SUBJECTIVE OUTCOME FOLLOWING MANIPULATION AND CAST APPLICATION FOR DISPLACED EXTRAARTICULAR DISTAL RADIUS FRACTURES IN ELDERLY PATIENTS.

Abstract

Background: Extraarticular distal radius fracture is the second most common osteoporotic fracture seen in the elderly patients.

Purpose: To establish relationship between radiological parameters and final functional outcome in conservatively treated displaced extraarticular distal radial fractures in elderly patients.

Methods: Twenty-two wrists with displaced extraar-ticular distal radial fractures in twenty sedentary, low demand elderly patients treated with manipulation under anaesthesia and plaster application between May 1999 and June 2000. The case notes and radiographs of these patients were assessed retrospectively and subjective outcome was evaluated with validated DASH Questionnaire at 3 years post- reduction. Overall satisfaction, ability to return to the previous level of activity and concern over wrist appearance was further analyzed. Only those patients with more than 5 mm of shortening and more than 15 degrees of dorsal angulation at initial radiographs were included. Results were analysed using Pearson Correlation Sig.(2 –Tailed) formula.

Results: There were 16 female and 4 male patients with a mean age of 71 years. The mean follow-up was 3 years. DASH score of less than 25 was seen in 14, between 25-50 in 3 and between 50-75 in 3 patients with mean of 21.426 and standard deviation of 22.353. Despite residual deformity in some patients, there was high degree of patient satisfaction consistent with low level of DASH score found in 71% patients. It was also noticed that Males in the study group were younger and have lower dash scores. Patients with more than 5 mm of shortening and more than 15 degrees of dorsal angu-lation at initial radiographs showed no adverse correlation with subjective outcome. Statistical analysis of the results confirmed that higher the age lower the DASH score there by better functional result.

Conclusion: It was noted that the higher the age the lower the dash score. Radiological picture and functional outcome are found to be two independent variables in the elderly subgroup of patients with displaced extrar-ticular distal radius fractures. Nonoperative treatment yields satisfactory results with high patient satisfaction rate and is advocated in elderly patients.