Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures

Abstract

Background: Surgeons are sometimes presented with patients with distal radius fractures who present in a delayed fashion or lose reduction after several weeks of attempted closed management. There are limited studies on delayed surgical treatment of distal radius fractures to assist providers in decision-making. Methods: We conducted a matched cohort study to compare radiographic outcomes and complications for patients with a distal radius fracture treated with delayed (3-5 weeks) or early (0-2 weeks) surgical fixation. Patients ages 18+ who underwent open reduction and internal fixation of distal radius fractures by a volar approach at 2 Level I trauma centers between 2003 and 2015 were eligible. We measured radiographic outcomes and reviewed medical records to determine operative approach and complications. Results: There were 25 cases and 50 controls matched for age (18-87), sex, and AO fracture type. The delayed group had surgery at a mean of 24.8 days from injury and the early group at 5.6 days. There was no statistically significant difference between the delayed and early cohorts in radiographic parameters on injury x-rays, in improvement in radiographic parameters on first postoperative x-rays, or in maintenance of radiographic parameters at union. Conclusion: We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. Providers treating patients with late presentation or late displacement have the option of surgical fixation beyond the first few weeks after injury. Level of Evidence: III (Retrospective matched cohort study)

Does Time to Imaging and Surgery for Distal Radius Fractures Vary based on Geographic Socioeconomic Disadvantage?

“…19 However, longterm outcomes may be comparable for immediate versus delayed surgery for either open or closed DRFs. 26,27,40 Despite similar long-term clinical outcomes, patients must be given equitable access to acute fracture surgery, as governed by the medical ethical principle of justice and importance of timely fracture treatment for subjective patient well-being. Early operative fixation means earlier functional rehabilitation and reduction of immobilization time, thereby having a lesser effect on the patient's psychological health and disturbance of their daily lives.…”

“…19 However, long-term outcomes may be comparable for immediate versus delayed surgery for either open or closed DRFs. 26,27,40…”

“…[8][9][10]13,14 DRFs are one of the most common fractures in adults, and previous studies have illustrated the importance of timely repair of upper extremity long bone fractures. 17,18 While long-term outcomes for DRF do not appear to be affected by delayed surgery, 26,27 patients see better short-term outcomes with earlier fixation. 19 Evaluation of how community-level socioeconomic disadvantage impacts management of operative DRFs may provide insight on important structural, large-scale targets for disparity interventions.…”

New Research on Distal Radius Fractures

“…[2][3][4][5] The fracture pattern, surgeon preference and experience, and the literature orientation in any point in time guide hand surgeons in the management of distal radius fractures. [11][12][13][14][15][16] The evidence for best practice needs to be regularly updated through scientific rigor and peer review, a process that has survived the test of time in the surgical world. For this reason, HAND has dedicated a supplemental issue to the research in distal radius fractures highlighting current trends, techniques, and outcomes for hand surgeon's interpretation and resolution in their quest to provide the best possible prevailing care for their patients.…”