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surgery-versus-conservative-treatment-of-distal-radius-fracture-inpatients-older-than-85-years-a-retrospective-study-in-94-cases-2329-9509-1000156.pdf

op is oros and P h Barat et al., J Osteopor Phys Act 2015, 3:3 Osteoporosis & Physical Activity http://dx.doi.org/10.4172/2329-9509.1000156 te
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  J Osteopor Phys ActISSN: 2329-9509 JOPA, an open access journal Research ArticleOpen Access Osteoporosis & Physical Activity           J       o       u           r       n       a                     l        o        f     O     s      t    e   o   p  o  r  o s i s   a  n  d     P    h     y     s     i        c     a      l                A       c  t       i        v  i       t      y ISSN: 2329-9509 Barat et al., J Osteopor Phys Act 2015, 3:3http://dx.doi.org/10.4172/2329-9509.1000156 Volume 3 ã Isse 3 ã 1000156 Patients were identified using the digital medical records o the hospital. We used the CIM-10 classification [7] codes: S52-5 and S52-6. Statistical analyses were conducted using the on-line sofware o the Jussieu Paris VI University  :  BiostaGV [8]. Student’s t-test and Fisher’s exact F-test were used or that mean. Te main outcome was the unctional result at the end o the patient’s ollow up. It was measured objectively with wrist motility and subjectively with the common satisaction o the patient and the surgeon. Secondary outcomes included hospitalization time, immobilization duration, rate and nature o complications, and the pain at the end o the ollow up. Source of Funding  Tere was no external unding source or this study. Results Ninety-our patients were hospitalized in our institution between January 1 st , 2010 and June 30 th  2013. Tere were 74 surgical treatments and 20 conservatives’ treatments. Te mean age was 88.7 (85-101). *Corresponding author:  Maxime Barat, Service d’Orthopédie, Hôpital Simone Veil 14 Rue de Saint-Prix, 95600 Eaubonne, France,Tel: +331 34 06 61; E-mail: maxime.barat89@gmail.com Received  August 07, 2015; Accepted  August 26, 2015; Published  September 02, 2015 Citation: Barat M, Genser L, Tabbara M, Pourre D (2015) Surgery versus Conservative Treatment of Distal Radius Fracture in Patients Older Than 85 Years:  A Retrospective Study in 94 Cases. J Osteopor Phys Act 3: 156. doi:10.4172/2329-9509.1000156 Copyright: © 2015 Barat M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the srcinal author and source are credited. Surgery versus Conservative Treatment of Distal Radius Fracture in Patients Older Than 85 Years: A Retrospective Study in 94 Cases Maxime Barat 1 *, Laurent Genser  1 , Malek Tabbara 2  and Damien Pourre 1 1 Service d’Orthopédie, Hôpital Simone Veil 14 Rue de Saint-Prix, 95600 Eaubonne, France 2  6 avenues René Fonk, Studio A107, 75019 Paris, France Keywords: Wrist racture; Elderly; Conservative treatment Introduction Distal radius ractures (DRF) are the most common ractures occurring in emergency [1,2] (640000 cases per years in the USA) and the second racture site in patients older than 65 years afer proximal emur ractures. en percent (10%) o women older than 65 years will have a DRF[3]. Lie expectancy is always growing [4]. A lot o treatment exists or these ractures but there are only ew evidence o the superiority o one on them particularly in old patients[5].Te purpose o the present study was to determine i a surgical treatment or DRF in older than 85 years is justified and to compare these results to a conservative treatment. Materiel and Methods Tis is an observational retrospective study that included all patients older than 85 diagnosed with DRF and hospitalized in our institution between January 1 st , 2010 and June 30 th , 2013. Patients were divided in 2 groups: surgical treatment and conservative treatment. A systematic review o the patients’ medical records was done. We collected inormation about patients demographics (age, sex, liestyle, comorbidities), the existence o contraindication or anaesthesia, and we noted the nature o the trauma and i the ractures were intra-articular or not. Te characteristics o the ractures were evaluated by re-examining the radiographs, and were categorized as displaced