title: Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older.
abstract: OBJECTIVE
  To compare complication rates for distal radius fractures treated operatively versus nonsurgical in patients older than 65 years. We hypothesized that surgical intervention would improve fracture alignment, but it would be associated with more complications and equivalent functional outcomes when compared with the nonsurgical group.
  
  
  METHODS
  Patients (operative, n = 129) and controls (nonsurgical, n = 129) were identified from a prospective clinical and operating room database. They were matched on fracture severity (AO-A/B/C1 vs AO-C2/C3), sex, age, and energy of injury. Data on complications were extracted from medical charts using a validated complications checklist, and radiologic data were collected for all patients. Functional outcomes (Patient-Related Wrist Evaluation) at 1 year were available in only a subset of patients. We determined differences in complication and reoperation rates using a chi-square test.
  
  
  RESULTS
  A significant number of patients experienced complications in the operative group (operative = 37 of 129; nonsurgical = 22 of 129). The most common complication was median neuropathy (n = 8 operative; n = 14 nonsurgical), followed by surgical site infections (n = 16 operative; 12 of 16 were pin site infections) and complex regional pain syndrome (n = 4 operative; 3 nonsurgical). The complication rate in patients treated with volar plate was 22% (16 of 74), for dorsal plate it was 50% (2 of 4), for external fixation it was 42% (16 of 38), and for percutaneous pinning it was 23% (3 of 13). The number of patients requiring reoperations was similar in both groups (11 [9%] operative; 7 [5%] nonsurgical). Our secondary radiologic and functional outcomes demonstrate that despite a higher incidence of malunion in nonsurgical patients (nonsurgical: 69% vs operative: 29%), a subset of patients from both groups (n = 140) had minimal pain and disability at 1 year (Patient-Related Wrist Evaluation operative: 16.9 ± 23.2; nonsurgical: 15.7 ± 17.5).
  
  
  CONCLUSIONS
  In a study matching fracture severity, sex, age, and energy of injury, we found that elderly patients with distal radius fractures who underwent surgery had higher complication rates than those treated nonsurgically.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Clinical Research Laboratory, Division of Orthopedic Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Division of Plastic Surgery, Department of Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Orthosports Orthopaedic and Sports Medicine Service, Sydney NSW, Australia.
authors.forename: Kristina
authors.initials: K
authors.lastname: Lutz
authors.affiliation: Clinical Research Laboratory, Division of Orthopedic Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Division of Plastic Surgery, Department of Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Orthosports Orthopaedic and Sports Medicine Service, Sydney NSW, Australia.
authors.forename: Kwan M
authors.initials: KM
authors.lastname: Yeoh
authors.affiliation: Clinical Research Laboratory, Division of Orthopedic Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Division of Plastic Surgery, Department of Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Orthosports Orthopaedic and Sports Medicine Service, Sydney NSW, Australia.
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.affiliation: Clinical Research Laboratory, Division of Orthopedic Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Division of Plastic Surgery, Department of Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Orthosports Orthopaedic and Sports Medicine Service, Sydney NSW, Australia.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Symonette
authors.affiliation: Clinical Research Laboratory, Division of Orthopedic Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Division of Plastic Surgery, Department of Surgery, Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Orthosports Orthopaedic and Sports Medicine Service, Sydney NSW, Australia. Electronic address: rgrewa@uwo.ca.
authors.forename: Ruby
authors.initials: R
authors.lastname: Grewal
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery
keywords: Complications; distal radius fracture; elderly; function; matched cohort