PMID- 32675679 OWN - NLM STAT- MEDLINE DCOM- 20210222 LR - 20240329 IS - 1535-1386 (Electronic) IS - 0021-9355 (Print) IS - 0021-9355 (Linking) VI - 102 IP - 14 DP - 2020 Jul 15 TI - Volar Locked Plating Versus Closed Reduction and Casting for Acute, Displaced Distal Radial Fractures in the Elderly: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PG - 1280-1288 LID - 10.2106/JBJS.19.01442 [doi] AB - BACKGROUND: It remains unclear whether volar locked plating (VLP) yields a better functional outcome than closed reduction and casting (CRC) for elderly patients with an acute, displaced distal radial fracture. Our purpose was to conduct a systematic review and meta-analysis of randomized controlled trials comparing outcomes of VLP and CRC for elderly patients (age, >/=60 years). METHODS: Multiple databases, including MEDLINE, were searched for randomized controlled trials evaluating outcomes following distal radial fracture treatment. Raw data were obtained for studies that included patients of all ages, and the elderly subgroup was included for analysis. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at >/=1 year of follow-up. Secondary outcomes included the 3-month DASH score, range of motion, final radiographic alignment, and complications. Effect sizes for the comparison of each outcome between groups were pooled across studies using random-effects models with the inverse variance weighting method. Changes in DASH score were compared with a minimal clinically important difference (MCID) estimate of 10 to assess clinical relevance. RESULTS: Of 2,152 screened articles, 6 were included. Demographics were similar for the 274 VLP and 287 CRC patients. DASH scores were significantly better following VLP than CRC at the time of final follow-up (12 to 24 months postoperatively; score difference, -5.9; 95% confidence interval [CI], -8.7 to -3.1) and at 3 months (-8.9; 95% CI, -13.0 to -4.8). VLP yielded significantly better palmar tilt, radial inclination, and supination, with no differences in ulnar variance, flexion-extension, pronation, or total complication rates. CONCLUSIONS: Functional outcome was significantly better following VLP than CRC 3 months into the treatment of acute, displaced distal radial fractures in an elderly population and up to 2 years after injury. However, the observed differences in the final DASH score did not exceed published estimates of the MCID, suggesting that clinical outcomes are similar for both treatment options. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. FAU - Stephens, Andrew R AU - Stephens AR AUID- ORCID: 0000-0003-3877-7723 AD - Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah. FAU - Presson, Angela P AU - Presson AP AUID- ORCID: 0000-0001-7400-3923 AD - Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah. FAU - McFarland, Mary M AU - McFarland MM AUID- ORCID: 0000-0002-9062-2393 AD - Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah. FAU - Zhang, Chong AU - Zhang C AUID- ORCID: 0000-0002-5014-4331 AD - Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah. FAU - Sirnio, Kai AU - Sirnio K AUID- ORCID: 0000-0002-4018-4022 AD - Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. FAU - Mulders, Marjolein A M AU - Mulders MAM AUID- ORCID: 0000-0002-0575-0447 AD - Trauma Unit, Department of Surgery, University of Amsterdam, Amsterdam, the Netherlands. FAU - Schep, Niels W L AU - Schep NWL AUID- ORCID: 0000-0002-6475-7286 AD - Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands. FAU - Tyser, Andrew R AU - Tyser AR AUID- ORCID: 0000-0003-1580-1428 AD - Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah. FAU - Kazmers, Nikolas H AU - Kazmers NH AUID- ORCID: 0000-0002-3685-1662 AD - Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah. LA - eng GR - UL1 RR025764/RR/NCRR NIH HHS/United States GR - UL1 TR000105/TR/NCATS NIH HHS/United States GR - UL1 TR001067/TR/NCATS NIH HHS/United States GR - UL1 TR002538/TR/NCATS NIH HHS/United States PT - Journal Article PT - Meta-Analysis PT - Systematic Review PL - United States TA - J Bone Joint Surg Am JT - The Journal of bone and joint surgery. American volume JID - 0014030 SB - IM CIN - J Bone Joint Surg Am. 2020 Jul 15;102(14):e84. PMID: 32675682 MH - Aged MH - *Bone Plates MH - Fracture Fixation, Internal/*methods MH - Humans MH - Radius Fractures/*surgery MH - Randomized Controlled Trials as Topic PMC - PMC7431141 EDAT- 2020/07/18 06:00 MHDA- 2021/02/23 06:00 PMCR- 2021/07/15 CRDT- 2020/07/18 06:00 PHST- 2020/07/18 06:00 [entrez] PHST- 2020/07/18 06:00 [pubmed] PHST- 2021/02/23 06:00 [medline] PHST- 2021/07/15 00:00 [pmc-release] AID - 00004623-202007150-00019 [pii] AID - JBJS-D-19-01442 [pii] AID - 10.2106/JBJS.19.01442 [doi] PST - ppublish SO - J Bone Joint Surg Am. 2020 Jul 15;102(14):1280-1288. doi: 10.2106/JBJS.19.01442.