Patient discussions—not X-ray results—should guide common forearm fracture treatment in older adults
Treatment decisions for common forearm fractures in older patients should be driven by individual needs and environment, not X-ray results or age.
That’s according to Michigan Medicine physicians and other researchers who analyzed more than a decades’ worth of treatment outcomes for their findings, published June 17 in JAMA Network Open. There is no one-size-fits-all method for treating distal radius fractures, they concluded, which occur in more than 85,000 Medicare patients each year.
"Traditionally, surgeons look at these broken bones on X-rays and they have to assess various ways of fixing it based off fracture anatomy and patient age," said lead author Kevin Chung, MD, MS, and Charles B. G. De Nancrede, both with the Ann Arbor, Michigan, institution’s department of surgery. "However, in older patients, we determined that the patient-centered care in tailoring particular treatments to their needs, social environment and risk tolerance for surgery are all considerations in prescribing treatment."
For their study, the authors examined more than 180 participants from 20 medical centers across the globe over a 10-year period. Patients were randomized to receive treatment either with volar locking plates, external fixation, or pinning. Those who refused surgery underwent casting.
Early on, those treated with plating could more easily perform daily tasks. That gap narrowed at six months, however, and each treatment approach ended up with similar outcomes.
The bottom line is X-ray results, nor any other single feature, should direct surgical treatment for distal radius fractures, the authors explained. And discussions between the surgeon, patient and family are key.
"For hand surgery, this is the most intense, collaborative effort to try and answer a 200-year puzzle about distal radius fractures in older adults," Chung added. "For the good of public health, we needed to answer this question."
Read the entire study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.