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- Talk
- USA
The Wrist and Radius Injury Surgical Trial (WRIST): Twenty-Four Month Outcomes from a 24-Center Multicenter, International Randomized Clinical Trial
Description
In this presentation, Bertrand Perry discusses the treatment protocols for distal radius fractures in older patients, highlighting the lack of consensus on optimal surgical versus conservative treatments despite extensive research. He emphasizes the rising incidence of these fractures among an aging population, foreseeing 20% of the population to be over 65 by 2050. Perry details a study aimed at comparing outcomes from surgical treatment and casting, adopting rigorous criteria for participants aged 60 and over. The study identifies three surgical treatment arms—volar plate fixation, external fixation, and K-wire alone—and relies on patient-reported outcomes over a 24-month period.
The results show that volar plate fixation yields the fastest recovery, notably in grip strength and range of motion, particularly within the first three months. However, overall outcomes for all groups equalized by six months, with conservative treatment also yielding satisfactory results, albeit with higher malunion rates. Perry provides case studies illustrating decision-making for active older adults contemplating surgery versus conservative treatment for their fractures. He concludes that casting may benefit less active patients with comorbidities while discouraging external fixation as a treatment option due to worse outcomes compared to nonoperative measures. The presentation concludes by advocating for an individualized approach in treatment selection for older patients.