| Objective: To comparative analyze the clinical efficacy and complications of operative treatment and nonoperative treatment of type-C distal radius fracture in elderly.Methods: 200 cases of elderly patients with type-C distal radius fracture who underwent the treatment in the department of orthopedics in Shandong province Qingdao No.401 hospital from January 2013 to July 2016 were the subjects.Comprehensive consideration the factors of feasibility of treatment,functional requirements,patient wishes and economic conditions,the patients were divided into operative-treatment group(n=107)and nonoperative-treatment group(n=93).Operative-treatment group was treated with the method of open reduction and plate internal fixation.Nonoperative-treatment group was treated with traditional manual reduction and external fixation by splintlet,plaster and brace.The basic clinical data of all the patients were collected before treatment.According to the imaging data and AO classification system,the fractures of patients were divided into C1,C2 and C3.All the patients were followed up for six months,and the fracture healing time of the two groups were compared.The plam inclination,ulnar deviation and radius length of the two groups were compared before treatment and 3 and 6 months after treatment.The range of wrist active motion(flexion and extension,ulnar and radial,pronation and supination),degree of recovery of wrist(strength of grip and pinch),wrist function score(Gartland-Werley)of the two groups were evaluated in 6 months after treatment.All the complications of two groups were recorded,and the correlation between the two methods and complications were analyzed according to the different stages(early complications and late complications).Results: 1.There was no significant difference between the nonoperative-treatment group and operative-treatment group in general information including gender,average age,average time of injury to admission,ipsilateral distribution,injury cause,AO typing,number of patients with ulnar styloid fracture,number of patients withosteoporosis and complication(P>0.05).2.Comparative analysis results of clinical efficacy in the two groups(1)The fracture healing time of the two groups was similar,and there was no significant difference(P=0.092).(2)The plam inclination,ulnar deviation and radius length of the two groups after treatment were significantly improved compared with before treatment(P<0.01).In the one day,one month,three months and six months after treatment,the plam inclination,ulnar deviation and radius length of the two groups had no significant change,and they were no significant difference of each group in different time periods(P>0.05).(3)Six months after treatment,the excellent rate of fracture reduction in operative-treatment group(82.2%)was significantly higher than that in nonoperative-treatment group(73.1%)(P=0.016).(4)Three months after treatment,the activities range of wrist joint(flexion and extension,ulnar deviation and radialdeviation)and the degree of recovery of wrist force(grip and pinch)in operative-treatment group were better than that in nonoperative-treatment group(P<0.05).However,there was no significant difference in pronation and supination between the two groups(P>0.05).Six months after treatment,the activities range of wrist joint and the degree of recovery of wrist force were similar in the two groups(P>0.05).(5)Although the excellent rate of wrist joint function Gartland-Werley score in operative-treatment group(86.0%)was a little higher than that in nonoperative-treatment group(79.6%),but there was no significant difference between the two groups(P>0.05).3.Comparative analysis results of safetyin the two groups(1)Early complications of nonoperative-treatment group werereset loss and acute carpal tunnel syndrome.Early complications of operative-treatment group were incision infection,reset loss,tendon injury and acute carpal tunnel syndrome.The late complications in the two groups were complex regional pain syndrome,traumatic arthritis,delayed fracture healing and wrist deformity.(2)Theearly complication incidence(21.5% and 17.8%,respectively;P=0.631),late complication incidence(31.2% and 20.6%,respectively;P=0.086)and total incidence(51.6% and 38.3%,respectively;P=0.059)in the two groups were similar.However,the incidence of complications associated with operation such as incision infection and tendon injury in operative-treatment group was significantly higher(P=0.012;P=0.035),and the incidence of reset loss in nonoperative-treatment group was significantly higher than that in operative-treatment group(P=0.037).Conclusion: 1.Nonoperative-treatment and operative-treatment both can be effective in the reduction of the fracture site,and the efficacy of the operative-treatmenton the type-C distal radius fracture in elderly is better than that of the nonoperative-treatment.2.The short-term clinical efficacy ofoperative-treatmentis superiorto nonoperative-treatment for elderly patients with type-C distal radius fracture,and it has the better wrist joint function recovery during 3 months after treatment.The long-term clinical efficacy of the two treatments are similar,both of them can recover the wrist function after fracture.3.There is no significant difference of the incidences of early complication and late complication of operative-treatment and nonoperative-treatment for elderly patients with type-C distal radius fracture.However,nonoperative-treatment is easy to reset lose,and operative-treatment is easy to cause tendon injury.4.The treatment for the elderly patients with type C distal radius fractures needs to be individualized according to the specific circumstances of the patients.Nonoperative-treatment of elderly patients with type-C distal radius fracture has poor stability. |
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