Management of Distal Radius Fractures in the Elderly Patients

Case Report

Austin J Musculoskelet Disord. 2015; 2(3): 1025.

Management of Distal Radius Fractures in the Elderly Patients

D’Arienzo M*, Conti A and D’Arienzo A

Università degli Studi Di Palermo, Clinica Ortopedica e Traumatologica, Italy

*Corresponding author: D’Arienzo M, Università degli Studi Di Palermo, Clinica Ortopedica e Traumatologica, Italy

Received: April 04, 2015; Accepted: September 05, 2015; Published: September 10, 2015


Distal radius fractures are one of the most common injuries treated by the orthopedic surgeons representing almost 1/6 of the fractures that are treated in the emergency departments and the 75% of all fractures of the upper limb and are second only to hip fractures in elderly population. The age distribution of this kind of injury is typically bimodal with peaks in the young patients (6-25) and in the elderly patients older than 65. In the first case the mechanism of injury is usually a high energy trauma, such as a car accident, whilst in the second one is usually a low energy trauma like a domestic fall. Various classification systems have been proposed for these fractures. The classic eponymy-based classification, which divides the fractures in “Colles, Smith, Hutchinson, etc” is always useful but we think that the best system could be a combination with the classic eponymy-based classification with the one proposed by the AO Trauma. Distal radius fractures are frequent in elderly active patients and are usually treated with closed reduction and cast immobilization for 5-6 weeks. Decision for surgical treatment in osteoporotic and elderly patients is difficult as there are no significant differences of functional outcome after non surgical and surgical treatment, patient’s comfort, pre- injury activity level, life style requirement, stage of osteoporosis, fracture stability, joint congruency, loss of previous reduction and bilateral fractures should be considered in decision making. Of different kinds of surgical treatment we prefer k-wires fixation, epibloc or ORIF with locking plate.


DASH: Disability of Arm, Shoulder, and Hand; AAOS: American Academy of Orthopaedic Surgeons; ORIF: Open Reduction and Internal Fixation

Case Presentation

In our Clinic, from January 2010 to December 2013, we treated 434 distal radius fractures, 38% of them occurred in elderly patients, usually for a low- energy trauma (Figure 1a,1b). In every cases, except one, we performed closed reduction and in 45% of them we casted them. In the other 55% we performed a k-wire fixation or an epibloc fitation. The only case that we treated with open reduction was one patient with bilateral wrist fracture. Results has been evaluated looking at the x-rays one month, 5 months and one year after the surgery or non-operative treatment and analyzing the scores in DASH and Mayo Clinic wrist. The scores showed excellent results in 51%, good in 38%, fair in 9% and poor in 2%. In our opinion every patient should be individually assessed basing on the balance of risks and benefits. Since it seems to be no great difference in long-term functional outcome, we suggest informing the patient about the risk and benefits of operative versus non operative treatment and treating operatively those patients that wanted to come back at their own activities as soon as possible. We also suggest to treat operatively also those patients who have a bilateral distal radius fracture for not limitate too much their life. The patients with reduction cannot be maintained with cast, the fractures which lose reduction at one or two weeks, because in osteoporotic bone, repeated manipulations are ineffective and often correlate to complex regional pain syndrome [1]. And further more. It has been demonstrated correlation between increasing displacement and low bone mineral density [2].