Long-term Outcomes of the Treatment of Distal Radial Fractures: a Narrative Review.

Abstract

Background: Distal radius fractures are the second most common type of fractures encountered in the emergency room, with an incidence of 16 to 32 fractures per 10,000 person/year (the most common being hand bone fractures). The objective of this study was to review the literature on the long-term (a minimum of 3 years' follow-up) functional outcomes of treating distal radial fractures with different methods and get insight into the possible superiority of certain treatment methods (operative vs conservative) over other methods.

Material and methods: Randomized clinical trials and observational studies reporting on functional and radiological outcomes of distal radial fractures treated conservatively vs operatively in adult patients found in the PubMed and Medline databases were reviewed. Published papers from the PubMed and Medline databases were included.

Results: Nine studies were found that met the inclusion criteria for the analysis. The range of follow-up duration varied from 3 to 14 years, the size of the study groups ranged from 32 to 342 individuals and age of the patients ranged from 18 to 76 years. All the papers reported no significant differences between long-term functional outcomes after surgical vs conservative treatment. All studies reported better radiological outcomes after surgical treatment and worse outcomes for plaster cast immobilization, the latter combined with a high rate of re-dislocations and frequent malunions. This, however, did not translate into worse clinical outcomes. We noticed some significant bias in the studies analysed that significantly affects the reliability and validity of conclusions drawn from these studies.

Conclusions: 1. Our review shows that treatment outcomes of distal radial fractures are generally good regardless of the method used. 2. Current literature does not provide uniform evidence to prove the superiority of a particular treatment method when long-term functional outcomes are compared. 3. Conservative treatment by closed reduction and plaster cast immobilization still appears to be a good option for treatment of these fractures, particularly in older patients. 4. There is still a need for research conducted according to trustworthy and credible scientific criteria, to obtain reliable data and improve the treatment guidelines.