Nonoperative Management Is Associated With an Increased Risk of Adverse Mental Health Conditions in Elderly Patients With Distal Radius Fractures: A Retrospective Cohort Analysis

Abstract

Background: Previous research comparing operative versus nonoperative management of distal radius fractures in elderly patients has reported similar functional outcomes, leaving treatment decisions controversial. However, limited studies have analyzed how these approaches impact the mental well-being of patients. The purpose of this study is to compare the incidence of mental health conditions during the 1-year post-injury period following operative and nonoperative treatment. Methods: A retrospective query of the TriNetX database identified patients 65 years and older with distal radius fractures who underwent open reduction with internal fixation (ORIF) within 1 month of diagnosis. These patients were 1:1 propensity score matched to a cohort treated nonoperatively with closed reduction for demographic factors and confounding comorbidities. Mental health outcomes within 1 year post-fracture were analyzed. Results were calculated as risk percentages, risk ratios (RRs), 95% confidence intervals (CIs), and P values. Results: Patients undergoing ORIF had a significantly lower risk of major depressive disorder (MDD) (1.7% vs 2.2%; RR, 0.78; 95% CI, 0.66-0.93; P = .01), selective serotonin reuptake inhibitor (SSRI) use (3.1% vs 4.0%; RR, 0.79; 95% CI, 0.69-0.90; P < .01), and opioid dependence (0.1% vs 0.2%; RR, 0.48; 95% CI, 0.27-0.88; P = .01) compared to the nonoperative cohort. There was no significant difference in the risk of depressive episodes, generalized anxiety disorder, or alcohol dependence. Conclusions: Operative fixation of closed distal radius fractures in elderly patients is associated with a lower incidence of new-onset perioperative mental health conditions, including MDD, SSRI use, and opioid dependence, compared with nonoperative treatment.