[Is corrective osteotomy for malunited distal radius fractures also indicated for elderly patients?].
BACKGROUND
Corrective osteotomy of the distal radius is a well accepted procedure in younger, manual working and active patients with a malunited distal radius fracture. These functional improving procedures are often abandoned in elderly patients on accout of an uncertain benefit.


OBJECTIVE
To investigate the radiological and clinical outcome after corrective osteotomy for malunited fractures of the distal radius in the elderly and to answer the question, whether there is a benefit or not.


METHODS
In a prospective study the results of corrective osteotomy for malunion of distal radius fractures in 17 patients aged 65 years and more were investigated and compared with the results of 31 patients below an age of 65 years. Radiological parameters were radius tilt, ulnar inclination and ulnar variance. Clinically wrist motion, forearm rotation, pain at activity and grip strength were measured. Both groups were comparable according to their preoperative data. The statistical analyses were performed with use of the Mann-Whitney-U-test and the Wilcoxon test for paired differences, accepting p < 0.05 as significant.


RESULTS
All osteotomies achieved bony union. Loss of correction or other complications did not occur. Postoperatively both groups demonstrated improvement of all clinical and radiological parameters. Improvement was significant in eleven of twelve parameters in the group below 65 years and for eight of twelve parameters in the elderly. A comparison among the two groups revealed significant better results for five of the twelve parameters in the younger patients.


CONCLUSIONS
Radial corrective osteotomy leads to an improvement of the clinical situation not only in the younger but also in the elderly patient. Therefore, radial corrective osteotomy can be recommended for elderly patients. However, elderly patients may not experience the same amount of benefit from a corrective osteotomy of the distal radius as the younger patients. An age-related higher complication rate or unsatisfying long term results were not detected.
Pillukat
T
T
Klinik für Handchirurgie, Rhönklinikum Bad Neustadt/Saale. t.pillukat@handchirurgie.de
van Schoonhoven
J
J
Prommersberger
K-J
KJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D005593:Fracture Fixation, Internal; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011446:Prospective Studies; D011859:Radiography; D011884:Radius / Q000601:surgery*; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D020127:Recovery of Function; D016896:Treatment Outcome; D014955:Wrist Joint / Q000502:physiology