Is reduction necessary in overriding metaphyseal distal radius fractures in children under 11 years: a systematic review and meta-analysis of comparative studies.

OBJECTIVE: To determine the necessity of reduction in the treatment of overriding metaphyseal distal radius fractures (DRF) in children under 11 years. METHODS: In this systematic review and meta-analysis, PubMed, Embase, and Cochrane databases were searched to retrieve studies published from inception to 2023. Two reviewers independently screened for studies with observational or randomized control design comparing two treatments for overriding metaphyseal DRF in patients under 11 years: simple casting without reduction (SC group) versus closed reduction plus casting or pin fixation (CRC/F group); with varying outcomes reported (CRD471761). The risk of bias was assessed using the ROBINS-I tool. RESULTS: Out of 3,024 screened studies, three met the inclusion criteria, 180 children (mean age 7.1 ± 0.9 years) with overriding metaphyseal DRF: SC-group (n = 79) versus CRC/F-group (n = 101). Both treatment groups achieved 100% fracture consolidation without requiring further manipulation. The SC-group showed significantly fewer complications (mean difference [MD] 0.08; 95% CI [0.01, 0.53]; I2 = 22%; P < 0.009) and trends towards better sagittal alignment (MD 5.11; 95% CI [11.92, 1.71]; I2 = 94%; P < 0.14), less reinterventions (MD 0.31; 95% CI [0.01, 8.31]; P < 0.48), and fewer patients with motion limitation at the end of follow-up (MD 0.23; 95% CI [0.03,  1.98]; P < 0.18), although these findings were not statistically significant. CONCLUSIONS: Despite a limited number of studies comparing SC versus CRC/F in overriding DRF in children under 11 years, this study suggests that anatomical reduction is not necessary. Treating these fractures with SC, even when presenting with an overriding position, leads to reduced complications, shows a trend towards fewer reinterventions, improved sagittal alignment, and less limitation in patient motion. LEVEL OF EVIDENCE: Level III, Systematic review of Level-III studies.

Comportamiento de fracturas diafisarias del fémur en el niño

Introducción: Las fracturas de la diáfisis del fémur en las edades pediátricas representan un problema de salud que necesita de la intervención del ortopedista, quien aplica una de las distintas modalidades de tratamiento, que van desde la conservadora a la quirúrgica. Objetivo: Describir las características epidemiológicas de un grupo de pacientes pediátricos diagnosticados y tratados con esta enfermedad traumática. Métodos: Se realizó un estudio observacional descriptivo en 54 pacientes atendidos en el Hospital Pediátrico Provincial Dr. Eduardo Agramonte Piña de la provincia Camagüey desde el primero de enero de 2018 al 31 de diciembre del año 2022 con un total de 60 meses. Resultados: La razón sexo masculino-femenino de los 54 pacientes fue de 2,8 a 1, fémur izquierdo-derecho de 1,2 a 1. El promedio de edades en general fue de 8,1 años. La estadía hospitalaria promedio fue de seis días. El tercio medio estuvo afectado en el 57,4 % de los casos. Los meses de julio y diciembre en conjunto con los días del martes y domingo fueron los que presentaron la mayor cantidad de pacientes. El tratamiento más empleado fue la colocación de espica de yeso en 28 pacientes para un 51,8 %, los clavos rígidos fueron utilizados en 16 enfermos y representó el 29,6 %. Por su parte, los clavos flexibles fueron colocados en 10 casos para un 18,5 %. Conclusiones: Las fracturas de la diáfisis femoral en las edades pediátricas son más frecuentes en el sexo masculino, lado izquierdo, en el tercio medio, con patrón transversal. Los meses del año con mayor incidencia fueron julio y diciembre y los días martes y domingo. El tratamiento depende de la edad, peso y configuración de la fractura.

