Abstract
BackgroundThis systematic review and meta-analysis assessed the role of nonoperative treatment and volar locking plate (VLP) fixation in elderly patients with distal radial fracture.MethodsThe systematic literature review identified randomized controlled trials (RCTs) and observational studies using VLP and nonoperative treatment for distal radial fractures in the elderly. Two investigators independently extracted data and evaluated the quality of the studies. A meta-analysis was performed using RevMan version 5.3.ResultsThe five RCTs and six observational studies included 585 and 604 patients in the VLP and nonoperation groups, respectively. The quality of these 11 studies was moderate. Compared to nonoperation treatment, VLP did not improve the disabilities of the arm, shoulder and hand (DASH) score (weighted mean difference [WMD] = −1.67; 95% confidence interval [CI], −3.58–−0.24; P = 0.09), decrease complications (odds ratio = 1.05; 95% CI, 0.51–2.19; P = 0.89), or improve range of motion in flexion, extension, pronation, supination, and radial deviation. The VLP group had better grip strength (WMD = 10.52; 95% CI, 6.19–14.86; P < 0.0001) and radiographic assessment than the nonoperation group.ConclusionsAlthough insufficient, the study evidence shows that VLP does not improve DASH scores, complications, or range of motion, but it might provide better grip strength and radiographic assessment than nonoperation treatment.
Highlights
Distal radial fractures are the most common fractures encountered in health care [1], accounting for about 17.5% of all fractures in 2000, especially among elderly people
Inclusion and exclusion criteria The inclusion criteria were as follows: (1) randomized controlled trials (RCTs) or prospective or retrospective controlled studies, (2) participants aged above 50 years and with distal radial fractures, (3) patients treated surgically with volar locking plate (VLP) or nonoperation treatment with casting, (4) reported outcomes including wrist function, radiographic assessment, and complications in follow-up, (5) follow-up of at least 12 months
The lowest age in all studies was more than 50 years and most were more than 65 years of age
Summary
Distal radial fractures are the most common fractures encountered in health care [1], accounting for about 17.5% of all fractures in 2000, especially among elderly people. Since locking plate fixation (VLP) introduction, there has been a tendency to manage distal radial fracture in elderly people with VLP [4] and the rate of operative treatment in the elderly has increased gradually over the decades [5]. Until recently, surgical treatment with a volar locking plate for unstable fractures among the elderly population has not been proven to be superior to nonoperative treatment [6–8]. Some authors have suggested that elderly patients with distal radial fractures should be managed nonoperatively because fracture reduction and anatomic alignment on radiographs are not correlated with better functional outcomes in these patients [10–12], or the correlation is not clearly proven [13]. This systematic review and meta-analysis assessed the role of nonoperative treatment and volar locking plate (VLP) fixation in elderly patients with distal radial fracture
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