Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics1554210.17816/2311-2905-15542ReviewsОбзорыReviewsReview ArticleTreatment of Distal Radius Fractures in Elderly Patients: A ReviewЛечение переломов дистального метаэпифиза лучевой кости у пожилых пациентов: обзор литературыhttps://orcid.org/0000-0001-6309-7119LatypovNiyaz A.ЛатыповНияз Альбертович
Russian Federation
niyaz.a.latypov@gmail.comhttps://orcid.org/0000-0002-1291-5094GolubevIgor O.ГолубевИгорь Олегович
Russian Federation

Dr. Sci. (Med.), Professor

д-р мед. наук, профессор

Iog305@mail.ruNational Medical Research Center for Traumatology and Orthopedics named after N.N. PriorovФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Н.Н. Приорова» Минздрава России310320243011291411509202309012024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journal.rniito.org/jour/article/view/15542

Background. Distal radius fractures (DRF) are one of the most common injuries in the elderly population. Their incidence increases steadily, with epidemiologists predicting further growth. Despite its growing prevalence, the efficacy of surgical treatment for this pathology in elderly patients remains debatable.

Aim — to determine the optimal method for treating distal radius fractures in the elderly population basing on a comparative analysis of the literature data on various treatment methods, including conservative and surgical ones.

Methods. A search was performed in PubMed/MEDLINE, Scopus, Google Scholar, and eLIBRARY databases according to the following keywords, their derivatives and combinations in the titles and abstracts: treatment, distal radius fracture, elderly. Initial analysis for meeting the inclusion criteria was performed on the article titles and abstracts, followed by analysis of the full-text articles. The sources with unavailable full-text versions were excluded from the analysis.

Results. Current epidemiological data were studied, specific aspects of physical examination of elderly patients with distal radius fractures were described, the main treatment methods were determined. The main treatment method remains the conservative one: closed reduction and immobilisation. Open reduction and internal fixation with a volar locking plate has become the leading surgical treatment method in recent decades, replacing such methods as closed reduction and fixation with wires or external fixation. At early follow-up, elderly patients operated on with volar locking plate show better functional results than those who received conservative treatment. However, at long-term follow-up, most studies show no significant differences in functional outcomes after surgical and conservative treatment, despite the differences in radiological data in favour of surgical treatment.

Conclusion. For the majority of elderly patients, conservative treatment may be the optimal treatment option. Surgical intervention using a volar locking plate may be justified for certain groups of elderly patients, as this method may accelerate rehabilitation after injury.

Актуальность. Переломы дистального метаэпифиза лучевой кости (ДМЛК) — одна из самых частых травм среди пожилого населения. Их количество неуклонно растет, и эпидемиологи предсказывают дальнейший рост. Несмотря на растущую популярность, эффективность хирургического лечения данной патологии у пожилых пациентов остается дискутабельной.

Цель — определить оптимальный метод лечения переломов дистального метаэпифиза лучевой кости в старшей возрастной группе пациентов на основе сравнительного анализа данных литературы о различных методах лечения — консервативных и хирургических.

Материал и методы. Поиск литературы проведен в базах данных PubMed/MEDLINE, Scopus, Google Scholar, eLIBRARY. Поиск осуществлен по наличию в заголовках и резюме следующих ключевых слов, их производных и комбинаций: лечение, дистальный метаэпифиз лучевой кости, пожилые люди; treatment, distal radius fracture, elderly. Первичный анализ на соответствие критериям включения выполнялся по заголовкам и резюме статей, после чего проводился анализ полнотекстовых статей. Источники, полнотекстовые версии которых были недоступны, исключались из анализа.

Результаты. Проанализированы актуальные эпидемиологические данные, описаны особенности обследования данной возрастной категории пациентов с переломами ДМЛК, выделены основные методы лечения. Основным методом лечения остается консервативное лечение: закрытая репозиция и иммобилизация. Среди хирургических методов лечения в последние десятилетия открытая репозиция с фиксацией ладонной блокируемой пластиной стала доминирующей, вытеснив такие методы, как закрытая репозиция и фиксация спицами либо аппаратом внешней фиксации. На ранних сроках наблюдения пожилые пациенты, оперированные с помощью ладонной блокируемой пластины, имеют функциональные преимущества по сравнению с теми, кто получил консервативное лечение. Однако на отдаленных сроках наблюдения большинство исследований показывают отсутствие существенных различий в функциональных результатах между хирургическим и консервативным лечением, несмотря на различия в рентгенологических результатах в пользу хирургического метода лечения.

Заключение. Для большинства пожилых пациентов оптимальным методом лечения может быть консервативное лечение. Хирургическое вмешательство с помощью ладонной блокируемой пластины оправдано для некоторых групп пожилых пациентов, так как этот метод может увеличивать скорость восстановления после травмы.

distal radius fractureosteoporotic fracturesvolar locking platecastimmobilisationперелом дистального метаэпифиза лучевой костиостеопортотические переломыладонная блокируемая пластинагипсиммобилизацияNellans K.W., Kowalski E., Chung K.C. The epidemiology of distal radius fractures. Hand Clin. 2012;28:113-125. doi: 10.1016/j.hcl.2012.02.001.Список использованной литературыJerrhag D., Englund M., Karlsson M.K., Rosengren B.E. Epidemiology and time trends of distal forearm fractures in adults – a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord. 2017;18(1):240. doi: 10.1186/s12891-017-1596-z.[1] Gehrmann SV, Windolf J, Kaufmann RA. Distal radius fracture management in elderly patients: a literature review. J Hand Surg 2008;33:421–9. https://doi.org/10.1016/j.jhsa.2007.12.016.Stirling E.R.B., Johnson N.A., Dias J.J. Epidemiology of distal radius fractures in a geographically defined adult population. J Hand Surg Eur Vol. 2018;43(9):974-982. doi: 10.1177/1753193418786378.[2] Brenner H, Arndt V. Epidemiology in aging research. Exp Gerontol 2004;39:679–86. https://doi.org/10.1016/j.exger.2004.02.006.Viberg B., Tofte S., Rønnegaard A.B., Jensen S.S., Karimi D., Gundtoft P.H. Changes in the incidence and treatment of distal radius fractures in adults – a 22-year nationwide register study of 276,145 fractures. Injury. 2023;54(7):110802. doi: 10.1016/j.injury.2023.05.033.