Comparison of emergency versus selective surgical operations for extra-articular fractures of distal radius complicated with dorsal displacement and comminuted metaphysis in elderly females

Abstract

Objective To compare the functional outcomes between emergency operation and delayed selective operation for extra-articular fractures of distal radius complicated with dorsal displacement and comminuted metaphysis in elderly females. Methods Included for this study were 60 elderly female patients who had been treated at Department of Orthopedic Trauma, The Second People's Hospital of Shenzhen from March 2016 to March 2017 for extra-articular fractures of the dorsally displaced distal radius with a volar locking plate. They were all female, aged from 65 to 80 years (average, 73.8 years). Of them, 30 received surgical operation on the day or the next day after injury (emergency group) and the other 30 did 5 to 15 days after surgery (mean, 8 days) (selective group). Follow-ups were conducted at 4, 12 and 48 weeks after surgery to assess the ranges of motion (ROMs) of the wrist and forearm, grip strength (GS), the Disability of Arm, Shoulder and Hand (DASH) scores and complications. Results The 2 groups were comparable because there were no signifi-cant differences between them in their preoperative general data (P>0.05). A 4 weeks after operation, the ROMs, GS and DASH scores were all significantly improved in both groups, but the ROM of dorsal extension (49.6°±4.1°), ROM of volar flexion (58.6°±3.5°), ROM of supination (78.1°±7.5°), ROM of pronation (81.4°±7.0°), GS (58.5%±11.2%) and DASH scores (17.3±7.9) in the emergency group were all sig-nificantly better than those in the selective group (37.0°±6.3°, 45.1°±3.6°, 70.7°±9.6°, 67.1°±10.3°, 37.3%±9.1% and 32.5±9.6, respectively) (all P 0.05). At 48 weeks after op-eration, there were no significant differences between the 2 groups in ROMs, GS or DASH scores (P>0.05). Postoperatively, superficial infection happened in one case and the extensor pollicis longus muscle tendon was ruptured in another in the emergency group. Conclusion In the elderly women with dorsally displaced extra-articular fracture of the distal radius, emergency surgery with a volar locking plate may lead to better functional recovery within 12 weeks post-surgery than the elective or delayed surgery. Key words: Wrist joint; Humeral fracture; Fracture fixation, internal; Bone plate