Complications of Distal Radius Fractures in the Elderly: A Systematic Review and Meta-analysis

Abstract

There is no financial information to disclose. Optimal treatment for elderly patients with distal radius fractures has remained controversial as the benefits and risks of surgical fixation are less clear than for a younger patient. Since complication rates can be unstable in small studies, synthesis may provide more accurate risk estimates. The purpose of this review was to assess the complications associated with the treatment of distal radius fractures in elderly patients through a systematic review and meta-analysis of the literature. A systematic review of the literature was conducted using the PubMed, Medline, and Cochrane databases to search for studies that satisfied predetermined inclusion and exclusion criteria. We compared the complications associated with each specified DRF treatment option. A validated complication checklist was used to grade the severity of each reported complication. The Structured Effectiveness Quality Evaluation Scale (SEQES) and the Sackett level of evidence scale was used to critically appraise the included studies. We identified 1,229 articles in the primary search, and 33 studies for full text evaluation. Based on our inclusion/exclusion criteria 20 studies were included for analysis. Sackett level of evidence (LOE) studies included were: 3 level one, 6 level two, 2 level three and 9 level four studies. There were 6 randomized control trials, 3 prospective cohorts, 2 case controls and 9 retrospective case series studies identified. The incidence of complications (i.e. requiring intervention) was significantly higher in the operative group (129/1095, 11.8%) versus the non-operative group (40/483, 8.3%) (P = 0.008). External fixation (51/227, 22.5%) had significantly higher complication rates when compared to other fixation methods except dorsal plating (3/15, 20%). Percutaneous pinning (1/83, 1.2%) had significantly lower major complications compared to volar locked plating (VLP) (14/86, 16.3%). Furthermore, percutaneous pinning (0/83, 0%) had significantly less reoperation rates when compared to the VLP group (11/86, 12.8%) (P = 0.006). •Elderly patients who underwent surgery had higher major complications than those treated conservatively.•Given that complication rates are less with percutaneous pinning than plating, this minimally invasive fixation may have advantages for fixation of fractures in older adults.•With equivocal outcomes shown among different treatment strategies, complication profiles should be considered when making treatment decisions in this population.