Study of functional outcome of distal radial fractures treated by conservative and surgical methods
International Journal of Orthopaedics Sciences
Back ground: During the 2 years follow-up, we compared the functional outcome of distal radial fractures treated by different methods, 1.closed reduction and casting (CAST), 2.Closed reduction and 'K' wire fixation and 3. Open reduction and internal fixation (ORIF) with volar locking plate in elderly patients in a teaching hospital situated in a backward area of Chittoor -Andhra Pradesh. Patients and Methods: Total 88 consecutive patients in the age groups of 40yrs to70yrs were included in our
... tudy. There were 64-female and 24-male patients. The mechanism of injury was fall in 66 patients [75%] and road traffic accidents in 22 patients [25%]. Majority of patients [60%] were treated by closed reduction & cast immobilisation method. 25% of patients were treated by closed reduction & 'K' wire fixation and 15% of cases were treated by open reduction & Internal fixation (ORIF) with volar locking plate. For treatment decision and documentation we fallowed AO classification. Objective and subjective functional results based on active range of motion, grip strength, disabilities of the arm, shoulder and hand (DASH) score, Patient related wrist evaluation (PRWE) score, visual analogue scale and radiographic assessment (dorsal tilt, radial inclination, radial shortening, fracture union and posttraumatic arthritis were assessed. Results: At final fallow-up there was significant difference between the two groups of patients treated non-surgically and surgically for ROM, grip strength, DASH score and PRWE score. Pain level was significantly less for the patients in the CAST group in spite of clinical deformity present in 17% of patients for which the elderly were not complained. And no such deformity was seen in the 'K' wire and ORIF groups. We achieved excellent results in 35 patients [40%], good results in 22 patients [25%], fair results in 26 patients [30%] and poor results in 5 patients [5%]. Conclusion: Traditionally elderly patients should be treated non-surgically with closed reduction and POP cast under local anaesthesia or sedation. The unstable fractures can be treated with closed reduction and "K" wire fixation and POP cast. The ORIF with locking plate has limited value and beneficial in selected patients only. Functional outcomes are better with conservative treatment.