Validation of the Clavien-Dindo Classification System for Complications Following Open Reduction and Internal Fixation of Distal Radius Fractures

Abstract

Background:

The study aims to classify complications of open reduction and internal fixation (ORIF) of distal radius fractures, to determine risk factors of complications, and to validate a Clavien-Dindo scale modified for distal radius ORIF (mCD-DR).

Methods:

Patients undergoing distal radius ORIF at a single institution were retrospectively reviewed. Demographics, comorbidities, surgery length, and complications were collected. Complications were graded using the mCD-DR: Grade 1 is deviation from standard postoperative requirements, grade 2 requires additional pharmacologic management or monitoring, grade 3 requires procedural intervention, grade 4 includes life-threatening medical problems, and grade 5 is death. Two reviewers blindly graded complications, and agreement was determined using Cohen kappa coefficient. Logistic regression assessed predictors of complications.

Results:

A total of 160 patients were included: 112 (70.0%) women and 48 (30.0%) men. Sixty patients (37.5%) experienced a total of 67 complications. There were 25 (33.3%) grade 1, 12 (16.0%) grade 2, and 38 (50.7%) grade 3 complications. The most common complications were removal of hardware (22.7%), wrist injections (17.3%), and hand or wrist stiffness (9.3%). Blinded grading demonstrated near-perfect intra- and interrater agreement, with kappa coefficients of 0.95 to 0.97 and 0.87 to 0.95, respectively. Regression analysis revealed that longer surgeries, moderate Charlson Comorbidity Index, above-median age, and use of general anesthesia were predictive of complications.

Conclusion:

The mCD-DR identified an overall complication rate of 37.5% following distal radius ORIF, with grade 3 complications being the most common. Near-perfect agreement was observed among raters, demonstrating the reliability of the scale for classifying complications following distal radius ORIF.