Review Article

Distal Radius Fractures in the

Elderly

Abstract
L. Scott Levin, MD, FACS Distal radius fractures are common in elderly patients, and the
Joshua C. Rozell, MD incidence continues to increase as the population ages. The goal of
treatment is to provide a painless extremity with good function. In
Nicholas Pulos, MD
surgical decision making, special attention should be given to the
patient’s bone quality and functional activity level. Most of these
fractures can be treated nonsurgically, and careful closed reduction
should aim for maintenance of anatomic alignment with a focus on
protecting fragile soft tissues. Locked plating is typically used for
fracture management when surgical fixation is appropriate. Surgical
treatment improves alignment, but improvement in radiographic
parameters may not lead to better clinical outcomes. Treatment
principles, strategies, and clinical outcomes vary for these injuries,
with elderly patients warranting special consideration.

From the Department of Orthopaedic

Surgery, University of Pennsylvania
Perelman School of Medicine,
Philadelphia, PA. T he distal radius is the second
most commonly fractured bone
in elderly persons and the most fre-
An evidence-based review of the
evaluation and treatment of distal
radius fractures, the effects on health-
Dr. Levin or an immediate family
member has received royalties from quent upper extremity fracture in care costs, and preventive strategies
Mavrek; has received research or women aged .50 years. Most stud- reveals an intensified focus on main-
institutional support from AxoGen; and ies define the elderly as patients aged taining and improving bone health in
serves as a board member, owner,
officer, or committee member of the
50 to 75 years,1-10 a range that is the growing elderly population.
American College of Surgeons, the used in this review. An increasingly
American Society for Reconstructive active and expanding elderly pop-
Microsurgery, the American Society ulation is responsible for the
for Surgery of the Hand, the
Epidemiology
International Hand and Composite
increased incidence of distal radius
Tissue Allotransplantation Society, fractures over the past 40 years.11 Distal radius fractures account for up
the United Network for Organ Sharing, Controversy remains as to whether to 18% of all fractures in the elderly
the Vascularized Composite Allograft these fractures should be treated sur- population.11 White race, female
Transplantation Committee, and the
World Society for Reconstructive
gically or nonsurgically. Aside from sex, and osteoporosis are risk factors
Microsurgery. Neither of the following radiographic parameters of displace- for distal radius fractures. There may
authors nor any immediate family ment and angulation, the decision to also be seasonal variations; elderly
member has received anything of proceed to surgery depends on the patients are predisposed to fracture
value from or has stock or stock
options held in a commercial company
patient’s functional outcome and in the winter months because of
or institution related directly or activity level. Particularly in elderly slippery walking conditions. Typi-
indirectly to the subject of this article: patients, the potential for cosmetic cally, the mechanism of injury is a
Dr. Rozell and Dr. Pulos. deformity of the wrist after non- fall onto an outstretched hand.
J Am Acad Orthop Surg 2017;25: surgical treatment may influence the Patients with intact cognitive and
179-187 personal decision to undergo cor- neuromuscular systems may have a
DOI: 10.5435/JAAOS-D-15-00676 rective surgery.12 Regardless of the higher risk of fracture because of
treatment modality, the goals of their reflexive ability to reach out
Copyright 2017 by the American
Academy of Orthopaedic Surgeons. care are to improve pain and restore during a fall as opposed to falling
function. onto their side.13

March 2017, Vol 25, No 3 179

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Distal Radius Fractures in the Elderly