[3] Sabharwal S, Wilson H, Reilly P, Gupte CM. Heterogeneity of the definition of elderly age in current orthopaedic research. SpringerPlus 2015;4:516. https://doi.org/10.1186/s40064-015-1307-x.Rundgren J., Bojan A., Mellstrand Navarro C., Enocson A. Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register. BMC Musculoskelet Disord. 2020;21(1):88. doi: 10.1186/s12891-020-3097-8.[4] Меньшикова ЛВ, Дзизинский AA, Храмцова НА. Частота переломов проксимального отдела бедра и дистального отдела предплечья среди населения Иркутской области. Научно-Практическая Ревматология 2000;38:17–22. https://doi.org/10.14412/1995-4484-2000-1443.Brenner H., Arndt V. Epidemiology in aging research. Exp Gerontol. 2004;39(5):679-686. doi: 10.1016/j.exger.2004.02.006.Men'shikova L.V., Dzizinskiy A.A., Khramtsova N.A. Chastota perelomov proksimal’nogo otdela bedra I distal’nogo otdela predplech’ya sredi naselenya Irkutskoy oblasti. Rheumatology Science and Practice. 2000;38(3):17-22. (In Russ.) https://doi.org/10.14412/1995-4484-2000-1443Sabharwal S., Wilson H., Reilly P., Gupte C.M. Heterogeneity of the definition of elderly age in current orthopaedic research. Springerplus. 2015;4:516. doi: 10.1186/s40064-015-1307-x.[5] Зоткин Е, Зубкова ИИ. Частота переломов проксимального отдела шейки бедренной кости и лучевой кости среди взрослого населения Санкт-Петербурга. Научно-Практическая Ревматология 2006;44.Соломянник И.А., Загородний Н.В., Родионова С.С., Дорохин А.И., Коньшина А.В., Горбатюк Д.С. и др. Травматизм, ортопедическая заболеваемость, организация травматолого-ортопедической помощи в Российской Федерации. Под ред. С.П. Миронова. Москва; 2022. с. 150-153. Solomyannik I.A., Zagorodnii N.V., Rodionova C.C., Dorokhin A.I., Kon’shina A.V., Gorbatyuk D.S. et al. Injury rate, orthopedic morbidity, organization of trauma and orthopedic care in the Russian Federation. Ed. by S.P. Mironov. Moscov; 2022. p. 150-153.Zotkin E., Zubkova I.I. Chastota perelomov proksimal’nogo otdela sheiki bedrennoi kosti i luchevoi kosti sredi vzroslogo naseleniya Sankt-Peterburga. Rheumatology Science and Practice. 2006;44(2s):86c-86. (In Russ.)Flinkkilä T., Sirniö K., Hippi M., Hartonen S., Ruuhela R., Ohtonen P. et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-2312. doi: 10.1007/s00198-010-1463-3.[6] Соломянник И.А., Загородний Н.В., Родионова С.С., Дорохин А.И., Коньшина А.В., Горбатюк Д.С. и соавт. Травматизм, ортопедическая заболеваемость, организация травматолого-ортопедической помощи в Российской Федерации, / под ред. С.П.Миронова // Москва: Министерство Здравоохранения Российской Федерации ФГБУ “НМИЦ ТО имени Н.Н. Приорова”; 2022, p. 150–3.Levin L.S., Rozell J.C., Pulos N. Distal Radius Fractures in the Elderly. J Am Acad Orthop Surg. 2017;25(3):179-187. doi: 10.5435/JAAOS-D-15-00676.Solomyannik I.A., Zagorodnii N.V., Rodionova C.C., Dorokhin A.I., Kon'shina A.V., Gorbatyuk D.S. et al. Travmatism Travmatizm ortopedicheskaya zabolevaemost' organizaciya travmatologo-ortopedicheskoj pomoshchi v Rossijskoj Federacii, / pod red. S.P.Mironova // Moskva: Ministerstvo Zdravoohraneniya Rossijskoj Federacii FGBU “NMIC TO imeni N.N. Priorova”; 2022, p. 150–3. (In Russ.)Raudasoja L., Aspinen S., Vastamäki H., Ryhänen J., Hulkkonen S. Epidemiology and Treatment of Distal Radius Fractures in Finland – A Nationwide Register Study. J Clin Med. 2022;11(10):2851. doi: 10.3390/jcm11102851.[7] MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther Off J Am Soc Hand Ther 2016;29:136–45. https://doi.org/10.1016/j.jht.2016.03.003.Giladi A.M., Shauver M.J., Ho A., Zhong L., Kim H.M., Chung K.C. Variation in the Incidence of Distal Radius Fractures in the US Elderly as Related to Slippery Weather Conditions. Plast Reconstr Surg. 2014;133(2):321-332. doi: 10.1097/01.prs.0000436796.74305.38.[8] Viberg B, Tofte S, Rønnegaard AB, Jensen SS, Karimi D, Gundtoft PH. Changes in the incidence and treatment of distal radius fractures in adults - a 22-year nationwide register study of 276,145 fractures. Injury 2023;54:110802. https://doi.org/10.1016/j.injury.2023.05.033.Solvang H.W., Nordheggen R.A., Clementsen S., Hammer O.-L., Randsborg P.-H. Epidemiology of distal radius fracture in Akershus, Norway, in 2010-2011. J Orthop Surg. 2018;13(1):199. doi: 10.1186/s13018-018-0904-0.[9] Jerrhag D, Englund M, Karlsson MK, Rosengren BE. Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord 2017;18:240. https://doi.org/10.1186/s12891-017-1596-z.Михайлов Е.Е., Беневоленская Л.И. Эпидемиология остеопороза и переломов. В кн.: Руководство по остеопорозу. Под. ред. Л.И. Беневоленской. Москва: БИНОМ. Лаборатория знаний; 2003. p. 10-55. Mikhailov E.E., Benevolenskaya L.I. In: A guide to osteoporosis. Ed. by L.I. Benevolenskaya. Moscow: BINOM. Laboratoriya znanii; 2003. р. 10-55.[10] Stirling ERB, Johnson NA, Dias JJ. Epidemiology of distal radius fractures in a geographically defined adult population. J Hand Surg Eur Vol 2018;43:974–82. https://doi.org/10.1177/1753193418786378.Oyen J., Brudvik C., Gjesdal C.G., Tell G.S., Lie S.A., Hove L.M. Osteoporosis as a risk factor for distal radial fractures: a case-control study. J Bone Joint Surg Am. 2011;93:348-356. doi: 10.2106/JBJS.J.00303.[11] Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012;28:113–25. https://doi.org/10.1016/j.hcl.2012.02.001.Barrett-Connor E., Sajjan S.G., Siris E.S., Miller P.D., Chen Y.-T., Markson L.E. Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int. 2008;19(5): 607-613. doi: 10.1007/s00198-007-0508-8.[12] Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord 2007;8:48. https://doi.org/10.1186/1471-2474-8-48.Chen C.-W., Huang T.-L., Su L.-T., Kuo Y.-C., Wu S.-C., Li C.-Y. et al. Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years. J Trauma Acute Care Surg. 2013;74(1):317-321. doi: 10.1097/ta.0b013e31824bb325.[13] Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P, et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2011;22:2307–12. https://doi.org/10.1007/s00198-010-1463-3.Lewiecki E.M., Watts N.B., McClung M.R., Petak S.M., Bachrach L.K., Shepherd J.A. et al. Official positions of the international society for clinical densitometry. J Clin Endocrinol Metab. 2004;89(8):3651-3655. doi: 10.1210/jc.2004-0124.[14] Levin LS, Rozell JC, Pulos N. Distal Radius Fractures in the Elderly. J Am Acad Orthop Surg 2017;25:179–87. https://doi.org/10.5435/JAAOS-D-15-00676.Евстигнеева Л.П., Кузнецова Е.В., Низамутдинова Р.М., Васев А.В., Лаврентьев А.С. Диагностика и лечение остеопороза у пациентов старших возрастных групп после низкотравматичного перелома лучевой кости. Остеопороз и остеопатии. 2016;19(2):22. doi: 10.14341/osteo2016222-22. Evstigneeva L.P., Kuznetsova E.V., Nizamutdinova R.M., Vasev A.V., Lavrent’ev A.S. Diagnosis and treatment of osteoporosis in patients of older age groups after a low-traumatic fracture of the radius. Osteoporosis and Bone Diseases. 