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Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly
Author(s) -
Wu YaoSen,
Yang Jie,
Xie LinZhen,
Zhang JiaYu,
Yu XianBin,
Hu Wei,
Chen Hua,
Sun LiaoJun
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15395
Subject(s) - medicine , univariate analysis , orthopedic surgery , surgery , distal radioulnar joint , displacement (psychology) , impaction , wrist , multivariate analysis , psychology , psychotherapist
Background The treatment of senile distal radius fractures had not been clearly defined. The objective of this study was to identify the factors associated with the decision for operative treatment of displaced distal radius fractures in patients aged over 55 years. Methods Data of 318 patients with displaced distal radius fractures were collected on patient‐, fracture‐ and surgeon‐related characteristics that were plausibly related to the decision for operation. Mean comparisons or chi‐squared test were used for univariate analysis of the above‐mentioned factors, and then multiple logistic regression was used to identify factors associated with the decision for operation. Results Univariate analysis showed that age, osteoporosis, Charlson score, associated orthopaedic injuries requiring surgery, Orthopaedic Trauma Association (AO) and Fernandez classification, radial height, volar tilt, volar/dorsal comminution, ulnar variance, intra‐articular displacement/step‐off, associated distal radioulnar joint instability or radiocarpal joint dislocation and subspecialty of treating surgeons had statistically significant association with operative intervention. In the multivariate analysis, the predictors of operative intervention were younger patient age ( P = 0.028), associated orthopaedic injuries requiring surgery ( P = 0.020), higher AO classification ( P = 0.037), higher Fernandez classification ( P = 0.041), radial shortening >5 mm ( P = 0.020), volar tilt > −10° ( P = 0.020), volar/dorsal comminution ( P = 0.020), ulnar variance >5 mm ( P = 0.023), intra‐articular displacement/step‐off >2 mm ( P = 0.004), associated distal radioulnar joint instability or radiocarpal joint dislocation ( P = 0.047) and treatment by an upper extremity specialist ( P = 0.038). Conclusion The decision for surgery was predominantly influenced by the characteristics and severity of the fracture. Patients' age and treatment by an upper extremity specialist were also significant factors associated with a higher likelihood of operative intervention.