In 2007, distal radius fractures cost discrimination values and the ability to surgery, such as corrective osteotomy
Medicare $170 million, or $1,983 per detect light touch in the median, ulnar, for malunion, is considered.
beneficiary.14 Although most distal and radial nerve territories. The pres-
radius fractures in elderly patients are ence of any paresthesia or numbness in
managed nonsurgically, the use of the median distribution warrants Management
internal fixation has increased in the careful attention because acute carpal
In the most recent American Acad-
United States. Internal fixation not tunnel syndrome has been reported in
emy of Orthopaedic Surgeons
only costs Medicare nearly three times 5.4% to 8.6% of all distal radius
(AAOS) clinical practice guideline on
as much as nonsurgical treatment,15 fractures.16 The motor examination,
distal radius fractures, the Work-
but it may also increase hospitaliza- which may be limited secondary to
group was unable to recommend for
tion rates and related expenses. pain, should evaluate the anterior and
or against surgical treatment of these
Despite the overall trend toward posterior interosseous nerves as well
fractures in elderly patients.18 The rec-
internal fixation for distal radius as the radial nerve proper and median
ommendation regarding volar locked
fractures, the practice varies demo- and ulnar nerves. The examiner
plating versus percutaneous pinning
graphically and geographically. In a should also note the presence of lac-
was also graded “inconclusive.”
study of Medicare beneficiaries, frac- erations or skin tears to rule out an
Kodama et al8 created a scoring system
tures were more likely to be treated open fracture, ecchymosis, edema, or
to aid in surgical decision making for
surgically in women and in Caucasian angular deformities (eg, dinner fork
distal radius fractures. For patients
patients.15 Furthermore, the use of deformity). Skin tearing is very com-
aged $50 years, important factors
internal fixation ranged from 4.6% mon in elderly patients with thin soft
include fracture pattern, radiographic
to 42.1% among hospital referral tissues, and care must be taken, espe-
parameters, age, hand dominance, and
regions, a nearly 10-fold difference. cially during closed reduction, to
occupation. In a multiple logistic
Patients treated by fellowship-trained avoid shearing of these tissues.
regression analysis, the authors found
hand surgeons were also more likely
close correlations between clinical
to undergo surgery.15
outcome and comminution of the
Radiographic Evaluation dorsal cortex and the volar cortex after
reduction, ulnar neck fracture, volar
Clinical Evaluation Three radiographic views of the hand
tilt before and after closed reduction,
and wrist (ie, AP, lateral, and oblique)
and ulnar variance after closed reduc-
The clinical history should include are usually sufficient to identify most
tion.8 Although this scoring system
the mechanism of injury and pre- distal radius fractures. Important
may be used to guide treatment, it has
senting reports, such as pain, loss of radiographic parameters to assess
yet to be prospectively validated.
function, and deformity. Information include, but are not limited to, angula-
regarding hand dominance, hobbies, tion, rotational deformity, shortening,
and occupation is equally valuable. It comminution, and joint alignment. Nonsurgical
is important to ask about sequelae Specifically for distal radius fractures, At our institution, minimally displaced
from previous trauma to the upper parameters include radial inclination fractures are initially placed in a sugar
extremity or existing osteoarthritis (22°; mean, 19° to 29°), radial height tong plaster splint (including the elbow
that may limit the patient’s preinjury (11 to 12 mm), and volar tilt (11°; joint) to limit supination and pronation
range of motion and function. Inquiry mean, 11° to 14.5°).17 Radiographs of (Figure 1). Fractures with substantial
into the use of walking aids and the forearm and elbow also should be displacement are treated with closed
independence in performing activities obtained to detect more proximal reduction and are immobilized in a
of daily living is crucial for a better injuries or elbow instability. After sugar tong splint. On the palmar
understanding of the demands on the closed reduction and splinting, the aspect of the hand, the splint ends just
elderly patient’s upper extremities and clinician should obtain radiographs proximal to the metacarpal heads, al-
may influence treatment decisions. documenting appropriate restoration lowing early finger range of motion to
A systematic examination of the of the previously mentioned parame- prevent stiffness and preserve mobility.
hand and wrist should progress distally ters. CT is increasingly used by hand Limited compression with the elastic
to proximally. The vascular status of surgeons as a diagnostic aid or to bandage wrapping holds the splint in
the hand should be assessed by verify- better quantify fracture patterns (ie, place. Fracture characteristics deter-
ing digital capillary refill and radial and intra-articular, impaction, shear frag- mine the preferred closed reduction
ulnar pulses at the wrist. The sensory ments) and to aid in surgical planning. maneuver. Analgesia is provided by
examination should include two-point CT may also be used when revision the emergency department staff, and a

