Complication rates by surgeon type after open treatment of distal radius fractures

Background: Distal radius fractures (DRFs) are the most common upper extremity fractures in adults. This study seeks to elucidate the impact age, fracture type, and patient comorbidities have on the current treatment of DRFs and risk of complications. We hypothesized that comorbidities rather than age would relate to the risk of complications in the treatment of DRFs. Methods: A retrospective review of data was performed for patients treated between 2007 and 2014 using Truven Health MarketScan Research Databases. Patients who sustained a DRF were separated into “closed” versus “open” treatment groups, and the association between patient demographics, treatment type, and comorbidities with complication rates was analyzed, along with the trend of treatment modalities throughout the study time interval. Results: In total, 155 353 DRFs were identified; closed treatment predominated in all age groups with the highest percentage of open treatment occurring in the 50- to 59-year age group. Between 2007 and 2014, there was an increase in the rate of open reduction and internal fixation (ORIF) in all age groups <90 with the largest increase (11%) occurring in the 70- to 79-year age group. Higher complication rates were observed in the open treatment group in all ages <90 years with a trend toward decreasing complication rates as age increased. Comorbidities were more strongly associated with the risk of developing complications than age. Conclusions: Closed treatment of DRFs remains the predominant treatment method among all age groups, but DRFs are increasingly being treated with ORIF. Emphasis on the patients’ comorbidities rather than chronological age should be considered in the treatment decision-making process of elderly patients with DRFs.

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145 Outcomes of Unstable Distal Radius Fractures – A Meta-Analysis of Bridging External Fixation Versus Volar Plating

British Journal of Surgery ◽

10.1093/bjs/znab135.012 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

J Mulrain ◽

K Joshi ◽

F Doyle ◽

A Abdulkarim

Keyword(s):

External Fixation ◽

Distal Radius ◽

Plate Fixation ◽

Meta Analysis ◽

Distal Radius Fractures ◽

Complication Rates ◽

Volar Plating ◽

Radius Fractures ◽

Increased Risk

Abstract Introduction Distal radius fractures are common and trends for fixation have changed with increased use of volar locking plates in recent time. A meta-analysis will summarise the best evidence for treatment. Method A systematic review was conducted using PRISMA methodology to identify studies that reported clinical and/or radiological outcomes in patients with AO type C distal radius fractures when treated with external fixation versus ORIF. Results 10 randomised trials were included in this review, reporting on 967 patients. Clinical outcomes are in favour of volar plating at 3 months post-operation, but no difference between the two groups is seen at 6 or 12 months. Analysis of complication rates shows a minute increase in risk-ratio for volar plating versus external fixation. Subgroup analysis showed significantly higher re-operations after plate fixation and significantly higher infection after external fixation. Conclusions Internal fixation of complex distal radius fractures confers an improved clinical outcome at early follow up only and a minimally increased risk of complications. The improved grip strength with volar plating is only superior at early follow up and no long-term superiority is seen with either intervention. The type of surgery in this injury type therefore remains at the surgeon’s consideration on a case-by-case basis.

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Treatment of Distal Radius Fractures in Women Older than 80 Years: A Preliminary Report of Functional and Radiographic Outcomes after Open Reduction and Internal Fixation

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1729439 ◽

2021 ◽

Author(s):

Lili E. Schindelar ◽

Richard M. McEntee ◽

Robert E. Gallivan ◽

Brian Katt ◽

Pedro K. Beredjiklian

Keyword(s):

Internal Fixation ◽

Distal Radius ◽

Functional Outcomes ◽

Open Reduction ◽

The Elderly ◽

Distal Radius Fractures ◽

Implant Design ◽

Complication Rates ◽

Radius Fractures ◽

Hardware Failures

Abstract Background Distal radius fractures are one of the most common fractures seen in the elderly. The management of distal radius fractures in the elderly, especially patients older than 80 years, has not been well defined. The purpose of this study was to evaluate operative treatment of distal radius fractures in patients older than 80 years to determine functional outcomes and complication rates. Materials and Methods A retrospective review was performed to identify patients 80 years or older who were treated for a distal radius fracture with open reduction and internal fixation (ORIF). Medical records were reviewed for demographics, medical history, functional outcomes including quick Disabilities of the Arm, Shoulder, and Hand (qDASH), radiographs, and postoperative complications. Results There were 40 patients included for review. Average age was 84 years. The preoperative qDASH score was 69. At 6 months follow-up, the postoperative qDASH score was 13 (p < 0.001). There were five (12.5%) complications reported postoperatively. All fractures healed with adequate radiographic alignment and there were no hardware failures. Conclusion Distal radius fractures in patients older than 80 years treated with ORIF have good functional outcomes and low complication rates. Increased functionality and independence of the elderly, as well as updated implant design can lead to the effective surgical management of these patients. When indicated from a clinical perspective, operative fixation of distal radius fractures should be considered in patients older than 80 years.

