title: [Clinical results following conservative and surgical treatment of osteoporotic distal radius fractures in the elderly : Overview of best available evidence].
abstract: Fractures of the distal radius in elderly patients increasingly contribute to the workload in emergency departments worldwide. There is still no consensus about the best treatment option, e. g. closed reduction and cast stabilization, percutaneous pinning, external fixation or open reduction and internal fixation with volar locking plates (ORIF). In addition, the influence of pharmacological antiosteoporotic treatment (e. g. bisphosphonates) is unclear. In this overview five comparative studies were analyzed, which had been identified in a previous systematic review. The evaluation included 3 cohort studies and 2 randomized trials enrolling a total of 515 patients. A clinical or statistical advantage of ORIF over conservative treatment with respect to DASH scores 12 months after the index fracture event could not be demonstrated with a mean difference of 0.25 (95 % confidence interval CI -0.57-1.07). According to current best scientific evidence from preclinical and clinical investigations, antiosteoporotic medication does not have an unfavorable influence on fracture healing and should be continued due to its proven effectiveness in reducing subsequent osteoporotic fractures. Following distal radius fractures in elderly patients with clinical risk factors, an osteoporosis screening should be routine practice and a specific therapy should be initiated if the fracture risk is increased.
authors.affiliation: Zentrum für Orthopädie, Osteoporose und Osteologie München, Rosa-Bavarese-Str. 1, 80639, München, Deutschland. chbartl@gmx.de.
authors.forename: C
authors.initials: C
authors.lastname: Bartl
authors.affiliation: Zentrum für Klinische Forschung, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Stengel
authors.affiliation: Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Gülke
authors.affiliation: Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Gebhard
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001860:Bone Plates; D002370:Casts, Surgical; D003131:Combined Modality Therapy / Q000379:methods; D019317:Evidence-Based Medicine; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007103:Immobilization / Q000379:methods*; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000175:diagnosis / Q000628:therapy*
chemical_list: D050071:Bone Density Conservation Agents
keywords: Cast immobilization; Locking plate fixation; Osteoporosis; Quality of life; Rehabilitation