Purpose: A paucity of evidence exists regarding the optimal treatment of open fractures of the distal radius. The purpose of this study was to compare short-term complication rates between various treatment options following open fractures of the distal radius.
Methods: We performed a retrospective review of all open fractures of the distal radius at a single level 1 trauma center over a 10-year period. The primary outcome measure was the number of minor and major complications. Demographic and clinical characteristics of patients across treatment and outcome groups were compared and models were used to describe the relationships between outcome and treatment.
Results: Ninety patients met the inclusion criteria for evaluation. An even distribution between high-energy (n = 45) and low-energy (n = 45) injuries was seen with 61 fractures Gustilo I (67%), 19 Gustilo II (22%), and 10 Gustilo III (11%). The majority of fractures were intra-articular (n = 48 AO type C vs n = 42 AO type A/B). Fractures were treated with immediate open reduction internal fixation (ORIF) in 67 cases (74%), external fixation in 12 (13%), initial external fixation followed by ORIF at a later time in 8 (9%), or closed reduction and percutaneous pinning in 3 (4%). We observed 33 complications (37%) of which 24 were major and 9 minor. Mechanism of injury and type of treatment were the only variables shown to correlate with an increased rate of complications.
Conclusions: We conclude that open fractures of the distal radius treated by immediate ORIF at the time of index debridement can result in satisfactory outcomes compared with other forms of treatment.
Type of study/level of evidence: Therapeutic IV.
Keywords: Distal radius fracture; open fracture; treatment.
Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Conversion of External Fixation to Open Reduction and Internal Fixation for Complex Distal Radius FracturesRM Natoli et al. Orthop Traumatol Surg Res 102 (3), 339-43. PMID 27026500.In total, 16 patients were identified, only one of which developed an infection following conversion to ORIF. Fisher's exact testing showed that infection did not depend …
Adolescent Distal Humerus Fractures: ORIF Versus CRPPP Bell et al. J Pediatr Orthop 37 (8), 511-520. PMID 26683504.Closed reduction and pinning of extra-articular distal humerus fractures in adolescents resulted in predictable clinical and radiographic outcomes and allowed for earlier …
Complications Following Open Reduction and Internal Fixation Versus External Fixation in Treating Unstable Distal Radius Fractures: Grading the Evidence Through a Meta-AnalysisZZ Yuan et al. Orthop Traumatol Surg Res 104 (1), 95-103. PMID 29031702. - Meta-AnalysisSixteen studies that included a total of 1280 patients met the inclusion criteria. Compared with ORIF, EF results in higher incidence of total complications, infection an …
External Fixation Versus Open Reduction With Plate Fixation for Distal Radius Fractures: A Meta-Analysis of Randomised Controlled TrialsJ Esposito et al. Injury 44 (4), 409-16. PMID 23298757. - ReviewORIF with plate fixation provides lower DASH scores, better restoration of radial length and reduced infection rates as compared to external fixation for treatment of dis …
Arthroscopically Assisted Versus Standard Open Reduction and Internal Fixation Techniques for the Acute Ankle FractureTA Gonzalez et al. Foot Ankle Int 37 (5), 554-62. PMID 26660864. - ReviewAnkle arthroscopy is a valuable tool in identifying and treating intra-articular lesions associated with ankle fractures. The presence of such intra-articular pathology m …