Effectiveness and Safety of Different Treatment Modalities for Patients Older Than 60 Years with Distal Radius Fracture: A Network Meta-Analysis of Clinical Trials

Héctor Gutiérrez-Espinoza, Felipe Araya-Quintanilla (), Iván Cuyul-Vásquez, Rodrigo Gutiérrez-Monclus, Sara Reina-Gutiérrez, Iván Cavero-Redondo and Sergio Núñez de Arenas-Arroyo
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Héctor Gutiérrez-Espinoza: Escuela de Fisioterapia, Universidad de las Americas, Quito 170504, Ecuador
Felipe Araya-Quintanilla: Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago 7510157, Chile
Iván Cuyul-Vásquez: Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco 4780000, Chile
Rodrigo Gutiérrez-Monclus: Traumatology Institute of Santiago, Santiago 7501241, Chile
Sara Reina-Gutiérrez: Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
Iván Cavero-Redondo: Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
Sergio Núñez de Arenas-Arroyo: Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain

IJERPH, 2023, vol. 20, issue 4, 1-16

Abstract: The aim of this study was to compare the clinical effectiveness and complications of different treatment modalities for elderly patients with distal radius fracture (DRF). Methods: We performed a network meta-analysis (NMA) of randomized clinical trials (RCTs). Eight databases were searched. The eligibility criteria for selecting studies were RCTs that compared different treatment modalities (surgical or nonoperative) in patients older than 60 years with displaced or unstable intra-articular and/or extra-articular DRFs. Results: Twenty-three RCTs met the eligibility criteria (2020 patients). For indirect comparisons, the main findings of the NMA were in volar locking plate (VLP) versus cast immobilization, with the mean differences for the patient-rated wrist evaluation (PRWE) questionnaire at −4.45 points ( p < 0.05) and grip strength at 6.11% ( p < 0.05). Additionally, VLP showed a lower risk ratio (RR) of minor complications than dorsal plate fixation (RR: 0.02) and bridging external fixation (RR: 0.25). Conversely, VLP and dorsal plate fixation showed higher rates of major complications. Conclusions: Compared with other treatment modalities, VLP showed statistically significant differences for some functional outcomes; however, most differences were not clinically relevant. For complications, although most differences were not statistically significant, VLP was the treatment modality that reported the lowest rate of minor and overall complications but also showed one of the highest rates of major complications in these patients. PROSPERO Registration: CRD42022315562.

Keywords: distal radius fracture; surgical intervention; cast immobilization; elderly patients; randomized controlled trial; network meta-analysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:20:y:2023:i:4:p:3697-:d:1073672

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