ractures, radio-carpal intra-articular and distal radio-ulnar intra-articular ractures. Fractures were classified using the Kapanji’s [6] wrist ractures classification. Characteristics o the treatment were analyzed (immobilization time, physiotherapy). At last, the ollow up was analyses (time o the ollow up, wrist unction, recovery time, complications). Abstract Background:  Distal radius fractures are the most common fractures occurring in emergency. There’s no evidence for the superiority of one of the different treatment we can choose, particularly in old patients. The purpose of the present study was to determine if a surgical treatment for DRF in older than 85 is justied and to compare these results to a conservative treatment. Methods : This is an observational retrospective study that included all patients older than 85 years diagnosed with distal radius fractures and hospitalized in our institution between January 1 st , 2010 and June 30 th  2013. Patients were divided in 2 groups. The main outcome was the functional result at the end of the patient’s follow up. It was measured objectively with wrist motility and subjectively with the common satisfaction of the patient and the surgeon. Secondary outcomes included hospitalization time, immobilization duration, rate and nature of complications, and the pain at the end of the follow up. Results:  94 were included, 20 had a conservative treatment, 74 a surgical treatment. Groups were homogeneous at the admission. There were not statistically signicant difference in the main outcome with the objective or the subjective evaluation (p=0.046; OR: 0.1729 CI-95% [0.0205; 1.2662]). Immobilization time was signicantly longer in the surgical treatment group (42,4 vs. 35,7 days p: 0.045). Conclusions : Conservative treatment is the best treatment for distal radius fractures in elderly. Level of Evidence : Level III.  Citation:  Barat M, Genser L, Tabbara M, Pourre D (2015) Surgery versus Conservative Treatment of Distal Radius Fracture in Patients Older Than 85 Years: A Retrospective Study in 94 Cases. J Osteopor Phys Act 3: 156. doi:10.4172/2329-9509.1000156 Page 2 of 3 J Osteopor Phys ActISSN: 2329-9509 JOPA, an open access journal Volume 3 ã Isse 3 ã 1000156 Groups were homogeneous at the admission (able 1). Te middle ollow-up was 78.8 days.Te main outcome results were not statistically significant with the objective nor the subjective evaluation (p=0.046; OR: 0.1729 CI-95% [0.0205; 1.2662]) (able 2).Hospitalization time was significantly longer in the conservative treatment group (10.8 vs. 5.1 days p: 0,039). Immobilization time was significantly longer in the surgical treatment group (42,4 vs. 35,7 days p: 0.045).In the group « surgical treatment » 67 reduction (ORIF) with metal pins and 7 plates were realized (able 3).73% had physiotherapy in the two groups (p=1). 60 % o patients were ollowed by physical therapist afer immobilization (64% o patients in the surgery group and 53% o patients in the conservative treatment group p>0.05). Other patients had sel-physical therapy 0.28% o patients had complications (Figure 1). Tere were only 2 cases o arthritis ollowing surgical treatment; other complications were expected in this type o ractures. Tere was no tendon complication ound that was related to surgery. Discussion Our study did not show any significant difference between our 2 groups. Tis might be due to the small patients sample in the conservative treatment group. Most patients with conservative treatment are managed in the emergency room and thus are not easily identified ound in our electronic medical record. Only a prospective study could reduce this bias o recruitment. We can estimate that less o 1 patient on 2 is usually hospitalized or a conservative treatment [9]. In their study, Camelot et al [10] ollowed consecutively 280 patients with a DRF treated conservatively. Teir complication rate and nature o these complications were comparable to ours. Tis element consolidates the quality o our study, despite the bias o recruitment.o classiy ractures, we used Kapanji’s classification [11]. Although there’s no perect classification or DRF [12], this one seems to be clear and reproducible particularly or the