Association of Timing With Postoperative Complications in the Management of Open Distal Radius Fractures

Abstract

Background:

This study investigates whether open distal radius fractures (ODRFs) treated after 24 hours from time of injury have an increased risk of infection or overall complication profile compared with those treated within 24 hours.

Methods:

Retrospective review was performed of all patients treated for ODRF over a 6-year period at a single large academic institution. Postoperative complications included surgical site infections, need for revision irrigation and debridement, delayed soft tissue healing, loss of reduction, nonunion, and malunion.

Results:

One-hundred twenty patients were treated for ODRF. Mean (SD) age at time of injury was 59.92 (17.68) years. Twenty patients (16.7%) had postoperative complications. Regarding mechanism of injury, 78 (65.0%) had a low-energy and 42 (35.0%) had a high-energy injury. Age and fracture grade were not significant factors. Mean (SD) open wound size was 1.18 (1.57) cm. Mean (SD) time from injury presentation to the emergency department (ED) and first dose of intravenous antibiotics was 3.07 (4.05) hours and mean (SD) time from presentation to the ED and operative treatment was 11.90 (6.59) hours, which did not show a significant association with postoperative complications. Twenty-four patients (20.0%) were treated greater than 24 hours after presentation to the ED, which was not significantly distinct from those treated within 24 hours.

Conclusion:

Patients with ODRFs treated after 24 hours were not associated with a greater risk of postoperative complications. Factors including age, energy and mechanism of injury, and fracture grade did not alter outcome in any statistically significant manner.

Level of Evidence:

Level IV

Keywords

open distal radius fractures fracture management hand surgery wrist surgery orthopedic surgery trauma

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References

Chung

Spilson

SV.

The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908-915.

Diaz-Garcia

Oda

Shauver

, et al A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am. 2011;36(5):824-835.

Jawa

Open fractures of the distal radius. J Hand Surg Am. 2010;35(8):1348-1350.

Rozental

Beredjiklian

Steinberg

, et al Open fractures of the distal radius. J Hand Surg Sm. 2002;27(1):77-85.

Kurylo

Axelrad

Tornetta

III , et al Open fractures of the distal radius: the effects of delayed debridement and immediate internal fixation on infection rates and the need for secondary procedures. J Hand Surg Am. 2011;36(7):1131-1134.

Glueck

Charoglu

Lawton

JN.

Factors associated with infection following open distal radius fractures. Hand (N Y). 2009;4(3):330-334.

Matos

Lima

de Oliveira

LA.

Predisposing factors for early infection in patients with open fractures and proposal for a risk score. J Orthop Traumatol. 2015;16(3):195-201.

Yang

Eisler

Treatment of isolated type I open fractures: is emergent operative debridement necessary. Clin Orthop Relat Res. 2003;410:289-294.

Iorio

Harper

Rozental

TD.

Open distal radius fractures: timing and strategies for surgical management. Hand Clin. 2018;34(1):33-40.

10.

Harper

Dowlatshahi

Rozental

TD.

Evaluating outcomes following open fractures of the distal radius. J Hand Surg Am. 2020;45(1):41-47.

11.

Kaufman

Pensy

O’Toole

, et al Safety of immediate open reduction and internal fixation of geriatric open fractures of the distal radius. Injury. 2014;45(3):534-539.

12.

Kim

Park

SD.

Outcomes after volar plate fixation of low-grade open and closed distal radius fractures are similar. Clin Orthop Relat Res. 2013;471(6):2030-2035.

13.

Henry

Matzon

McEntee

, et al Outcomes of type I open distal radius fractures: a comparison of delayed and urgent open reduction internal fixation. Hand. 2022;17:952-956. doi:10.1177/1558944720964965

14.

Gustilo

Anderson

JT.

Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453-458.

15.

Friedrich

PL.

Die aseptische Versorgung frischer Wundern. Langenbecks Arch Klin Chir. 1898;57:288-310.

16.

Harley

Beaupre

Jones

, et al The effect of time to definitive treatment on the rate of nonunion and infection in open fractures. J Orthop Trauma. 2002;16(7):484-490.

17.

Pollak

Jones

Castillo

, et al The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg Am. 2010;92(1):7-15.

18.

Reuss

Cole

JD.

Effect of delayed treatment on open tibial shaft fractures. Am J Orthop (Belle Mead NJ). 2007;36(4):215-220.

19.

Halawi

Morwood

MP.

Acute management of open fractures: an evidence-based review. Orthopedics. 2015;38(11):e1025-e1033.

20.

Tripuraneni

Ganga

Quinn

, et al The effect of time delay to surgical debridement of open tibia shaft fractures on infection rate. Orthopedics. 2008;31(12):1-2.

21.

Patzakis

Wilkins

Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36-40.

22.

Velmahos

Toutouzas

Sarkisyan

Severe trauma is not an excuse for prolonged antibiotic prophylaxis. Arch Surg. 2002;137(5):537-542.

23.

Schenker

Yannascoli

Baldwin

, et al Does timing to operative debridement affect infectious complications in open long-bone fractures? a systematic review. J Bone Joint Surg Am. 2012;94A:1057-1064.

24.

Skaggs

Friend

Alman

, et al The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am. 2005;87(1):8-12.

25.

Gustilo

Merkow

Templeman

The management of open fractures. J Bone Joint Surg Am. 1990;72(2):299-304.

26.

Gustilo

Mendoza

Williams

DN.

Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742-746.

27.

Bone

Johnson

Weigelt

, et al Early versus delayed stabilization of femoral fractures: a prospective randomized study. J Bone Joint Surg Am. 1989;71:336-340.

28.

Grosse

Christie

Taglang

, et al Open adult femoral shaft fracture treated by early intramedullary nailing. J Bone Joint Surg Br. 1993;75(4):562-565.

29.

Lhowe

Hansen

ST.

Immediate nailing of open fractures of the femoral shaft. J Bone Joint Surg Am. 1988;70(6):812-820.

30.

O’Brien

Meek

Powell

, et al Primary intramedullary nailing of open femoral shaft fractures. J Trauma. 1991;31:113-116.

31.

Egol

Tejwani

Capla

, et al Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma. 2005;19(7):448-455.

32.

Haidukewych

GJ.

Temporary external fixation for the management of complex intra- and periarticular fractures of the lower extremity. J Orthop Trauma. 2002;16(9):678-685.

33.

Pape

Tornetta

III Tarkin

, et al Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg. 2009;17(9):541-549.

34.

Nowotarski

Turen

Brumback

, et al Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000;82(6):781-788.

35.

Sirkin

Sanders

DiPasquale

, et al A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999;13(2):78-84.

36.

Okike

Bhattacharyya

Trends in the management of open fractures. A critical analysis. J Bone Joint Surg Am. 2006;88(12):2739-2748.

37.

Tareen

Kaufman

Pensy

, et al Timing of treatment of open fractures of the distal radius in patients younger than 65 years. Orthopedics. 2019;42(4):219-225.

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