Outcomes of Staged Treatment for Complex Distal Radius Fractures

Abstract

IntroductionDistal radius fractures are common, but the results and complications of treatment with early external fixation and staged open reduction internal fixation have not been previously reported.Materials and methodsPatients who received staged distal radius fracture treatment from 1/1/2008 to 12/31/2015 at the University of Alabama at Birmingham were identified. Patient, injury, and treatment characteristics, as well as complications, were collected from the medical record.ResultsThere were 50 fractures in 47 patients, with mean follow-up of 9.3 months. Thirty-eight were open and 45 were intra-articular. For definitive treatment, 41 received a volar approach and nine a dorsal approach. Twenty wrists experienced one or more complications, including two non-unions. Five patients developed infections – one Kirschner wire site infection, one external fixator (ex-fix) pin site infection, and three deep infections. All deep infections occurred in tobacco users. The rate of deep infection with volar approach was 2.4%, compared to 22.2% with dorsal approach. Ex-fix pin sites overlapped radiographically with the plate in 20 fractures, with three deep infections in this group (15%) and no deep infections in the group without overlap. None of these differences reached statistical significance.ConclusionsThis protocol results in reliable healing of complex fractures, with a 96% union rate. However, 40% sustained complications. We conclude that this protocol is useful for temporizing complex fractures but caution that the complication rate is high. Since recent literature indicates that low-grade open distal radius fractures do not require emergent debridement and that immediate internal fixation is safe, complications might be avoided by restricting this protocol to complex or physiologically unstable patients.

Risk factors for surgical site infection after surgical treatment of closed distal radial fractures

“…In fact, every patient with a diagnosis of diabetes who developed an SSI had poor glycaemic control (HbA1c >7) in the perioperative period. The current literature corroborates our findings that a diagnosis of diabetes alone is not clearly associated with SSI after surgery on distal radial fractures (Ficke et al., 2018; Koehler et al., 2015; Zumsteg et al., 2014). In the preoperative assessment of risk of SSI in patients, it is probably more valuable to measure the level of glycaemic control than to classify them simply as diabetic versus non-diabetic.…”

“…In a recent study of 417 distal radial fractures by Hess et al (2020), smoking was not found to be associated with SSI, although it was associated with other complications. In a study of 50 distal radial fractures treated in a staged manner by Ficke et al (2018), more infections occurred in smokers but the results were not statistically significant.…”

“…In addition to SSIs that met NSQIP criteria, we also included infections at the pin-site. While these infections do not meet NSQIP criteria, they are typically included in studies of infection after hand and wrist surgery (Ahlborg and Josefsson, 1999; Egol et al., 2006; Ficke et al., 2018; Hammer et al., 2019; Hargreaves et al., 2004; Margaliot et al., 2005; Rozental et al., 2002) and may alter the course of treatment, leading to antimicrobial treatment or early pin removal.…”

“…However, the influence of other factors is less clear. In addition, although tobacco use and diabetes have both been shown to be risk factors for SSI in other orthopaedic operations, neither has been clearly associated with SSI after surgical treatment of distal radial fractures (Ficke et al., 2018; Koehler et al., 2015; Zumsteg et al., 2014). The aim of the present study was to clarify the role of various potential risk factors for SSI after distal radial fractures treated surgically.…”

Complex distal radius fracture (CDRF) with median nerve injury management using one-stage distraction bridge plate fixation (DBPF) without nerve exploration allows nerve function recovery: a case report

“…CDRFs are high-energy injuries with severe articular disruption, high degrees of comminution, ligamentous instability, and neurovascular injury. 4, 5 Neurological complications are rarely accompanied by distal fracture radius, yet median nerve injury has been reported in 5% to 7% of cases of this fracture. 6 Direct injury of the median nerve after distal radius fracture is unusual.…”