INTRODUCTION

Distal radius fractures are among the most common fractures encountered in orthopedic practice, especially in the elderly population. These fractures typically result from a fall on an outstretched hand and represent a significant proportion of fragility fractures linked to osteoporosis and age-related bone quality deterioration. With the increasing life expectancy globally, the incidence of distal radius fractures in elderly patients has shown a rising trend, making their optimal management a critical issue in orthopedics and geriatric care [1].

The management of distal radius fractures in elderly patients remains controversial. Traditionally, conservative treatment involving closed reduction and immobilization with plaster cast or splints has been the mainstay of treatment for most elderly patients, primarily due to concerns related to surgical risks and comorbidities. However, conservative management often leads to malunion, functional impairment, or persistent pain due to inadequate anatomical reduction and stabilization, which can affect hand function and quality of life [2].

On the other hand, surgical intervention has evolved considerably with the advent of newer fixation devices and minimally invasive techniques. Surgical options such as open reduction and internal fixation (ORIF) using volar locking plates, external fixation, or percutaneous pinning aim to restore anatomical alignment and provide early mobilization, potentially leading to better functional outcomes and faster rehabilitation [3]. Nonetheless, surgery in elderly patients carries inherent risks including infection, neurovascular injury, and complications related to anesthesia, which need careful consideration.

Several studies have compared surgical and conservative approaches in distal radius fractures among elderly patients, but the evidence remains inconclusive. Some have reported superior functional outcomes and radiological alignment with surgery, while others have shown comparable results with conservative treatment, especially in low-demand elderly individuals [4]. The choice of management is further influenced by fracture type, patient comorbidities, bone quality, functional demands, and surgeon expertise.

Aim

To compare the clinical and functional outcomes of surgical versus conservative management in elderly patients with distal radius fractures.

Objectives

1. To evaluate and compare the functional outcomes of elderly patients with distal radius fractures treated surgically versus conservatively using standardized scoring systems.
2. To assess radiological parameters and fracture healing in both treatment groups.
3. To analyze the complication rates and patient satisfaction associated with surgical and conservative treatments.

Source of Data

The data for this study was obtained from elderly patients presenting with distal radius fractures to the Orthopedic Department at tertiary care center.

Study Design

This was a prospective, observational comparative study.

Study Location

The study was conducted at the Department of Orthopedics.

Study Duration

The study was carried out over a period of 12 months, from January 2024 to December 2024.

Sample Size

A total of 200 elderly patients diagnosed with distal radius fractures were included in the study. Among them, 100 patients were managed surgically, and 100 patients were treated conservatively.

Inclusion Criteria

• Patients aged 60 years and above.
• Patients presenting with closed distal radius fractures confirmed by radiographs.
• Patients who consented to participate in the study.
• Patients able to comply with follow-up and rehabilitation protocols.

Exclusion Criteria

• Open fractures of the distal radius.
• Patients with pathological fractures due to malignancy.
• Patients with associated ipsilateral upper limb injuries that would affect functional assessment.
• Patients with previous wrist surgeries or deformities.
• Patients with cognitive impairment precluding informed consent or adherence to treatment protocols.

Procedure and Methodology

After initial clinical evaluation and radiographic assessment, patients were categorized into surgical or conservative treatment groups based on fracture characteristics, patient preference, comorbidities, and surgeon’s recommendation.

• Conservative Management: Patients underwent closed reduction under local or regional anesthesia followed by immobilization in a below-elbow cast for 4-6 weeks. Periodic radiographs were taken to monitor fracture alignment and healing. After cast removal, wrist mobilization exercises were initiated under physiotherapist supervision.
• Surgical Management: Patients underwent open reduction and internal fixation using volar locking plates or percutaneous pinning based on fracture morphology. Surgery was performed under regional or general anesthesia following standard aseptic protocols. Postoperative immobilization was applied for 1-2 weeks, followed by active and passive wrist mobilization. Radiographs were obtained immediately postoperative and during follow-up visits to assess fixation and fracture union.

All patients were followed up at regular intervals (2 weeks, 6 weeks, 3 months, 6 months) to evaluate pain, range of motion, grip strength, functional outcomes, and complications.

Sample Processing

Radiographs were analyzed for volar tilt, radial inclination, ulnar variance, and signs of union or malunion. Functional assessment was done using validated scoring systems like the Disabilities of the Arm, Shoulder and Hand (DASH) score and Patient-Rated Wrist Evaluation (PRWE). Grip strength was measured using a dynamometer.

Statistical Methods

Data were entered into Microsoft Excel and analyzed using SPSS version 25. Quantitative variables were expressed as mean ± standard deviation, and qualitative variables as frequencies and percentages. Comparison between groups was performed using Student’s t-test for continuous variables and Chi-square test for categorical variables. A p-value < 0.05 was considered statistically significant.

Data Collection

Demographic data, clinical findings, radiological parameters, treatment details, functional scores, and complications were systematically recorded in a pre-designed proforma. Follow-up data were collected through outpatient visits and telephonic interviews where necessary.

