Non Surgical Wrist Fracture Treatments Moberly MO
Osteopath (DO), Physical Therapist
Outpatient Physical Therapy
Wrist Fractures in the Elderly: Is Surgery Necessary?
Wrist fractures are common in older adults. In particular, distal radial fractures receive a lot of attention. The radius is one of two bones in the forearm (located on the thumb side of the forearm).
With a fall or traumatic injury, fracture at the end of the bone at the wrist can be considered unstable if the broken pieces have shifted and no longer line up as they should. Is it okay to put a cast on an unstable distal radial wrist fracture and let it heal as is? Or is surgery really needed to reset the bone perfectly?
That's the question orthopedic surgeons from the New York University Hospital for Joint Diseases asked. Their specific interest was in the older population. All patients included in the study were at least 65 years old. The average age was in the mid-70s. The goal was to compare results in patients with a distal radial fracture treated with cast immobilization to results for patients with the same diagnosis who were treated surgically.
You may wonder: doesn't putting an unstable wrist fracture in a cast cause the bone to heal crooked or with some kind of misalignment? Yes, that is exactly what happened with one group. The other group had surgery to reset the break and hold it together with a metal plate and wires or an external device and pins. Anyone with an open fracture (bone poking through the skin) was automatically placed in the surgical group.
The results were measured (before and after treatment) in several different ways. X-rays were taken. A special test of function was given called the Disabilities of the Arm, Shoulder, and Hand (DASH). Grip strength and wrist motion were measured and recorded. Pain intensity was recorded at regular intervals (at two, six, 12, 24, and 52 weeks after treatment was started).
In the end, the differences between the two groups were negligible. In other words, the differences in motion, pain, function, and strength were so small, there was no difference. Complications (e.g., nerve compression, tenosynovitis, stiffness, wrist pain) were equal between the two groups. Carpal tunnel syndrome was more of a problem in the group treated without surgery but the symptoms went away and were not permanent. Scores for the DASH test were basically the same for patients in both groups each time they were tested.
The two differences seen during follow-up didn't amount to anything significant. These included better grip strength in the group that had surgery when measured at the end of the first year. But this apparent weakness didn't seem to affect function. The X-rays showed a cleaner, more stable fracture site for the operative group. The break in the bones was set so that the surgical group had a more normal angle and length of bone. But again, the less optimal radiographic findings in the nonoperative group only translated into a small decrease in wrist motion that didn't affect function.
The researchers were careful to match patients between the two groups by age, se...