Age Should Be no Obstacle to Treatment
While in the last century reduction loss and its consequences for the patient (renewed reduction, pain, complex regional pain syndrome [CRPS]…) were common problems, these complications occur only very rarely today thanks to the surgical management of unstable distal radius fractures with volar locking plate fixation (1, 2). The sometimes catastrophic outcomes in patients who developed a complex regional pain syndrome are almost unknown to younger colleagues; the ability to prevent this complication is a blessing for patients and this treatment should be made available for “older patients ≥ 65 years of age“ as well. We enrolled 762 patients in our prospective study; stable fractures (282 patients) were treated with standard casting techniques, while unstable fractures (480 patients) were treated with volar locking plate fixation—none of the patients treated with this approach developed a complex regional pain syndrome (3).
The authors’ conclusion that the standard casting techniques represent a valid treatment concept for the primary management of unstable C2 and C3 fractures in elderly patients does not make sense to us, given a conversion rate of 41% due to secondary reduction loss, especially when the distribution pattern of the fractures in the group treated with standard casting techniques is taken into consideration (4). It is likely that secondary slipping occurred mostly along with unstable fractures—as expected—and that therefore surgical treatment was ultimately required. Under this assumption, we are approaching—with 37 converted patients and 38 patients with C2/C3 fractures treated with standard casting techniques—a conversion rate of almost 100%. My interpretation of the data: Elderly patients with unstable distal radius fracture should be immediately treated with locking plate fixation, while stable fractures should be treated with standard casting techniques. With this approach, predictable complications can be prevented: despite economic constraints, elderly patients, too, have the right to receive care that quickly restores hand function.
Dr. med. Klaus-Jürgen Maier
Unfallchirurgie, RoMed Klinik Bad Aibling
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Dresing K, Stürmer KM, et al.: Deutsche Gesellschaft für Unfallchirurgie: Leitlinien Distale Radiusfraktur. http://www.awmf.org/leitlinien/detail/ll/012–015.html|
|2.||Stanos SP, Harden RN, Wagner-Raphael L, Saltz SL: A prospective clinical model for investigating the development of CRPS. in: Complex regional pain syndrome: progress in pain research and management. vol. 22. IASP Press, Seattle; 2001: 151–64.|
|3.||Maier KJ: Behandlungsergebnisse nach palmarer, optional variabel winkelstabiler Plattenosteosynthese distaler Radiusfrakturen mit einer 2,7 mm Platte. Dissertation zum Erwerb des Doktorgrades in der Medizin an der Med. Fakultät der LMU München.|
|4.||Bartl C, Stengel D, Bruckner T, Gebhard F and the ORCHID Study Group: The treatment of displaced intra-articular distal radius fractures in elderly patients—a randomized multi-center study (ORCHID) of open reduction and volar locking plate fixation versus closed reduction and cast immobilization. Dtsch Arztebl Int 2014; 111: 779–87 VOLLTEXT|