|
|
|
« Back
Six Things to Know About Geriatric Wrist Fractures
|
Posted on: 12/31/2012
|
In this article, Charles S. Day medical doctor and surgeon at the Harvard Medical School in Boston teaches us six things about geriatric wrist fractures. The specific injury is a displaced (meaning the fracture ends are separated) distal (tells us the fracture is at the end of the bone near the hand rather than up at the elbow) radial (refers to one of the two bones in the forearm) fracture. That's a mouthful!
The first item of interest is a definition of "geriatric" wrist fracture. The second goal is to identify what age group(s) are involved most often. The third is information more for surgeons: a discussion of the management of geriatric radial (wrist) fractures per Abraham Colles' (an Irish surgeon who first described this fracture back in 1814).
Dr. Day also summarizes an important study published in 1986 by Knirk and Jupiter on distal radial fractures in young adults. The last two discussion points in this article are: a comparison of two randomized-controlled trials looking at treatment results with surgical versus nonsurgical methods. And finally, a list of the advantages of conservative (nonoperative) care for wrist fractures in the older adult.
Let's take a look at each of these educational objectives and see what the current evidence there is regarding the treatment of this type of fracture in this group of adult patients. That brings us back to Dr. Day's first point: what is a "geriatric" wrist fracture? Most organizations use the age 65 years old and older as the cutoff point between what is considered middle age and what constitutes older, elderly, or geriatric.
This particular type of fracture actually occurs in two different age groups: the young and old but with different causes. Children and teens are more likely to be involved in a high-energy, traumatic injury. Older adults can fall from a standing position and break their wrists.
Treatment ideas have ranged from the early days of Dr. Colles (even if the break doesn't heal perfectly, the arm will function fine) to efforts started during the 1950s to "fix" the deformity and make it look straight again. The Knirk and Jupiter study mentioned earlier set us on a course to reduce the fracture as much as possible thinking that would ensure a more functional outcome.
But today, after many trials of different surgical methods of repair and restoration, it looks like the evidence supports Dr. Colles' ideas. The extra cost of surgery and risk of complications may not be worth it -- because studies are showing that surgery doesn't always yield a better result.
It comes down to this one thing: having a perfectly placed wrist fracture (as seen on X-rays) isn't necessary to regain full function and use of the wrist. And, in fact, this type of anatomic alignment isn't linked with loss of wrist and hand function in the older adult.
Studies comparing results between surgical repair and nonoperative treatment show equal results six and 12 months after the injury. And, patients treated with surgery suffer more complications more often that are worse than in the nonoperative groups studied. Patients treated conservatively report high levels of satisfaction with nonoperative care.
So now, instead of performing surgery right away to reset the bones and hold the two ends together with a metal plate and screws or pins, surgeons should discuss all the pros and cons of both treatment approaches (surgical versus nonsurgical). Patients should be given full disclosure based on current evidence when making a treatment decision between surgery and conservative care for displaced distal radial wrist fractures.
|
References:
Charles S. Day, MD, MBA, and Michael C. Daly, MSc. Management of Geriatric Distal Radius Fractures. In The Journal of Hand Surgery. December 2012. Vol. 37A. No. 12. Pp. 2619-2622.
|
|
|
« Back
|
|
|
|
*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
 | All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission. |
|
