Published 12/1/2010

How do we treat wrist fractures in the elderly?

Treatment Received by Patient Age Group (PDF)

Distal radius fracture (DRF) predominantly affects the elderly population, with some 80,000 fractures sustained per year, costing the U.S. healthcare system an estimated $632 million. These fractures have traditionally been treated with casting, a conservative and relatively inexpensive treatment. But the use of internal fixation in elderly patients is growing, according to the results of a study presented at the 2010 annual meeting of the American Society for Surgery of the Hand.

The study, presented by Kevin C. Chung, MD, MS, identified 85,924 patients aged 65 years or older who had received treatment within 2 weeks of DRF diagnosis. Although 74 percent of patients were treated with casting, 17 percent underwent internal fixation, 7.6 percent received percutaneous pinning, and 1.3 percent received external fixation. Internal fixation had the highest rate of 90-day major complications—nearly 6 percent of cases.

In comparing patient demographics, the researchers found the following significant differences:

  • Men were less likely than women to receive internal fixation versus closed treatment.
  • Men were more likely than women to receive internal fixation versus pinning or external fixation.
  • African American patients were less likely than Caucasian patients to receive internal fixation versus closed treatment.

The authors attribute these differences to the reduced risk of osteoporosis in men and African Americans.

Compared to younger patients, older patients were less likely to receive internal fixation versus other treatments. Patients with higher socioeconomic status (SES) were more likely to receive internal fixation versus pinning or external fixation than those in the lowest SES group. Patients with comorbid conditions were less likely than patients without comorbidities to receive internal fixation versus pinning or external fixation.

Hand surgeons performed internal fixation one third of the time, compared to orthopaedic surgeons, who generally used closed treatment (71.8 percent). The difference could be explained by severity of fracture and likelihood of referral to a specialist, as well as by a higher awareness among specialists of newer techniques and implants—specifically, the volar locking plating system for DRF.

The use of internal fixation for DRF in the Medicare population has been growing, from 3 percent of cases in 1996 to 16 percent in 2005, and is likely to continue, note the authors. They concluded by calling for a randomized multi-center clinical trial to determine whether or not the money is well spent.

Coauthors include Melissa J. Shauver, MPH; Huiying Yin, MA; and John D. Birkmeyer, MD. The authors report no conflicts.

Bottom line

  • Despite the increasing use of internal fixation techniques, most elderly patients with distal radius fractures are still treated with closed treatment.
  • Demographic factors, such as patient gender, race and age, have a significant effect on the type of treatment received.