Assessment of Distal Radius Fracture Complications Among Adults 60 Years or Older : A Secondary Analysis of the WRIST Randomized Clinical Trial

Key Points

Question

Do rates or types of complications after distal radius fractures depend on treatment type?

Findings

In this secondary analysis of a randomized clinical trial of 304 adults from 24 health systems, the method of treatment participants received was associated with the rate or type of complications. Compared with participants who received internal fixation, participants who received any other treatments experienced complications at significantly higher rates.

Meaning

Choice of distal radius fracture treatment method in older patients should be specific to individual goals to minimize complication risks and improve outcomes.

Abstract

Importance

Complications affect treatment outcomes and quality of life in addition to increasing treatment costs.

Objectives

To evaluate complication rates after the treatment of a distal radius fracture, to determine whether the rate or complication type is associated with treatment method, and to determine predictors of complications.

Design, Setting, and Participants

The multicenter Wrist and Radius Injury Surgical Trial (WRIST), a randomized clinical trial, enrolled participants from April 10, 2012, to December 31, 2016. The study included 304 adults 60 years or older with isolated unstable distal radius fractures; 187 were randomized and 117 opted for casting. The study was conducted at 24 health systems in the United States, Canada, and Singapore. Data for this secondary analysis were collected from April 24, 2012, to February 28, 2018.

Interventions

Participants opting for surgery were randomized to receive the volar locking plate system (n = 65), percutaneous pinning (n = 58), or bridging external fixation with or without supplemental pinning (n = 64). Patients who chose not to have surgery (n = 117) were not randomized and were enrolled for casting.

Main Outcomes and Measures

Complication rate.

Results

The WRIST enrolled a total of 304 participants, of whom 8 casting group participants were later found to be ineligible and were excluded from the analysis, leaving 296 participants. Randomized participants’ mean (SD) age was 68 (7.2) years, 163 (87%) were female, and 165 (88%) were white. Casting participants’ mean (SD) age was 75.6 (9.6) years, 93 (84%) were female, and 85 (85%) were white. The most common type of complications varied by treatment. Twelve of 65 participants (18.5%) in the internal fixation group reported a median nerve compression, while 16 of 26 participants (25.8%) who received external fixation and 13 of 56 participants (23.2%) who received pinning sustained pin site infections. Compared with the internal fixation group, complication rate for any severity complication was higher in participants who initially received casting (adjusted rate ratio, 1.88; 95% CI, 1.22-2.88), whereas the rate for moderate complications was higher in the external fixation group (adjusted rate ratio, 2.52; 95% CI, 1.25-5.09).

Conclusions and Relevance

The distal radius fracture treatment decision-making process for older patients should incorporate a complication profile for each treatment type. For example, external fixation and pinning could be used for patients after apprising them of pin site infection risk. Internal fixation can be done in patients with high functional demands who are willing to receive surgery. Internal fixation use should be substantiated owing to the time and cost involved.

Trial Registration

ClinicalTrials.gov Identifier: NCT01589692

Abstract

This secondary analysis of the WRIST (Wrist and Radius Injury Surgical Trial) randomized clinical trial evaluates complication rates among older patients receiving treatment for a distal radius fracture and whether the rate or complication type is associated with treatment method.