{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T09:14:51Z","timestamp":1792746891715,"version":"4.5.0"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Casting is recommended for adults older than 65 years with distal radius fractures (DRFs) because similar long-term outcomes are achieved regardless of treatment. However, physiologically younger adults could benefit from operative DRF management despite advanced chronologic age.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine how chronologic age compares with measures of physiologic age in DRF treatment recovery.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST) was performed from May 1 to August 31, 2022. WRIST was a 24-center randomized clinical trial that enrolled participants older than 60 years with unstable DRFs from April 1, 2012, to December 31, 2016.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Participants selected casting or surgery. Patients who selected surgery were randomly assigned to volar lock plating, percutaneous pinning, or external fixation. Participants were stratified by chronologic age, number of comorbidities, and activity status.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) score assessed at 6 weeks, 3 months, 6 months, and 1 year. Partial correlation (PC) analysis adjusted for confounding.<\/jats:p><\/jats:sec>Results<\/jats:title>The final cohort consisted of 293 participants (mean [SD] age, 71.1 [8.89] years; 255 [87%] female; 247 [85%] White), with 109 receiving casting and 184 receiving surgery. Increased chronologic age was associated with increased MHQ scores in the surgery group at all time points but decreased MHQ scores in the casting group at 12 months (mean [SD] score, \u22120.46 [0.21]; P<\/jats:italic>\u2009=\u2009.03). High activity was associated with improved MHQ scores in the surgical cohort at 6 weeks (mean [SD] score, 12.21 [5.18]; PC\u2009=\u20090.27; P<\/jats:italic>\u2009=\u2009.02) and 12 months (mean [SD] score, 13.25 [5.77]; PC\u2009=\u20090.17; P<\/jats:italic>\u2009=\u2009.02). Comorbidities were associated with decreased MHQ scores at all time points in the casting group. Clinically significant differences in MHQ scores were associated with low physical activity, 4 or more comorbidities, or increased age by 15 years.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this retrospective secondary analysis of WRIST, chronologic age was not associated with functional demand. These findings suggest that physicians should counsel active older adults with few comorbidities on earlier return to daily activities after surgery compared with casting.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT01589692<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.55786","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T16:01:49Z","timestamp":1676304109000},"page":"e2255786","source":"Crossref","is-referenced-by-count":45,"title":["Comparison of Distal Radius Fracture Outcomes in Older Adults Stratified by Chronologic vs Physiologic Age Managed With Casting vs Surgery"],"prefix":"10.1001","volume":"6","author":[{"given":"Mayank","family":"Jayaram","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wu","sequence":"additional","affiliation":[{"name":"University of Michigan School of Public Health, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred P.","family":"Yoon","sequence":"additional","affiliation":[{"name":"Section of Plastic Surgery, Department of Surgery, University of Michigan Hospital, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Kane","sequence":"additional","affiliation":[{"name":"Section of Plastic Surgery, Department of Surgery, The Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[{"name":"University of Michigan School of Public Health, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,2,13]]},"reference":[{"issue":"2","key":"zoi221587r1","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.hcl.2012.02.001","article-title":"The epidemiology of distal radius fractures.","volume":"28","author":"Nellans","year":"2012","journal-title":"Hand Clin"},{"issue":"3","key":"zoi221587r2","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1359\/jbmr.061113","article-title":"Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025.","volume":"22","author":"Burge","year":"2007","journal-title":"J Bone Miner Res"},{"issue":"46","key":"zoi221587r3","doi-asserted-by":"publisher","first-page":"779","DOI":"10.3238\/arztebl.2014.0779","article-title":"The treatment of displaced intra-articular distal radius fractures in elderly patients.","volume":"111","author":"Bartl","year":"2014","journal-title":"Dtsch Arztebl Int"},{"issue":"3","key":"zoi221587r4","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1001\/jamasurg.2020.5672","article-title":"Surgical plating vs closed reduction for fractures in the distal radius in older patients: a randomized clinical trial.","volume":"156","author":"Lawson","year":"2021","journal-title":"JAMA Surg"},{"issue":"1","key":"zoi221587r5","doi-asserted-by":"publisher","first-page":"e1919433","DOI":"10.1001\/jamanetworkopen.2019.19433","article-title":"Assessment of anatomic restoration of distal radius fractures among older adults: a secondary analysis of a randomized clinical trial.","volume":"3","author":"Chung","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"6","key":"zoi221587r6","doi-asserted-by":"publisher","first-page":"1054e","DOI":"10.1097\/PRS.0000000000006829","article-title":"The