Comparing Distal Radius Fracture Outcomes In Older Adults After Stratifying By Chronologic Age Versus Physiologic Age: A Secondary Analysis Of The Wrist Multicenter Randomized Trial
Mayank Jayaram, BS1, Alfred P. Yoon, MD1, Robert L. Kane, MD2, Kevin C. Chung, MD, MS, MD1.
1University of Michigan, Ann Arbor, MI, USA, 2Medical University of South Carolina, Charleston, SC, USA.
Casting is recommended for adults over 65 with distal radius fractures (DRF) because similar long-term outcomes are achieved regardless of treatment. However, physiologically “younger” adults could benefit from operative DRF management despite advanced chronologic age.
A secondary analysis of the NIH-funded Wrist and Radius Injury Surgical Trial (WRIST) was performed. Participants were divided into casting and surgery and stratified by chronologic age, activity status, and number of comorbidities. The primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) score assessed at 6 weeks, 3 months, 6 months, and 1 year.
Among 293 participants, 109 received casting and 184 received surgery. Mean age was 71.1 (SD 8.89) years. Increased chronologic age was associated with increased MHQ scores in the surgery group at 3 months (0.55 points/year, p=0.03) and 6 months (0.51 points/year, p=0.03), but decreased MHQ scores in the casting group at 6 months (-0.50/year, p=0.01) and 12 months (-0.57/year, p≤0.01). High activity was associated with improved MHQ scores in the surgical cohort at 6 weeks (11.82, p≤0.01) and 3 months (9.83, p≤0.01). Comorbidities was associated with decreased MHQ scores at all time points in the casting group. Clinically significant differences in MHQ scores was associated with low physical activity, 4 or more comorbidities, or increased age by 15 years.
Chronologic age is a poor predictor of functional demand. Physicians should counsel active older adults with few comorbidities on earlier return to daily activities after surgery compared to casting.
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