2016;19(2):22. (In Russian). doi: 10.14341/osteo2016222-22[15] Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiol Camb Mass 1996;7:612–8. https://doi.org/10.1097/00001648-199611000-00008.Clayton R.A.E., Gaston M.S., Ralston S.H., Court-Brown C.M., McQueen M.M. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am. 2009;91(3):613-619. doi: 10.2106/JBJS.H.00486.[16] Rundgren J, Bojan A, Mellstrand Navarro C, Enocson A. Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register. BMC Musculoskelet Disord 2020;21:88. https://doi.org/10.1186/s12891-020-3097-8.Fitzpatrick S.K., Casemyr N.E., Zurakowski D., Day C.S., Rozental T.D. The effect of osteoporosis on outcomes of operatively treated distal radius fractures. J Hand Surg. 2012;37(10):2027-2034. doi: 10.1016/j.jhsa.2012.06.025.[17] Raudasoja L, Aspinen S, Vastamäki H, Ryhänen J, Hulkkonen S. Epidemiology and Treatment of Distal Radius Fractures in Finland-A Nationwide Register Study. J Clin Med 2022;11:2851. https://doi.org/10.3390/jcm11102851.Hooper R.C., Zhou N., Wang L., Shauver M.J., Chung K.C., WRIST Group. Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older. PloS One. 2020;15(5):e0232684. doi: 10.1371/journal.pone.0232684.[18] Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Hochberg M, Haugeberg G. The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PloS One 2012;7:e43367. https://doi.org/10.1371/journal.pone.0043367.Niver G.E., Ilyas A.M. Carpal tunnel syndrome after distal radius fracture. Orthop Clin North Am. 2012;43(4):521-527. doi: 10.1016/j.ocl.2012.07.021.[19] Giladi AM, Shauver MJ, Ho A, Zhong L, Kim HM, Chung KC. Variation in the Incidence of Distal Radius Fractures in the US Elderly as Related to Slippery Weather Conditions. Plast Reconstr Surg 2014;133:321–32. https://doi.org/10.1097/01.prs.0000436796.74305.38.Mauck B.M., Swigler C.W. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am. 2018;49(2):211-222. doi: 10.1016/j.ocl.2017.12.001.[20] DeGoede KM, Ashton-Miller JA, Schultz AB. Fall-related upper body injuries in the older adult: a review of the biomechanical issues. J Biomech 2003;36:1043–53. https://doi.org/10.1016/s0021-9290(03)00034-4.Arora R., Gabl M., Erhart S., Schmidle G., Dallapozza C., Lutz M. Aspects of Current Management of Distal Radius Fractures in the Elderly Individuals. Geriatr Orthop Surg Rehabil. 2011;2 (5-6):187-194. doi: 10.1177/2151458511426874.[21] Solvang HW, Nordheggen RA, Clementsen S, Hammer O-L, Randsborg P-H. Epidemiology of distal radius fracture in Akershus, Norway, in 2010-2011. J Orthop Surg 2018;13:199. https://doi.org/10.1186/s13018-018-0904-0.Lawson A., Naylor J., Mittal R., Kale M., Xuan W., Harris I.A. Does Radiographic Alignment Correlate With Patient-Reported Functional Outcomes and Posttreatment Complications in Older Patients Treated for Wrist Fractures? J Hand Surg. 2023;48(6):533-543. doi: 10.1016/j.jhsa.2023.02.012.[22] Vogt MT, Cauley JA, Tomaino MM, Stone K, Williams JR, Herndon JH. Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures. J Am Geriatr Soc 2002;50:97–103. https://doi.org/10.1046/j.1532-5415.2002.50014.x.Dayican A., Unal V.S., Ozkurt B., Portakal S., Nuhoglu E., Tumoz M.A. Conservative treatment in intra-articular fractures of the distal radius: a study on the functional and anatomic outcome in elderly patients. Yonsei Med J. 2003;44(5):836-840. doi: 10.3349/ymj.2003.44.5.836.[23] Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR. Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group. Am J Epidemiol 1992;135:477–89. https://doi.org/10.1093/oxfordjournals.aje.a116314.Beumer A., McQueen M.M. Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop Scand. 2003;74(1): 98-100. doi: 10.1080/00016470310013743.[24] Михайлов ЕЕ, Беневоленская ЛИ. Эпидемиология остеопороза и переломов. Руководство По Остеопорозу, Москва: БИНОМ Лаборатория знаний; 2003, p. 10–55.Caruso G., Tonon F., Gildone A., Andreotti M., Altavilla R., Valentini A. et al. Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial. J Orthop Surg. 2019;14(1):477. doi: 10.1186/s13018-019-1530-1.Mikhailov E.E., Benevolenskaya L.I. V kn.: Rukovodstvo po osteoporozu. Pod red. L.I. Benevolenskoi. M.: BINOM. Laboratoriya znanii, 2003; 10-55.Gamba C., Fernandez F.A.M., Llavall M.C., Diez X.L., Perez F.S. Which immobilization is better for distal radius fracture? A prospective randomized trial. Int Orthop. 2017;41(9):1723-1727. doi: 10.1007/s00264-017-3518-y.[25] Oyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM. Osteoporosis as a risk factor for distal radial fractures: a case-control study. J Bone Joint Surg Am 2011;93:348–56. https://doi.org/10.2106/JBJS.J.00303.Park M.J., Kim J.P., Lee H.I., Lim T.K., Jung H.S., Lee J.S. Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study. J Hand Surg Eur Vol. 2017;42(5):487-492. doi: 10.1177/1753193417690464.[26] Barrett-Connor E, Sajjan SG, Siris ES, Miller PD, Chen Y-T, Markson LE. Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2008;19:607–13. https://doi.org/10.1007/s00198-007-0508-8.Ax M., Reito A., Hevonkorpi T.P., Palola V., Kukkonen J., Luokkala T. et al. A comparison of the functional results and costs of functional cast and volar-flexion ulnar deviation cast at 2-year follow-up in 105 patients aged 65 and older with dorsally displaced distal radius fracture: A randomized controlled trial. PloS One. 2023;18(4):e0283946. doi: 10.1371/journal.pone.0283946.[27] Chen C-W, Huang T-L, Su L-T, Kuo Y-C, Wu S-C, Li C-Y, et al. Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years. J Trauma Acute Care Surg 2013;74:317–21. https://doi.org/10.1097/ta.0b013e31824bb325.Lafontaine M., Delince P., Hardy D., Simons M. Instability of fractures of the lower end of the radius: apropos of a series of 167 cases. Acta Orthop Belg. 1989;55:203-216. (In French).[28] Mallmin H, Ljunghall S, Persson I, Naessén T, Krusemo UB, Bergström R. Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int 1993;52:269–72. https://doi.org/10.1007/BF00296650.Makhni E.C., Ewald T.J., Kelly S., Day C.S. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg. 2008;33(8):1301-1308. doi: 10.1016/j.jhsa.2008.04.031.[29] Mallmin H, Ljunghall S. Distal radius fracture is an early sign of general osteoporosis: bone mass measurements in a population-based study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 1994;4:357–61. https://doi.org/10.1007/BF01622198.Neidenbach P., Audigé L., Wilhelmi-Mock M., Hanson B., De Boer P. The efficacy of closed reduction in displaced distal radius fractures. Injury. 2010;41(6):592-598. doi: 10.1016/j.injury.2009.10.055.[30] Lewiecki EM, Watts NB, McClung MR, Petak SM, Bachrach LK, Shepherd JA, et al. Official positions of the international society for clinical densitometry. J Clin Endocrinol Metab 2004;89:3651–5. https://doi.org/10.1210/jc.2004-0124.Hassellund S.S., Oftebro I., Williksen J.H., Søreide E., Madsen J.E., Frihagen F. Closed reduction of dorsally displaced distal radius fractures in the elderly provided improved final radiographic results. J Orthop Surg. 2023;18(1):247. doi: 10.1186/s13018-023-03733-5.