Abstract
Background
Distal radial fractures in the elderly population have been traditionally managed by closed techniques, primarily due to their poor bone quality and low functional demands. Since the introduction of the volar locking plate (VLP), which provides a good fixation in osteoporotic bones, there maybe an increased use of open reduction and internal fixation (ORIF) in the elderly population.
Aim
We aimed to determine the changes in the management of these fractures in Scotland, and whether this differs between specialist regional centres and district general centres.
Patients and Methods
We retrospectively analysed distal radius fractures, in patients aged over 70 years in the period between 1989 and 2008. Data were obtained from the national statistical centre based on admission code and from discharge summaries. Data included patient demographics and treatment method; either open reduction and internal fixation (ORIF), Kirschner wire, or manipulation under anaesthetic (MUA).
Results
Incidence of distal radius fractures has increased by 75% from 1989 to 2008. In 2003 there were 94 (13.6%) ORIF, 109 (15.1%) K-wire and 492 (71.3%) MUA. In 2008 there were 131 (22.5%) ORIF, 81 (14.2%) K-wire and 361 (63.3%) MUA. There has been a 34% increase in the number of ORIF and a 26% decrease in K-wire procedures. There is a difference in the proportion treated by ORIF in university hospital and district general hospital trusts; 11.8% more fractures are treated by ORIF in university hospitals (p<0.5).
Conclusion
There has been an increasing tend to use VLP in the place of K wire fixation. However a vast majority of elderly patients are still treated primarily with MUA. There is an increased tendency to use VLP in university hospital trusts than in distict general hospitals. This may be a reflection of the availability and preferences of specialist orthopaedic hand surgeons.
