Volar plating versus nonoperative treatment for senile comminuted fractures of distal radius

Abstract

Objective To compare volar plating and nonoperative treatment for senile comminuted fractures of the distal radius. Methods From October 2012 to June 2015, 46 senile comminuted fractures of the distal radius (AO types B and C) were treated surgically or conservatively. Twenty old patients were managed by open reduction and fixation with a volar locked plate. They were 7 men and 13 women, with an average age of 67.9±10.7 years, including 7 cases of AO type 23-B and 13 cases of AO type 23-C. Twenty-six patients were managed with closed reduction and plaster cast. They were 8 men and 18 women, with an average age of 66.2±11.5 years, including 10 cases of AO type 23-B and 16 cases of AO type 23-C. The 2 groups were compared in terms of follow-up time, union time and wrist functional scores and complications. Results There was no significant difference between the 2 groups in follow-up time (P>0.05). Fractures in the 2 groups all united about 11 weeks after surgery. According to Dienst scoring for reduction, the volar plating group had 13 excellent cases, 4 good ones, 2 fair ones and one poor case, with an excellent to good rate of 85.0% while the nonoperative group had 5 excellent cases, 10 good ones, 5 fair ones and 6 poor ones, with an excellent to good rate of 57.7%. A significant difference was shown between the 2 groups (P<0.05). At final follow-ups, the volar plating group had significantly lower Gartland & Werley wrist functional score (2.16±1.82) and complication rate (30.0%, 6/20) than the nonoperative group[6.62±3.78 and 53.8% (14/26), respectively] (P<0.05). Conclusion In treatment of senile comminuted fractures of the distal radius, volar locked plating may lead to better functional recovery and fewer complications than nonoperative management. However, one should take full account of the physical condition and preference of the patient when surgery is chosen. Key words: Radial fractures; Fractures, comminuted; Fracture fixation, internal; Bone plates; Conservative treatment