Introduction: Fractures of the diaphysis of the femur in children, represent a health problem that requires the intervention of an orthopedist who applies various treatment modalities ranging from conservative to surgical. Objective: To describe the epidemiological characteristics of a group of pediatric patients with this traumatic entity. Methods: A descriptive observational study was carried out in 54 patients treated at the Dr. Eduardo Agramonte Piña Provincial Pediatric Hospital in the city of Camagüey from January 1st, 2018 to December 31st, 2022 with a total of 60 months. Results: The male-female sex ratio of the 54 patients was 2.8 to 1, left-right femur 1.2 to 1. The average age in general was 8.1 years. The average hospital stay was 6 days. The middle third was affected in 57.4 % of the cases. The months of July and December together with the days of Tuesday and Sunday were the ones that presented the largest number of patients. The most used treatment was the placement of a plaster spike in 28 patients for 51.8%, rigid intramedullary nails were used in 16 patients and represented 29.6 %. On the other hand, flexible intramedullary nails were placed in 10 cases for 18.5%. Conclusions: Femoral diaphysis fractures in children are more frequent in males, left side, in the middle third, with a transversal pattern. The months of the year with the highest incidence were July and December and on Tuesdays and Sundays. Treatment depends on age, weight, and configuration of the fracture.

Evaluation of an open access generic 3D software for Orthodontic diagnosis and treatment planning

Aim: To evaluate the accuracy and the validity of orthodontic diagnostic measurements, as well as virtual tooth transformations using a generic open access 3D software compared to OrthoAnalyzer (3Shape) software; which was previously tested and proven for accuracy. Methods: 40 maxillary and mandibular single arch study models were duplicated and scanned using 3Shape laser scanner. The files were imported into the generic and OrthoAnalyzer software programs; where linear measurements were taken twice to investigate the accuracy of the program. To test the accuracy of the program format, they were printed, rescanned and imported into OrthAnalyzer. Finally, to investigate the accuracy of editing capabilities, linear and angular transformation procedures were performed, superimposed and printed to be rescanned and imported to OrthoAnalyzer for comparison. Results: There was no statistically significant difference between the two groups using the two software programs regarding the accuracy of the linear measurements (p>0.05). There was no statistically significant difference between the different formats among all the measurements, (p>0.05). The editing capabilities also showed no statistically significant difference (p>0.05). Conclusion: The generic 3D software (Meshmixer) was valid and accurate in cast measurements and linear and angular editing procedures. It can be used for orthodontic diagnosis and treatment planning without added costs

Below- or above-elbow immobilization in conservative treatment of distal radius fractures: a systematic review and meta-analysis.

INTRODUCTION: There is no consensus regarding the range of immobilization in the conservative treatment of distal radius fractures (DRFs). Therefore, this systematic review and meta-analysis aimed to compare the clinical outcome of patients with DRFs treated conservatively with below- or above-elbow immobilization. MATERIALS AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, two independent reviewers searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and World Health Organization International Clinical Trials Registry Platform in April 2020; a subsequent update search was conducted in April 2021. We identified all randomised controlled trials comparing two immobilization methods in DRFs. The primary outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) or QuickDASH questionnaire scores in the short- and long-term (≤ and >six weeks, respectively) follow-up as well as the treatment failure rate. The secondary outcome measures were radiographic outcome, patient-rated wrist evaluation (PRWE) score, pain score and adverse events. Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2. We used the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence. RESULTS: The initial search revealed 1,775 records, and ten studies with 909 participants in total were included. There was no significant difference in DASH score in the short-term follow-up (4.99 lower, 95% confidence interval (CI): 10.45 lower to 0.46 higher; very low certainty) and treatment failure (risk ratio: 0.91, 95% CI: 0.59 to 1.40; low certainty). A clinically irrelevant but significant mean difference (0.83 lower, 95%CI: 1.64 lower to 0.03 lower; low certainty) was found in the DASH score in favour of below-elbow immobilization in the long-term follow-up. The overall risk of bias in DASH scores was high based on the measurement bias. Furthermore, there was no significant difference in secondary outcome measures. CONCLUSION: This meta-analysis did not demonstrate clinically meaningful difference between below- and above-elbow immobilization in terms of DASH score both in the short- and long-term follow-ups. However, overall certainty of evidence was considered very low, based on the very serious risk of bias, inconsistency and imprecision. Hence, there is a need for further higher quality research. TRIAL REGISTRATION NUMBER: UMIN000040134 (4/14/2020).