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Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420941310 ◽

2020 ◽

pp. 175319342094131

Author(s):

Brent R. DeGeorge ◽

Holly K. Van Houten ◽

Raphael Mwangi ◽

Lindsey R Sangaralingham ◽

Sanjeev Kakar

Keyword(s):

Upper Extremity ◽

Distal Radius ◽

Complication Rate ◽

Operative Management ◽

Distal Radius Fractures ◽

Complication Rates ◽

Radius Fractures ◽

Specific Complication ◽

Secondary Procedures ◽

Non Operative Management

To compare the outcomes of non-operative versus operative treatment for distal radius fractures in patients aged from 18 to 64 years, we performed a retrospective analysis using the OptumLabs® Data Warehouse using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes of distal radius fracture. Of the 34,184 distal radius fractures analysed, 11,731 (34%) underwent operative management. Short-term complications within 90 days of fracture identified an overall complication rate of 16.6 per 1000 fractures and the 1-year upper extremity-specific complication rate was 287 per 1000 fractures. Overall, post-injury stiffness was the most common 1-year upper extremity-specific complication and was associated with operative management (202.8 vs. 123.4 per 1000 fractures, operative vs. non-operative, p < 0.01). Secondary procedures were significantly more common following non-operative management (8.7% vs. 43%, operative vs. non-operative, p < 0.01) with carpal tunnel release representing the most common secondary procedure. Operative management of distal radius fractures resulted in significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness. Level of evidence: III

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Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate—Which Has Fewer Complications?

Hand ◽

10.1177/1558944716675129 ◽

2016 ◽

Vol 12 (6) ◽

pp. 561-567 ◽

Cited By ~ 7

Author(s):

Yoshihiro Abe ◽

Susumu Tokunaga ◽

Takuro Moriya

Keyword(s):

Distal Radius ◽

Locking Plate ◽

Clinical Results ◽

Distal Radius Fractures ◽

Complication Rates ◽

Radius Fractures ◽

Volar Approach ◽

Pathologic Fractures ◽

Dorsal Plating ◽

Plate System

Background: The aim of this study was to compare the functional outcomes and complications of volar and dorsal plating for the management of intra-articular distal radius fractures, with special regard to indications for dorsal plating. Furthermore, we examine the rationale for choosing dorsal plating and its frequency of use. Methods: Clinical assessments included range of motion measurements at the wrist; grip strength; the Quick Disabilities of the Arm, Shoulder, and Hand score; and the Gartland and Werley score. Clinical results were compared with those achieved using a volarly placed locking plate system. According to Lutsky’s plate theory, the rationale for choosing dorsal plating was based on 4 types of pathologic fractures. Results: Of 112 patients, 38 patients were treated with open reduction internal fixation via a dorsal approach and 68 patients were treated using a volar approach. Except for wrist flexion, there were no other statistical differences in the clinical results between groups for both subjective and objective parameters. There were no statistically significant differences in the complication rates between the volar and dorsal plated groups. One serious complication occurred after volar plating. The most common reason for choosing dorsal plating was irreducible dorsal die-punch fractures. Conclusions: The treatment of displaced intra-articular distal radius fractures with a dorsally versus a volarly placed interlocking plate system demonstrated similar clinical results. Postoperative complications were not readily observed in the patients treated with a dorsal locking plate. Certain fracture patterns are more appropriately stabilized using a dorsal plate fixation.

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Bridging versus Nonbridging Dynamic External Fixation of Unstable Distal Radius Fractures in the Elderly with Polytrauma: A Randomized Study

Journal of Wrist Surgery ◽

10.1055/s-0039-1692480 ◽

2019 ◽

Vol 08 (05) ◽

pp. 408-415

Author(s):

Marcio Aurelio Aita ◽

Fabio Lucas Rodrigues ◽

Karyse Helena Crispim Ribeiro Alves ◽

Ricardo Kaempf de Oliveira ◽

Gustavo Mantovani Ruggiero ◽

...

