articular fractures?Int Orthop. 2008,
32: 505–9.
14.
LawsonANaylorJMBuchbinderR, et al.
Surgical plating vs closed reduction for fractures in the distal radius in older patients. JAMA Surg. 2021,
156: 229–37.
15.
LuokkalaTLaitinenMKHevonkorpiTPRaittioLMattilaVMLaunonenAP.Distal radius fractures in the elderly population. EFORT Open Rev. 2020,
5: 361–70.
16.
MackenneyPMcQueenMEltonR.Prediction of instability in distal radial fractures. J Bone Joint Surg Am. 2006,
88: 1944–51.
17.
MakhniEEwaldTKellySDayC.Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am. 2008,
33: 1301–8.
18.
MartiCHenslerSHerrenDBNiedermannKMarksM.Measurement properties of the EuroQoL EQ-5D-5L to assess quality of life in patients undergoing carpal tunnel release. J Hand Surg Eur. 2016,
41: 957–62.
19.
Martinez-MendezDLizaur-UtrillaAde-Juan-HerreroJ.Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur. 2018,
43: 142–7.
20.
Mellstrand NavarroCBrolundAEkholmC, et al.
Treatment of radius or ulna fractures in the elderly: a systematic review covering effectiveness, safety, economic aspects and current practice. PLoS ONE. 2019,
14: e0214362.
21.
MoherDLiberatiATetzlaffJAltmanDG.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009,
6: e1000097.
22.
MuldersMWalenkampMvanDSGoslingsJSchepN.Volar plate fixation versus plaster immobilization in acceptably reduced extra-articular distal radial fractures: a multicenter randomized controlled trial. J Bone Joint Surg Am. 2019,
101: 787–96.
23.
OchenYPeekJvan der VeldeD, et al.
Operative vs nonoperative treatment of distal radius fractures in adults: a systematic review and meta-analysis. JAMA Netw Open. 2020,
3: e203497.
24.
SavingJSeverinWSOlssonK, et al.
Nonoperative treatment compared with volar locking plate fixation for dorsally displaced distal radial fractures in the elderly: a randomized controlled trial. J Bone Joint Surg Am. 2019,
101: 961–9.
25.
SchünemannHBrożekJGuyattGOxmanA. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. GRADE Work Gr. 2013. guidelinedevelopment.org/handbook (accessed 11 September 2021).
26.
SellesCAMuldersMAMWinkelhagenJvan EertenPVGoslingsJCSchepNWL.Volar plate fixation versus cast immobilization in acceptably reduced intra-articular distal radial fractures: a randomized controlled trial. J Bone Joint Surg Am. 2021,
103: 1963–9.
27.
SharmaHKhareGSinghSRamaswamyAKumaraswamyVSinghA.Outcomes and complications of fractures of distal radius (AO type B and C): volar plating versus nonoperative treatment. J Orthop Sci. 2014,
19: 537–44.
28.
SirniöKLeppilahtiJOhtonenPFlinkkiläT.Early palmar plate fixation of distal radius fractures may benefit patients aged 50 years or older: a randomized trial comparing 2 different treatment protocols. Acta Orthop. 2019,
90: 123–8.
29.
SorensenAAHowardDTanWHKetchersidJCalfeeRP.Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am. 2013,
38: 641–9.
30.
StephensARPressonAPMcFarlandMM, et al.
Volar locked plating versus closed reduction and casting for acute, displaced distal radial fractures in the elderly: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2020,
102: 1280–8.
31.
TahirMKhan ZimriFAhmedN, et al.
Plaster immobilization versus anterior plating for dorsally displaced distal radial fractures in elderly patients in Pakistan. J Hand Surg Eur. 2021,
46: 647–53.
32.
TahririanMAJavdanMNouraeiMHDehghaniM.Evaluation of instability factors in distal radius fractures.J Res Med Sci. 2013,
18: 892–6.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