[31] Евстигнеева ЛП, Кузнецова Ев., Низамутдинова Рм., Васев АВ, Лаврентьев Ас. Диагностика и лечение остеопороза у пациентов старших возрастных групп после низкотравматичного перелома лучевой кости. Остеопороз И Остеопатии 2016;19.Hoffer A.J., St George S.A., Banaszek D.K., Roffey D.M., Broekhuyse H.M., Potter J.M. If at first you don’t succeed, should you try again? The efficacy of repeated closed reductions of distal radius fractures. Arch Orthop Trauma Surg. 2023;143(8):5095-5103. doi: 10.1007/s00402-023-04904-z.Evstigneeva L.P., Kuznetsova E., Nizamutdinova R., Vasev A.V., Lavrent’ev A. Diagnostika I lechenie osteoporoza u patsientov starshikh vozrastnykh grupp posle nizkotravmatichnogo pereloma luchevoi kosti. Osteoporosis and Bone Diseases. 2016;19(2):22-22. (In Russ.) https://doi.org/10.14341/osteo2016222-22Schermann H., Kadar A., Dolkart O., Atlan F., Rosenblatt Y., Pritsch T. Repeated closed reduction attempts of distal radius fractures in the emergency department. Arch Orthop Trauma Surg. 2018;138(4):591-596. doi: 10.1007/s00402-018-2904-2.[32] Clayton RAE, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am 2009;91:613–9. https://doi.org/10.2106/JBJS.H.00486.Strohm P.C., Müller C.A., Boll T., Pfister U. Two procedures for Kirschner wire osteosynthesis of distal radial fractures. A randomized trial. J Bone Joint Surg Am. 2004;86(12): 2621-2628. doi: 10.2106/00004623-200412000-00006.[33] Fitzpatrick SK, Casemyr NE, Zurakowski D, Day CS, Rozental TD. The effect of osteoporosis on outcomes of operatively treated distal radius fractures. J Hand Surg 2012;37:2027–34. https://doi.org/10.1016/j.jhsa.2012.06.025.Yoon A.P., Shauver M.J., Hutton D.W., Chung K.C., WRIST Group. Cost-Effectiveness of Treatments after Closed Extraarticular Distal Radius Fractures in Older Adults from the WRIST Clinical Trial. Plast Reconstr Surg. 2021;147(2):240e-252e. doi: 10.1097/PRS.0000000000007528.[34] Hooper RC, Zhou N, Wang L, Shauver MJ, Chung KC, WRIST Group. Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older. PloS One 2020;15:e0232684. https://doi.org/10.1371/journal.pone.0232684.Wong T.C., Chiu Y., Tsang W.L., Leung W.Y., Yam S.K., Yeung S.H. Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial. J Hand Surg Eur Vol. 2010;35(3):202-208. doi: 10.1177/1753193409339941.[35] Niver GE, Ilyas AM. Carpal tunnel syndrome after distal radius fracture. Orthop Clin North Am 2012;43:521–7. https://doi.org/10.1016/j.ocl.2012.07.021.Yigit Ş. Comparative results of radius distal AO type C1 fractures of elderly women by two different techniques. Acta Bio-Medica Atenei Parm. 2020;91(2):315-321. doi: 10.23750/abm.v91i2.8712.[36] Mauck BM, Swigler CW. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am 2018;49:211–22. https://doi.org/10.1016/j.ocl.2017.12.001.Ochman S., Frerichmann U., Armsen N., Raschke M.J., Meffert R.H. Is use of the fixateur externe no longer indicated for the treatment of unstable radial fracture in the elderly? Unfallchirurg. 2006;109(12):1050-1057. (In German). doi: 10.1007/s00113-006-1166-6.[37] Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin 2005;21:279–88. https://doi.org/10.1016/j.hcl.2005.02.008.Atroshi I., Brogren E., Larsson G.-U., Kloow J., Hofer M., Berggren A.-M. Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: a randomized assessor-blind clinical trial of 38 patients followed for 1 year. Acta Orthop. 2006;77(3):445-453. doi: 10.1080/17453670610046389.[38] Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg 1997;22:792–800. https://doi.org/10.1016/s0363-5023(97)80071-8.Aktekin C.N., Altay M., Gursoy Z., Aktekin L.A., Ozturk A.M., Tabak A.Y. Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older. J Hand Surg. 2010;35(5):736-742. doi: 10.1016/j.jhsa.2010.01.028.[39] Arora S, Grover SB, Batra S, Sharma VK. Comparative evaluation of postreduction intra-articular distal radial fractures by radiographs and multidetector computed tomography. J Bone Joint Surg Am 2010;92:2523–32. https://doi.org/10.2106/JBJS.I.01617.Földhazy Z., Ahrengart L. External fixation versus closed treatment of displaced distal radial fractures in elderly patients: a randomized controlled trial. Curr Orthop Pract. 2010;21(3):288-295. doi: 10.1097/BCO.0b013e3181cd6513.[40] Frykman G. Fracture of the distal radius including sequelae--shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand 1967:Suppl 108:3+. https://doi.org/10.3109/ort.1967.38.suppl-108.01.Huang Y.-Y., Lin T.-Y., Chen C.-H., Chou Y.-C., Su C.-Y. Surgical outcomes of elderly patients aged more than 80 years with distal radius fracture: comparison of external fixation and locking plate. BMC Musculoskelet Disord. 2020;21(1):91. doi: 10.1186/s12891-020-3101-3.[41] Melone CP. Articular fractures of the distal radius. Orthop Clin North Am 1984;15:217–36.Geissler W.B. Management Distal Radius and Distal Ulnar Fractures with Fragment Specific Plate. J Wrist Surg. 2013;2(2):190-194. doi: 10.1055/s-0033-1341409.[42] Jupiter JB, Fernandez DL. Comparative classification for fractures of the distal end of the radius. J Hand Surg 1997;22:563–71. https://doi.org/10.1016/S0363-5023(97)80110-4.Beharrie A.W., Beredjiklian P.K., Bozentka D.J. Functional outcomes after open reduction and internal fixation for treatment of displaced distal radius fractures in patients over 60 years of age. J Orthop Trauma. 2004;18(10): 680-686. doi: 10.1097/00005131-200411000-00005.[43] Müller ME, Koch P, Nazarian S, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Berlin, Heidelberg: Springer; 1990.Jupiter J.B., Ring D., Weitzel P.P. Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg. 2002;27(4):714-723. doi: 10.1053/jhsu.2002.34007.[44] Andersen DJ, Blair WF, Steyers CM, Adams BD, el-Khouri GY, Brandser EA. Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg 1996;21:574–82. https://doi.org/10.1016/s0363-5023(96)80006-2.Orbay J.L., Fernandez D.L. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg. 2004;29(1):96-102. doi: 10.1016/j.jhsa.2003.09.015.[45] Arora R, Gabl M, Erhart S, Schmidle G, Dallapozza C, Lutz M. Aspects of Current Management of Distal Radius Fractures in the Elderly Individuals. Geriatr Orthop Surg Rehabil 2011;2:187–94. https://doi.org/10.1177/2151458511426874.Figl M., Weninger P., Jurkowitsch J., Hofbauer M., Schauer J., Leixnering M. Unstable distal radius fractures in the elderly patient – volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma. 2010;68(4):992-998. doi: 10.1097/TA.0b013e3181b99f71.