Moutinot Bérénice, Sojevic Ivana, Bouvet Cindy, Mares Olivier, Vouga Manon, Beaulieu Jean-Yves
Department of Orthopaedic Surgery, Geneva University Hospitals, Geneva, Switzerland.
Department of Orthopaedic Surgery, Nîmes University Hospital, Nîmes, France.
J Hand Surg Glob Online. 2022 Dec 22;5(2):140-144. doi: 10.1016/j.jhsg.2022.11.004. eCollection 2023 Mar.
Currently, there is no consensus on the treatment of distal radius fractures in the super-elderly population. The aim of this study was to evaluate the perioperative morbidities and the need for rehabilitation care after a distal radius fracture treated with locking plates among patients aged 85 years or older.
A retrospective study was conducted in all patients aged 85 years or older who underwent open surgical treatment using a locking plate for an isolated distal radius fracture from January 2013 to December 2018 at a level 1 trauma center. The occurrence of minor complications (tendinopathy, neuropathy, carpal tunnel syndrome, and infection), major complications (complex regional pain syndrome, nonunion, loss of reduction, intra-articular screw, and hardware failure), and the need for revision surgery were recorded. The need and timing of rehabilitation were also documented. A nested case-control study was performed to evaluate predictive factors associated with the need for inpatient rehabilitation.
The majority of fractures were AO type A, numbering 88 (55.7%), followed by 64 type C (40.5%), and then 6 type B (3.8%). The overall complication rate among the 158 included patients was 17% (n = 26), with 12 (7.6%) having minor complications and 14 (8.9%) having major complications. Inpatient rehabilitation was required for one-third of the patients (n = 59), and 11 (7%) were definitively discharged to a nursing home. The place of residence before the fracture, American Society of Anesthesiologist score, and the type of anesthesia were associated with a need for inpatient rehabilitation.
Overall, this study suggests that perioperative morbidity of distal radius fractures treated using a locking plate is acceptable even in the super-elderly population. Nevertheless, given the frequent requirement for rehabilitation, the impact of age cannot be ignored.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
目前，对于高龄人群桡骨远端骨折的治疗尚无共识。本研究旨在评估85岁及以上患者采用锁定钢板治疗桡骨远端骨折后的围手术期发病率以及康复护理需求。
对2013年1月至2018年12月期间在一级创伤中心接受切开复位锁定钢板内固定术治疗孤立性桡骨远端骨折的所有85岁及以上患者进行回顾性研究。记录轻微并发症（肌腱病、神经病变、腕管综合征和感染）、严重并发症（复杂性区域疼痛综合征、骨不连、复位丢失、关节内螺钉和内固定失败）的发生情况以及翻修手术需求。还记录了康复需求和时机。进行巢式病例对照研究以评估与住院康复需求相关的预测因素。
大多数骨折为AO A型，共88例（55.7%），其次是64例C型（40.5%），然后是6例B型（3.8%）。158例纳入患者的总体并发症发生率为17%（n = 26），其中12例（7.6%）发生轻微并发症，14例（8.9%）发生严重并发症。三分之一的患者（n = 59）需要住院康复，11例（7%）最终被转至养老院。骨折前的居住地、美国麻醉医师协会评分和麻醉类型与住院康复需求相关。
总体而言，本研究表明即使在高龄人群中，采用锁定钢板治疗桡骨远端骨折的围手术期发病率也是可以接受的。然而，鉴于康复需求频繁，年龄的影响不容忽视。
研究类型/证据水平：治疗性IV级。