Keyword(s):

Elderly Patients ◽

Grip Strength ◽

External Fixation ◽

Distal Radius ◽

Randomized Study ◽

Distal Radius Fractures ◽

Complication Rates ◽

Radius Fractures ◽

Dynamic Fixation ◽

The Mean

Background Despite the high prevalence of unstable distal radius fractures (DRFs), there is no consensus regarding the optimal method and treatment timing, especially for elderly patients with multiple associated injuries. Purpose This study aimed to compare the grip strength achieved with two different methods for definitive dynamic external fixation of DRFs in elderly patients with polytrauma operated on within the first 24 hours. Methods In this prospective randomized trial, 35 patients were assigned to undergo definitive external dynamic fixation of DRFs using the nonbridging (group A) or bridging (group B) method. The grip strength, range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) score for pain, and radiographic characteristics were evaluated at 6 and 12 months. Results At 12 months, no significant between-group difference was observed with respect to grip strength. All patients showed results in the third or fourth quartiles. The mean ROMs were 96.94 and 96.38% and the mean QuickDASH scores were 3.53 and 3.85 in groups A and B, respectively. The VAS scores were 1.60 and 1.85 in groups A and B, respectively. The overall complication rates were 13.3 and 15% in groups A and B, respectively. Initial fracture reduction was maintained in 86.67 and 95% of the patients in groups A and B, respectively. Conclusions Both bridging and nonbridging external definitive dynamic fixation proved safe and reliable for the treatment of unstable DRFs in elderly patients with polytrauma. The grip strength results in both groups predicted the restoration of ability in elderly patients to perform activities of daily living independently.

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Operative Treatment of Distal Radius Fractures

Scandinavian Journal of Surgery ◽

10.1177/145749690809700403 ◽

2008 ◽

Vol 97 (4) ◽

pp. 290-296 ◽

Cited By ~ 14

Author(s):

J. Vasenius

Keyword(s):

Distal Radius ◽

Extensor Tendon ◽

Distal Radius Fractures ◽

Fixation Method ◽

Complication Rates ◽

Radius Fractures ◽

Articular Fractures ◽

Radiocarpal Joint ◽

Median Nerve Neuropathy ◽

Dorsal Plating

The incidence of distal radius fractures is increasing together with the average age of population. Intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. Thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. A computed tomography (CT) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. New implants have been designed to provide stable enough fixation for early mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. The most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy, and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. More randomized prospective studies are needed to prove superiority of any fixation method to another.

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Distal Radius Fractures in Diabetic Patients: An Analysis of Surgical Timing and Other Factors That Affect Complication Rate

Hand ◽

10.1177/1558944720944262 ◽

2020 ◽

pp. 155894472094426

Author(s):

Ajith Malige ◽

Andrew Konopitski ◽

Chinenye O. Nwachuku ◽

Kristofer S. Matullo

Keyword(s):

Distal Radius ◽

Complication Rate ◽

Distal Radius Fractures ◽

Diabetic Patients ◽

Complication Rates ◽

Radius Fractures ◽

Surgical Timing ◽

Surgical Delay ◽

Surgical Fixation ◽

Total P

Background While not studied for distal radius fractures, the effect of surgical timing on complication rate has been extensively analyzed in the treatment of pilon fractures. The primary aim of this study was to identify any effect surgical timing has on postoperative complication rates after surgical fixation of distal radius fractures in diabetic patients. Methods All patients who underwent surgical fixation of distal radius fractures at a single suburban academic hospital between 2012 and 2019 were reviewed. For each patient, demographics, comorbidities, injury details, fixation method, and postoperative complications were noted. The effect surgical delay, among other factors, had on complication rate in diabetic and nondiabetic patients was explored. Results Overall, 124 diabetic and 371 nondiabetic distal radius fractures were included. While diabetics had a statistically higher rate of total complications (21.0 vs. 13.5%, P = .045) but similar major complications requiring surgery ( P = .12), there was no difference in surgical delay between groups among patients who had total ( P = .31) or major ( P = .69) complications. Surgical timing was not a risk factor for total ( P = .50) or major complications ( P = .32) in diabetic fracture bivariate or multivariate analysis. Only younger age and higher energy injuries were significant risk factors for total complications in bivariate ( P = .02, P = .03) and multivariate ( P = .04, P < .05) analysis. Conclusion Complication rates after surgically stabilized distal radius fractures in diabetic patients are higher than in nondiabetic patients. However, this rate is not affected by surgical timing. Instead, surgeons should consider factors such as diabetic control in an effort to maximize outcomes and decrease complications. Level of Evidence Prognostic Level III

