Fractures of the distal radius are common in the elderly population. Elderly patients have been considered to be functionally low-demand, but as the population becomes more active, expectations of outcomes may be increasing. The aim of this review was to determine whether there is any correlation between radiographic and functional outcome for elderly patients following fracture of the distal radius.
Methods
Medline, PubMed, CINAHL, Embase and AMED were searched for studies including elderly patients managed conservatively or surgically following distal radius fracture, either alone or in combination with younger patients.
Results
Eleven studies were selected for review. A wide variety of outcome measures and radiological parameters were found to be used. Of the 11 studies, 6 found no correlation between functional outcome and radiological outcome.
Discussion
The literature reviewed suggests functional outcome for elderly patients following distal radius fracture is not dependant on radiological outcome. This may give therapists better insight into potential outcomes for their patients, however further studies may be required to determine the most effective therapeutic management of these patients.
Court-BrownCCaesarB. Epidemiology of adult fractures: a review. Injury2006; 37: 691–697.
2.
ChungKCKotsisSVKimHM. Predictors of functional outcomes after surgical treatment of distal radius fractures. J Hand Surg2007; 32A(1): 76–83.
3.
WangJJupiterJBIntroduction to distal radius fractures. In: HunterJMackinECallahanA (eds). Rehabilitation of the hand and upper extremity, 5th ed. St Louis: Mosby, 2002.
4.
JaremkoJLLambertRGWRoweBH. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?Clin Radiol2007; 62: 65–72.
5.
HandollHHGMadhokR. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev2003; 2CD000314. DOI: 10.1002/14651858.CD000314.
6.
HandollHHGMadhokRHoweTE. Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev2006; 3CD003324. DOI: 10.1002/14651858.CD003324.pub2.
7.
WakefieldAEMcQueenMM. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. J Bone Joint Surg2000; 82-B: 972–976.
8.
AnzarutAJohnsonJARoweBH. Radiological and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg2004; 29A(6): 1121–1127.
CooneyWPLinscheidRLDobynsJHFractures and dislocations of the wrist. In: RockwoodCAGreenDPBucholzRW (eds). Rockwood and green's fractures in adults, 4th edn. Philadelphia, PA: Lippincott-Raven, 1996.
12.
CollesA. On the fracture of the carpal extremity of the radius. Edinburgh Med Surg J1814; 10: 182–186.
13.
MeadsBMProsserRDistal radius fractures. In: ProsserRConollyWB (eds). Rehabilitation of the hand and upper limb, Edinburgh: Butterworth Heinemann, 2003.
14.
RabyNBermanLDe LaceyG. Accident and emergency radiology: a survival guide, 2nd edn. Philadelphia: Elsevier Saunders, 2005.
15.
CooneyWP. Fractures of the distal radius: a modern treatment based classification. Orthop Clin North Am1993; 24: 211–216.
16.
Fernandez DLJupiterJB. Fractures of the distal radius, Berlin: Springer-Verlag, 1995.
17.
MüllerMENazarianSKochP. The comprehensive classification of fractures of long bones, 1st edn. Berlin: Springer-Verlag, 1990.
18.
BrogrenEPetranekMAtroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord2007; 8: 48–48.
19.
Diaz-GarciaRJTakashiOShauverMJ. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg2011; 36A: 824–835.
RanjeetNEstrellaE. Distal radius fractures: does a radiologically acceptable reduction really change the results?J Clin Diag Res2012; 6(8): 1388–1392.
22.
BeumerAMcQueenMM. Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop Scand2003; 74(1): 98–100.
23.
GartlandJJWerleyCW. Evaluation of healed Colles' fractures. J Bone Joint Surg1951; 33-A: 897–907.
24.
CooneyWBusseyRDobynsJ. Difficult wrist fractures perilunate fracture dislocations of the wrist. Clin Orthop Relat Res1987; 214: 136–147.
25.
SaitoHShibataMClassification of fracture at the distal end of the radius with reference to treatment of comminuted fractures. In: BoswickJA (ed). Current concepts in hand surgery, Philadelphia, PA: Lea and Febiger, 1983.
26.
HudakPLAmadioPCBombardierC. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Indus Med1996; 29: 602–608.
27.
ChungKCPillsburyMSWaltersMR. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg1998; 23: 575–587.
28.
MacDermidJCTurgeonTRichardsRS. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma1998; 12(8): 577–586.
29.
KotsisSVLauFHChungKC. Responsiveness of the Michigan Hand Outcomes Questionnaire and physical measurements in outcome studies of distal radius fracture treatment. J Hand Surg2007; 32A: 84–90.
30.
AbramoAKopylovPTägilM. Evaluation of a treatment protocol in distal radius fractures. Acta Orthop2008; 79(3): 376–385.
31.
KwokIHYLeungFYuenG. Assessing results after distal radius fracture treatment: a comparison of objective and subjective tools. Geriatr Orthop Surg Rehabil2011; 2(4): 155–160.
32.
SarmientoAPrattGBerryN. Colles' fractures. J Bone Joint Surg1975; 57A: 311–317.
33.
ChungKHaasA. Relationship between patient satisfaction and objective functional outcome after surgical treatment for distal radius fractures. J Hand Ther2009; 22(4): 302–308.
34.
FujiiKHenmiTKanematsuY. Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg2002; 10(1): 9–15.
35.
WilckeMKTAbbaszadeganHAdolphsonPY. Patient-perceived outcome after displaced distal radius fractures: a comparison between radiological parameters, objective physical variables and the DASH score. J Hand Ther2007; 20(4): 290–299.
36.
MacDermidJCDonnerARichardsRS. Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture. J Clin Epidemiol2002; 55: 849–854.
37.
AroraRGablMGschwentnerM. A comparative study of clinical and radiological outcomes of unstable Colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma2009; 23(4): 237–242.
38.
SynnAJMakhniECMakhniMC. Distal radius fractures in older patients: Is anatomic reduction necessary?Clin Orthop Relat Res2009; 467: 1612–1620.
39.
BrogrenEHoferMPetranekM. Fractures of the distal radius in women aged 50 to 75 years: natural course of patient-reported outcome, wrist motion and grip strength between 1 year and 2–4 years after fracture. J Hand Surg2011; 36E(7): 568–576.
40.
BrogrenEHoferMPetranekM. Relationship between distal radius fracture malunion and arm-related disability: a prospective population-based cohort study with 1 year follow-up. BMC Musculoskelet Disord2011; 12: 9–9.
41.
KumarSPenematsaSSadriM. Can radiological results be surrogate markers of functional outcome in distal radial extra-articular fracture?Int Orthop2008; 32: 505–509.
42.
RüediTPBuckleyREMoranCG. AO principles of fracture management, 2nd edn. New York: Thieme Medical Publishers, 1983, 2007.
