The results of non-surgical treatment for unstable distal radius fractures in elderly patients

Objectives: This study was designed to evaluate anatomical and functional results of non-surgical treatment for unstable distal radius fractures in the elderly. Methods: Twenty-nine patients (7 males, 22 females; mean age 72±2 years) aged >65 years were treated with closed reduction and short-arm circular casting for unstable distal radius fractures. According to the AO classification, all pa¬tients had type C fractures. Anatomical and functional re¬sults were assessed using the Stewart criteria and Q-DASH (Quick-Disability of Arm, Shoulder and Hand) question¬naire, respectively. Bone mineral density measurements were performed. Grip strength and wrist range of motion were measured in comparison to the unaffected side. The mean follow-up was eight months (range 6 to 12 months). Results: Union was achieved in all fractures within a mean of 4±1 weeks. Bone mineral density measurements showed os¬teoporosis in 22 patients (75.9%), and 26 patients (89.7%) had regional osteoporosis in cortical width measurements. After treatment, radiographic measurements showed the following: radius tilt angle +5.6±5.4°, inclination angle 17±4.6°, radial height 9±2.3 mm, and positive ulnar variance 2.8±2 mm. Five patients (17.2%) exhibited an articular step-off of less than 1 mm on the radial surface. According to the Stewart criteria, the results were good in 15 patients (51.7%), moderate in 12 patients (41.4%), and poor in two patients (6.9%). The mean Q-DASH score was 38±19.2 at three months, and 23±2.4 at final follow-up. Grip strength, extension/flexion, and prona- tion/supination were measured as 57.3±12.5%, 52±14%, and 75±16% of the unaffected side, respectively. Complications were seen in 11 patients (37.9%). Three patients (10.3%) de¬veloped malunion which required corrective osteotomy. Conclusion: Unstable distal radius fractures can be treated with closed reduction and cast application in low-demand elderly patients to avoid risks and complications of surgery.