MALUNION, INTERVENTION, AND PATIENT-REPORTED OUTCOMES IN PATIENTS AGED 65 YEARS AND OLDER WITH A FRACTURE OF THE DISTAL RADIUS

The aim was to determine the rate of radiographic malunion and subsequent intervention following a dorsally displaced distal radius fracture in patients aged 65 and older. Patients were identified from a retrospective database and radiographs at a minimum of 28 days post-injury measured to determine whether or not radiographic malunion was present. Patient-reported outcome measures in the form of the QuickDASH, PRWE, Normal Wrist Score (NWS) and ED-5D-3L were obtained at a mean of 5 years post-injury. There were 385 distal radius fractures in the cohort. Patients had a mean age of 75 years and were predominantly female (88.1%). Of the 73 (19.0%) patients managed with primary operative intervention, a complication occurred in 20.5%. There was a 77.9% rate of radiographic malunion, with 86.67% occurring in patients managed non-operatively. Five patients (1.67%) underwent a surgical procedure for the management of symptomatic malunion. There were no significant differences in the QuickDASH (p=0.636), PRWE (p=0.964), NWS (p=0.192) or EQ-5D-3L (p=0.506) when comparing patients who developed and malunion and those who did not. There was a high rate of radiographic malunion but a low rate of surgical intervention for symptomatic malunion. Malunion was significantly more likely following non-operative management although there was no significant difference in patient-reported outcome when comparing patients with and without radiographic malunion. This tolerance of malunion, combined with the complication rate with primary operative management and low rate of further surgery required for symptomatic malunion, has implications regarding better defining the optimal management of these injuries the elderly.