Objective: To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction.
Methods: The clinical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with no-operation and operation from February 2005 to March 2009. Thirty-seven patients underwent closed reduction and splintlet fixation or cast application (non-operation group), and forty-one patients underwent open reduction and internal fixation (operation group). In non-operation group, there were 15 males and 22 females with an average age of 73 years (60-83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62-80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P > 0.05) in sex, age, disease course and fracture classification between two groups.
Results: All incisions obtained healing by first intention after operation in operation group. All patients were followed up for 9-36 months (20 months on average). Fracture healing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P > 0.05) in fracture healing time between non-operation group [(10.8 +/- 2.0) weeks] and operation group [(11.7 +/- 2.5) weeks]. At last follow-up, the palmar tilt angle was (5.6 +/- 2.0) degrees and (8.6 +/- 3.0) degrees, the radial inclination angle was (19.1 +/- 4.9) degrees and (21.8 +/- 2.0) degrees, and the radial length was (8.3 +/- 1.3) mm and (10.4 +/- 1.4) mm in non-operation group and operation group, respectively; showing significant differences (P < 0.05) between two groups. According to the Gartland-Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in non-operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P > 0.05) between two groups. There were no significant differences (P > 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronation-supination activity, grip and pinch strength between two groups.
Conclusion: Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients.
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