Risk factors for avascular necorosis after closed reduction of developmental dysplasia of the hips / 中华骨科杂志

Objective:To analyze the risk factors of avascular necrosis (AVN) after closed reduction and spcia casting in treating developmental dysplaisa of the hip (DDH).Methods:The patients with DDH who received closed reduction in our department from January 2016 to December 2017 were retrospectively reviewed. The inclusion criteria included aged at reduction ≥6 months, achieving successful reduction, having complete data with more than 2 years follow-up. A total of 48 cases with 54 hips were included in the present study. Among them, there were 2 males and 46 females, 41 unilateral hips and 13 bilateral hips. The mean age at closed reduction was 16.4±3.8 months (range 6-24 months). The mean follow-up duration was 2.9±1.8 years (range 2.3-4.1 years). Closed reduction was conducted under general anesthesia followed with a spcia cast immobilization. The abduction angle of the cast was recorded. The stability of reduction was evaluated by Ramsey safety zone. The maximum abduction and re-dislocation abduction were recorded. The quality of reduction was evaluated by the medial gap and femoral head coverage on intraoperative arthrography and post-reduction MRI. AVN was diagnosed according to Salter criteria. The risk factors of AVN were analyzed by univariate and binary logistic regression analysis.Results:AVN occurred in 12 hips (22.2%) of 54 hips. International Hip Dysplasia Institute (IHDI) grade and the difference between maximum abduction and cast abduction (Max-Cast abduction) were related to the occurrence of AVN in univariate analysis. The incidence of AVN in hips of IHDI grade 4 (42.9%, 9/21) was significantly higher than that in hips of IHDI grade 3 (9.7%, 3/31) (χ 2=6.007, P=0.018). However, the hips of IHDI grade 3 and 2 (0%, 0/2) presented a similar incidence of AVN (χ 2=0.000, P=1.000). The Max-Cast abduction was -0.7°±5.9° in the AVN group and 6.1°±7.6° in the AVN group ( t=2.125, P=0.038). Finally, IHDI grade ( OR=8.256, P=0.015) and Max-Cast abduction ( OR=0.832, P=0.047) were both independent factors of AVN in multivariate analysis. Conclusion:Most of the hips with AVN are IHDI grade 4 after closed reduction for DDH. The abduction angle in a spica cast could not be significantly related to the occurrence of AVN. However, the risk of AVN might be increased when the cast abduction is close to or beyond the maximum abduction. Safe abduction in the cast should be 5 to 10 degrees less than maximum abduction at least.

Commitment devices in the treatment of diabetic foot ulcers.

BACKGROUND: Non-removable offloading devices are recommended for the treatment of uncomplicated plantar diabetic foot ulcers because adherence to using removable devices is low. However, patients may not always understand how crucial the non-removability is to ulcer healing, leaving them with the impression that it is the device per se that heals the ulcer. Thus, after ulcer healing when patients return to using removable offloading devices, typically therapeutic footwear, they often return to a low level of adherence resulting in high reulceration rates. To change this pattern of behavior based on a misconception, we need to start with how we as clinicians are conceptualizing treatment with offloading devices. NON-REMOVABLE OFFLOADING DEVICES AS COMMITMENT DEVICES: Commitment devices are voluntary restrictions people put on their future selves to resist short-term temptations and achieve long-term goals. In this paper, it is suggested that a change from viewing non-removable offloading devices as means to force compliance, to viewing them as commitment devices could facilitate a change to a clinical thinking that emphasizes the importance of high adherence without compromising respect for patient autonomy. CONCLUSION: Viewing non-removable offloading devices as commitment devices seems to be a promising approach to emphasize the importance of adherence while respecting patient autonomy. Hopefully, patients' higher appreciation of the role of adherence can lead to higher adherence to using therapeutic footwear after healing and consequently to reduced reulceration rates.

Thermoplastic nipple splint: A simple method of maintaining nipple projection

Maintaining projection of the reconstructed nipple is important for achieving natural and aesthetically appealing outcomes in breast reconstruction. Although various methods of avoiding mechanical force on the reconstructed nipple have been developed, the existing methods are inconvenient, crude, non-reusable, and difficult to clean or adjust. In the present study, a simple method of creating a nipple splint using a thermoplastic material is described. This splint can be easily manipulated, washed, and reused, and it is comfortable to wear for long-term use without any complications and convenient for the patient to apply.

Analysis of Airborne Dust as a Result of Plaster Cast Sawing.