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Treatment Modality of Distal Ulnar Head and Neck Fractures Associated With Operatively Treated Distal Radius Fractures Does Not Affect Outcomes

Hand ◽

10.1177/1558944720922923 ◽

2020 ◽

pp. 155894472092292

Author(s):

Georgina Glogovac ◽

Allison K. Perry ◽

Michael D. Wigton ◽

Peter J. Stern

Keyword(s):

Head And Neck ◽

Distal Radius ◽

Nonoperative Treatment ◽

Distal Radius Fractures ◽

Complication Rates ◽

Radius Fractures ◽

Distal Ulna ◽

Ulnar Head ◽

Patient Reported

Background: This study compares the functional outcomes and complications between operatively and nonoperatively treated distal ulnar head and neck fractures associated with internal fixation of concomitant distal radius fractures. Methods: A 7-year retrospective chart review was performed to identify patients with operatively treated distal radius fractures associated with distal ulnar head and neck fractures. Ulnar styloid fractures were excluded. Fifty-eight patients who had a minimum of 6 months of follow-up were identified. Patients were divided into 3 treatment groups: nonoperative, open reduction internal fixation (ORIF), and distal ulna resection. Reviewed data included demographics, injury and treatment details, complications, and patient-reported outcome measures. Outcomes measures included Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Patient-Rated Wrist Evaluation (PRWE) surveys. Due to inadequate power, 5 patients treated with distal ulna resection were excluded from statistical analysis. Results: The average patient age was 56 years, with an average follow-up of 27 months. All patients underwent ORIF of the distal radius fracture. Distal ulna fractures were treated nonoperatively in 25 patients, with ORIF in 28 patients, and with distal ulna resection in 5 patients. There were no statistically significant differences in wrist or forearm range of motion, complication rates, secondary procedure rates, PRWE scores, or PROMIS scores between ORIF and nonoperative treatment. Conclusion: No differences in wrist or forearm range of motion, complication rates, secondary procedure rates, PRWE scores, or PROMIS scores were observed between ORIF and nonoperative treatment of distal ulnar head and neck fractures associated with operatively treated distal radius fractures.

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Complications of Volar Plating of Distal Radius Fractures: A Systematic Review

Journal of Wrist Surgery ◽

10.1055/s-0038-1667304 ◽

2018 ◽

Vol 08 (03) ◽

pp. 255-262 ◽

Cited By ~ 7

Author(s):

Todd H. Alter ◽

Kristin Sandrowski ◽

Gregory Gallant ◽

Moody Kwok ◽

Asif M. Ilyas

Keyword(s):

Systematic Review ◽

Distal Radius ◽

Complication Rate ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Complication Rates ◽

Volar Locking Plate ◽

Radius Fractures ◽

Total N

Background In recent years, there has been an increased utilization of volar locking plate fixation of distal radius fractures (DRFs). However, reported long-term complication rates with this technique remain unclear. Purpose The purpose of this systematic review was to investigate the pooled incidence of complications associated with volar locking plating of DRF. Methods A search of the Scopus database was performed from 2006 through 2016. Studies were considered eligible if they had a diagnosis of a DRF and were treated with a volar locking plate with an average of 12 months or longer follow-up. Results The literature search yielded 633 citations, with 55 eligible for inclusion in the review (total n = 3,911). An overall complication rate of 15% was identified, with 5% representing major complications requiring reoperation. The most common complication types identified included nerve dysfunction (5.7%), tendon injury (3.5%), and hardware-related issues (1.6%). Conclusion Nerve complications were reportedly higher than tendon and hardware-related complications combined. However, despite varying complication rates in the literature, this systematic review reveals an overall low complication rate associated with volar locking plating of DRF.

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