Volar Locking Plate Fixation for Distal Radius Fractures in Hemodialysis Patients

Abstract

Purpose: Although the possibility of distal radius fractures is strong in hemodialysis patients, there are many difficult problems such as the bleeding tendency, hypervascularity and injury to arteriovenous fistula. We studied the outcomes of open reduction and volar locking plate fixation of the distal radius fractures in hemodyalisis patients with ipsilateral arteriovenous fistula. Methods:From 2007 to 2009, a retrospective chart review was performed of eleven hemodialysis patients who underwent volar locking plate fixation for treatment of distal radius fractures. Eight of them were female and three were male and mean age was 68 years (range, 57-81 years). Mean follow-up period was 19 months (range, 12-28 months). All patients had osteoporosis with mean T-score of -2.7. All operations were performed on the next day of hemodialysis.Scheduled hemodialysis was possible on the next day of surgery without splint.We analyzed radiographic results, the wrist range of motion, Mayo wrist score and disabilities of the arm, shoulder and hand (DASH) score at the last follow-up.Results: All fractures achieved anatomical reduction and united at final followup. Complications such as hematoma or occlusion of arteriovenous fistula were not observed. Mean Mayo wrist score was 78 and mean DASH score was 22.Conclusion: Volar locking plate fixation for distal radius fractures provides immediate support for continuing hemodialysis and exercise. Open reduction of the fractures and the use of tourniquet don't seem to increase the vascular complications like hematoma and fistula occlusion.

Fracture Management in Chronic Kidney Disease: Challenges and Considerations for Orthopedic Surgeons

“…The authors 51) suggested that meticulous hemostasis without a tourniquet may be appropriate in patients with an ipsilateral AVF. On the other hand, Im et al 52) reported on treating 11 cases of DRF with volar plating, in which tourniquets were used during all surgeries; however, no complications such as hematoma or fistula occlusion were observed. Additionally, Hyatt et al 53) suggested that dorsal bridge plate fixation may be the optimal treatment for patients with an ipsilateral AVF, multiple comorbidities, osteoporotic bone, and a need for immediate weight-bearing.…”