wrist and radius injury surgical trial: 12-month outcomes from a multicenter international randomized clinical trial.","volume":"145","author":"Chung","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"2","key":"zoi221587r8","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1177\/1558944717691133","article-title":"Distal radius fractures: AAOS appropriate use criteria versus actual management at a level I trauma center.","volume":"13","author":"Kyriakedes","year":"2018","journal-title":"Hand (N Y)"},{"issue":"8","key":"zoi221587r9","doi-asserted-by":"publisher","first-page":"506","DOI":"10.5435\/JAAOS-21-08-506","article-title":"AAOS appropriate use criteria: treatment of distal radius fractures.","volume":"21","author":"Hammert","year":"2013","journal-title":"J Am Acad Orthop Surg"},{"issue":"7","key":"zoi221587r10","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1001\/jamasurg.2022.0810","article-title":"Physiologic vs chronologic age for distal radius fracture treatment.","volume":"157","author":"Chung","year":"2022","journal-title":"JAMA Surg"},{"issue":"19","key":"zoi221587r11","first-page":"1","article-title":"United States life tables, 2019.","volume":"70","author":"Arias","year":"2022","journal-title":"Natl Vital Stat Rep"},{"issue":"3","key":"zoi221587r12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003936","article-title":"A comparison over 2 decades of disability-free life expectancy at age 65 years for those with long-term conditions in England: analysis of the 2 longitudinal Cognitive Function and Ageing Studies.","volume":"19","author":"Bennett","year":"2022","journal-title":"PLoS Med"},{"issue":"5","key":"zoi221587r13","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1016\/j.jhsa.2011.02.005","article-title":"A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly.","volume":"36","author":"Diaz-Garcia","year":"2011","journal-title":"J Hand Surg Am"},{"issue":"8","key":"zoi221587r14","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1016\/j.jhsa.2016.05.015","article-title":"Distal radius fractures: approaches, indications, and techniques.","volume":"41","author":"Alluri","year":"2016","journal-title":"J Hand Surg Am"},{"issue":"6","key":"zoi221587r15","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1016\/j.jhsa.2008.02.016","article-title":"Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years.","volume":"33","author":"Chung","year":"2008","journal-title":"J Hand Surg Am"},{"issue":"8","key":"zoi221587r16","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/j.jhsa.2018.05.029","article-title":"Use of a 5-Item Modified Frailty Index for risk stratification in patients undergoing surgical management of distal radius fractures.","volume":"43","author":"Wilson","year":"2018","journal-title":"J Hand Surg Am"},{"issue":"4","key":"zoi221587r17","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1177\/1558944717751194","article-title":"Treatment trends, complications, and effects of comorbidities on distal radius fractures.","volume":"14","author":"Mosenthal","year":"2019","journal-title":"Hand (N Y)"},{"issue":"5","key":"zoi221587r18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0232684","article-title":"Pre-injury activity predicts outcomes following distal radius fractures in patients age 60 and older.","volume":"15","author":"Hooper","year":"2020","journal-title":"PLoS One"},{"issue":"4","key":"zoi221587r19","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1097\/BOT.0000000000000235","article-title":"The impact of patient activity level on wrist disability after distal radius malunion in older adults.","volume":"29","author":"Nelson","year":"2015","journal-title":"J Orthop Trauma"},{"issue":"4","key":"zoi221587r20","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/S0363-5023(98)80042-7","article-title":"Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.","volume":"23","author":"Chung","year":"1998","journal-title":"J Hand Surg Am"},{"issue":"11","key":"zoi221587r21","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1002\/acr.20274","article-title":"Validity and responsiveness of the Michigan Hand Questionnaire in patients with rheumatoid arthritis: a multicenter, international study.","volume":"62","author":"Waljee","year":"2010","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"1","key":"zoi221587r22","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.jhsa.2004.10.006","article-title":"Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder and Hand questionnaire in carpal tunnel surgery.","volume":"30","author":"Kotsis","year":"2005","journal-title":"J Hand Surg Am"},{"issue":"4","key":"zoi221587r23","doi-asserted-by":"publisher","first-page":"558e","DOI":"10.1097\/PRS.0000000000008317","article-title":"Using rasch analysis to validate the Michigan Hand Outcomes Questionnaire from the Wrist and Radius Injury Surgical Trial.","volume":"148","author":"Jayaram","year":"2021","journal-title":"Plast Reconstr Surg"},{"key":"zoi221587r24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jht.2021.06.003","article-title":"Determining the Minimally Important Change of the Michigan Hand outcomes Questionnaire in patients undergoing trigger finger release.","author":"Koopman","year":"2021","journal-title":"J Hand