Table 1: Baseline Demographic and Clinical Profile of Study Participants (n=200)

The baseline demographic and clinical profile of the study participants showed no significant differences between the surgical and conservative groups. The mean age in the surgical group was 69.4 ± 6.8 years compared to 68.7 ± 7.2 years in the conservative group (p=0.45). Male participants comprised 34.0% in the surgical group and 29.0% in the conservative group (p=0.43). The incidence of injury to the dominant hand was similar between groups (45.0% vs. 48.0%, p=0.67), as was the prevalence of comorbidities (61.0% vs. 64.0%, p=0.66). The average time from injury to treatment initiation was marginally shorter in the surgical group (3.2 ± 1.6 days) compared to the conservative group (3.6 ± 1.9 days), but this difference was not statistically significant (p=0.09).

Table 2: Functional Outcomes in Surgical versus Conservative Groups (n=200)

In terms of functional outcomes, the surgical group demonstrated significantly better results compared to the conservative group. The mean DASH score was notably lower (better) in the surgical group at 18.6 ± 7.9 versus 27.3 ± 10.4 in the conservative group (p<0.001). Similarly, PRWE scores favored surgery (20.1 ± 8.5 vs. 29.5 ± 11.2, p<0.001). Grip strength, expressed as a percentage of the contralateral side, was higher in the surgical group (78.2% ± 14.7%) than in the conservative group (66.5% ± 15.8%, p<0.001). Additionally, wrist range of motion was greater following surgical treatment (72.9° ± 13.6°) compared to conservative management (62.7° ± 15.4°, p<0.001).

Table 3: Radiological Parameters and Fracture Healing (n=200)

Radiological evaluation revealed superior anatomical restoration in the surgical group. Volar tilt was significantly better maintained (8.2° ± 3.1° vs. 3.9° ± 4.8°, p<0.001), as was radial inclination (22.7° ± 4.3° vs. 16.4° ± 6.0°, p<0.001). Ulnar variance was also more favorable in the surgical group (0.7 mm ± 1.3 mm) compared to the conservative group (2.3 mm ± 2.0 mm, p<0.001). The time to radiological union did not differ significantly between groups (7.8 ± 1.9 weeks for surgery vs. 8.3 ± 2.1 weeks for conservative, p=0.07).

Table 4: Complications and Patient Satisfaction (n=200)

Complications occurred more frequently in the surgical group with infections reported in 7.0% versus 1.0% in the conservative group, a statistically significant difference (p=0.02). Incidence of complex regional pain syndrome (CRPS) and tendon irritation or rupture was comparable between the groups (p>0.3). Patient satisfaction was significantly higher in the surgical group, with a mean Likert score of 4.2 ± 0.7 compared to 3.4 ± 1.0 in the conservative group (p<0.001), reflecting greater overall contentment with surgical management.

Baseline Demographic and Clinical Profile: In this study of 200 elderly patients with distal radius fractures, the surgical and conservative groups were comparable in baseline demographics and clinical characteristics. The mean ages (69.4 vs. 68.7 years), gender distribution (34% vs. 29% male), dominant hand involvement, presence of comorbidities, and time to treatment showed no statistically significant differences (all p > 0.05). This comparability is consistent with prior studies such as Song J et al. (2015)[5] and Chen Y et al. (2016)[6], which also reported similar baseline profiles across treatment groups in elderly populations. Maintaining homogeneity in these factors strengthens the validity of outcome comparisons.

Functional Outcomes: Significant improvements in functional scores were observed in the surgical group compared to conservative management. The DASH and PRWE scores were markedly lower (better) in surgically treated patients, indicating reduced disability and pain. Grip strength and wrist range of motion were also significantly greater in the surgical cohort. These findings echo the conclusions of Ju JH et al. (2015)[7] and Walenkamp MM et al. (2014)[8], who demonstrated superior wrist function and patient-reported outcomes after volar plating compared to cast immobilization in elderly distal radius fractures. The early mobilization and anatomical restoration afforded by surgery likely contribute to these improved functional results.

Radiological Parameters and Fracture Healing: Radiographic analysis revealed significantly better volar tilt, radial inclination, and ulnar variance restoration in the surgical group. Although time to radiological union was slightly shorter in the surgical group, this difference was not statistically significant. This aligns with findings from Ochen Y et al. (2020)[9], who highlighted improved alignment after surgical fixation but comparable healing times between surgical and conservative treatments. Adequate restoration of these radiological parameters is crucial as malalignment has been linked to functional impairment and arthritis progression.

Complications and Patient Satisfaction: Complications such as infections were more frequent in the surgical group (7% vs. 1%, p=0.02), consistent with the known risks of operative interventions. However, rates of CRPS and tendon irritation were comparable between groups, similar to reports by Wu YS et al. (2019)[10]. Despite the higher infection rate, patient satisfaction scores were significantly higher in the surgical group, reflecting patients’ appreciation for better functional outcomes and anatomical restoration. This supports the notion that patients may accept increased surgical risks in exchange for improved quality of life.

In elderly patients with distal radius fractures, surgical management offers superior functional outcomes, better restoration of anatomical alignment, and higher patient satisfaction compared to conservative treatment. Despite a slightly increased risk of complications such as infection, surgical intervention facilitates improved grip strength, range of motion, and reduced disability as evidenced by lower DASH and PRWE scores. Conservative management remains a viable option for select patients, particularly those with low functional demands or contraindications to surgery. Individualized treatment decisions should consider patient comorbidities, fracture characteristics, and patient preferences to optimize outcomes.

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