Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden.
Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
BMC Geriatr. 2022 Feb 19;22(1):140. doi: 10.1186/s12877-022-02825-x.
The distal radius fracture (DRF) is the most common fracture in adults. With an ageing population, the number of wrist fractures in the superelderly (≥ 80 years) is expected to rise. Optimal treatment for displaced DRFs remains controversial, especially in the superelderly group. In addition, basic knowledge of the outcome after a DRF in this heterogenic group is lacking. The aim of this study was to study injury characteristics, treatment and outcome of DRFs in superelderly patients using data from a large national register.
We used prospectively collected data from the Swedish Fracture Register. All distal radius fractures registered between April 2012 and December 2018 in patients ≥ 80 years of age were included. Data on epidemiology, fracture type, trauma mechanism and treatment are registered by the physician treating the patient. Patients are also sent a subjective outcome questionnaire including EQ-5D, EQ-VAS and Short Musculoskeletal Function Assessment questionnaire (SMFA-score) at the time of injury and after 12 months. The 12-month questionnaire was sent to those who had completed the questionnaire at the time of injury. A Mann-Whitney U-test was used to assess differences between treatment methods.
Mean age for this population was 86 years (80-105 years), a majority of the patients were female (86.7%). The dominating injury mechanism was a simple fall (74.6%) in the patient's residence. The majority of fractures were AO type A (70%) followed by AO type C (20.9%) and type B (8.6%). The incidence of open fractures was significantly higher in females (2.6%) compared to males (1.5%). A majority of the fractures were treated with a cast (87.5%) with volar locking plate as the second most common treatment method (6.6%). Patient-reported outcome measures (PROMs) EQ-5D, EQ-VAS and the Arm Hand Function Index of the SMFA-score deteriorated somewhat one year after injury compared to pre-injury. PROMs did not correlate to treatment with cast or a volar plate.
This nationwide register study provides detailed data on DRFs in the superelderly regarding epidemiology, treatment and self-reported outcome. A good self-reported outcome is possible, but many patients do not recover completely. PROMs did not correlate to type of treatment. The frequency of open fractures was significantly higher in females. The reason for this is unclear but different skin thickness in older males versus females may be one explanation.
桡骨远端骨折（DRF）是成年人中最常见的骨折。随着人口老龄化，超级老年人（≥80 岁）手腕骨折的数量预计将会上升。对于移位的 DRF，最佳治疗方法仍存在争议，尤其是在超级老年人群中。此外，对于这个异质群体，DRF 后的基本结果知识还很缺乏。本研究的目的是使用大型国家登记处的数据，研究超级老年患者 DRF 的损伤特征、治疗和结果。
我们使用瑞典骨折登记处前瞻性收集的数据。2012 年 4 月至 2018 年 12 月期间≥80 岁的所有桡骨远端骨折患者均纳入研究。医生治疗患者时，会记录流行病学、骨折类型、创伤机制和治疗等数据。患者在受伤时和 12 个月时还会收到包括 EQ-5D、EQ-VAS 和短肌肉骨骼功能评估问卷（SMFA 评分）在内的主观结果问卷。12 个月问卷寄给那些在受伤时已经完成问卷的人。采用 Mann-Whitney U 检验评估治疗方法之间的差异。
该人群的平均年龄为 86 岁（80-105 岁），大多数患者为女性（86.7%）。主要损伤机制为简单跌倒（74.6%），发生在患者居住场所。大多数骨折为 AO 型 A（70%），其次为 AO 型 C（20.9%）和 B 型（8.6%）。女性开放性骨折的发生率明显高于男性（2.6%比 1.5%）。大多数骨折采用石膏固定（87.5%），其次是掌侧锁定钢板（6.6%）。与受伤前相比，受伤 1 年后患者报告的结果测量（PROMs）EQ-5D、EQ-VAS 和 SMFA 评分的上肢手功能指数恶化。PROMs 与石膏或掌板治疗无相关性。
这项全国性登记研究提供了有关超级老年人桡骨远端骨折的流行病学、治疗和自我报告结果的详细数据。自我报告的结果可能很好，但许多患者并未完全康复。PROMs 与治疗类型无关。女性开放性骨折的频率明显更高。原因尚不清楚，但老年男性与女性皮肤厚度不同可能是一个解释。
