Abstract
IntroductionDistal radius fractures are common, but the results and complications of treatment with early external fixation and staged open reduction internal fixation have not been previously reported.Materials and methodsPatients who received staged distal radius fracture treatment from 1/1/2008 to 12/31/2015 at the University of Alabama at Birmingham were identified. Patient, injury, and treatment characteristics, as well as complications, were collected from the medical record.ResultsThere were 50 fractures in 47 patients, with mean follow-up of 9.3 months. Thirty-eight were open and 45 were intra-articular. For definitive treatment, 41 received a volar approach and nine a dorsal approach. Twenty wrists experienced one or more complications, including two non-unions. Five patients developed infections – one Kirschner wire site infection, one external fixator (ex-fix) pin site infection, and three deep infections. All deep infections occurred in tobacco users. The rate of deep infection with volar approach was 2.4%, compared to 22.2% with dorsal approach. Ex-fix pin sites overlapped radiographically with the plate in 20 fractures, with three deep infections in this group (15%) and no deep infections in the group without overlap. None of these differences reached statistical significance.ConclusionsThis protocol results in reliable healing of complex fractures, with a 96% union rate. However, 40% sustained complications. We conclude that this protocol is useful for temporizing complex fractures but caution that the complication rate is high. Since recent literature indicates that low-grade open distal radius fractures do not require emergent debridement and that immediate internal fixation is safe, complications might be avoided by restricting this protocol to complex or physiologically unstable patients.
Highlights
Distal radius fractures are common, but the results and complications of treatment with early external fixation and staged open reduction internal fixation have not been previously reported
Received 07/30/2018 Review began 09/02/2018 Review ended 09/09/2018 Published 09/10/2018. This protocol results in reliable healing of complex fractures, with a 96% union rate
Since recent literature indicates that low-grade open distal radius fractures do not require emergent debridement and that immediate internal fixation is safe, complications might be avoided by restricting this protocol to complex or physiologically unstable patients
Summary
Patients who received staged distal radius fracture treatment from 1/1/2008 to 12/31/2015 at the University of Alabama at Birmingham were identified. All patients receiving staged treatment of distal radius fractures with external fixation followed by open reduction internal fixation from 1/1/2008 through 12/31/2015 were identified using a Current Procedural Terminology (CPT) (American Medical Association, Chicago, Illinois) code search. Patients were included if they had a distal radius fracture that was treated initially with external fixation and later converted to open reduction internal fixation. Patients were excluded if they did not have a distal radius fracture (18), were not treated with the staged protocol (14), had less than two months of follow-up (14), were placed into an external fixator for existing infection (two), or were under age 18 (one). Forty-seven patients and 50 wrists treated were included in the study
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