[46] Lawson A, Naylor J, Mittal R, Kale M, Xuan W, Harris IA. Does Radiographic Alignment Correlate With Patient-Reported Functional Outcomes and Posttreatment Complications in Older Patients Treated for Wrist Fractures? J Hand Surg 2023;48:533–43. https://doi.org/10.1016/j.jhsa.2023.02.012.Martinez-Mendez D., Lizaur-Utrilla A., de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol. 2018;43(2):142-147. doi: 10.1177/1753193417727139.[47] Bruyere A, Vernet P, Botero SS, Igeta Y, Hidalgo Diaz JJ, Liverneaux P. Conservative treatment of distal fractures after the age of 65: a review of literature. Eur J Orthop Surg Traumatol Orthop Traumatol 2018;28:1469–75. https://doi.org/10.1007/s00590-018-2150-x.Jakubietz R.G., Gruenert J.G., Kloss D.F., Schindele S., Jakubietz M.G. A randomised clinical study comparing palmar and dorsal fixed-angle plates for the internal fixation of AO C-type fractures of the distal radius in the elderly. J Hand Surg Eur Vol. 2008;33(5):600-604. doi: 10.1177/1753193408094706.[48] Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am 2009;91:1868–73. https://doi.org/10.2106/JBJS.H.01297.Marcheix P.S., Dotzis A., Benkö P.E., Siegler J., Arnaud J.P., Charissoux J.L. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg Eur Vol. 2010;35(8):646-651. doi: 10.1177/1753193410364179.[49] Leone J, Bhandari M, Adili A, McKenzie S, Moro JK, Dunlop RB. Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. Arch Orthop Trauma Surg 2004;124:38–41. https://doi.org/10.1007/s00402-003-0597-6.Schmelzer-Schmied N., Wieloch P., Martini A.K., Daecke W. Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly. Int Orthop. 2009;33(3):773-778. doi: 10.1007/s00264-007-0504-9.[50] Dayican A, Unal VS, Ozkurt B, Portakal S, Nuhoglu E, Tumoz MA. Conservative treatment in intra-articular fractures of the distal radius: a study on the functional and anatomic outcome in elderly patients. Yonsei Med J 2003;44:836–40. https://doi.org/10.3349/ymj.2003.44.5.836.Mellstrand Navarro C., Brolund A., Ekholm C., Heintz E., Hoxha Ekström E., Josefsson P.O. et al. Treatment of radius or ulna fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and current practice. PloS One. 2019;14(3):e0214362. doi: 10.1371/journal.pone.0214362.[51] Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg 2000;25:19–28. https://doi.org/10.1053/jhsu.2000.jhsu025a0019.Franovic S., Pietroski A.D., Druskovich K., Page B., Burdick G.B., Fathima B. et al. A Cost-Effectiveness Analysis of the Various Treatment Options for Distal Radius Fractures. J Hand Surg Glob Online. 2022;5(2): 169-177. doi: 10.1016/j.jhsg.2022.11.007.[52] Beumer A, McQueen MM. Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop Scand 2003;74:98–100. https://doi.org/10.1080/00016470310013743.Lauder A., Agnew S., Bakri K., Allan C.H., Hanel D.P., Huang J.I. Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures. J Hand Surg. 2015;40(8):1554-1562. doi: 10.1016/j.jhsa.2015.05.008.[53] Anzarut A, Johnson JA, Rowe BH, Lambert RGW, Blitz S, Majumdar SR. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg 2004;29:1121–7. https://doi.org/10.1016/j.jhsa.2004.07.002.Richard M.J., Katolik L.I., Hanel D.P., Wartinbee D.A., Ruch D.S. Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg. 2012;37(5):948-956. doi: 10.1016/j.jhsa.2012.02.034.[54] Caruso G, Tonon F, Gildone A, Andreotti M, Altavilla R, Valentini A, et al. Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial. J Orthop Surg 2019;14:477. https://doi.org/10.1186/s13018-019-1530-1.Falk S.S.I., Mittlmeier T., Gradl G. Results of geriatric distal radius fractures treated by intramedullary fixation. Injury. 2016;47 Suppl 7:S31-S35. doi: 10.1016/S0020-1383(16)30851-8.[55] Gamba C, Fernandez FAM, Llavall MC, Diez XL, Perez FS. Which immobilization is better for distal radius fracture? A prospective randomized trial. Int Orthop 2017;41:1723–7. https://doi.org/10.1007/s00264-017-3518-y.Anger F., Legré R., Nguyen M.K. Results of wrist hemiarthroplasty for comminuted distal radius fractures in independent elderly people: A retrospective study on eleven patients. Hand Surg Rehabil. 2019;38(3):150-156. doi: 10.1016/j.hansur.2018.11.004.[56] Park MJ, Kim JP, Lee HI, Lim TK, Jung HS, Lee JS. Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study. J Hand Surg Eur Vol 2017;42:487–92. https://doi.org/10.1177/1753193417690464.Ozer K. Chung K.C. The use bone grafts and substitutes in the treatment of distal radius fractures. Hand Clin. 2012;28(2):217-223. doi: 10.1016/j.hcl.2012.02.004.[57] Ax M, Reito A, Hevonkorpi TP, Palola V, Kukkonen J, Luokkala T, et al. A comparison of the functional results and costs of functional cast and volar-flexion ulnar deviation cast at 2-year follow-up in 105 patients aged 65 and older with dorsally displaced distal radius fracture: A randomized controlled trial. PloS One 2023;18:e0283946. https://doi.org/10.1371/journal.pone.0283946.Hegde C., Shetty V., Wasnik S., Ahammed I., Shetty V. Use of bone graft substitute in the treatment for distal radius fractures in elderly. Eur J Orthop Surg Traumatol. 2013;23(6):651-656. doi: 10.1007/s00590-012-1057-1.[58] Lafontaine M, Delince P, Hardy D, Simons M. [Instability of fractures of the lower end of the radius: apropos of a series of 167 cases]. Acta Orthop Belg 1989;55:203–16.Funayama T., Noguchi H., Kumagai H., Sato K., Yoshioka T., Yamazaki M. Unidirectional porous beta-tricalcium phosphate and hydroxyapatite artificial bone: a review of experimental evaluations and clinical applications. J Artif Organs. 2021;24(2):103-110. doi: 10.1007/s10047-021-01270-8.[59] Makhni EC, Ewald TJ, Kelly S, Day CS. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg 2008;33:1301–8. https://doi.org/10.1016/j.jhsa.2008.04.031.Lutz K., Yeoh K.M., MacDermid J.C., Symonette C., Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg. 2014;39(7):1280-1286. doi: 10.1016/j.jhsa.2014.04.018.[60] Neidenbach P, Audigé L, Wilhelmi-Mock M, Hanson B, De Boer P. The efficacy of closed reduction in displaced distal radius fractures. Injury 2010;41:592–8. https://doi.org/10.1016/j.injury.2009.10.055.Chung K.C., Malay S., Shauver M.J., Kim H.M., WRIST Group. Assessment of Distal Radius Fracture Complications Among Adults 60 Years or Older: A Secondary Analysis of the WRIST Randomized Clinical Trial. JAMA Netw Open. 2019;2(1):e187053. doi: 10.1001/jamanetworkopen.2018.7053.[61] Hassellund SS, Oftebro I, Williksen JH, Søreide E, Madsen JE, Frihagen F. Closed reduction of dorsally displaced distal radius fractures in the elderly provided improved final radiographic results. J Orthop Surg 2023;18:247. https://doi.org/10.1186/s13018-023-03733-5.Thorninger R., Wæver D., Tjørnild M., Lind M., Rölfing J.D. VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years. J Orthop Traumatol. 2022;23(1):54. doi: 10.1186/s10195-022-00673-4.