![]() ![]() However, these guidelines use chronologic age as a proxy for estimating functional demand and do not consider that older adults in the US are living longer and leading active lifestyles well into older age. 7 - 9 These guidelines provide evidence that operative management of DRFs in patients older than 65 years does not improve long-term (>1 year) patient-reported outcomes and suggest that casting should be the preferred treatment for DRFs in older adults. In 2020, the American Academy of Orthopedic Surgeons published appropriate use criteria for DRF management. Compared with other treatments, VLPs are associated with significantly better patient-reported outcomes in the early recovery period and enable faster return to mobility. 5, 6 However, key differences among DRF treatments are evident in their short-term outcomes. Evidence from randomized clinical trials suggests long-term patient-reported outcomes are comparable, regardless of treatment received or postreduction radiographic alignment. Although numerous studies 3, 4 have compared operative with nonoperative treatment of DRFs, no consensus has been reached regarding optimal management in the geriatric population. 2 Distal radius fractures are treated nonoperatively with casting or surgically with volar locking plates (VLPs), percutaneous pinning (PP), or external fixation (EF). 1 The estimated cost of treating DRFs in older adults in 2025 is $600 million. Trial Registration Identifier: NCT01589692ĭistal radius fractures (DRFs) account for 18% of fractures in the active elderly population. These findings suggest that physicians should counsel active older adults with few comorbidities on earlier return to daily activities after surgery compared with casting. Clinically significant differences in MHQ scores were associated with low physical activity, 4 or more comorbidities, or increased age by 15 years.Ĭonclusions and Relevance In this retrospective secondary analysis of WRIST, chronologic age was not associated with functional demand. Comorbidities were associated with decreased MHQ scores at all time points in the casting group. High activity was associated with improved MHQ scores in the surgical cohort at 6 weeks (mean score, 12.21 PC = 0.27 P = .02) and 12 months (mean score, 13.25 PC = 0.17 P = .02). Increased chronologic age was associated with increased MHQ scores in the surgery group at all time points but decreased MHQ scores in the casting group at 12 months (mean score, −0.46 P = .03). ![]() Results The final cohort consisted of 293 participants (mean age, 71.1 years 255 female 247 White), with 109 receiving casting and 184 receiving surgery. Partial correlation (PC) analysis adjusted for confounding. Main Outcomes and Measures The primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) score assessed at 6 weeks, 3 months, 6 months, and 1 year. ![]() Participants were stratified by chronologic age, number of comorbidities, and activity status. Patients who selected surgery were randomly assigned to volar lock plating, percutaneous pinning, or external fixation. Interventions Participants selected casting or surgery. WRIST was a 24-center randomized clinical trial that enrolled participants older than 60 years with unstable DRFs from April 1, 2012, to December 31, 2016. Objective To examine how chronologic age compares with measures of physiologic age in DRF treatment recovery.ĭesign, Setting, and Participants This retrospective secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST) was performed from May 1 to August 31, 2022. However, physiologically younger adults could benefit from operative DRF management despite advanced chronologic age. Importance Casting is recommended for adults older than 65 years with distal radius fractures (DRFs) because similar long-term outcomes are achieved regardless of treatment. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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