Is Time Truly of the Essence? Outcomes of Open Distal Radius Fracture Management

Abstract

BACKGROUND: The standard of care of open distal radius fractures is urgent irrigation and debridement along with operative fixation. Herein, we investigate if open distal radius fractures (ODRF) treated after 24 hours from time of injury have an increased risk of infection or overall complication profile compared to open distal radius fractures treated urgently. METHODS: An IRB-approved retrospective chart review was performed of all patients treated for ODRF over a 6-year period at an academic institution in a large metropolitan city. Post-operative complications included: surgical site infections, need for revision irrigation and debridement, delayed soft tissue healing, loss of reduction, non-union, and malunion. For statistical analyses, nominal data were compared for distributional equality between complication dichotomy via Pearson chi-square or Fisher’s exact test depending on sample size distribution. Ordinal data were tested for ordinal association via exact Kendall’s tau test. Rank equivalency between complication dichotomy was determined for numeric data via Mann-Whitney U tests. All statistical tests were two-sided with p<0.05 considered statistically significant. RESULTS: Ninety-four patients were treated for ODRF with 62% female and 38% male patients included in the cohort. The mean (SD) age at time of injury was 58.6 (17.41) years. Notably, 28% of patients had a history of smoking. Overall, there were 16 patients (16.8%) with post-operative complications: 2 infections, 8 re-operations, 4 wound healing complications, 2 loss of reductions, 7 non-unions, and 1 malunion. Regarding energy and mechanism of injury, 74.4% had a low energy injury and 26.6% had a high energy injury, and this was not statistically significant for any post-operative complications (0.352). Likewise, age (p = 0.197) and fracture grade (p = 0.068) were not statistically significant factors for any surgical complications. The overwhelming majority of patients were treated with irrigation, debridement, and ORIF with volar locking plates. The mean (SD) open wound size was 1.6 (1.66) cm, ulnar sided, and did not correlate with any post-operative complications (p = 0.093). The mean (SD) time from injury presentation to the ER to the first dose of intravenous antibiotics was 4.7 (14.88) hours, and was not statistically significant for any post-operative complications (p = 0.186). The mean (SD) time from presentation to the ER to operative treatment was 19.1 (30.57) hours, and was not statistically significant for the presence of any post-operative complications (p = 0.092). There were 11 patients (11.7%) treated greater than 24 hours after presentation to the ER, which was not significantly distinct from those treated prior to 24 hours (p=1.000). CONCLUSION: Patients with open distal radius fractures treated after 24 hours did not have a greater risk of post-operative complications, including surgical site infections and non-union. Regarding factors that may influence urgent treatment, age, energy and mechanism of injury, and fracture grade were all not statistically significant for any post-operative complications in ODRF management.