Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis

Langenbecks Arch Surg. 2015 Oct;400(7):767-79. doi: 10.1007/s00423-015-1324-9. Epub 2015 Aug 30.


Purpose: The best treatment of distal radius fractures (DRFs) in the elderly is uncertain. The purpose of this meta-analysis was to compare the outcomes of surgical and nonsurgical management of DRFs in persons 65 years of age or older.

Methods: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until April 27, 2015 using the following search terms: distal radius fracture, conservative treatment, nonoperative treatment, nonsurgical treatment, surgical treatment, operative, elderly, and older. The primary outcome measure was DASH score, and secondary outcomes were functional and radiological assessments. The standard difference in post-treatment means was calculated for the outcomes to compare the two groups.

Results: Of 59 articles identified, eight studies with a total of 440 patients in the surgical groups and 449 in the control groups were included in the analysis. No significant differences in DASH score, VAS pain score, grip strength, wrist extension, pronation, or supination, and ulnar deviation were noted between the groups. The nonsurgical group had significantly greater wrist flexion, radial deviation, and ulnar variance and less radial inclination than the surgical group.

Conclusions: Surgical and nonsurgical methods produce similar results in the treatment of DRFS in the elderly, and minor objective functional differences did not result an impact on subjective function outcome and quality of life.

Keywords: Distal radius fracture; Elderly; Internal fixation; Meta-analysis; Nonsurgical; Open reduction.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Casts, Surgical*
  • Female
  • Fracture Fixation, Internal / methods*
  • Fracture Healing / physiology
  • Geriatric Assessment
  • Humans
  • Injury Severity Score
  • Male
  • Pain Measurement
  • Radiography
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / surgery*
  • Radius Fractures / therapy
  • Randomized Controlled Trials as Topic
  • Range of Motion, Articular / physiology*
  • Recovery of Function
  • Risk Assessment
  • Wrist Injuries / diagnostic imaging
  • Wrist Injuries / therapy*