Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2020 Jan 2;102(1):37-44. doi: 10.2106/JBJS.18.00561.
The purpose of the present study was to identify trends in management and to compare the outcomes and complications following nonoperative and operative management (including external fixation, closed reduction and percutaneous pinning, and open reduction and internal fixation) for distal radial fractures in patients ≥65 years of age.
We performed a retrospective analysis, with use of the OptumLabs Data Warehouse database, of patients ≥65 years of age who had been managed for a distal radial fracture between 2009 and 2014 (as indicated by diagnosis codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification). Ninety-day and 1-year complication rates per 1,000 fractures were analyzed overall and by treatment modality.
Thirteen thousand, seven hundred and thirteen distal radial fractures were analyzed. The overall 90-day complication rate was 36.5 per 1,000 fractures, and the 1-year upper-extremity-specific complication rate was 236.2 and 307.5 per 1,000 fractures for nonoperative and operative management, respectively. Overall, post-injury stiffness was the most common 1-year upper-extremity-specific complication (incidence, 11.5%). There was no significant difference between operative and nonoperative management in terms of 90-day complication rates. However, operative management had a higher 1-year complication rate than nonoperative management (307.5 versus 236.2 per 1,000 fractures). Overall, the 5 most common upper-extremity-specific complications following operative treatment of distal radial fracture were stiffness (16.0%), chronic regional pain syndrome (9.9%), median neuropathy (8.0%), implant-related complications (3.8%), and tendon-related complications (2.8%). Stiffness was significantly more frequent following operative management (16.0% versus 9.8%; p < 0.01).
Operative management of a distal radial fracture should be carefully considered when discussing treatment options with patients ≥65 years of age.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究的目的是确定桡骨远端骨折患者的治疗趋势，并比较非手术和手术治疗（包括外固定、闭合复位经皮克氏针固定和切开复位内固定）的结果和并发症，这些患者的年龄均≥65 岁。
我们使用 OptumLabs Data Warehouse 数据库，对 2009 年至 2014 年间（根据国际疾病分类第 9 版临床修订版的诊断代码确定）≥65 岁桡骨远端骨折患者进行回顾性分析。总体上以及按治疗方式分析每 1000 例骨折的 90 天和 1 年并发症发生率。
共分析了 13713 例桡骨远端骨折。总体 90 天并发症发生率为每 1000 例骨折 36.5 例，非手术和手术治疗的 1 年上肢特定并发症发生率分别为每 1000 例骨折 236.2 和 307.5 例。总体而言，受伤后僵硬是最常见的 1 年上肢特定并发症（发生率为 11.5%）。手术治疗与非手术治疗在 90 天并发症发生率方面无显著差异。然而，手术治疗的 1 年并发症发生率高于非手术治疗（每 1000 例骨折分别为 307.5 例和 236.2 例）。总体而言，桡骨远端骨折手术后最常见的 5 种上肢特定并发症是僵硬（16.0%）、慢性区域性疼痛综合征（9.9%）、正中神经病变（8.0%）、植入物相关并发症（3.8%）和肌腱相关并发症（2.8%）。僵硬在手术治疗后明显更为常见（16.0%比 9.8%；p<0.01）。
在与≥65 岁的患者讨论治疗选择时，应仔细考虑桡骨远端骨折的手术治疗。
治疗性 III 级。请参阅作者说明以获取完整的证据等级描述。