[62] Hoffer AJ, St George SA, Banaszek DK, Roffey DM, Broekhuyse HM, Potter JM. If at first you don’t succeed, should you try again? The efficacy of repeated closed reductions of distal radius fractures. Arch Orthop Trauma Surg 2023. https://doi.org/10.1007/s00402-023-04904-z.Diaz-Garcia R.J., Oda T., Shauver M.J., Chung K.C. A Systematic Review of Outcomes and Complications of Treating Unstable Distal Radius Fractures in the Elderly. J Hand Surg. 2011;36(5):824-835.e2. doi: 10.1016/j.jhsa.2011.02.005.[63] McQueen MM, MacLaren A, Chalmers J. The value of remanipulating Colles’ fractures. J Bone Joint Surg Br 1986;68:232–3. https://doi.org/10.1302/0301-620X.68B2.3958009.Chen Y., Chen X., Li Z., Yan H., Zhou F., Gao W. Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis. J Hand Surg. 2016;41(3): 404-413. doi: 10.1016/j.jhsa.2015.12.008.[64] Strohm PC, Müller CA, Boll T, Pfister U. Two procedures for Kirschner wire osteosynthesis of distal radial fractures. A randomized trial. J Bone Joint Surg Am 2004;86:2621–8. https://doi.org/10.2106/00004623-200412000-00006.Li Q., Ke C., Han S., Xu X., Cong Y.-X., Shang K. et al. Nonoperative treatment versus volar locking plate fixation for elderly patients with distal radial fracture: a systematic review and meta-analysis. J Orthop Surg. 2020;15(1):263. doi: 10.1186/s13018-020-01734-2.[65] Yoon AP, Shauver MJ, Hutton DW, Chung KC, WRIST Group. Cost-Effectiveness of Treatments after Closed Extraarticular Distal Radius Fractures in Older Adults from the WRIST Clinical Trial. Plast Reconstr Surg 2021;147:240e–52e. https://doi.org/10.1097/PRS.0000000000007528.Stephens A.R., Presson A.P., McFarland M.M., Zhang C., Sirniö K., Mulders M.A.M. et al. 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. J Bone Joint Surg Am. 2020;102(14):1280-1288. doi: 10.2106/JBJS.19.01442.[66] Wong TC, Chiu Y, Tsang WL, Leung WY, Yam SK, Yeung SH. Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial. J Hand Surg Eur Vol 2010;35:202–8. https://doi.org/10.1177/1753193409339941.Голубев И.О., Крупаткин А.И., Максимов А.А., Меркулов М.В., Бушуев О.М., Ширяева Г.Н. и др. Хирургическое лечение неправильно сросшихся переломов дистального метаэпифиза лучевой кости. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2013;20(3):51-58. doi: 10.17816/vto201320351-58. Golubev I.O., Krupatkin A.I., Maksimov A.A., Merkulov M.V., Bushuev O.M., Shiryaeva G.N. et al. Surgical Treatment of Malunited Fractures of Radius Distal Metaepiphysis. N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(3):51-58. (In Russian). doi: 10.17816/vto201320351-58.[67] Yigit Ş. Comparative results of radius distal AO type C1 fractures of elderly women by two different techniques. Acta Bio-Medica Atenei Parm 2020;91:315–21. https://doi.org/10.23750/abm.v91i2.8712.Amorosa L.F., Vitale M.A., Brown S., Kaufmann R.A. A functional outcomes survey of elderly patients who sustained distal radius fractures. Hand (N Y). 2011;6(3):260-267. doi: 10.1007/s11552-011-9327-7.[68] Ochman S, Frerichmann U, Armsen N, Raschke MJ, Meffert RH. Is use of the fixateur externe no longer indicated for the treatment of unstable radial fracture in the elderly? Unfallchirurg 2006;109:1050–7. https://doi.org/10.1007/s00113-006-1166-6.Jaremko J.L., Lambert R.G.W., Rowe B.H., Johnson J.A., Majumdar S.R. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment? Clin Radiol. 2007;62(1):65-72. doi: 10.1016/j.crad.2006.08.013.[69] Atroshi I, Brogren E, Larsson G-U, Kloow J, Hofer M, Berggren A-M. Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: a randomized assessor-blind clinical trial of 38 patients followed for 1 year. Acta Orthop 2006;77:445–53. https://doi.org/10.1080/17453670610046389.Nelson G.N., Stepan J.G., Osei D.A., Calfee R.P. The Impact of Patient Activity Level on Wrist Disability after Distal Radius Malunion in Older Adults. J Orthop Trauma. 2015;29(4):195-200. doi: 10.1097/BOT.0000000000000235.[70] Pritchett JW. External fixation or closed medullary pinning for unstable Colles fractures? J Bone Joint Surg Br 1995;77:267–9.Clement N.D., Duckworth A.D., Court-Brown C.M., McQueen M.M. Distal radial fractures in the superelderly: does malunion affect functional outcome? ISRN Orthop. 2014;2014:189803. doi: 10.1155/2014/189803.[71] Fu Y-C, Chien S-H, Huang P-J, Chen S-K, Tien Y-C, Lin G-T, et al. Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients. J Trauma 2006;60:330–3. https://doi.org/10.1097/01.ta.0000203538.29179.5b.Fujii K., Henmi T., Kanematsu Y., Mishiro T., Sakai T., Terai T. Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg (Hong Kong). 2002;10(1):9-15. doi: 10.1177/230949900201000103.[72] Aktekin CN, Altay M, Gursoy Z, Aktekin LA, Ozturk AM, Tabak AY. Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older. J Hand Surg 2010;35:736–42. https://doi.org/10.1016/j.jhsa.2010.01.028.Hung L.P., Leung Y.F., Ip W.Y., Lee Y.L. Is locking plate fixation a better option than casting for distal radius fracture in elderly people? Hong Kong Med J. 2015;21:407-410. doi: 10.12809/hkmj144440.[73] Földhazy Z, Ahrengart L. External fixation versus closed treatment of displaced distal radial fractures in elderly patients: a randomized controlled trial. Curr Orthop Pract 2010;21:288–95. https://doi.org/10.1097/BCO.0b013e3181cd6513.Saving J., Severin Wahlgren S., Olsson K., Enocson A., Ponzer S., Sköldenberg O. et al. Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly: A Randomized Controlled Trial. J Bone Joint Surg Am. 2019;101(11):961-969. doi: 10.2106/JBJS.18.00768.[74] Huang Y-Y, Lin T-Y, Chen C-H, Chou Y-C, Su C-Y. Surgical outcomes of elderly patients aged more than 80 years with distal radius fracture: comparison of external fixation and locking plate. BMC Musculoskelet Disord 2020;21:91. https://doi.org/10.1186/s12891-020-3101-3.Sirniö K., Leppilahti J., Ohtonen P., Flinkkilä T. Early palmar plate fixation of distal radius fractures may benefit patients aged 50 years or older: a randomized trial comparing 2 different treatment protocols. Acta Orthop. 2019;90(2):123-128. doi: 10.1080/17453674.2018.1561614.[75] Geissler WB. Management Distal Radius and Distal Ulnar Fractures with Fragment Specific Plate. J Wrist Surg 2013;2:190–4. https://doi.org/10.1055/s-0033-1341409.Arora R., Lutz M., Deml C., Krappinger D., Haug L., Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am. 2011;93(23):2146-2153. doi: 10.2106/JBJS.J.01597.[76] Beharrie AW, Beredjiklian PK, Bozentka DJ. Functional outcomes after open reduction and internal fixation for treatment of displaced distal radius fractures in patients over 60 years of age. J Orthop Trauma 2004;18:680–6. https://doi.org/10.1097/00005131-200411000-00005.Arora R., Gabl M., Gschwentner M., Deml C., Krappinger D., Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237-242. doi: 10.1097/BOT.0b013e31819b24e9.[77] Jupiter JB, Ring D, Weitzel PP. Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg 2002;27:714–23. https://doi.org/10.1053/jhsu.2002.34007.Bartl C., Stengel D., Bruckner T., Gebhard F., ORCHID Study Group. The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arzteblatt Int. 2014;111(46):779-787. doi: 10.3238/arztebl.2014.0779.