Plaster splints are used daily in surgical and orthopedic fields in order to immobilize injured children and adults. The aim of this study was to measure the aerodynamic diameter and concentration of dust particles in the air caused by sawing plaster splints (calcium sulfate dehy-drate). We performed fractional measurements of airborne dust particles. The measured particles, which can potentially be inhaled, may have a specific negative effect on human health. Measurements were conducted in laboratory research facilities that simulated hospital conditions within a casting room and the associated waiting room. Measurements within the casting room were made using two particle collector devices and one laser photometer. The measurement for the simulated waiting room was performed using the same principles and devices. The collected plaster dust particles differed in aerodynamic diameter and concentration according to the various locations observed. The highest concentration of particles of all sizes was recorded at the site of cast sawing. There was direct correlation between distance from the source and concentration of airborne particles; this concentration was lowest in the waiting room. The concentrations of plaster dust recorded were lower than the recommended minimal limit values for total and respiratory fractions in Croatia. Accordingly, it can be assumed that sawing of plaster splints has no harmful health effects on the exposed patients and health personnel.

[Treatment of children with femoral subtrochanteric fractures by the external fixation combined with single hip plaster].

OBJECTIVE: To explore curative effects of external fixation combined with single hip plaster in treating children with femoral subtrochanteric fracture. METHODS: Form March 2009 to July 2016, 15 children with femoral subtrochanteric fracture were treated with external fixation combined with single hip plaster, including 9 males and 6 females with a mean age of 8.5 years old ranging from 5 to 14 years old. According to fracture classification of Seinsheimer, 3 cases were type IIA, 4 cases were type IIB, 3 cases were type IIC, 2 cases were type IIIA, 1 case was type IIIB, 1 case was type IV, 1 case was type V. Complications and radiographs were retrospectively reviewed. Postoperative function of hips were evaluated according to Sanders criteria. RESULTS: All children were followed up from 16 to 48 months with an average of 32 months. No early closure of epiphysis, bone nonunion and breakage of screw occurred. According to the Sanders score standard of hip function, the result was excellent in 14 cases, good in 1 case. There were no hip inversion, limb shortening, excessive growth and other malformations. CONCLUSIONS: External fixation combined with single hip plaster for the treatment of children is a safe and effective fixation, which provide a new choice of femoral subtrochanteric fracture.

Treatment of children with femoral subtrochanteric fractures by the external fixation combined with single hip plaster / 中国骨伤

<p><b>OBJECTIVE</b>To explore curative effects of external fixation combined with single hip plaster in treating children with femoral subtrochanteric fracture.</p><p><b>METHODS</b>Form March 2009 to July 2016, 15 children with femoral subtrochanteric fracture were treated with external fixation combined with single hip plaster, including 9 males and 6 females with a mean age of 8.5 years old ranging from 5 to 14 years old. According to fracture classification of Seinsheimer, 3 cases were type IIA, 4 cases were type IIB, 3 cases were type IIC, 2 cases were type IIIA, 1 case was type IIIB, 1 case was type IV, 1 case was type V. Complications and radiographs were retrospectively reviewed. Postoperative function of hips were evaluated according to Sanders criteria.</p><p><b>RESULTS</b>All children were followed up from 16 to 48 months with an average of 32 months. No early closure of epiphysis, bone nonunion and breakage of screw occurred. According to the Sanders score standard of hip function, the result was excellent in 14 cases, good in 1 case. There were no hip inversion, limb shortening, excessive growth and other malformations.</p><p><b>CONCLUSIONS</b>External fixation combined with single hip plaster for the treatment of children is a safe and effective fixation, which provide a new choice of femoral subtrochanteric fracture.</p>

A Nipple Splint Using a Textile-Like Thermoplastic Cast

Nipples are protected by nipple splints after reconstructing or reshaping them using various materials. We have devised a nipple splint using textile-like thermoplastic tape, which is made out of knitted hybrid fabric, is latex-free, and keeps its position well beneath a brassiere with simple taping. Its conformation is readily modifiable according to each patient's breast shape, if it is soaked into hot water. A patient who underwent nipple reconstructive surgery had this thermoplastic cast applied for a month, and the contour of the nipple was well preserved without reports of skin irritation or pressure sores developing on the areola.

Driving with a short arm cast in a simulator.

