Traitement prothétique des fractures du radius distal irréparables du sujet âgé autonome. Résultats préliminaires, étude prospective de 10 cas

Abstract

The purpose of this paper was to define irreparable acute DRF in autonomous elderly patients and to review the current results of a prospective study using a resurfacing implant to treat these injuries. A total of 10 wrists in 10 women were prospectively included. The average age was 75 years (range 64–87). General health status was normal in 3 patients and there were co-morbidities in seven. However, all patients were autonomous at home. Functional needs were high in 3, intermediate in 7. All but one DRF were articular o C O type. Displacement was volar in 4 patients and dorsal in 6 patients. Circumferential comminution was present in all cases. The average intra-articular displacement severity score (Intra-DSS) was 11,5–12. Impaction and cartilage defect were present in all cases. All patients sustained total wrist arthroplasty through a single dorsal approach. An ulnar head resection was combined in 8–10 cases. Postoperative immobilization was 3 weeks followed by a splint for 3 weeks. Follow-up consisted of clinical and radiographic evaluation at 6 weeks, 2, 6, 12 months. A wrist clinical score was used as well as the Quick DASH and PRWE. Reflex sympathetic dystrophy was present in 2 patients. In the 5 patients with more than 3 months of follow-up and no RSD, the average VAS pain was 1,6. Average ranges of active motion were – pronation 65°, supination 66°, wrist extension 28°, flexion 21°. The average grip strength was 38% of the contralateral side. The average wrist score was 57 pts. Implant surgery at the acute stage for complex fractures in the elderly is an old validated concept for hip, shoulder and elbow. This concept recently emerged for DRF as well. Indeed some DRF in the elderly are beyond any osteosynthesis fixation. Autonomous elderly patients are good candidates to prosthetic surgery. Our preliminary results confirm that there may be a room for prosthetic replacement of the distal radius at the acute stage in selected elderly patients. Further controlled prospective studies are necessary to validate this concept.