Department of Orthopaedic Surgery, Tone Chuo Hospital, Numasu-machi, Numata, Gunma, Japan; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan.
Department of Rehabilitation, Gunma University Graduate School of Health Sciences, Showa-machi, Maebashi, Gunma, Japan.
J Hand Surg Am. 2024 Oct;49(10):1038.e1-1038.e8. doi: 10.1016/j.jhsa.2022.12.013. Epub 2023 Feb 8.
Previous studies have suggested little association between radiographic malalignment and long-term functional outcomes of nonsurgical treatment of distal radius fractures in geriatric patients. However, no report has stratified the elderly by age and focused on short-term outcomes. The purpose of this study was to determine how the relationship between malunion and patient outcomes differs between early- and late-geriatric patients in the short and long terms after injury, thereby informing explanations and decision-making on treatment options for geriatric patients with distal radius fractures.
One hundred patients treated nonsurgically for distal radius fractures were evaluated retrospectively; 52 were defined as early-geriatric patients (aged 60-72 years) and 48 as late-geriatric (aged >77 years). Malunion (dorsal tilt > 10°, ulnar variance > 3 mm, or intra-articular displacement or step-off > 2 mm), range of motion, and grip strength were investigated at 3 months. Multiple regression analysis was performed for each age group using Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores at 3 months as the dependent variable. QuickDASH scores over 1 year after injury were analyzed in the same way.
The early-geriatric patients included 33 acceptable unions and 19 malunions. The late-geriatric patients included 12 acceptable unions and 26 malunions. The significant predictors of QuickDASH scores at 3 months were malunion for the early-geriatric group and grip strength for the late-geriatric group (standardized coefficient β, 0.31 and -0.49, respectively). No factor significantly predicted the QuickDASH scores after at least 1 year in either group.
Malunion was associated with worse QuickDASH scores at 3 months after injury in the early-geriatric patients but not in the late-geriatric patients and did not predict the QuickDASH scores at 1 year after injury in either age group.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
先前的研究表明，在老年患者中，非手术治疗桡骨远端骨折的放射学对线不良与长期功能结果之间关联不大。然而，尚无研究按年龄对老年人进行分层，并关注短期结果。本研究的目的是确定放射学对线不良与受伤后短期和长期内老年患者的结果之间的关系在早老年和晚老年患者之间有何不同，从而为桡骨远端骨折老年患者的治疗方案提供解释和决策依据。
回顾性评估了 100 例接受非手术治疗的桡骨远端骨折患者；其中 52 例为早老年患者（年龄 60-72 岁），48 例为晚老年患者（年龄>77 岁）。在受伤后 3 个月时，评估了对线不良（背倾>10°，尺侧偏差>3mm，或关节内移位或台阶>2mm）、活动范围和握力。使用 3 个月时的快速上肢功能测试（Quick-Disabilities of the Arm, Shoulder, and Hand，QuickDASH）评分作为因变量，对每个年龄组进行多元回归分析。以同样的方式分析受伤后 1 年以上的 QuickDASH 评分。
早老年组中，33 例为可接受愈合，19 例为对线不良愈合；晚老年组中，12 例为可接受愈合，26 例为对线不良愈合。3 个月时 QuickDASH 评分的显著预测因素是早老年组的对线不良和晚老年组的握力（标准化系数β分别为 0.31 和-0.49）。两组在任何一个时间点均无其他因素能显著预测 QuickDASH 评分。
对线不良与早老年患者受伤后 3 个月时的 QuickDASH 评分较差相关，但与晚老年患者无关，且在两个年龄组中均不能预测受伤后 1 年时的 QuickDASH 评分。
类型的研究/证据水平：预后 IV 级。