PURPOSE: To test the ability to steer in a driving simulator in subjects with a short arm cast. METHODS: 17 men and 13 women aged 23 to 67 (mean, 37) years who had a valid driver's licence were randomised to the cast-first group (n=16; 7 had the cast on the dominant arm) or the cast-second group (n=14; 8 had the cast on the dominant arm) and drove in a simulator. A short arm plaster-of-Paris cast was applied in a neutral position, allowing free movement of the metacarpophalangeal joints, thumb, and elbow joint. Outcome measures included the number of driving off track instances, the number of crashes, the lap time, and the effect of hand dominance on these parameters. Subjects were asked whether the cast had impeded their steering ability. RESULTS: Subjects with or without a cast were comparable in terms of the number of driving off track instances, number of crashes, and lap time. Compared with no cast, the odds ratio (OR) of a subject in a cast driving off the track was 1.02 (p=0.921) and having a crash was 0.79 (p=0.047). All subjects were 1.23 times more likely to drive off the track in their first lap (OR=2.66, p=0.019). The mean lap time decreased for each consecutive lap from the 2nd to 5th laps. Subjects driving with a cast on the dominant or non-dominant arm were comparable. 26 out of the 30 participants considered that the plaster cast impeded their steering ability. CONCLUSION: Compared with no cast, driving with a short arm cast did not significantly decrease steering ability in a driving simulator.

Acquired localised hypertrichosis in a Chinese child after cast immobilisation.

Hypertrichosis refers to excessive hair growth that is independent of any androgen effect. Hypertrichosis could be congenital or acquired, localised or generalised. The phenomenon of acquired localised hypertrichosis following cast application for a fracture is well known to orthopaedic surgeons, but is rarely encountered by primary care physicians. We describe a 28-month-old Chinese boy who had fracture of right leg as a result of an injury. He had a cast applied by an orthopaedic surgeon as treatment. On removal of the cast 6 weeks later, he was noticed to have significant hair growth on his right leg compared with the left leg. The patient was reassessed 3 months after removal of the cast. The hypertrichosis resolved completely with time. This patient was one of the youngest among the reported cases of acquired localised hypertrichosis after cast application. We illustrate the significance of management of post-cast-acquired localised hypertrichosis in the primary care setting.

Is locking plate fixation a better option than casting for distal radius fracture in elderly people?

OBJECTIVES: To compare the outcomes of locking plate fixation versus casting for displaced distal radius fracture with unstable fracture pattern in active Chinese elderly people. DESIGN: Historical cohort study. SETTING: Orthopaedic ward and clinic at Tseung Kwan O Hospital, Hong Kong. PATIENTS: Between 1 May 2010 and 31 October 2013, 57 Chinese elderly people aged 61 to 80 years were treated either operatively with locking plate fixation (n=26) or conservatively with cast immobilisation (n=31) for unstable displaced distal radius fracture. MAIN OUTCOME MEASURES: Clinical, radiological, and functional outcomes were assessed at 9 to 12 months after treatment. RESULTS: The functional outcome (based on the quick Disabilities of the Arm, Shoulder and Hand score) was significantly better in the locking plate fixation group than in the cast immobilisation group, while clinical and radiological outcomes were comparable with those in other similar studies. CONCLUSIONS: Locking plate fixation resulted in better functional outcome for displaced distal radius fracture with unstable fracture pattern in active Chinese elderly people aged 61 to 80 years. Further prospective study with long-term follow-up is recommended.

Protótipo para realização de cranioplastia de baixo custo / Prototype for cranioplasty low cost in postoperative decompressive craniotomy

Objetivo: O presente trabalho propõe uma técnica para realização de cranioplastia com metilmetacrilato em formas pré-moldadas e esterilizadas visando evitar cranioplastia com prototipagem pré-moldada.Método: Conforme rotina apresentada, o flap ósseo realizado para craniotomia descompressiva é armazenado em recipientes com formol e enviado para o serviço de patologia do hospital. Quando realizamos a cranioplastia, utilizamos o flap ósseo armazenado para realização dos moldes que serão utilizados na cranioplastia. Resultado: O resultado estético é muito bom e os índices de complicação e infecção são baixos. Conclusão: Apresenta resultados estéticos semelhantes aos casos de prototipagemcom baixo custo na confecção.

