Operative vs Nonoperative Treatment of Distal Radius Fractures

Researchers have found in a meta-analysis that operative treatment might be the preferred treatment option for the most common injury among adults. The study revealed that operative treatment of distal radius fractures improved the medium-term Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score and grip strength over nonoperative treatment in adults. These findings suggest that operative treatment might be preferred for distal radius fractures.

The study has been published in JAMA Network Open.

The researchers conducted the meta-analysis to ascertain outcomes associated with operative vs nonoperative treatment of distal radius fractures in adults.

Researchers at the Department of Orthopedic Surgery at Harvard Medical School Orthopedic Trauma Initiative searched PubMed/MEDLINE, Embrase, CENTRAL, and CINAHL databases from inception to June 15, 2019, for studies that compared operative and nonoperative treatment of distal radius fractures. The inclusion criteria for the studies were:

• Acute distal radius fracture
• Operative treatment versus nonoperative treatment
• Patients >18 years old
• Reported on functional outcome

Data extraction was performed independently by 2 reviewers. Effect estimates were pooled using random-effects models and presented as risk ratios (RRs) or mean differences (MDs) with 95% CIs. Data were analyzed in September 2019.

The primary outcome measures included medium-term functional outcome measured with the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the overall complication rate after operative and nonoperative treatment.

It was found that patients who underwent operative treatment had significant improvement in grip strength, measured in kilograms (MD, 2.73; 95% CI, .15-5.32; P=.04) and as a percentage of the unaffected side (MD, 8.21; 95% CI, 2.26-14.15; P=.007).

Moreover, in a subgroup of patients of adults >60 years old, there was no improvement in medium-term DASH score (MD, -.98; 95% CI, -3.52 to 1.57; P=.45), compared with a large improvement after operative treatment in studies that included patients >18 years old (MD, -7.5; 95% CI, -12.4 to -2.5; P=.003). The difference between the subgroups was statistically significant (P=.02).

This meta-analysis suggests that operative treatment of distal radius fractures improves the medium-term DASH score and grip strength compared with nonoperative treatment in adults, with no difference in overall complication rate.

Having an operative treatment was associated with increased improvements over nonoperative treatment for distal radius fractures in adults. The findings suggest that operative treatment might be more effective and have a greater effect on the health and well-being of younger, nonelderly patients.

For further reference log on to:

The study, "Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults," JAMA Netw Open. 2020;3(4):e203497. doi:10.1001/jamanetworkopen.2020.3497