[78] Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg 2004;29:96–102. https://doi.org/10.1016/j.jhsa.2003.09.015.Chung K.C., Kim H.M., Malay S., Shauver M.J., Wrist and Radius Injury Surgical Trial Group. The Wrist and Radius Injury Surgical Trial: 12-Month Outcomes from a Multicenter International Randomized Clinical Trial. Plast Reconstr Surg. 2020;145(6):1054e-1066e. doi: 10.1097/PRS.0000000000006829.[79] Figl M, Weninger P, Jurkowitsch J, Hofbauer M, Schauer J, Leixnering M. Unstable distal radius fractures in the elderly patient--volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma 2010;68:992–8. https://doi.org/10.1097/TA.0b013e3181b99f71.Hassellund S.S., Williksen J.H., Laane M.M., Pripp A., Rosales C.P., Karlsen Ø. et al. Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. Bone Jt J. 2021;103-B(2):247-255. doi: 10.1302/0301-620X.103B2.BJJ-2020-0192.R2.[80] Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol 2018;43:142–7. https://doi.org/10.1177/1753193417727139.Lawson A., Naylor J., Buchbinder R., Ivers R., Balogh Z., Smith P. et al. A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE): a statistical analyses plan. Trials. 2020;21(1):651. doi: 10.1186/s13063-020-4228-0.[81] Jakubietz RG, Gruenert JG, Kloss DF, Schindele S, Jakubietz MG. A randomised clinical study comparing palmar and dorsal fixed-angle plates for the internal fixation of AO C-type fractures of the distal radius in the elderly. J Hand Surg Eur Vol 2008;33:600–4. https://doi.org/10.1177/1753193408094706.Shaikh S.A., Tahir M., Ahmed N., Maniglio M. Conservative management versus volar plating for dorsally displaced distal radius fractures in the elderly: A randomized control trial. Pak J Med Sci. 2023;39(3):891-897. doi: 10.12669/pjms.39.3.6522.[82] Marcheix P-S, Dotzis A, Benkö P-E, Siegler J, Arnaud J-P, Charissoux J-L. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg Eur Vol 2010;35:646–51. https://doi.org/10.1177/1753193410364179.Tahir M., Khan Zimri F., Ahmed N., Rakhio Jamali A., Mehboob G., Watson K.R. et al. Plaster immobilization versus anterior plating for dorsally displaced distal radial fractures in elderly patients in Pakistan. J Hand Surg Eur Vol. 2021;46(6):647-653. doi: 10.1177/1753193420977780.[83] Schmelzer-Schmied N, Wieloch P, Martini AK, Daecke W. Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly. Int Orthop 2009;33:773–8. https://doi.org/10.1007/s00264-007-0504-9.Testa G., Vescio A., Di Masi P., Bruno G., Sessa G., Pavone V. Comparison between Surgical and Conservative Treatment for Distal Radius Fractures in Patients over 65 Years. J Funct Morphol Kinesiol. 2019;4(2):26. doi: 10.3390/jfmk4020026.[84] Mellstrand Navarro C, Brolund A, Ekholm C, Heintz E, Hoxha Ekström E, Josefsson PO, et al. Treatment of radius or ulna fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and current practice. PloS One 2019;14:e0214362. https://doi.org/10.1371/journal.pone.0214362.Walenkamp M.M., de Muinck Keizer R.J., Goslings J.C., Vos L.M., Rosenwasser M.P., Schep N.W. The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures. Clin Orthop. 2015;473(10):3235-3241. doi: 10.1007/s11999-015-4376-9.[85] Franovic S, Pietroski AD, Druskovich K, Page B, Burdick GB, Fathima B, et al. A Cost-Effectiveness Analysis of the Various Treatment Options for Distal Radius Fractures. J Hand Surg Glob Online 2022;5:169–77. https://doi.org/10.1016/j.jhsg.2022.11.007.Malay S., SUN Study Group, Chung K.C. The minimal clinically important difference after simple decompression for ulnar neuropathy at the elbow. J Hand Surg Am. 2013;38(4):652-659. doi: 10.1016/j.jhsa.2013.01.022.[86] Lauder A, Agnew S, Bakri K, Allan CH, Hanel DP, Huang JI. Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures. J Hand Surg 2015;40:1554–62. https://doi.org/10.1016/j.jhsa.2015.05.008.Franchignoni F., Vercelli S., Giordano A., Sartorio F., Bravini E., Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther. 2014;44(1): 30-39. doi: 10.2519/jospt.2014.4893.[87] Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch DS. Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg 2012;37:948–56. https://doi.org/10.1016/j.jhsa.2012.02.034.Gutiérrez-Espinoza H., Araya-Quintanilla F., Olguín-Huerta C., Gutiérrez-Monclus R., Valenzuela-Fuenzalida J., Román-Veas J. et al. Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2022;108(5):103323. doi: 10.1016/j.otsr.2022.103323.[88] Falk SSI, Mittlmeier T, Gradl G. Results of geriatric distal radius fractures treated by intramedullary fixation. Injury 2016;47:S31–5. https://doi.org/10.1016/S0020-1383(16)30851-8.[89] Wakasugi T, Shirasaka R. Intramedullary Nail Fixation for Displaced and Unstable Distal Radial Fractures in Patients Aged 65 Years or Older. J Hand Surg Asian-Pac Vol 2016;21:59–63. https://doi.org/10.1142/S2424835516500089.[90] Anger F, Legré R, Nguyen MK. Results of wrist hemiarthroplasty for comminuted distal radius fractures in independent elderly people: A retrospective study on eleven patients. Hand Surg Rehabil 2019;38:150–6. https://doi.org/10.1016/j.hansur.2018.11.004.[91] Herzberg G, Burnier M, Marc A, Izem Y. Primary Wrist Hemiarthroplasty for Irreparable Distal Radius Fracture in the Independent Elderly. J Wrist Surg 2015;4:156–63. https://doi.org/10.1055/s-0035-1558841.[92] Roux J-L. Replacement and resurfacing prosthesis of the distal radius: a new therapeutic concept. Chir Main 2009;28:10–7. https://doi.org/10.1016/j.main.2008.11.009.[93] Ozer K, Chung KC. THE USE BONE GRAFTS AND SUBSTITUTES IN THE TREATMENT OF DISTAL RADIUS FRACTURES. Hand Clin 2012;28:217–23. https://doi.org/10.1016/j.hcl.2012.02.004.[94] Hegde C, Shetty V, Wasnik S, Ahammed I, Shetty V. Use of bone graft substitute in the treatment for distal radius fractures in elderly. Eur J Orthop Surg Traumatol Orthop Traumatol 2013;23:651–6. https://doi.org/10.1007/s00590-012-1057-1.[95] Funayama T, Noguchi H, Kumagai H, Sato K, Yoshioka T, Yamazaki M. Unidirectional porous beta-tricalcium phosphate and hydroxyapatite artificial bone: a review of experimental evaluations and clinical applications. J Artif Organs 2021;24:103–10. https://doi.org/10.1007/s10047-021-01270-8.[96] Herrera M, Chapman CB, Roh M, Strauch RJ, Rosenwasser MP. Treatment of unstable distal radius fractures with cancellous allograft and external fixation. J Hand Surg 1999;24:1269–78. https://doi.org/10.1053/jhsu.1999.1269.[97] Cannegieter DM, Juttmann JW. Cancellous grafting and external fixation for unstable Colles’ fractures. J Bone Joint Surg Br 1997;79:428–32. https://doi.org/10.1302/0301-620x.79b3.6835.[98] Lutz K, Yeoh KM, MacDermid JC, Symonette C, Grewal R. Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older. J Hand Surg 2014;39:1280–6. https://doi.org/10.1016/j.jhsa.2014.04.018.