The new findings will guide the future treatment of distal radius fractures.
A decade-long study of the most common forearm fractures in the elderly showed that personalized medicine should be provided to guide treatment based on the patient's personal needs and environment (rather than age or X-rays).
Led by the Michigan Medical Doctor, the research team examined the treatment results of patients with distal radius fractures (the larger of the two bones of the forearm) within two years. They found that there is no one-size-fits-all cure for fractures. Every year, more than 85,000 Medicare beneficiaries maintain fracture treatment.
"Traditionally, surgeons view these fractures on X-rays, and they have to evaluate various repair methods based on the fracture anatomy and the age of the patient," said Kevin Chung, the research leader and Charles BG De Nancrede Professor of Surgery. Michigan Medicine. "However, for elderly patients, we determine patient-centered care and tailor specific treatment plans according to their needs, social environment and surgical risk tolerance. These are all considerations for prescription treatment."
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The new research, published on JAMA Network Open, was funded by the National Institutes of Health, and covered more than 180 participants in more than 20 global medical centers in the past 10 years.
"For hand surgery, this is the most intense collaborative effort to try to answer a 200-year-old problem of distal radius fractures in the elderly," Chung said. "For this group of patients, this is one of the most common fractures in the world-your parents and grandparents will get this type of fracture. For public health, we need to answer this question."
Participants in the trial were randomly assigned to receive one of three treatment strategies, including volar locking plate, external fixation, and pinning. Those who chose not to undergo surgery received casting treatment. Although participants who received palm electroplating treatment reported better ability to perform daily tasks in the subsequent phases of the trial, the gap between electroplating and other methods disappeared after six months. All participants were satisfied with the results at the end of the study.
"Surgeons need to know how to use all available techniques to treat distal radius fractures, rather than ingrained in only the plate system, because most trainees now only learn the system," Chung said. "But there are too many fracture modes that require one person to have all the necessary tools and skills to ensure that patients receive tailored treatments for their injuries."
The results show that the interaction between the surgeon, the patient, and the patient’s family is key, because patient satisfaction requires a more personalized approach rather than a single interest in repairing fractures, Chung said.
"We know that the actual age does not determine the biological age of the patient," he said. "When a person is 70 years old, their biological age may be 40-50 years old. These patients need to resume physical activity and independent living, so we should treat them more positively."
It is difficult for the research team to recruit trials that last 10 years. Chung said that some of the elderly who participated in this historic study were struggling with transportation and wanted to help others.
"Due to the time and energy invested by patients, it is difficult to participate in this trial," he said. "These people are special. They have contributed their lives to the science of helping other elderly patients who will suffer from this kind of fracture. Their commitment is inspiring to us, and despite the great challenges, it allows our research team to move forward. We are grateful. The support of our research participants, the National Institutes of Health and the American people."
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Paper cited/DOI: "Comparison of results after treatment of distal radius fractures at 24 months", published on the JAMA network. DOI: 10.1001/jamanetworkopen.2021.12710
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