Volar plating for acute distal radius fractures (DRF) in the elderly has been recommended. Some papers suggested that ORIF in this situation results in frequent complications.
Our purpose was to provide a definition of irreparable DRF in autonomous elderly patients, and to review the results of a preliminary retrospective series of Wrist hemiarthroplasty (WHA) in this patient population.
Description of technique (video)
The approach was dorsal longitudinal. An osteotome entered longitudinally the dorsal aspect of fracture medial to Lister's tubercle. Two thick osteoperiosteal flaps were elevated radially and ulnarly in a “book-opening like” fashion. The distal radius articular surface was excised. The implant was impacted into the radial canal with attention to restoring distal radius length. The 2 osteo-periosteal flaps were brought back together and sutured so as to close like a book the osseous and soft tissues around the implant.
Between 2011 and 2014, 11 consecutive autonomous elderly patients (12 wrists) with irreparable intra-articular DRF were treated with primary WHA at the acute stage. A resection of the ulnar head was associated in 9 wrists. A total of 11 wrists with more than 2 years of follow-up form the basis of this presentation. At mean follow-up of 27 months, average VAS pain was 1/10. Mean QuickDASH score was 32, mean PRWE score was 24. Mean forearm rotation arc was 151°. Mean active flexion–extension arc was 60°. Mean active extension was 34°. Mean grip strength was 14kg (64% of contralateral wrist). Mean Lyon wrist score was 73%. Bone healing around the implants was satisfactory in all but one case.
Out data suggests that treatment of irreparable DRF in the autonomous elderly patient with a bone preserving WHA may be a viable option. Longer-term follow-up and comparative studies are needed to confirm the validity of this concept.Le texte complet de cet article est disponible en PDF.