The Journal of Bone and Joint Surgery (American). 2009;91:1868-1873.
doi:10.2106/JBJS.H.01297
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Trends in the United States in the Treatment of Distal Radial Fractures in the Elderly

Kevin C. Chung, MD, MS1, Melissa J. Shauver, MPH1 and John D. Birkmeyer, MD2

1 Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340. E-mail address for K.C. Chung: kecchung{at}umich.edu
2 Section of General Surgery, Department of Surgery, The University of Michigan Health System, 2920 Taubman Center, SPC 5331, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0331

Investigation performed at the University of Michigan, Ann Arbor, Michigan

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the American Foundation for Surgery of the Hand, the National Institute of Arthritis and Musculoskeletal and Skin Diseases Exploratory/Developmental Research Grant Award (R21 AG030526), a Clinical Trial Planning Grant (R34 AR055992-01), and a Midcareer Investigator Award in Patient-Oriented Research (K24 AR053120). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Traditionally, distal radial fractures in the elderly have been treated nonoperatively with casting. However, since the introduction of the volar locking plating system in 2000, there has been an interest in the use of more aggressive treatment methods. The purpose of the present study was to assess changing trends in the treatment of distal radial fractures in elderly patients in the United States.

Methods: We evaluated a 5% sample of Medicare data from 1996 to 1997 and a 20% sample from 1998 to 2005. Information on four treatment methods (closed treatment, percutaneous pin fixation, internal fixation, and external fixation) was extracted from the dataset. Other available data were diagnosis, physician specialty, and patient age, sex, and race. We calculated frequencies and rates to compare the utilization of different treatments over time.

Results: Over the ten-year time period examined, the rate of internal fixation of distal radial fractures in the elderly increased fivefold, from 3% in 1996 to 16% in 2005. Closed treatment, however, remained the predominant method (used for 82% of the fractures in 1996 and 70% in 2005). Fractures in patients with an age of eighty-five years or more were significantly more likely to be treated in a closed fashion (p < 0.0001). There was a large variation among physician specialties with regard to the fixation methods that were used. Orthopaedic surgeons were significantly more likely to use closed treatment than hand surgeons were, whereas hand surgeons were significantly more likely to use internal fixation than orthopaedic surgeons were.

Conclusions: Since 2000, although the majority of distal radial fractures are still treated nonoperatively, there has been an increase in the use of internal fixation and a concurrent decrease in the rate of closed treatment of distal radial fractures in the elderly in the United States.


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