Plating or Casting in Older Patients with Distal Radius Fractures?

In a randomized trial presented at the AAOS 2021 Annual Meeting, plaster casting and surgical plating led to similar outcomes in older patients with distal radius fractures. However, the authors, led by Muhammad Tahir, MD, from the Department of Orthopedics at Jinnah Postgraduate Medical Centre in Karachi, Pakistan, found that patients who underwent plating had improvements in radiographic parameters and fewer complications.

This randomized study included older patients (age ≥60 years) with an isolated, closed, unilateral distal radius fracture; participants were assigned to undergo plating or casting at a tertiary hospital between August 2016 and December 2019.

In the casting group, patients were immobilized in a complete plaster for four to five weeks after 10 days of immobilization in the dorsal splint. In the plating group, participants underwent fracture fixation by an anterior locking plate under fluoroscopic guidance.

The study’s primary outcome was Patient-Rated Wrist Evaluation (PRWE) score, and clinical difference for distal radius fractures was defined as at least a PRWE score of 11.5. Secondary outcomes included performance on the Mayo Wrist Score and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scales, active range of motion, and grip strength. The researchers also measured radiographic parameters immediately after treatment.

Six and 12 months after treatment, patients in both groups had similar functional outcome scores, with clinically significant differences. Also, at various follow-up intervals, there was no significant difference in range of motion or grip strength.

Radiographic parameters, however, significantly improved with plating compared to casting. Casting was also associated with higher rates of complications, including malunion, subsequent corrective osteotomies, incidences of transient nerve palsy, and complex regional pain syndrome.

Overall, the findings support plating for distal radius fractures in this population, the authors concluded.

“Even if there is no clinical difference at the end of follow-up, and the radiological and clinical outcome seems not to be related one to another, there are cases in which a malunion is leading to a corrective osteotomy,” they wrote. “In these cases, the malunion may be perceived so troublesome to justify another surgery.”