Objective: This paper proposes a technique for cranioplasty with methyl methacrylate and molded into shapes pre-sterilized to avoid aiming cranioplasty with pre molded prototyping. Method: As presented routine bone flap performed to decompressive craniectomy is stored in containers with formalin and sent to the pathology service of the hospital. When we performed the cranioplasty, we used the bone flap stored for realization of molds that will be used in cranioplasty. Result: The aesthetic result is very good and the rates of complication and infection are lo

Splint versus plaster cast external fixator for the treatment of distal forearm buckle fracture in children:systematic review / 中国组织工程研究

BACKGROUND:The distal forearm buckle fracture in children has no secondary displacement risk, and the literatures have reported that the fracture can be treated with external fixators of plaster cast, palm side plate, splint, brace and bandage, and obtain good effect. But different external fixators have different effects on the functional recovery and viability. OBJECTIVE:To assess the clinical efficacy and safety of splint versus plaster cast for the treatment of distal forearm buckle fracture in Children. METHODS: The Medline database, Embase database, Cochrane Library, CNKI database and CBM database were searched from the database establishment to April 2011 with the computer;the relative conference papers were hand searched;the Important Clinical Trial Register was searched online without limitation of language. Randomized control ed trials and quasi-randomized control trials were selected for quality evaluation, and the Meta-analysis was performed with Revman 5.1. RESULTS AND CONCLUSION:Two published trials including a total of 314 patients were included, and one randomized control ed trial was evaluated as B scale, another one quasi-randomized control trial was evaluated as C scale. The results demonstrate that no fracture, un-union or re-fracture occurred after treated with splint and plaster case external fixator, and there were no significant differences in pain scores as wel as the daily activities of writing, drawing, self-eating and washing;while the early bathing ability of the patients in the splint group was earlier than that in the plaster cast group, and had no significant difference in the advanced bathing ability. The regular exercise participation in the splint group was better than that in the plaster cast group. There were no significant differences in the incidence of adverse events between two groups. The results indicate that the pain score of the patients with distal forearm buckle fracture in children do not improved after treated with splint and plaster cast, but splint fixation is better than plaster cast fixation in maintaining the batching and regular exercise participation ability with good safety. But the wel-designed and implement large sample and multi-center randomized control ed trials are needed for validation.

Calamine lotion to reduce skin irritation in children with cast immobilisation.

PURPOSE. To evaluate the effect of calamine lotion in reducing skin irritation in children with cast immobilisation and to identify factors correlating with skin irritation. METHODS. 250 children aged 6 to 15 years who underwent cast immobilisation for limb fractures were assigned into calamine (n=122) and non-calamine (n=128) groups. Data were collected at the time the cast was applied and removed. Potential confounders (gender, age, race, medical history, drug allergy, cast type, duration of casting, and extent of itch prior to casting) were identified. Each patient graded his levels of itch, sweat, and heat using a 5-point scale (with 5 indicating most severe). The on-duty plaster technician recorded the presence and type of skin lesions (blisters, wounds, or others) during cast removal. RESULTS. Children in the calamine group were less likely to develop skin lesions (1 vs. 9, odds ratio [OR]=0.115, p=0.009), had less itch during casting (mean difference=0.74, p<0.0001), had a greater decrease in the itch level (mean difference=0.84, p<0.0001), and had lower sweat levels (p=0.048). After adjusting for confounders, the chance of developing skin lesions remained lower in the calamine group (OR=0.063, p=0.003). Being an older child and having shorter duration of casting were associated with presence of skin lesions. The odds for having skin lesions increased by 39.2% per year increase in age (OR=1.392, p=0.04) and decreased by 9.4% per day increase in casting duration (OR=0.906, p=0.03). The decrease in itch level remained significantly greater in the calamine group after adjusting for confounders (p<0.0001). CONCLUSION. Calamine lotion may reduce skin irritation in children with full casts.

Treatment options of unstable distal radial fractures in elderly patients / 中华老年医学杂志

Objective To study the advantage and disadvantage of different treatments of unstable distal radial fractures in elderly patients. Methods In the period from August 2005 to January 2010, 55 elderly patients with unstable d istal radial fractures were treated with manual diaplasis and external plaster splint fixation, operation and internal plate fixation, or external fixation. Clinical outcomes were evaluated by Gartland-Werley wrist scoring systems and questionnaire of the disabilities of the Arm, Shoulder and Hand (DASH). We used SPSS13.0 software package for statistical analysis. Results Compared with the manual diaplasis group, the operation and internal plate fixation group or external fixation group was better in Gartland-Werley scores, the differences were statistically significant (P<0.05), but there were no differences in DASH scores among the 3 groups. Conclusions The treatment of unstable distal radial fractures in elderly patients should be chosen based on the characteristics of the fractare and patients desire.