Abstract
BackgroundWe evaluated the effects on arteriovenous fistula (AVF) function and clinical outcomes in patients given cast fixation, external skeletal fixation [ESF], or volar locking plate fixation [VLPF] for an ipsilateral distal radial fracture (DRF).MethodsThirteen patients were assigned to the surgery group or the cast group; follow-up was ≥12 months. One-year clinical outcomes and serial AVF function and radiographic outcomes were recorded and analyzed.ResultsAll fractures were union and all AVFs were preserved with continuous hemodialysis. The surgery group had better immediately (radial inclination and articular step-off) and 1-year post-index procedure radiographic findings (radial height, radial inclination, volar tilting, ulnar variance, and articular step-off) and better 1-year functional outcomes (Mayo and QuickDASH score) than did the cast group. The VLPF subgroup had better QuickDASH scores and radiographic outcomes (radial inclination and ulnar variance) than did the ESF subgroup.ConclusionsOne year after the index procedure, none of the treatment affected shunt function in DRFs ipsilateral to AVFs. ESF and VLPF yielded better functional and radiographic outcomes than did cast fixation in patients with ipsilateral DRFs and AVFs.Level of EvidenceIII
Highlights
We evaluated the effects on arteriovenous fistula (AVF) function and clinical outcomes in patients given cast fixation, external skeletal fixation [ESF], or volar locking plate fixation [Volar locking plate fixation (VLPF)] for an ipsilateral distal radial fracture (DRF)
Upper extremity fractures ipsilateral to an arteriovenous fistula (AVF) in hemodialysis patients are not rare [1]
Few case series have reported the clinical outcomes of surgical repair for distal radial fracture (DRF) ipsilateral to an AVF [1, 2]
Summary
We evaluated the effects on arteriovenous fistula (AVF) function and clinical outcomes in patients given cast fixation, external skeletal fixation [ESF], or volar locking plate fixation [VLPF] for an ipsilateral distal radial fracture (DRF). Few case series have reported the clinical outcomes of surgical repair for distal radial fracture (DRF) ipsilateral to an AVF [1, 2]. In addition to cast fixation, surgical repairs—volar locking plate fixation (VLPF) and external skeletal fixation (ESF)—are feasible treatment options. Our search of the literature showed that no published study has compared the effects of VLPF, cast fixation, or ESF on ipsilateral AVF function. We evaluated the effects of VLPF, cast fixation, and ESF on ipsilateral AVF function and clinical outcomes. We hypothesized that surgical treatment would provide better clinical and radiographic outcomes in this population
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