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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR062066-03
Application #
8538230
Study Section
Special Emphasis Panel (ZAG1-ZIJ-8 (J4))
Program Officer
Panagis, James S
Project Start
2011-08-15
Project End
2016-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
3
Fiscal Year
2013
Total Cost
$791,011
Indirect Cost
$133,021
Name
University of Michigan Ann Arbor
Department
Surgery
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Shauver, M J; Zhong, L; Chung, K C (2015) Mortality after distal radial fractures in the Medicare population. J Hand Surg Eur Vol 40:805-11
Johnson, Shepard P; Malay, Sunitha; Chung, Kevin C (2015) The quality of control groups in nonrandomized studies published in the Journal of Hand Surgery. J Hand Surg Am 40:133-9
Rehim, Shady A; Chung, Kevin C (2015) Educational video recording and editing for the hand surgeon. J Hand Surg Am 40:1048-54
Maroukis, Brianna L; Ogawa, Takeshi; Rehim, Shady A et al. (2015) Guyon canal: the evolution of clinical anatomy. J Hand Surg Am 40:560-5
Giladi, Aviram M; Yuan, Frank; Chung, Kevin C (2015) Plastic surgery practice models and research aims under the Patient Protection and Affordable Care Act. Plast Reconstr Surg 135:631-9
Rehim, Shady A; Kowalski, Evan; Chung, Kevin C (2015) Enhancing aesthetic outcomes of soft-tissue coverage of the hand. Plast Reconstr Surg 135:413e-28e
Giladi, A M; Malay, S; Chung, K C (2015) A systematic review of the management of acute pyogenic flexor tenosynovitis. J Hand Surg Eur Vol 40:720-8
Michelotti, Brett F; Adkinson, Joshua M; Chung, Kevin C (2015) Chronic Scapholunate Ligament Injury: Techniques in Repair and Reconstruction. Hand Clin 31:437-49
Zhong, Lin; Mahmoudi, Elham; Giladi, Aviram M et al. (2015) Utilization of Post-Acute Care Following Distal Radius Fracture Among Medicare Beneficiaries. J Hand Surg Am 40:2401-9.e8
Adkinson, Joshua M; Chung, Kevin C (2014) Advances in small joint arthroplasty of the hand. Plast Reconstr Surg 134:1260-8

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