CAYANAN, JASPER JOHN M.
BSN-2B
02/07/2025
RELATED READING
TITLE: ASSOCIATION OF OPEN REDUCTION AND INTERNAL FIXATION WITH
VOLAR LOCKING PLATE FOR DISTAL RADIUS FRACTURES WITH
PATIENTREPORTED OUTCOMES IN OLDER ADULTS
AUTHOR: Mayank Jayaram, BS1; Shannon M. Wood, BS2; Robert L. Kane, MD3; et al
DATE PUBLISHED: June 16, 2023
REFERENCE: Jayaram M, Wood SM, Kane RL, Yang L, Chung KC. Association of
Open Reduction and Internal Fixation With Volar Locking Plate for Distal Radius
Fractures With
Patient-Reported Outcomes in Older Adults: A Network Meta-analysis. JAMA Netw
Open. 2023;6(6):e2318715. doi:10.1001/jamanetworkopen.2023.18715
ABSTRACT
Importance
Randomized clinical trials (RCTs) and meta-analyses have reported inconsistent
conclusions regarding optimal distal radius fracture (DRF) treatment in older adults
and are limited due to the inclusion of cohort studies with small sample sizes. A
network meta-analysis (NMA) addresses these limitations by only synthesizing direct
and indirect evidence from RCTs and may clarify optimal DRF treatment in older
adults.
Objective
To examine DRF treatment results in optimal short-term and intermediate-term patient
reported outcomes.
Data Sources
Searches of MEDLINE, Embase, Scopus, and Cochrane Central Register of
Controlled Trials were conducted for RCTs that investigated DRF treatment outcomes
in older adults between January 1, 2000, and January 1, 2022.
Study Selection
Randomized clinical trials including patients with a mean age of 50 years or older that
compared the following DRF treatments were eligible for inclusion: casting, open
reduction and internal fixation with volar lock plating (ORIF), external fixation,
percutaneous pinning, and nail fixation.
Data Extraction and Synthesis
Two reviewers independently completed all data extraction. An NMA aggregated all
direct and indirect evidence among DRF treatments. Treatments were ranked by
surface under the cumulative ranking curve score. Data are reported as standard
mean differences (SMDs) and 95% CIs.
Main Outcomes and Measures
The primary outcome was short-term (≤3 months) and intermediate-term (>3 months
to 1 year) Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores.
Secondary outcomes included Patient-Rated Wrist Evaluation (PRWE) scores and 1year complication rates.
Results
In this NMA, 23 RCTs consisting of 3054 participants (2495 women [81.7%]) with a
mean (SD) age of 66 (7.8) years were included. At 3 months, DASH scores were
significantly lower for nail fixation (SMD, −18.28; 95% CI, −29.93 to −6.63) and ORIF
(SMD, −9.28; 95% CI, −13.90 to −4.66) compared with casting. The PRWE scores
were also significantly lower for ORIF (SMD, −9.55; 95% CI, −15.31 to −3.79) at 3
months. In the intermediate term, ORIF was associated with lowered DASH (SMD,
−3.35; 95% CI, −5.90 to −0.80) and PRWE (SMD, −2.90; 95% CI, −4.86 to −0.94)
scores. One-year complication rates were comparable among all treatments.
Conclusions and Relevance
The findings of this NMA suggest that ORIF may be associated with clinically
significant improvements in short-term recovery compared with casting for multiple
patient-reported outcomes measures with no increase in 1-year complication rates.
Shared decision-making with patients may be useful to identify patient preferences
regarding recovery to determine optimal treatment.
Summary
The article "Association of Open Reduction and Internal Fixation With Volar Locking
Plate for Distal Radius Fractures With Patient-Reported Outcomes in Older Adults: A
Network Meta-Analysis" explores the effectiveness of different treatments for wrist
fractures in older adults. The study included 23 clinical trials, with a total of 3054
participants, mostly older women with an average age of 66. It primarily aimed to
compare the recovery outcomes for open reduction and internal fixation (ORIF) using
a volar locking plate, casting, and pinning. The findings indicated that ORIF with a
volar locking plate led to faster recovery in the first three months after treatment when
compared to casting and pinning. The recovery was assessed using two widely
recognized tools: the Disabilities of the Arm, Shoulder, and Hand (DASH) scale and
the Patient-Rated Wrist Evaluation (PRWE), which measure patients’ self-reported
functional status and wrist-related disabilities. Although ORIF showed superior shortterm recovery results, particularly in the initial three months, the long-term benefits did
not show significant differences among the various treatment options. The
complication rates across all treatments were found to be comparable. The authors
concluded that ORIF with a volar locking plate may be an ideal choice for older adults
seeking a quicker recovery, although the treatment decision should consider individual
patient factors and preferences.
Reflection/Learning
Through this article, I gained valuable insights into the importance of personalized
care, especially when it comes to older adults. The study highlighted that every
patient’s needs and recovery goals should shape their treatment plan. For older
patients, whose recovery process can often be more complex, understanding their
priorities, whether it's faster recovery, minimizing complications, or achieving longterm functionality, is essential in making the best treatment recommendation. I also
learned the tools like the DASH and PRWE, which are critical in assessing how
patients feel about their recovery and their ability to perform daily activities after
treatment. These measurement tools are valuable not just for tracking physical
recovery, but also for addressing the psychological impact of the injury on the patient,
which is often overlooked in clinical settings. The study highlighted how patient
reported outcomes (PROs) can inform clinical decisions and help tailor interventions
that focus on both the physical and emotional aspects of recovery.
Application to Nursing Practice
The article has significant implications for nursing practice, particularly in the preand postoperative care of older adults. It highlighted the importance of clear
communication with patients, ensuring they are well-informed about their treatment
options and the expected outcomes. In nursing practice, this means discussing the
benefits and risks of different treatments, setting realistic expectations for recovery,
and involving patients in shared decision-making. Understanding the patients'
preferences and recovery goals is crucial for providing holistic care and fostering a
therapeutic relationship.
Moreover, the study emphasizes the importance of closely monitoring post-surgical
recovery, particularly for complications, and supporting the rehabilitation process. This
aligns with the role of nurses in the post-operative phase, where we not only ensure
physical recovery but also address any psychosocial needs patients may have. Nurses
must collaborate with other healthcare providers, such as physical therapists, to
optimize the rehabilitation process and improve the patient's overall functional
outcomes.
The use of tools like the DASH and PRWE in my nursing practice will be invaluable
for assessing patient progress. By incorporating these tools, I can track how well
patients are recovering from their treatments, identify potential issues early on, and
adjust care plans accordingly. In the future, I can use these outcomes to advocate for
more personalized interventions, enhancing patient care and contributing to better
clinical results. Ultimately, this study has reinforced the importance of individualized
care, patient-centered communication, and teamwork across disciplines in achieving
the best outcomes for older adults recovering from fractures.