[A comparison of open reduction and closed reduction in treating distal radius fractures in elderly patients]

To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction.

The clinical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with no-operation and operation from February 2005 to March 2009. Thirty-seven patients underwent closed reduction and splintlet fixation or cast application (non-operation group), and forty-one patients underwent open reduction and internal fixation (operation group). In non-operation group, there were 15 males and 22 females with an average age of 73 years (60-83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62-80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P > 0.05) in sex, age, disease course and fracture classification between two groups.

All incisions obtained healing by first intention after operation in operation group. All patients were followed up for 9-36 months (20 months on average). Fracture healing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P > 0.05) in fracture healing time between non-operation group [(10.8 +/- 2.0) weeks] and operation group [(11.7 +/- 2.5) weeks]. At last follow-up, the palmar tilt angle was (5.6 +/- 2.0) degrees and (8.6 +/- 3.0) degrees, the radial inclination angle was (19.1 +/- 4.9) degrees and (21.8 +/- 2.0) degrees, and the radial length was (8.3 +/- 1.3) mm and (10.4 +/- 1.4) mm in non-operation group and operation group, respectively; showing significant differences (P < 0.05) between two groups. According to the Gartland-Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in non-operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P > 0.05) between two groups. There were no significant differences (P > 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronation-supination activity, grip and pinch strength between two groups.

Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients.