In the United States, over 300,000 individuals over age 65 suffer from distal radius fractures (DRFs) each year. Despite the frequency of this injury and over 200 years of experience treating DRFs, management of elderly DRFs is still controversial. Close reduction and casting is a nonsurgical technique that is frequently used, but osteoporotic fractures, common in the elderly, often collapse and displace. The three currently applied surgical techniques are close reduction and percutaneous pinning, external fixation with or without percutaneous pinning, and internal fixation with volar locking plating. Preliminary evidence indicates that locking plate fixation can permit elderly patients to move their hands and wrists much sooner in order to return to self-care activities more quickly. Although these outcomes are promising, there is no randomized controlled clinical trial to demonstrate that the more invasive, and perhaps more costly, plating technique is superior to the other simpler approaches.
The specific aim of this 21-center randomized controlled trial is to compare outcomes of these three surgical techniques in treating unstable DRFs in the elderly. The secondary aim is to follow a cohort of elderly patients who choose not to have surgery to evaluate outcomes following treatment by close reduction and casting alone. This clinical trial is the most ambitious study in hand surgery by assembling most of the leading centers in North America to collect evidence-based data to guide future treatment of this prevalent injury in the growing elderly population.

Public Health Relevance

The goal of this 21-center randomized controlled trial is to compare the physical, functional and quality of life outcomes of three different surgical methods for treating distal radius fractures in the elderly: close reduction and percutaneous pinning, external fixation with or without percutaneous pinning and internal fixation with volar locking plates. We will also follow a cohort of patients who opt for the non-surgical treatment, close reduction and casting, to examine and compare the same outcomes following non-surgical treatment.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Special Emphasis Panel (ZAG1-ZIJ-8 (J4))
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Panagis, James S
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Johnson, Shepard P; Adkinson, Joshua M; Chung, Kevin C (2014) Addressing medical errors in hand surgery. J Hand Surg Am 39:1877-82
Wang, Keming; Kowalski, Evan J; Chung, Kevin C (2014) The art and science of photography in hand surgery. J Hand Surg Am 39:580-8
Shauver, Melissa J; Chang, Kate Wan-Chu; Chung, Kevin C (2014) Contribution of functional parameters to patient-rated outcomes after surgical treatment of distal radius fractures. J Hand Surg Am 39:436-42
Waljee, Jennifer; McGlinn, Evan P; Sears, Erika Davis et al. (2014) Patient expectations and patient-reported outcomes in surgery: a systematic review. Surgery 155:799-808
Rehim, Shady A; Singhal, Maneesh; Chung, Kevin C (2014) Dermal skin substitutes for upper limb reconstruction: current status, indications, and contraindications. Hand Clin 30:239-52, vii
Kotsis, Sandra V; Chung, Kevin C (2014) Manuscript rejection: how to submit a revision and tips on being a good peer reviewer. Plast Reconstr Surg 133:958-64
Aliu, Oluseyi; Diaz-Garcia, Rafael J; Zhong, Lin et al. (2014) Mortality trends and the effects of d├ębridement timing in the management of mediastinitis in the United States, 1998 to 2010. Plast Reconstr Surg 134:457e-463e
Waljee, Jennifer F; Zhong, Lin; Shauver, Melissa et al. (2014) Variation in the Use of Therapy following Distal Radius Fractures in the United States. Plast Reconstr Surg Glob Open 2:e130
McGlinn, Evan P; Chung, Kevin C (2014) A pause for reflection: incorporating reflection into surgical training. Ann Plast Surg 73:117-20
Aliu, Oluseyi; Corlew, Scott D; Heisler, Michele E et al. (2014) Building surgical capacity in low-resource countries: a qualitative analysis of task shifting from surgeon volunteers' perspectives. Ann Plast Surg 72:108-12

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