A new study examined whether the precise anatomical repair of distal radius fractures (DRF) was associated with improved function and patient-reported results, and found that they may not be relevant.

According to the study authors, about 90,000 adults in the United States suffer from DRF each year, accounting for nearly one-fifth of fractures seen by doctors, and it is the second most common fracture among the elderly.

The researchers wrote in the reason for conducting the current study, “Previous research reports on DRF results for people 60 years of age and older stated that in order to obtain satisfactory functional results, precise anatomical reduction is not required, because compared with young people, This population needs less functional recovery. Patience. However, these conclusions do not apply to older people who are currently more active and functionally independent than previous generations. In the current population of 60 years and older who have greater needs for functional ability , DRF’s impact on the perception of disability will be more pronounced."

For analysis, the researchers collected data from the Wrist and Radius Injury Surgical Trial (WRIST). Multicenter, randomized clinical trials evaluated the treatment of DRF in adults 60 years of age and older. Patients were enrolled between April 10, 2012 and December 31, 2016; the data was analyzed from January 3, 2019 to August 19, 2019. Patients were randomly assigned to receive one of the following treatments: volar locking plate, percutaneous nailing, or external fixation; non-surgical patients received casting. The main results were 12-month grip strength, wrist arc, radial deviation, ulnar deviation, Michigan Hand Outcome Questionnaire (MHQ) total score, MHQ function score, and MHQ activity of daily living (ADL) score.

The final analysis included 166 WRIST patients (mean [SD] age, 70.9 [8.9] years; 144 [86.7%] women). According to the study authors, “only 2 of the 84 calculated correlation coefficients are statistically significant.” In patients 70 years and older, the radial tilt of the fractured hand increased by 22 degrees compared to the contralateral hand. , Is 1.1 kg weaker than the contralateral hand (95% confidence interval [CI], 0.38-1.76; P = 0.004). For a normal ulnar variance of 0 mm, the MHQ ADL score will increase by 10.4 points (95% CI, –16.84 to –3.86) for every additional millimeter. Nonetheless, neither of these two measures are related to the MHQ total score or the functional score.

The research was published on JAMA Network Open.

The study authors wrote in their conclusions: “With this evidence, surgeons may choose to reduce surgical time, resource usage, and related costs. These costs could have been used to achieve perfect or near-perfect reduction-during the production process, surgical Doctors can prioritize patient preferences rather than the need for precise readjustment."