Comparing the Outcomes of Surgical and Non-Surgical Approaches in Management of Older Patients with Distal Radius Fracture; a Retrospective Cohort Study

Introduction: Distal radius fractures (DRFs) are the most common orthopedic injuries in emergency depart- ment. This study aimed to compare the outcomes of conservative and surgical managements of DRFs in the aged population. Methods: In this retrospective cohort study, ninety patients with unilateral DRFs were treated using either surgical or conservative (casting) approach and the management outcomes as well as complica- tions were compared between the two groups at 3 and 6-month follow-ups. Results: A total of 90 patients over 70 years old were included (45 treated with cast immobilization, and 45 using the surgical method). The mean age (p = 0.56) and gender (p = 0.85) was similar in the two groups. Except for quality of life in both follow-up times, patients treated with surgical methods showed better outcomes in other aspects, including 3-month (p = 0.042) and 6-month (p = 0.022) mean Disability of the Arm Shoulder Hand (DASH) score, 3-month (p = 0.013) and 6-month (p = 0.006) mean range of motion (ROM), and 3-month (p = 0.003) and 6-month (p = 0.033) pain in- tensity based on Visual Analogue Scale (VAS). A total of 70 (77.77%) adverse events were registered (33 (36.6%) in the casting group and 37 (41.1%) in the surgical group; p = 0.05). The rate of mal-unio‎n (p = 0.021) and superficial radial nerve injury (p = 0.026) were significantly lower in the surgical group. Conclusion: The findings suggest that surgical approach for management of DRFs in elder cases has better clinical and functional outcomes than cast immobilization.