Kevin C. Chung
LAS VEGAS — Older patients with distal radius fractures experienced faster recovery when treated with internal fixation using a volar locking plate system compared with external fixation, percutaneous pinning or casting, according to results presented at the American Society for Surgery of the Hand Annual Meeting.
Kevin C. Chung, MD, MS , and colleagues randomly assigned patients aged 60 years or older with unstable distal radius fractures to receive treatment with internal fixation with a volar locking plate (n=65), external fixation (n=64), percutaneous pinning (n=58) or conservative management with casting (n=117).
“We used 24-month Michigan Hand Questionnaires as our primary measure,” Chung said in his presentation here. “Secondary outcomes are Michigan [Hand Questionnaire] with six different domains, SF-36, grip strength, range of motion and wrist radiographs.”
Chung noted patients in the volar locking plate group had faster improvement at 6 weeks and 3 months compared with the other three groups. However, he added the groups had no differences in outcomes at 24 months. Results showed patients had a mean Michigan Hand Questionnaire Summary score of 86, a mean Michigan Hand Questionnaire Activities of Daily Living score of 88 and a Michigan Hand Questionnaire Satisfaction score of 84.
“The best scores, the highest scores were with the volar locking system, whereas the lowest [scores] were for [external fixation] ex-fix,” Chung said.
Overall, Chung noted use of a volar locking plate system is the best treatment for older patients with distal radius fractures as long as they are healthy and willing to undergo surgery. He added casting is better for less active older adults and those with more comorbidities, while percutaneous pinning is an appropriate treatment as long as patients know how to clean the pins to avoid infection.
“External fixation in older adults is no longer the technique we can use because of lower recovery and also the high risk of contracting infections,” Chung said. “The reason we had difficulties recruiting for this trial was because of ex-fix. It was the most common reason for patients not wanting to be randomized into this trial.” – by Casey Tingle
Chung KC, et al. Abstract 1. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 5-7, 2019; Las Vegas.
Disclosure: Chung reports no relevant financial disclosures.