Epidemiology and changed surgical treatment methods for fractures of the distal radius

Abstract

Background and purpose The incidence of fractures of the distal radius may have changed over the last decade, and operative treatment has been commoner during that time. We investigated the incidence of fractures of the distal radius and changing trends in surgical treatment during the period 2004–2010. Patients and methods Registry data on 42,583 patients with a fracture of the distal radius from 2004 to 2010 were evaluated regarding diagnosis, age, sex, and surgical treatment. Results The crude incidence rate was 31 per 10 4 person-years with a bimodal distribution. After the age of 45 years, the inci-dence rate in women increased rapidly and leveled off first at a very high age. The incidence rate in postmenopausal women was lower than previously reported. In men, the incidence was low and it increased slowly until the age of 80 years, when it amounted to 31 per 10 4 person-years. The number of surgical procedures increased by more than 40% despite the fact that there was reduced incidence during the study period. In patients ≥ 18 years of age, the proportion of fractures treated with plating increased from 16% to 70% while the use of external fixation decreased by about the same amount. Interpretation The incidence rate of distal radius fractures in postmenopausal women appears to have decreased over the last few decades. There has been a shift in surgical treatment from external fixation to open reduction and plating.  The incidence of fractures of the distal radius was reported to increase from the 1950s until the 1990s, when it leveled off (Bengnér and Johnell 1985, Melton et al. 1998, Jónsson et al. 1999) and recent studies have suggested a declining inci-dence rate in postmenopausal women over the last 2 decades (Brogren et al. 2007, Lofthus et al. 2008, Sigurdardottir et al. 2011). Undisputedly, the incidence rate of fractures of the distal radius increases rapidly after menopause in women, but some authors have reported a continuous increase (Begnér and Johnell 1985, Mallmin and Ljunghall 1992, O'Neill et al. 2001, Thompson et al. 2004, Brogren et al. 2007, Flinkkilä et al. 2011) whereas others have described a leveling off of the incidence rate in older women (Alffram and Bauer 1962, Falch 1983, Miller and Evans 1985, Schmalholz 1988). The first aim of this study was to determine the incidence of fractures of the distal radius in Stockholm County (with 2 million inhabitants) during the period 2004–2010. In the past decade, there has been a considerable increase in the use of volar locking plates for fixation of fractures of the distal radius (Koval et al. 2008, Chung et al. 2009, Mattila et al. 2011). Our second aim was to investigate the operative treatment used.