180 Journal of the American Academy of Orthopaedic Surgeons

Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
 L. Scott Levin, MD, FACS, et al

hematoma block is infiltrated directly Figure 1

into the fracture site, if possible.We
place our patients in finger-trap trac-
tion before reduction to fatigue the
deforming muscular forces surround-
ing the wrist. The index and long
fingers are placed in the traction device
coincident with the linear alignment of
the radiocarpal joint so as not to
exacerbate any deformity. In general,
the mechanism that is causing the
deformity is recreated, and the mech-
anism is reversed. Multiplanar liga-
mentotaxis involves the combined use
of longitudinal traction and palmar
translation of the hand on the forearm
to allow the capitate to rotate on the
lunate, thereby tilting the distal radial
fragment in a palmar direction.19 In
the coronal plane, radioulnar trans-
A, Clinical photograph of the wrist demonstrating the use of a sugar tong splint
lation realigns the distal fragment onto with slight volar mold and neutral rotation to prevent redisplacement of a volar
the radial shaft.19 The typical Colles distal radius fracture. The splint should not extend beyond the metacarpal heads,
fracture reduction involves placing a and the fingers should show a normal cascade. AP (B) and lateral (C)
thumb over the fracture site as a lever, radiographs of the wrist show a well-padded sugar tong splint with no wrinkles in
the plaster or cotton roll.
hyperextension of the fracture frag-
ment to disengage it from the radial
metaphysis, longitudinal traction, and in elderly patients and is reportedly Surgical
flexion to lever the dorsally displaced as high as 89%.20 In osteoporotic Surgical treatment options for distal
fracture fragment into position. In patients treated nonsurgically, the cast radius fractures in elderly patients
elderly patients with fragile skin and serves more for fracture support and
include closed reduction and external
soft tissues, care is taken to prevent pain alleviation than for anatomic
fixation or percutaneous Kirschner
skin tearing; this can often be avoided reduction.7
by placing a piece of cotton cast Nondisplaced distal radius fractures wire fixation and open reduction and
padding between the patient’s skin in the elderly may have a lower chance internal fixation (ORIF) using a volar
and the physician’s fingers at the wrist of subsequent displacement; however, or dorsal locking plate or a dorsal
during the reduction. Finally, a careful at our institution, these patients are bridge plate (Figure 2). Although fre-
neurovascular examination is repeated typically scheduled for weekly follow- quently used, the locked volar plate is
after reduction. ups for 4 to 6 weeks after injury to not without complications (Figure 3).
All patients are instructed to follow assess for secondary collapse. At the Another surgical option for ORIF is
up in 1 week for repeat radiographs. In follow-up visits, cosmetic deformity of dorsal plating. The advantage of dorsal
patients who undergo definitive non- the wrist is discussed. Because of the plating for intra-articular fractures is
surgical treatment, a short arm cast is limited amount of soft tissue, the that it allows visualization of the joint
applied, and the patient is assessed patient should understand that his or surface without disruption of the
weekly for the first several weeks to her wrist may not appear as it did stouter volar carpal ligaments and the
evaluate for secondary displacement before injury. In a study of 13 women risk of future instability of the radio-
or collapse of the fracture. Conversion aged .71 years, McQueen and carpal joint. In volar lunate facet frac-
to a cast decreases the overall bulk of Caspers21 reported that 12 had a mild tures, fragment-specific fixation may
the splint and allows increased range to moderate cosmetic deformity at be used. An internal distraction plate
of motion and thus less stiffness. least 4 years after injury. Arora et al7 that uses ligamentotaxis to obtain
However, secondary displacement of reported that, despite this clinical reduction is particularly beneficial in
distal radius fractures upon conver- appearance, many elderly patients— patients with fractures that extend into
sion to a cast is still a risk; overall sec- especially those with low demands— the radial diaphysis and in polytrauma
ondary displacement is more common are able to live with their deformity. patients who may require load bearing

March 2017, Vol 25, No 3 181

Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
Distal Radius Fractures in the Elderly

Figure 2

AP (A) and lateral (B) radiographs of the wrist demonstrating external fixation of the distal radius in an elderly patient. C, AP
radiograph of the wrist demonstrating distal radius fixation with volar locked plating. D, AP radiograph of the wrist
demonstrating distal radius fixation with dorsal locked plating. E, AP radiograph of the wrist demonstrating distal radius
fixation with a spanning dorsal bridge plate. (Panel D copyright Derek J. Donegan, MD, Philadelphia, PA.)

