Surgical Outcomes Following Fixation of Peri-Implant Distal Radius Fractures: A Case Series

J Hand Surg Am. 2022 Feb;47(2):192.e1-192.e6. doi: 10.1016/j.jhsa.2021.04.016. Epub 2021 Jun 10.

Abstract

Purpose: The purpose of this study was to evaluate surgical outcomes following fixation of peri-implant distal radius fractures.

Methods: A retrospective chart review was conducted of peri-implant distal radius fractures treated surgically at a large academic practice over 18 years. Patients were included if they had previously undergone open reduction and internal fixation of a distal radius fracture; subsequently sustained a fracture at, or adjacent to, the existing hardware; and then undergone revision fixation with the removal of hardware. Fractures were categorized into 3 groups: type A (distal to the implant), type B (at the level of the implant), and type C (proximal to the implant). Outcomes, including range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, and radiographic alignment, were recorded at the latest follow-up visit.

Results: Twelve peri-implant distal radius fractures that had undergone revision surgical fixation were identified. At the time of injury, the average patient age was 63 years. Ten occurred around a volar plate, 1 occurred around an intramedullary device, and 1 occurred around a dorsal plate. One fracture occurred proximal to previous hardware (type C), 9 fractures occurred at the level of previous hardware (type B), and 2 fractures occurred distal to previous hardware (type A). The median time from initial fixation to peri-implant fracture was 2.7 years. At a mean follow-up of 6 months after the removal of the hardware and revision fixation, radiographic alignment was within acceptable parameters for all injuries. At the final follow-up, the average wrist motion for flexion, extension, supination, and pronation were 66°, 66°, 83°, and 86°, respectively. The average DASH score was 6.7. Three patients experienced complications.

Conclusions: Although peri-implant fractures are infrequent complications following distal radius fracture internal fixation, outcomes of surgically treated peri-implant distal radius fractures are satisfactory with respect to radiographic alignment, range of motion, and function.

Type of study/level of evidence: Therapeutic IV.

Keywords: Distal radius; fracture; hardware; outcomes; peri-implant.

MeSH terms

  • Bone Plates
  • Fracture Fixation, Internal / methods
  • Humans
  • Middle Aged
  • Periprosthetic Fractures*
  • Radius Fractures* / complications
  • Radius Fractures* / diagnostic imaging
  • Radius Fractures* / surgery
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome
  • Wrist Joint