4 However, a randomized clinical trial (RCT) demonstrated that surgical treatment with open reduction and internal fixation with volar lock plating (ORIF) results in better short-term outcomes (≤3 months) compared with casting. 3 The American Academy of Orthopedic Surgeons has published treatment guidelines for DRFs that recommend casting for adults older than 65 years, citing evidence that 1-year outcomes are similar regardless of treatment received. 1, 2 Additionally, the economic burden of DRFs in older adults is estimated to reach $600 million in the next 3 years, a 20% increase since 2005. Nearly 50% of all distal radius fractures (DRFs) occur in adults older than 65 years, accounting for 20% of fractures in this patient population. Shared decision-making with patients may be useful to identify patient preferences regarding recovery to determine optimal treatment. One-year complication rates were comparable among all treatments.Ĭonclusions and Relevance The findings of this NMA suggest that ORIF may be associated with clinically significant improvements in short-term recovery compared with casting for multiple patient-reported outcomes measures with no increase in 1-year complication rates. ![]() ![]() In the intermediate term, ORIF was associated with lowered DASH (SMD, −3.35 95% CI, −5.90 to −0.80) and PRWE (SMD, −2.90 95% CI, −4.86 to −0.94) scores. The PRWE scores were also significantly lower for ORIF (SMD, −9.55 95% CI, −15.31 to −3.79) at 3 months. At 3 months, DASH scores were significantly lower for nail fixation (SMD, −18.28 95% CI, −29.93 to −6.63) and ORIF (SMD, −9.28 95% CI, −13.90 to −4.66) compared with casting. Results In this NMA, 23 RCTs consisting of 3054 participants (2495 women ) with a mean (SD) age of 66 (7.8) years were included. Secondary outcomes included Patient-Rated Wrist Evaluation (PRWE) scores and 1-year complication rates. Main Outcomes and Measures The primary outcome was short-term (≤3 months) and intermediate-term (>3 months to 1 year) Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. Data are reported as standard mean differences (SMDs) and 95% CIs. Treatments were ranked by surface under the cumulative ranking curve score. An NMA aggregated all direct and indirect evidence among DRF treatments. Study Selection Randomized clinical trials including patients with a mean age of 50 years or older that compared the following DRF treatments were eligible for inclusion: casting, open reduction and internal fixation with volar lock plating (ORIF), external fixation, percutaneous pinning, and nail fixation.ĭata Extraction and Synthesis Two reviewers independently completed all data extraction. Objective To examine DRF treatment results in optimal short-term and intermediate-term patient-reported outcomes.ĭata Sources Searches of MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials were conducted for RCTs that investigated DRF treatment outcomes in older adults between January 1, 2000, and January 1, 2022. A network meta-analysis (NMA) addresses these limitations by only synthesizing direct and indirect evidence from RCTs and may clarify optimal DRF treatment in older adults. Importance Randomized clinical trials (RCTs) and meta-analyses have reported inconsistent conclusions regarding optimal distal radius fracture (DRF) treatment in older adults and are limited due to the inclusion of cohort studies with small sample sizes. Shared Decision Making and Communication. ![]()
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