through the wrist for mobilization. A the size of the bone defect, blood flow calcium phosphate and allograft bone
distraction plate has also been effec- to the fracture site, and the method of chips in other cases. Calcium phos-
tive in the treatment of comminuted, fixation and/or immobilization affect phate may work well in elderly
osteoporotic distal radius fractures.22 the healing process and the mainte- patients because of ease of use, rela-
This plate is removed after 12 weeks nance of the reduction.27 Given the tively low cost, and the potential to
with good functional outcomes.23 added morbidity associated with provide structural support and thus
Volar locked plating has improved autogenous bone grafting, materials satisfactory healing and functional
radiographic outcomes in terms of such as hydroxyapatite, tricalcium recovery.27
radial shortening, volar tilt, and radial phosphate, and biphasic calcium
inclination, with a low complication phosphate have been used. The use
rate reported.24 Clinically, it was also of allograft bone is advantageous Postoperative Rehabilitation
associated with improved function, because of its osteoconductive and The optimal postoperative physical
improved grip strength, and decreased osteoinductive properties, but it lacks therapy regimen for patients who
pain in the first 6 months compared the osteogenic nature of autograft. sustain distal radius fractures is still
with dorsal plating.24 Furthermore, In addition, allograft also lacks the debated, and there is considerable
compared with volar locked plating, same degree of structural properties of variability between home-based and
dorsal plating had a higher risk of autograft. Allograft bone does repre- formal hand therapy programs.29
secondary fracture displacement and sent a reasonable alternative if auto- One systematic review examined the
extensor tendon irritation in up to graft is not available. Citing the unique differences between formal therapy
30% of cases.25 Volar plating also scaffolding properties of hydroxyapa- and home therapy and found equal
showed superior radiographic and tite, a subcategory of allograft, Hegde benefits among patients without sur-
clinical results compared with percu- et al28 used this graft in 27 patients gical complications.30 Souer et al31
taneous wire and external fixations in aged .50 years with distal radius found pain to be the most important
elderly patients.2,26 fractures. They reported improved independent predictor of disability in
To support the joint surface in range of motion and maintained radial patients who underwent volar locked
elderly patients with comminuted length (ie, no collapse) at 16-week plating. In their cohort, formal
fractures and metaphyseal bone loss follow-up. Although no graft is ideal, physical therapy did not improve
following restoration of length and Ozer and Chung27 recommend the use average disability scores or motion
alignment, bone graft substitutes are of iliac crest bone graft in cases of after 6 months, suggesting that
often used. The quality of the bone, major bone loss and nonunion and patients may benefit from more active

182 Journal of the American Academy of Orthopaedic Surgeons

Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
 L. Scott Levin, MD, FACS, et al

Figure 3

AP (A) and lateral (B) radiographs of the wrist in a 74-year-old woman after open reduction and internal fixation of a
distal radius fracture. The initially well-fixed volar locking plate developed a complication in that the fracture collapsed,
resulting in penetration of the articular surface by screws. AP (C) and lateral (D) radiographs at the 4-week follow-up
visit.

and autonomous therapy versus a nonsurgical complication was median nonsurgical versus surgical treatment
passive approach that limits progress neuropathy (11%). CRPS, extensor (regardless of fixation strategy) of
according to pain tolerance. How- tendon rupture, and device irritation distal radius fractures in elderly
ever, certain patients may benefit were also reported.32 patients.5-7 Patients treated surgically
from therapy provided by a certified Malunion is another complication appear to have better grip strength
hand therapist, including those with associated with nonsurgical treatment, than do those treated nonsurgically,
decreased finger motion, advanced age, with reported rates as high as 89%3 but they demonstrated no difference
and various comorbidities including and obvious deformity noted on in the ability to perform activities of
osteoarthritis, carpal tunnel syndrome, physical examination. In a systematic daily living.7 In a recent randomized
and complex regional pain syndrome review of unstable distal radius frac- prospective trial comparing volar
(CRPS).29 Early finger range of motion tures in elderly patients, worse radio- locked plating with closed reduction
can help to prevent stiffness, a major graphic outcomes were reported in and cast immobilization in patients
complication of immobilization fol- patients with fractures treated non- aged .65 years, the surgical group
lowing distal radius fractures. surgically; however, functional out- showed better wrist function in the
comes were similar between patients early postoperative period.10 How-
who were treated surgically and those ever, at 6 and 12 months, there was
Outcomes treated nonsurgically.4 Major compli- no significant difference in wrist
Lutz et al32 compared the complica- cation rates were higher for fractures function or pain between groups. At
tions associated with nonsurgical and treated surgically. Although patients all time points, grip strength was
surgical management of distal radius often have minimal pain and disability considerably better in the surgical
fractures in elderly patients. The following nonsurgical treatment,3,32 group.10
authors found that, of 258 patients the possibility of cosmetic deformity Overall, patient satisfaction with
with an average age of 74 years who must be discussed with them early to surgical treatment remains high. In
were identified in a prospective data- inform the treatment decision-making terms of cost, surgical treatment is
base, the most common surgical process (Figure 4). more expensive than nonsurgical
complication was surgical site infec- Multiple studies have shown no treatment. Shauver et al33 performed
tion (12%), and the most common difference in clinical outcomes of an economic analysis of treatment of

