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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Adjunct Professor Lars E. Adolfsson, Linköping University
- Second opponent: Associate Professor Yngvar Krukhaug, University of Bergen
- Third member and chair of the evaluation committee: Professor II Inger Holm, University of Oslo
Chair of the Defence
Professor II Magne Røkkum, Faculty of Medicine, University of Oslo
Principal Supervisor
Associate Professor Frede Frihagen, Faculty of Medicine, University of Oslo
Summary
Dorsally displaced distal radius fractures are common, especially in elderly women. Surgery with a volar locking plate has become the most common treatment for displaced distal radius fractures many places, also in elderly patients. The clinical gain and economic effect of increased surgery is debated and is the background for this work.
Displaced distal radius fractures in elderly are especially unstable due to osteoporotic bone. Redisplacement after initial closed reduction is common and lead to a non-anatomical healing of the fracture. This was also the case in our retrospective material, where 290 patients with an initially displaced distal radius fracture were treated non-operatively after closed reduction. However, we found improved radiographic alignment at final follow-up compared to initial radiographs in 69% of the patients.
In a randomized controlled trial, patients 65 years or older, with a dorsally displaced distal radius fracture were included. They were randomized to cast immobilization, or to surgery with open reduction and fixation with a volar locking plate. Despite better radiological outcome in the operative group, the main finding was that the clinical result after non-operative treatment was similar to surgery 6 and 12 months after injury. However, we found better clinical scores after operation at 3 months follow up after and concluded that surgery led to a faster recovery.
We also found higher health care costs in the operative group during the first year after injury. Despite a slightly higher quality of life-score in of the operative group, this did not outweigh the increased costs and non-operative treatment was considered cost-effective.
Most independently living patients, 65 years or older, regain good function after a distal radius fracture. Some elderly will benefit from surgery, but our results indicate that most patients over 65 years should be treated non-operatively after a dorsally displaced distal radius fracture.
Additional information
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