Operative vs. Conservative Management of Adult Patients with Distal Radius Fractures: A Systematic Review and Meta-analysis

Author(s):

Alanoud Abdullah Alharbi*, Arwa Modawi Asiri, Abdulrahman Mohammed Al-qahtani, Rana Abdullhadi Bugshan, Alhanouf Abdullah Almusllam, Shahd Saeed Dlboh, Sultan Mohammed Alhussain, Yazeed Abdullah Alhumaidi, Mohammed Saad Althobaiti and Ghadeer Adel Mosfer Alghamdi

Background: The distal radius is the maximum common site of fracture within the upper extremity. Dorsal articulations are frequent in distal radius fractures (DRFs) since fall on an outstretched hand is the common mechanism of injury and the dorsal cortex is much weaker at the distal radius end. This dorsal comminution makes the management difficult, and dorsal rim fractures sometimes develop all through dorsal comminution of DRF. Aim: This work aims to determine the efficacy and safety of operative vs. conservative management of adult patients with distal radius fractures. Materials and Methods: A systematic search was performed over different medical databases to identify orthopedic surgery studies, which studied the outcome of the Operative group versus the Conservative group of adult patients with distal radius fractures. Using the meta-analysis process, either with fixed or random-effects models, we conducted a meta-analysis on Disabilities of the Arm, Shoulder, and Hand (DASH) score, as a primary outcome, and on overall complications rate as a secondary outcome. Results: Seven studies were identified involving 14279 patients, with 4025 patients in the Operative group, and 10254 patients in the Conservative group. The meta-analysis process revealed a significant decrease in the mean DASH score in the Operative group compared to the Conservative group (p=0.022). On the other hand, we found a nonsignificant difference in overall complications rate in the Operative group compared to the Conservative group (p>0.05). Conclusion: To conclude, our meta-analysis implies that operative management of distal radius fractures helps to improve the mediumterm DASH score as compared to non-operative treatment in adults, with no difference in overall complication rate. Also, we found that operative treatment is more effective but has greater drawbacks.