March 2017, Vol 25, No 3 183

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Distal Radius Fractures in the Elderly

Figure 4

AP (A) and lateral (B) radiographs of the wrist demonstrating a distal radius fracture malunion in a low-demand 77-year-old
patient with an intra-articular distal radius fracture that was treated nonsurgically. AP (C) and lateral (D) radiographs of the
wrist obtained at 3-month follow-up show increasing consolidation. Clinically, the patient had 40° of wrist extension, 15° of
wrist flexion, and 60°/50° of pronation/supination, respectively, and was satisfied with the level of function.

distal radius fractures in patients function, strength, or wrist motion at related to osteoporosis. In a Scandi-
aged $65 years. Although ORIF was 1-year follow-up. A study of “super- navian sample, the prevalence of
more expensive than casting, surgery elderly” patients (defined as those osteoporosis among females who
was found to be worthwhile in terms aged $80 years) with and without experienced a distal radius fracture
of cost per quality–adjusted life-year. malunion following treatment of dis- was 34% compared with 10% in
After fracture of the distal radius, tal radius fractures found that the control subjects.37 In a retrospective
pain, grip strength, and range of ability to perform activities of daily review of patients who sustained
motion may continue to improve for living, wrist pain, return to a normal distal radius fractures, 64% were
up to 4 years after injury.9 Despite the level of function, grip strength, and diagnosed as having osteoporosis/
potential for cosmetic deformity range of motion were comparable.35 osteopenia following screening.38
associated with distal radius fractures However, Rozental et al36 found that Patients with a distal radius fracture
in the elderly and an initial decline in the survival rate after distal radius also had an increased rate of hip and
independence that necessitates assis- fractures was only 57% at 7 years other osteoporotic fractures,39 an
tance with activities of daily living, compared with 71% for a matched incidence attributed to architectural
patients are able to adapt and regain cohort without fracture at 7 years. bone changes and more active life-
much of their functionality. In the This effect was even more pronounced styles11 as well as balance difficulties
setting of distal radius malunion, in men; the reasons for this finding and heightened risk of falls.
long-term functional outcomes are not have not been elucidated but may Because distal radius fractures typi-
affected, even among highly active relate to the overall shorter lifespan of cally occur many years before an
persons. In a cross-sectional study of men compared with women.36 osteoporotic hip fracture,40 they may
96 patients aged $60 years, Nelson serve as a tool to identify patients with
et al34 found no significant difference a heightened risk of more debilitating
between those with a well-aligned Special Considerations for fractures, allowing appropriate lifestyle
fracture and those with distal radius Patients With Osteoporosis modifications and medical treatment
malunion in terms of Disabilities of to decrease this risk. Bone mineral
the Arm, Shoulder, and Hand In the elderly population, distal density (BMD) testing is commonly a
(DASH) score, visual analog scale radius fractures are considered to be prerequisite to specialty referral, and