stability and the comminution. Moreover, it’s a very popular and used classification by orthopedic surgeons.Our mean ollow-up time was relatively short: 78.8 days. Tis is another limit o the study. In act it has clearly been shown that a 12 month ollow-up [13] is necessary or definitive results evaluation. However, the most requently seen complications appears very early in the ollow up.Although most o the studies ocus on patient over 65 [14]. We decided to study patients older than 85. So we can evaluate the benefit o a surgical treatment versus a conservative treatment in an older population. aking in consideration, that, this group o patients will have a reduction o their normal daily activity and different requirements in unctional outcomes compared to a younger population.Conservative treatment o DRF has always been a dilemma to surgeons. Indeed, quality o the anatomic reduction assessed on radiographs is ofen recognized as a predictive actor or a good unctional result [15,16]. Te main criterion is the respect o the radio-carpal articulation [17], which could be achieved using volar-locking plates [18]. However, several studies proved that this dogma was disputable: despites wrist arthritis, which is significantly more requent in the case o radiographic displacement, unctional result is not different [19,20]. In our study, the length o stay was longer in patients SurgeryConservative treatmentp  Age88.589.40.30 GenderMen210.52 Women7219 Retierement home32.00%45.00%0.30 Anticoagulation56.00%45.00%0.45 Fall98.60%100.00%1.00 Time to consultation0.190.20.95 Associated trauma31.08%0.60%0.04 SideLeft42121.00 Right3281.00 Fracture  Articular14.00%0.00%0.11Displacement97.30%80.00%0.02Complication001.00  Kapanji's Classication 0150.0016113261300470 Table 1 : Patients baseline characterstics. Motilities SurgeryConservative TreatmentpObjective Main Outcome (Degrees) Flexion52.1438.330.26Extension32.8638.330.86 Abduction14.1711.670.67 Adduction28.3328.331.00Suppination63.3353.330.66Pronation73.3333.330.29 Table 2 : Main outcome results.  SurgeryConservative Treatmentp Disunion13.24%25.00%0.17Malunion42.38%35.73%0.04Hospitalisation time (days)5.1410.80.04Complications25.67%40.00%0.26Pain26.92%57.14%0.19 Table 3 : Secondaries outcomes results.  Algodystrophy carpal tunnel malunion displacement arthrisisSurgery groupConservative treatment group109876543210 Figure 1  Citation:  Barat M, Genser L, Tabbara M, Pourre D (2015) Surgery versus Conservative Treatment of Distal Radius Fracture in Patients Older Than 85 Years: A Retrospective Study in 94 Cases. J Osteopor Phys Act 3: 156. doi:10.4172/2329-9509.1000156 Page 3 of 3 J Osteopor Phys ActISSN: 2329-9509 JOPA, an open access journal Volume 3 ã Isse 3 ã 1000156 receiving a conservative treatment and this could be contributed to their extensive comorbidities.In 2011, Diaz-Garcia et al. published a metanalysis comparing conservative and surgical treatment in DRF in patients older than 60 years [21]. Functional, radiologic results and complications were compared. wenty-one studies and 1027 patients were analyzed. Tere were 220 (21%) conservative treatments. Tere was no significant difference ound on the unctional result despite a worst radiographic result in the conservative treatment group. However, there was significantly more complication in the surgical treatment group. A systematic review o the literature comparing conservative treatment and external fixation in DRF [21] ound similar results. As well as the prospective Arora et al [22] study in 2012 which ound no differences afer a 12 month ollow up in instable DRF between anterior locking plates and a conservative treatment. Conclusion No significant differences were ound between surgical and conservative treatment or DRF in patients older than 85 year. Tis result is in agreement with what has been published on DRF conservative treatment. We can conclude that conservative management is the best treatment needed or DRF. Tese results need to be re-inorced by a prospective study with an extended ollow-up period. Conict of Interest Statement The authors declare no conict of interest. References 1. Chung KC, Spilson SV (2001) The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg 