![]() ![]() Percutaneous pinning and external fixation are also options for the treatment of distal radial fractures in elderly patients. ![]() For instance, previous studies have shown that use of the volar locking plating system (VLPS) is increasing in the Medicare population, in which osteoporosis is common 1, 8- 10. Open reduction and internal fixation of distal radial fractures, a common treatment for younger adults that provides better fracture stabilization, is being increasingly and successfully used in the elderly population as well 7. However, fractures treated in this manner are prone to collapse and malunion because elderly individuals often have weak, osteoporotic bone 5, 6. These fractures have traditionally been treated conservatively with closed reduction and casting. The number of distal radial fractures, and the resulting cost of treatment, will likely continue to increase as the number of elderly Americans increases 4. As the second most common type of fracture experienced by these patients 2, 3, distal radial fractures contribute considerably to the estimated $1.1 billion spent annually in this population to treat fractures associated with osteoporosis 3. Medicare beneficiaries sustain approximately 80,000 distal radial fractures annually 1. The percentage of patients treated with internal fixation within a hospital referral region was positively correlated with the percentage of patients in that region who were treated by a hand surgeon (correlation coefficient, 0.34 p < 0.0001). Use of internal fixation ranged from 4.6% to 42.1% (nearly a ten-fold difference) among hospital referral regions. Patients were more likely to be treated with internal fixation rather than with another treatment if they were treated by a hand surgeon than if they were treated by an orthopaedic surgeon who was not a hand surgeon (odds ratio, 2.49 95% confidence interval, 2.29 to 2.70). Fractures were significantly less likely to be treated with internal fixation in men than in women (odds ratio, 0.84 95% confidence interval, 0.80 to 0.89) and in black patients than in white patients (odds ratio, 0.74 95% confidence interval, 0.65 to 0.85). We identified 85,924 Medicare beneficiaries with a closed distal radial fracture who met the inclusion criteria, and 17.0% of these patients were treated with internal fixation.
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