A Comparison of Functional Outcomes and Cost of Rehabilitation Treatment in the Conservative Treatment of Distal Radius Fractures in a Geriatric Population Between Two Different Wrist Joint Immobilization Positions at One-Year Follow-Up.

Abstract

Introduction: Distal radius fracture (DRF) is the most common fall-related fracture, with an incidence of up to 18% of the elderly population who are being examined in the emergency department. Conservative treatment in the geriatric population is the treatment of choice, and traditionally the wrist after reduction is placed in volar flexion and ulnar deviation position (Cotton position). The aim of this study is to compare two-cast position (Cotton and Functional position) for conservative treatment of geriatric DRFs, according to functional outcomes at twelve months.

Patients and methods: This randomized prospective study compared and evaluated the functional outcomes and cost of physiotherapy in the geriatric population with DRFs. Regarding functional outcomes, these were measured using the QuickDASH Score, Patient-Reported Wrist Evaluation, pain (VAS score), and health-related quality of life measurement (15D), while for the cost of physical therapy, the number of sessions performed by patients in both groups was measured.

Results: Ninety-three patients (75 female and 18 men) with an average age 79.2 ± 6 (range 67-90 years) with a DRF were included in the study. Among these patients, 9 underwent surgical intervention due to loss of reduction and were consequently excluded from our study. The study ultimately encompassed a total of 84 patients. The mean age for Group A was 79 ± 2 years, and for Group B, it was 79 ± 1 years (p = 0.61). The mean follow up for all patients was 1 year. Functional cast-position group (Group B) showed better results in terms of functional recovery: PRWE (Mdiff = 1.52, 95% CI [-7.77, 3.81]), QuickDASH Score (Mdiff = 8.00, 95% CI [2.27, 13.72]), and posttraumatic pain (Mdiff = 1.27, 95% CI [0.86, 1.69]). Cost of physiotherapy (z = 128, p < 0.001) and HRQol-15(Mdiff = 1.81, 95% CI [1.02, 2.60]) was statistically significantly greater in the Cotton position group versus Functional position group.

Conclusion: Our results indicate that functional cast-position produces better functional outcomes with a lower rate of complication than volar-flexion and ulnar-deviation cast (VFUDC) position. Despite the fact that the VFUDC group underwent a greater number of physical therapies, they presented less good functional results. In conclusion we recommend the use of functional cast in elderly low energy DRFs.