26:   908–915.2. White JS (2013) Fractures of the distal radius. Adv Emerg Nur J 35: 8–15.3. Cummings SR, Black DM, Rubin SM (1989) Lifetime risks of hip, Colles’, or  vertebral fracture and coronary heart disease among white postmenopausal women. Arch. Intern Med 149: 2445–2448.4. http://www.ined.fr/fr/france/mortalite_causes_deces/esperance_vie/5. Diaz-Garcia RJ, Chung KC (2012) Common myths and evidence in the management of distal radius fractures. Hand Clin 28: 127–133.6. Kapandji A (1987) Intra-focal pinning of fractures of the distal end of the radius 10 years later. Ann. Chir. Main Organe Off. Sociétés Chir Main 6: 57–63.7. http://apps.who.int/classications/icd10/browse/2008/fr  8. http://marne.u707.jussieu.fr/biostatgv/?module=tests9. Boufous S (2006) The epidemiology of hospitalised wrist fractures in older  people, New South Wales, Australia. Bone 39: 1144–1148.10. Camelot C, Ramaré S, Lemoine J, Saillant,G (1998) Orthopedic treatment of fractures of the lower extremity of the radius by the Judet technique. Anatomic results in function of the type of lesion: apropos of 280 cases. Rev. Chir. Orthopédique Réparatrice Appar. Mot 84: 124–135.11. Board T, Kocialkowski A, Andrew G (1999) Does Kapandji wiring help in older  patients? A retrospective comparative review of displaced intra-articular distal radial fractures in patients over 55 years. Injury 30: 663–669.12. Diaz-Garcia RJ, Chung KC (2012) Common myths and evidence in the management of distal radius fractures. Hand Clin 28: 127–133.13. Chung KC, Kotsis SV, Kim HM (2007) Predictors of functional outcomes after  surgical treatment of distal radius fractures. J Hand Surg 32: 76–83.14. Diaz-Garcia RJ, Oda T, Shauver MJ,Chung KC (2011) A systematic review of  outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg 36: 824–835.e2.15. McQueen M, Caspers J (1988) Colles fracture: Does the anatomical result  affect the nal function? J. Bone Joint Surg Br 70: 649–651. 16. Board T, Kocialkowski A, Andrew G (1999) Does Kapandji wiring help in older  patients? A retrospective comparative review of displaced intra-articular distal radial fractures in patients over 55 years. Injury 30: 663–669.17. Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J. Bone Joint Surg. Am 68: 647–659.18. Piétu G, Raynaud G (1994) Osteosynthesis by plate in fractures of the distal end of the radius. Ann. Chir 48: 70–73.19. Catalano LW (1997) Displaced intra-articular fractures of the distal aspect of  the radius. Long-term results in young adults after open reduction and internal  xation. J Bone Joint Surg. Am 79: 1290–1302. 20. Goldfarb CA, Rudzki JR, Catalano LW, Hughes M, Borrelli J (2006) Fifteen-year  outcome of displaced intra-articular fractures of the distal radius. J Hand Surg 31: 633–639.21. Handoll HHG, Huntley JS, Madhok R (2007) External xation versus  conservative treatment for distal radial fractures in adults. Cochrane Database Syst Rev CD006194.22.  Arora R (2011) A prospective randomized trial comparing nonoperative  treatment with volar locking plate xation for displaced and unstable distal radial fractures in patients sixty-ve years of age and older. J Bone Joint Surg.   Am 93: 2146–2153. Citation: Barat M, Genser L, Tabbara M, Pourre D (2015) Surgery versus Conservative Treatment of Distal Radius Fracture in Patients Older Than 85 Years: A Retrospective Study in 94 Cases. J Osteopor Phys Act 3: 156. doi:10.4172/2329-9509.1000156 OMICS International: Publication Benefits & Features Unique features: ã UIncreased global visibility of articles through worldwide distribution and indexingã Showcasing recent research output in a timely and updated mannerã Special issues on the current trends of scientic research Special features: ã 700 Open Access Journalsã 50,000 editorial teamã Rapid review processã Quality and quick editorial, review and publication processingã Indexing at PubMed (partial), Scopus, EBSCO, Index Copernicus and Google Scholar etcã Sharing Option: Social Networking Enabledã Authors, Reviewers and Editors rewarded with online Scientic Creditsã Better discount for your subsequent articlesSubmit your manuscript at: http://www.omicsonline.org/submission
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