Abstract：
BACKGROUND: Surgery and non-operative treatment produce similar 1-year functional outcomes in patients older than 65 years. Data are lacking for patients older than 75 years. The main objective of this study was to compare surgical vs. non-operative treatment regarding short-term outcomes in patients older than 75 years. In addition to an overall analysis, sub-group analyses were done in patients with displacement and severe displacement (>20 ° posterior tilt).
OBJECTIVE: Surgery provides better clinical and radiological outcomes than does non-operative treatment.
METHODS: Patients older than 75 years at the time of a distal radius fracture were included prospectively over a 2-year period. A follow-up duration of at least 6 months was required. Treatment choices were based on displacement, Charlson\'s Co-morbidity Index, and patient autonomy. Surgery consisted in open fixation using an anterior locking plate and non-operative treatment in a short arm cast without reduction. The main assessment was based on clinical criteria: range of motion, strength, visual analogue scale (VAS) scores, the short version of the Disabilities of the Arm, Shoulder, and Hand tool (QuickDASH), the Patient Rated Wrist Evaluation (PRWE), and the 36-Item Short Form Health Survey (SF-36). The secondary assessment criteria were the radiological outcomes and the complications.
RESULTS: 74 patients were included, among whom 24 were treated surgically and 50 non-operatively. At 1.5 months, surgery was associated with significantly better results for flexion, ulnar inclination, and supination, with range increases of at least 7 ° vs. non-operative treatment, and with greater dorsal angle and ulnar variance values (p < 0.05 for all comparisons). At 6 months, pronation and the radio-ulnar index were better with surgery (p < 0.05 for both comparisons). In the patients with displacement or severe displacement, surgery was associated with 10° gains vs. conservative treatment for flexion, ulnar inclination, and supination at 1.5 months (p < 0.05 for all comparisons).
CONCLUSIONS: In patients older than 75 years, surgery for distal radius fracture was associated with significantly better clinical and radiological outcomes within 6 months. Surgery is recommended for displaced and severely displaced distal radius fractures to expedite the recovery of joint motion ranges. Beyond 6 months, the outcomes are similar.
METHODS: III.
OBJECTIVE: Surgery provides better clinical and radiological outcomes than does non-operative treatment.
METHODS: Patients older than 75 years at the time of a distal radius fracture were included prospectively over a 2-year period. A follow-up duration of at least 6 months was required. Treatment choices were based on displacement, Charlson\'s Co-morbidity Index, and patient autonomy. Surgery consisted in open fixation using an anterior locking plate and non-operative treatment in a short arm cast without reduction. The main assessment was based on clinical criteria: range of motion, strength, visual analogue scale (VAS) scores, the short version of the Disabilities of the Arm, Shoulder, and Hand tool (QuickDASH), the Patient Rated Wrist Evaluation (PRWE), and the 36-Item Short Form Health Survey (SF-36). The secondary assessment criteria were the radiological outcomes and the complications.
RESULTS: 74 patients were included, among whom 24 were treated surgically and 50 non-operatively. At 1.5 months, surgery was associated with significantly better results for flexion, ulnar inclination, and supination, with range increases of at least 7 ° vs. non-operative treatment, and with greater dorsal angle and ulnar variance values (p < 0.05 for all comparisons). At 6 months, pronation and the radio-ulnar index were better with surgery (p < 0.05 for both comparisons). In the patients with displacement or severe displacement, surgery was associated with 10° gains vs. conservative treatment for flexion, ulnar inclination, and supination at 1.5 months (p < 0.05 for all comparisons).
CONCLUSIONS: In patients older than 75 years, surgery for distal radius fracture was associated with significantly better clinical and radiological outcomes within 6 months. Surgery is recommended for displaced and severely displaced distal radius fractures to expedite the recovery of joint motion ranges. Beyond 6 months, the outcomes are similar.
METHODS: III.
摘要：
背景：手术和非手术治疗在65岁以上的患者中产生相似的1年功能结果。75岁以上的患者缺乏数据。这项研究的主要目的是比较手术与75岁以上患者短期结局的非手术治疗.除了总体分析之外，对有移位和严重移位(后倾>20°)的患者进行亚组分析.
目的：手术比非手术治疗提供更好的临床和放射学结果。
方法：对桡骨远端骨折患者75岁以上的患者进行了为期2年的前瞻性研究。需要至少6个月的随访时间。治疗选择是基于流离失所，Charlson的合并症指数，患者自主性手术包括使用前锁定钢板进行开放式固定，并在短臂石膏中进行非手术治疗，而不复位。主要评估基于临床标准：运动范围，力量,视觉模拟量表（VAS）评分，手臂残疾的简短版本，肩膀,和手动工具（QuickDASH），患者额定腕部评估（PRWE），和36项简式健康调查(SF-36)。次要评估标准是放射学结果和并发症。
结果：包括74例患者，其中24例行手术治疗，50例行非手术治疗。1.5个月时，手术与明显更好的屈曲效果相关，尺骨倾斜度,和仰卧起坐,范围增加至少7°与非手术治疗,并且具有更大的背角和尺骨方差值（所有比较p<0.05）。6个月时,手术后的内旋和尺骨放射指数均较好（两组比较p<0.05）。在流离失所或严重流离失所的患者中，手术与10°增益和保守治疗屈曲，尺骨倾斜度,和在1.5个月时的旋后（所有比较p<0.05）。
结论：在75岁以上的患者中，桡骨远端骨折手术在6个月内的临床和放射学结局显著改善.建议对移位和严重移位的桡骨远端骨折进行手术，以加快关节运动范围的恢复。超过6个月,结果相似。
方法：III.
目的：手术比非手术治疗提供更好的临床和放射学结果。
方法：对桡骨远端骨折患者75岁以上的患者进行了为期2年的前瞻性研究。需要至少6个月的随访时间。治疗选择是基于流离失所，Charlson的合并症指数，患者自主性手术包括使用前锁定钢板进行开放式固定，并在短臂石膏中进行非手术治疗，而不复位。主要评估基于临床标准：运动范围，力量,视觉模拟量表（VAS）评分，手臂残疾的简短版本，肩膀,和手动工具（QuickDASH），患者额定腕部评估（PRWE），和36项简式健康调查(SF-36)。次要评估标准是放射学结果和并发症。
结果：包括74例患者，其中24例行手术治疗，50例行非手术治疗。1.5个月时，手术与明显更好的屈曲效果相关，尺骨倾斜度,和仰卧起坐,范围增加至少7°与非手术治疗,并且具有更大的背角和尺骨方差值（所有比较p<0.05）。6个月时,手术后的内旋和尺骨放射指数均较好（两组比较p<0.05）。在流离失所或严重流离失所的患者中，手术与10°增益和保守治疗屈曲，尺骨倾斜度,和在1.5个月时的旋后（所有比较p<0.05）。
结论：在75岁以上的患者中，桡骨远端骨折手术在6个月内的临床和放射学结局显著改善.建议对移位和严重移位的桡骨远端骨折进行手术，以加快关节运动范围的恢复。超过6个月,结果相似。
方法：III.