Ther"},{"issue":"4","key":"zoi221587r25","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.jhsa.2013.01.022","article-title":"The minimal clinically important difference after simple decompression for ulnar neuropathy at the elbow.","volume":"38","author":"Malay","year":"2013","journal-title":"J Hand Surg Am"},{"issue":"3","key":"zoi221587r26","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1097\/PRS.0000000000000034","article-title":"Determining the Michigan Hand Outcomes Questionnaire minimal clinically important difference by means of three methods.","volume":"133","author":"London","year":"2014","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"zoi221587r27","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.jhsa.2008.11.001","article-title":"The minimal clinically important difference of the Michigan hand outcomes questionnaire.","volume":"34","author":"Shauver","year":"2009","journal-title":"J Hand Surg Am"},{"issue":"4","key":"zoi221587r28","first-page":"A118","article-title":"The Rapid Assessment of Physical Activity (RAPA) among older adults.","volume":"3","author":"Topolski","year":"2006","journal-title":"Prev Chronic Dis"},{"issue":"2","key":"zoi221587r29","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1002\/art.10993","article-title":"The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research.","volume":"49","author":"Sangha","year":"2003","journal-title":"Arthritis Rheum"},{"issue":"4","key":"zoi221587r30","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1213\/ANE.0000000000004373","article-title":"Two-sample unpaired t tests in medical research.","volume":"129","author":"Schober","year":"2019","journal-title":"Anesth Analg"},{"issue":"2","key":"zoi221587r31","doi-asserted-by":"publisher","first-page":"152","DOI":"10.5395\/rde.2017.42.2.152","article-title":"Statistical notes for clinical researchers: chi-squared test and Fisher\u2019s exact test.","volume":"42","author":"Kim","year":"2017","journal-title":"Restor Dent Endod"},{"issue":"11","key":"zoi221587r32","first-page":"E537","article-title":"Longitudinal studies.","volume":"7","author":"Caruana","year":"2015","journal-title":"J Thorac Dis"},{"issue":"3","key":"zoi221587r33","first-page":"69","article-title":"Statistics corner: a guide to appropriate use of correlation coefficient in medical research.","volume":"24","author":"Mukaka","year":"2012","journal-title":"Malawi Med J"},{"issue":"2","key":"zoi221587r34","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.jamcollsurg.2017.11.005","article-title":"New 5-Factor Modified Frailty Index using American College of Surgeons NSQIP data.","volume":"226","author":"Subramaniam","year":"2018","journal-title":"J Am Coll Surg"},{"issue":"1","key":"zoi221587r36","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002085","article-title":"Implications of aging in plastic surgery.","volume":"7","author":"Roh","year":"2019","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"3","key":"zoi221587r37","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1111\/jgs.13332","article-title":"Chronic wound repair and healing in older adults: current status and future research.","volume":"63","author":"Gould","year":"2015","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"zoi221587r38","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.fsc.2011.04.003","article-title":"Aging skin: histology, physiology, and pathology.","volume":"19","author":"Khavkin","year":"2011","journal-title":"Facial Plast Surg Clin North Am"},{"issue":"3","key":"zoi221587r39","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1007\/s00268-003-7397-6","article-title":"Aging and wound healing.","volume":"28","author":"Gosain","year":"2004","journal-title":"World J Surg"},{"issue":"5","key":"zoi221587r40","doi-asserted-by":"publisher","first-page":"878","DOI":"10.3390\/ijerph15050878","article-title":"Exercise early and often: effects of physical activity and exercise on women\u2019s bone health.","volume":"15","author":"Troy","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"zoi221587r41","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1186\/s12877-022-03119-y","article-title":"Older adults\u2019 perspectives on rehabilitation and recovery one year after a hip fracture\u2014a qualitative study.","volume":"22","author":"Karlsson","year":"2022","journal-title":"BMC Geriatr"},{"key":"zoi221587r7","unstructured":"American Academy of Orthopaedic Surgeons. Management of distal radius fractures evidence-based clinical practice guideline. 2020. Accessed January 5, 2023. https:\/\/www.aaos.org\/globalassets\/quality-and-practice-resources\/distal-radius\/drfcpg.pdf"},{"key":"zoi221587r35","unstructured":"World Health Organization. WHO Methods and Data Sources for Life Tables 1990-2019. Dept of Data and Analytics, World Health Organization; December 2020. Accessed January 5, 2023. https:\/\/www.who.int\/docs\/default-source\/gho-documents\/global-health-estimates\/ghe2019_life-table-methods.pdf?sfvrsn=c433c229_5"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2801347\/jayaram_2023_oi_221587_1675372731.93986.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T16:01:58Z","timestamp":1676304118000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2801347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,13]]},"references-count":41,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.55786","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,13]]}}}