title: A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly.
abstract: OBJECTIVE
  As the population in developed countries continues to age, the incidence of osteoporotic distal radius fractures (DRFs) will increase as well. Treatment of DRF in the elderly population is controversial. We systematically reviewed the existing literature for the management of DRFs in patients aged 60 and over with 5 common techniques: the volar locking plate system, nonbridging external fixation, bridging external fixation, percutaneous Kirschner wire fixation, and cast immobilization (CI).
  
  
  METHODS
  We reviewed articles retrieved from MEDLINE, Embase, and CINAHL Plus that met predetermined inclusion and exclusion criteria in 2 literature reviews. Outcomes of interest included wrist arc of motion, grip strength, functional outcome measurements, radiographic parameters, and the number and type of complications. We statistically analyzed the data using weighted means and proportions based on the sample size in each study.
  
  
  RESULTS
  We identified 2,039 papers and selected 21 papers fitting the inclusion criteria in the primary review of articles with a mean patient age of 60 and older. Statistically significant differences were detected for wrist arc of motion, grip strength, and Disabilities of the Arm, Shoulder, and Hand score, although these findings may not be clinically meaningful. Volar tilt and ulnar variance revealed significant differences among groups, with CI resulting in the worst radiographic outcomes. The complications were significantly different, with CI having the lowest rate of complications, whereas the volar locking plate system had significantly more major complications requiring additional surgical intervention.
  
  
  CONCLUSIONS
  This systematic review suggests that despite worse radiographic outcomes associated with CI, functional outcomes were no different from those of surgically treated groups for patients age 60 and over. Prospective comparative outcomes studies are necessary to evaluate the rate of functional recovery, cost, and outcomes associated with these 5 treatment methods.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI 48109-5340, USA.
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Diaz-Garcia
authors.forename: Takashi
authors.initials: T
authors.lastname: Oda
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Shauver
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001864:Bone Wires; D016022:Case-Control Studies; D002370:Casts, Surgical; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D015577:Geriatric Assessment; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000628:therapy*