title: Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To assess the safety and efficacy of operative versus nonsurgical treatment of distal radius fractures in elderly patients.
  
  
  METHODS
  We comprehensively searched the PubMed, Web of Science, and Cochrane Library databases for studies that satisfied predetermined inclusion and exclusion criteria. Outcomes of interest included pain level, grip strength, wrist range of motion, wrist functional assessment, radiographic parameters, and complications; we compared these using continuous measurements. We performed a systematic review and meta-analysis to assess operative versus nonsurgical procedures in patients aged 60 years and older.
  
  
  RESULTS
  Two randomized controlled trials and 6 retrospective studies were included. Meta-analysis did not detect statistically significant differences in pooled data for pain level, functional assessment, and wrist range of motion between the operative and nonsurgical groups. Grip strength was significantly greater in the operative group. The incidence of major complications requiring surgery and that of tendon injury were significantly higher in the operative group. Radiographic outcomes including volar tilt, radial inclination, and ulnar variance were significantly better in the operative group. Considerable heterogeneity was present in all studies and adversely affected the precision of the meta-analysis.
  
  
  CONCLUSIONS
  The current literature does not support the theory that operative management can provide better clinical outcomes for elderly patients with distal radius fractures. Although operative management can offer better radiographic outcomes and grip strength than can nonsurgical treatment, the risk of complications requiring surgical treatment is greater. Thus, indications for operative fixation should be considered carefully in the treatment of elderly patients.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Division of Plastic and Hand Surgery, Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: chenyihenggk@sina.com.
authors.forename: Yiheng
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Division of Plastic and Hand Surgery, Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Xinglong
authors.initials: X
authors.lastname: Chen
authors.affiliation: Division of Plastic and Hand Surgery, Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Zhijie
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Plastic and Hand Surgery, Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Hede
authors.initials: H
authors.lastname: Yan
authors.affiliation: Division of Plastic and Hand Surgery, Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Feiya
authors.initials: F
authors.lastname: Zhou
authors.affiliation: Division of Plastic and Hand Surgery, Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Weiyang
authors.initials: W
authors.lastname: Gao
mesh_terms: D000368:Aged; D003952:Diagnostic Imaging; D005592:Fracture Fixation / Q000379:methods*; D018737:Hand Strength; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D011885:Radius Fractures / Q000601:surgery / Q000628:therapy*; D016059:Range of Motion, Articular; D020127:Recovery of Function
keywords: Meta-analysis; distal radius fractures; elderly patient; nonsurgical; operative