Hand and Wrist Fractures in the Elderly

Abstract

Hand and wrist fractures are a relatively common injury in the elderly population, often resulting from a low-energy fall or a fragility fracture. Initial closed reduction and stabilization in a splint are most often performed in the emergency room or location of initial presentation. Non-surgical management of hand and wrist fractures is typically reserved for non-displaced or minimally displaced fractures. Operative treatment is almost always recommended for open fractures, fractures with associated soft tissue defects, and those fractures associated with neurovascular injury. Surgery is also often recommended for unstable fractures, intra-articular fractures, or fractures in which closed reduction and casting fails to achieve and/or maintain adequate alignment. It is important to consider the patient's age, functional status, medical comorbidities, and concomitant injuries in the decision of whether or not to proceed with surgery. Techniques of operative stabilization include external fixation, closed reduction and percutaneous pinning, open reduction, and internal fixation. One of the challenges of treating hand and wrist fractures is the need for immobilization to facilitate fracture healing, which results in muscle atrophy and joint stiffness. Rehabilitation after a hand or wrist fracture is especially important in order to decrease the risk of complications and maximize functional recovery from the injury. Prevention of future falls and the evaluation and treatment of osteoporosis are additional important aspects of the management of hand and wrist fractures in the elderly.