184 Journal of the American Academy of Orthopaedic Surgeons

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 L. Scott Levin, MD, FACS, et al

patients who sustain or have a history with respect to radial height and ulnar be associated with distal radius frac-
of these fractures should be referred variance in more than half of patients, tures in adults, independent of BMD.
for baseline osteoporosis assessment, whereas volar tilt was maintained in In a case control study of men and
including possible evaluation by an more patients.37 women, an inverse dose-response
endocrinologist and a bone densitom- Treatment options for patients with relationship between vitamin D and
etry scan. Given the rising burden of osteoporotic distal radius fractures distal radius fractures was observed,
osteoporotic disease and its sequelae, include diphosphonates and calcium showing that low vitamin D levels
a comprehensive screening program and vitamin D supplementation in were a predictor of fractures inde-
would benefit many patients. Accord- addition to lifestyle modifications. In a pendent of BMD.47 In a recent pro-
ing to the International Society for randomized trial of 50 women aged spective study of postmenopausal
Clinical Densitometry and the .50 years, early initiation (ie, within patients with distal radius fractures,
National Osteoporosis Foundation, 2 weeks of injury) of diphosphonate up to 50% of those with a fragility
screening should involve BMD testing therapy in those with osteoporotic fracture did not have osteoporosis
for all women aged $65 years and for distal radius fractures treated surgi- as demonstrated by BMD testing;
men aged $70 years.41 cally did not appear to affect fracture however, the authors found no sig-
Compared with patients with nor- healing or clinical outcomes, includ- nificant difference in vitamin D levels
mal BMD, those with osteoporosis are ing DASH score, wrist motion, and between the fracture group and the
at increased risk of early instability, grip strength.44 However, the use of control group.48 Higher levels of
malunion, and late carpal malalign- volar locked plating to achieve pri- bone turnover markers, such as total
ment after distal radius fracture.42 In a mary bone healing in these patients procollagen type 1 N-terminal pro-
retrospective study of 64 post- may have subverted the potential peptide and osteocalcin, were observed
menopausal women treated with deleterious effect of diphosphonates in the fracture group, suggesting that
ORIF for distal radius fractures, the on callus formation. monitoring bone turnover markers
mean DASH scores of those with At our institution, elderly patients may be more useful in predicting
osteoporosis were 15 points higher with distal radius fractures are often fracture risk than monitoring vitamin
than the scores of patients with os- referred for further testing, especially D levels alone.48
teopenia. There was no significant if preliminary laboratory test results,
difference in range of motion or including calcium, vitamin D, phos-
radiographic data between the two phorus, and magnesium, are normal. Future Directions and
groups, yet the osteoporotic group In patients for whom the underlying Summary
had a higher rate of complications.42 cause of poor bone health is incom-
An inverse relationship has also been pletely understood, referral to meta- The incidence of osteoporosis-related
established between BMD and the bolic bone experts is suggested. fractures is increasing as the aging
severity of distal radius fractures.42,43 Vitamin C supplementation has also population expands. To date, no
Unlike fragility fractures of the hip or received attention for its proposed consensus exists regarding the treat-
lumbar spine, distal radius fractures effect on preventing CRPS following ment of distal radius fractures in
allow for reduction and monitoring of distal radius fractures, a complication elderly patients. The goals of treat-
the alignment, making them more observed in approximately 10% of ment are to provide a painless limb
amenable to objective comparisons. patients.45 Through its action on with good function. Although surgi-
Maintaining an anatomic reduction is oxygen free radicals, vitamin C is cal treatment improves alignment,
important for any patient, and close thought to inhibit local proin- radiographic assessment does not
follow-up within 1 to 2 weeks of flammatory cascades via antioxidant appear to be associated with better
closed reduction facilitates determi- mechanisms. Although the 2010 clinical outcomes. Further research
nation of definitive treatment on the AAOS guidelines included a moderate should more precisely target the
basis of fracture displacement. In a strength recommendation for the use molecular substrates of bone resorp-
retrospective review of 78 patients of vitamin C as an adjunct for pain tion without disrupting osteoblast
aged .65 years with closed reduction control,18 more recent studies and function in order to preserve and
of distal radius fractures, no relation- meta-analyses have not corroborated maintain bone mass. Attention has
ship was found between BMD and the the correlation between supplemental been focused on identifying risk factors
ability to maintain reduction in a use and the incidence of CRPS.44,46 for osteoporosis and on early pre-
splint.40 However, in another study, Debate exists regarding the role ventive strategies aimed at maintaining
despite reduction, fracture displace- that vitamin D plays in distal radius and improving bone health. Evalua-
ment returned to injury alignment fractures. Low vitamin D levels may tion and screening for osteoporosis

March 2017, Vol 25, No 3 185

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Distal Radius Fractures in the Elderly

should be undertaken in all elderly management of distal radius fractures in the function? J Bone Joint Surg Br 1988;70(4):
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