Distal Radius Fractures in the Elderly

This thesis combines quantitative, qualitative, and experimental approaches to address different aspects of distal radius fractures (DRFs) in the elderly.

Study I was a registry-based cohort study of 5,536 DRF patients, of whom 259 (5%) sustained a concomitant distal metaphyseal ulna fracture. These patients, with a mean age of 73 years (SD 15), had nearly twice the odds of reporting severe symptoms (DASH > 35) 1 year after injury compared with those with isolated DRFs (OR 1.97, 95% CI 1.40–2.75, P < 0.001).

Study II evaluated the mortality among 240 DRF patients aged 80 years or older. 1-year mortality was markedly lower than expected (SMR 0.44, 95% CI 0.18–0.69, P < 0.01), while at 5 years mortality approximated that of the general population (SMR 0.96, 95% CI 0.78–1.14). Living situation was the strongest predictor of survival, with residents of nursing homes having the worst prognosis.

Study III employed mixed methods, including qualitative interviews with 10 surgically treated patients during the COVID-19 pandemic, to explore experiences of video-based follow-up. Despite the inclusion of both elderly patients and patients with low levels of digital literacy, video consultations were described as simple and accessible. Many expressed a preference for digital follow-up after surgery.

Study IV used an osteoporotic rat model to evaluate the combination of locally applied calcium sulphate/hydroxyapatite (CaS/HA) biomaterial around a metallic screw followed by systemically administered zoledronic acid. The treatment significantly enhanced peri-implant bone formation compared with animals not receiving the CaS/HA material. The method was translated to a small cohort of hip fracture patients, suggesting potential to improve screw fixation in osteoporotic bone and in future wrist fracture surgery.

Taken together, these studies support tailoring DRF treatment to functional status rather than chronological age. They further emphasise the importance of prognostic awareness, the potential of digital follow-up, and opportunities to enhance surgical fixation in osteoporotic bone.