Indications for Fixation (Geriatric Patients)
Strong evidence suggests that operative treatment for geriatric patients (most commonly defined in studies as 65 years of age and older) does not lead to improved long-term patient reported outcomes compared to non-operative treatment.
Management of Distal Radius Fractures
This guideline was produced in collaboration with ASSH Endorsed by: AAHS, ASHT

Rationale

This guideline is based on 2 high quality studies, and 11 moderate quality studies comparing operative and nonoperative treatment in those >65 years of age. Some studies demonstrated improvements in patient reported outcomes in the short term (usually less than 3 mo.). Studies consistently showed no difference in patient reported outcomes in the long-term (1 year or greater) despite improvements in radiographic parameters as this is currently the most common metric (parameter or variable) cited in the relevant literature. The term geriatric was used as the spirit of this guideline is to address distal radius fractures in those patients with low functional demand. Age is commonly used as a proxy for functional demand when studying this population, often described as 65 and greater in age.

 

Risks and Benefits of Implementation

The workgroup acknowledges that age, as used in the cited evidence as well as this clinical practice guideline, is used as a proxy for functional demand. As such, a high functioning patient with high functional demands, despite having an age greater than 65, may benefit from operative fixation based on the literature supporting fixation in young, active patients. At the same time, there may be low functioning younger patients with low functional demands, that despite having an age less than 65, that may benefit from non-operative treatment. A patient-centered discussion understanding an individual patient’s values and preferences can inform appropriate decision making to ensure his/her age and functional demands align to appropriately apply this clinical practice guideline. The recommendations regarding operative treatment are principally based upon literature studying distal radius fracture as an isolated injury. Mitigating circumstances may also be factors in the shared decision-making process.

 

Future Research

Research using other tools that better describe a patient’s functional demand instead of age are needed. These tools could better inform point of care decisions for the treatment of distal radius fractures in the elderly that avoid the aforementioned risks of treatment based on age alone. While the workgroup acknowledges that functional demand would be a better explanatory variable for understanding the benefits of operative treatment, this clinical practice guideline uses age greater than 65 as this is what is used in the literature.


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