After the primary swelling has decreased, the slab converted to a complete below-elbow cast at 1 or 2 weeks. 20Ĭurrent protocol for nonoperative treatment of DRFs includes initially fracture reduction under local or general anesthesia in the emergency department and then immobilized with a below-forearm splint. 19 Sakai et al reported a significant correlation between increasing displacement of distal fracture fragment and lower bone mineral density. The risk for displacement with an unacceptable radiographic result was found to increase in patients older than 58 years. 18 Nesbitt et al reported that the age was the only statistically significant risk factor in predicting secondary displacement and instability treating DRFs by closed reduction and immobilization. Osteoporosis weakens the metaphyseal bone by decreasing trabecular bone volume, 17 so osteoporotic DRFs very often show a large metaphyseal defect or void, which increases fracture instability. 4 Fracture instability is also defined as a failure to hold the reduced position of the fracture within the forearm cast with a loss of reduction at 1 or 2 weeks. Primary reduction of the fracture is considered to be acceptable when dorsal tilt does not exceed 20°, radial shortening is not more than 3 mm, and intra-articular step off does not exceed 2 mm. Fracture reduction is assessed using radiographs after manipulation. Initially all displaced DRFs are recommended to be reduced under local or general anesthesia in the emergency department and then immobilized. 5 In unstable intra-articular DRFs, where fracture reduction cannot be maintained with cast immobilization, additional fixation is suggested. There is unanimity in the literature that stable fractures can be treated with closed reduction and cast immobilization with satisfactory outcome. 3 The current literature concerning the treatment of DRFs in the elderly individuals is more controversial.
These decisions are often made based on the data from treatments of much younger patients. Decision making for surgical or nonsurgical approach to osteoporotic DRFs is difficult. 4Ĭonsidering the increasing life expectancy of the elderly population, appropriate management of these fractures is of growing importance. 3 Many of the very old and frail individuals with low functional demands can accept and live with deformity and dysfunction of the wrist. 2 Some authors have recommended anatomic restoration of displaced, unstable DRFs in young patients to achieve best clinical results. 1 In unstable fracture patterns cast immobilization fails to maintain fracture reduction until bone union and therefore leads to malunion in more than 50%. Traditionally, DRFs in older patients have been treated with closed reduction and cast immobilization. This article reviews the different treatment options for DRFs in the elderly individuals reported in the recent literature.ĭiatal radius fractures (DRFs) are typical fractures of relatively fit persons with osteoporotic bone. Some investigators have recommended open reduction internal fixation (ORIF) as treatment for unstable DRFs in older patients, while others have suggested that elderly patients should be treated nonsurgically even if there is an unstable fracture situation because fracture reduction is not associated with functional outcomes as in younger patients.
The current literature concerning the treatment of DRFs in the elderly individuals is more controversial.
Considering the increasing life expectancy of the elderly population, appropriate management of these fractures is of growing importance. Diatal radius fractures (DRFs) are typical fractures of relatively fit persons with osteoporotic bone who remain active into older age.
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