[99] Chung KC, Malay S, Shauver MJ, Kim HM, WRIST Group. Assessment of Distal Radius Fracture Complications Among Adults 60 Years or Older: A Secondary Analysis of the WRIST Randomized Clinical Trial. JAMA Netw Open 2019;2:e187053. https://doi.org/10.1001/jamanetworkopen.2018.7053.[100] Thorninger R, Wæver D, Tjørnild M, Lind M, Rölfing JD. VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years. J Orthop Traumatol 2022;23:54. https://doi.org/10.1186/s10195-022-00673-4.[101] Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A Systematic Review of Outcomes and Complications of Treating Unstable Distal Radius Fractures in the Elderly. J Hand Surg 2011;36:824-835.e2. https://doi.org/10.1016/j.jhsa.2011.02.005.[102] Chen Y, Chen X, Li Z, Yan H, Zhou F, Gao W. Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis. J Hand Surg 2016;41:404–13. https://doi.org/10.1016/j.jhsa.2015.12.008.[103] Li Q, Ke C, Han S, Xu X, Cong Y-X, Shang K, et al. Nonoperative treatment versus volar locking plate fixation for elderly patients with distal radial fracture: a systematic review and meta-analysis. J Orthop Surg 2020;15:263. https://doi.org/10.1186/s13018-020-01734-2.[104] Stephens AR, Presson AP, McFarland MM, Zhang C, Sirniö K, Mulders MAM, et al. 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. J Bone Joint Surg Am 2020;102:1280–8. https://doi.org/10.2106/JBJS.19.01442.[105] Голубев ИО, Крупаткин АИ, Максимов АА, Меркулов МВ, Бушуев ОМ, Ширяева ГН, et al. Хирургическое лечение неправильно сросшихся переломов дистального метаэпифиза лучевой кости. Вестник Травматологии И Ортопедии Им НН Приорова 2013:51–8.Surgical Treatment of Malunited Fractures of Radius Distal Metaepiphysis / I.O. Golubev, A.I. Krupatkin, A.A. Maksimov, M.V. Merkulov, O.M. Bushuev, G.N. Shiryaeva et al. // Vestnik travmatologii i ortopedii im. N.N. Priorova. = N.N. Priorov Journal of Traumatology and Orthopedics. 2013. no. 3, pp. 51-58. (in Russ.)[106] Amorosa LF, Vitale MA, Brown S, Kaufmann RA. A functional outcomes survey of elderly patients who sustained distal radius fractures. Hand N Y N 2011;6:260–7. https://doi.org/10.1007/s11552-011-9327-7.[107] Jaremko JL, Lambert RGW, Rowe BH, Johnson JA, Majumdar SR. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment? Clin Radiol 2007;62:65–72. https://doi.org/10.1016/j.crad.2006.08.013.[108] Nelson GN, Stepan JG, Osei DA, Calfee RP. The Impact of Patient Activity Level on Wrist Disability after Distal Radius Malunion in Older Adults. J Orthop Trauma 2015;29:195–200. https://doi.org/10.1097/BOT.0000000000000235.[109] Clement ND, Duckworth AD, Court-Brown CM, McQueen MM. Distal radial fractures in the superelderly: does malunion affect functional outcome? ISRN Orthop 2014;2014:189803. https://doi.org/10.1155/2014/189803.[110] Fujii K, Henmi T, Kanematsu Y, Mishiro T, Sakai T, Terai T. Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg Hong Kong 2002;10:9–15. https://doi.org/10.1177/230949900201000103.[111] McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function? J Bone Joint Surg Br 1988;70:649–51. https://doi.org/10.1302/0301-620X.70B4.3403617.[112] Hung LP, Leung YF, Ip WY, Lee YL. Is locking plate fixation a better option than casting for distal radius fracture in elderly people? Hong Kong Med J Xianggang Yi Xue Za Zhi 2015;21:407–10. https://doi.org/10.12809/hkmj144440.[113] Saving J, Severin Wahlgren S, Olsson K, Enocson A, Ponzer S, Sköldenberg O, et al. Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly: A Randomized Controlled Trial. J Bone Joint Surg Am 2019;101:961–9. https://doi.org/10.2106/JBJS.18.00768.[114] Sirniö K, Leppilahti J, Ohtonen P, Flinkkilä T. Early palmar plate fixation of distal radius fractures may benefit patients aged 50 years or older: a randomized trial comparing 2 different treatment protocols. Acta Orthop 2019;90:123–8. https://doi.org/10.1080/17453674.2018.1561614.[115] Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011;93:2146–53. https://doi.org/10.2106/JBJS.J.01597.[116] Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma 2009;23:237–42. https://doi.org/10.1097/BOT.0b013e31819b24e9.[117] Bartl C, Stengel D, Bruckner T, Gebhard F, ORCHID Study Group. The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arzteblatt Int 2014;111:779–87. https://doi.org/10.3238/arztebl.2014.0779.[118] Chung KC, Kim HM, Malay S, Shauver MJ, Wrist and Radius Injury Surgical Trial Group. The Wrist and Radius Injury Surgical Trial: 12-Month Outcomes from a Multicenter International Randomized Clinical Trial. Plast Reconstr Surg 2020;145:1054e–66e. https://doi.org/10.1097/PRS.0000000000006829.[119] Hassellund SS, Williksen JH, Laane MM, Pripp A, Rosales CP, Karlsen Ø, et al. Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. Bone Jt J 2021;103-B:247–55. https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-0192.R2.[120] Lawson A, Naylor J, Buchbinder R, Ivers R, Balogh Z, Smith P, et al. A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE): a statistical analyses plan. Trials 2020;21:651. https://doi.org/10.1186/s13063-020-4228-0.[121] Shaikh SA, Tahir M, Ahmed N, Maniglio M. Conservative management versus volar plating for dorsally displaced distal radius fractures in the elderly: A randomized control trial. Pak J Med Sci 2023;39:891–7. https://doi.org/10.12669/pjms.39.3.6522.[122] Tahir M, Khan Zimri F, Ahmed N, Rakhio Jamali A, Mehboob G, Watson KR, et al. Plaster immobilization versus anterior plating for dorsally displaced distal radial fractures in elderly patients in Pakistan. J Hand Surg Eur Vol 2021;46:647–53. https://doi.org/10.1177/1753193420977780.[123] Testa G, Vescio A, Di Masi P, Bruno G, Sessa G, Pavone V. Comparison between Surgical and Conservative Treatment for Distal Radius Fractures in Patients over 65 Years. J Funct Morphol Kinesiol 2019;4:E26. https://doi.org/10.3390/jfmk4020026.[124] Walenkamp MMJ, de Muinck Keizer R-J, Goslings JC, Vos LM, Rosenwasser MP, Schep NWL. The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures. Clin Orthop 2015;473:3235–41. https://doi.org/10.1007/s11999-015-4376-9.[125] Malay S, SUN Study Group, Chung KC. The minimal clinically important difference after simple decompression for ulnar neuropathy at the elbow. J Hand Surg 2013;38:652–9. https://doi.org/10.1016/j.jhsa.2013.01.022.[126] Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014;44:30–9. https://doi.org/10.2519/jospt.2014.4893.[127] Copay AG, Subach BR, Glassman SD, Polly DW, Schuler TC. Understanding the minimum clinically important difference: a review of concepts and methods. Spine J Off J North Am Spine Soc 2007;7:541–6. https://doi.org/10.1016/j.spinee.2007.01.008.[128] Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Gutiérrez-Monclus R, Valenzuela-Fuenzalida J, Román-Veas J, et al. Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis. Orthop Traumatol Surg Res OTSR 2022:103323. https://doi.org/10.1016/j.otsr.2022.103323.