Ballet Safire, Guerzider-Regas Inès, Aouzal Zouhair, Pozet Astrid, Quemener-Tanguy Alexandre, Koehly Axel, Obert Laurent, Loisel François
Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, CHU Besançon, SINERGIES, Nanomédecine, Imagerie, Thérapeutique-EA 4662, Université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19 Rue Ambroise Paré, 25030 Besançon, France.
Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Edmond Garcin, Hôpital Public Aubagne, 179 avenue des sœurs Gastine, 13677 Aubagne, France.
Orthop Traumatol Surg Res. 2025 Feb;111(1):103959. doi: 10.1016/j.otsr.2024.103959. Epub 2024 Jul 24.
Surgery and non-operative treatment produce similar 1-year functional outcomes in patients older than 65 years. Data are lacking for patients older than 75 years. The main objective of this study was to compare surgical vs. non-operative treatment regarding short-term outcomes in patients older than 75 years. In addition to an overall analysis, sub-group analyses were done in patients with displacement and severe displacement (>20 ° posterior tilt).
Surgery provides better clinical and radiological outcomes than does non-operative treatment.
Patients older than 75 years at the time of a distal radius fracture were included prospectively over a 2-year period. A follow-up duration of at least 6 months was required. Treatment choices were based on displacement, Charlson's Co-morbidity Index, and patient autonomy. Surgery consisted in open fixation using an anterior locking plate and non-operative treatment in a short arm cast without reduction. The main assessment was based on clinical criteria: range of motion, strength, visual analogue scale (VAS) scores, the short version of the Disabilities of the Arm, Shoulder, and Hand tool (QuickDASH), the Patient Rated Wrist Evaluation (PRWE), and the 36-Item Short Form Health Survey (SF-36). The secondary assessment criteria were the radiological outcomes and the complications.
74 patients were included, among whom 24 were treated surgically and 50 non-operatively. At 1.5 months, surgery was associated with significantly better results for flexion, ulnar inclination, and supination, with range increases of at least 7 ° vs. non-operative treatment, and with greater dorsal angle and ulnar variance values (p < 0.05 for all comparisons). At 6 months, pronation and the radio-ulnar index were better with surgery (p < 0.05 for both comparisons). In the patients with displacement or severe displacement, surgery was associated with 10° gains vs. conservative treatment for flexion, ulnar inclination, and supination at 1.5 months (p < 0.05 for all comparisons).
In patients older than 75 years, surgery for distal radius fracture was associated with significantly better clinical and radiological outcomes within 6 months. Surgery is recommended for displaced and severely displaced distal radius fractures to expedite the recovery of joint motion ranges. Beyond 6 months, the outcomes are similar.
III.
手术治疗与非手术治疗在65岁以上患者中产生的1年功能预后相似。75岁以上患者的数据尚缺。本研究的主要目的是比较手术治疗与非手术治疗在75岁以上患者中的短期预后。除了进行总体分析外，还对移位和严重移位（后倾>20°）的患者进行了亚组分析。
手术治疗比非手术治疗能提供更好的临床和影像学预后。
前瞻性纳入2年内桡骨远端骨折时年龄超过75岁的患者。要求随访时间至少6个月。治疗选择基于移位情况、查尔森合并症指数和患者自主性。手术采用前路锁定钢板切开固定，非手术治疗采用短臂石膏固定且不进行复位。主要评估基于临床标准：活动范围、力量、视觉模拟量表（VAS）评分、手臂、肩部和手部功能障碍简表（QuickDASH）、患者腕关节评估（PRWE）以及36项简短健康调查（SF-36）。次要评估标准为影像学预后和并发症。
纳入74例患者，其中24例行手术治疗，50例接受非手术治疗。在1.5个月时，手术治疗在屈曲、尺偏和旋后方面的结果明显更好，活动范围增加至少7°，与非手术治疗相比，背侧角和尺骨变异值更大（所有比较p<0.05）。在6个月时，手术治疗的旋前和桡尺指数更好（两个比较p<0.05）。在移位或严重移位的患者中，与保守治疗相比，手术治疗在1.5个月时屈曲、尺偏和旋后的活动范围增加10°（所有比较p<0.05）。
在75岁以上的患者中，桡骨远端骨折手术治疗在6个月内的临床和影像学预后明显更好。对于移位和严重移位的桡骨远端骨折，建议手术治疗以加快关节活动范围的恢复。6个月后，预后相似。
Ⅲ级。
