The management of Distal Radial Fractures in patients 65 years and over when comparing External Fixation and Cast treatment

Elderly patients often sustain distal radial fractures. Authors of this study compared the results of dorsally displaced distal radius fractures in patients 65 years and over, when treated with either closed reduction plaster cast fixation or external fixation. They compared both the functional and radiographic outcomes.

This study included 46 patients, all of whom sustained distal radial fractures from accidental falls.
The patients were split into two groups. 24 patients, with a mean age of 71.2 years, were treated by closed reduction plaster cast fixation. The second group contained 22 patients, with a mean age of 69.8 years, were treated with external fixation.
Patients were measured using the Disabilities of Arm, Shoulder and Hand (DASH) Questionnaire score. Range of motion of the wrist and radiographic results were evaluated.

Results of the radiographs showed all 46 patients fractures had united by three months. The group treated via external fixation, were found to be functionally better with regards to wrist extension, ulnar deviation, palmer tilt and radial height than those in the group with cast treatment.
However, there was no statistically significant difference between groups with regards to the remaining range of motions, DASH scores or radiologic outcomes.

Overall, authors of this study found both the closed reduction plaster cast fixation and the external fixation methods to be useful when treating distal radial fractures in patients 65years and over.

Mike Hayton does not routinely use cast immobilisation nor external fixation for the majority of displaced distal radial fractures. He prefers to use a volar locking plate and immediate mobilisation.

Aktekin. C.N, Altay. M, Gursoy. Z, Aktekin, L.A, Ozturk, A.M, and Tabak, A.Y.

Ankara Numune Research and Training Hospital, Ankara, Turkey.
Journal of Hand Surgery 2010;35A: 736-742