Surgical Age Limitations
We are unable to recommend for or against operative treatment for patients over age 55 with distal radius fractures.
Rationale
We were interested in determining the role of operative treatment compared to non-operative treatment of patients defined by the published literature as “elderly” and that distinguished patients based on infirmity, functional demands, bone quality, or energy of injury. Three clinical trials met the inclusion criteria.43-45 Two trials compared external fixation to cast immobilization and one trial compared percutaneous pinning to cast immobilization. All had at least one methodological flaw and were downgraded to Level II. One addressed extra-articular fractures, one articular fractures, and one both. Age criteria included age over 55 in 2 studies and over age 60 in one study. We selected the age of 55 because these included studies enrolled patients no younger than 55 years. We were unable to identify studies that distinguished patients based on infirmity, functional demands, bone quality, or energy of injury. The average patient age in these trials was comparable to those considered in Recommendation 3. Inclusion was based on redisplacement in one study, initial radiographic alignment in one study, and instability not otherwise defined in one study. There were no differences in pain, function, complications or SF-36 at any time point.
- (43) Azzopardi T, Ehrendorfer S, Coulton T, Abela M. Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning. J Bone Joint Surg Br 2005;87(6):837-840.
- (44) Hegeman JH, Oskam J, van der PJ, Ten Duis HJ, Vierhout PAM. Primary external fixation versus plaster immobilization of the intra-articular unstable distal radial fracture in the elderly. Aktuelle Traumatologie 2004;34(2):64-70.
- (45) Roumen RMH, Hesp WLEM, Bruggink EDM. Unstable Colles' fractures in elderly patients. A randomised trial of external fixation for redisplacement. Journal of Bone and Joint Surgery - Series B 1991;73(2):307-311.