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Feasibility and Reliability of ORIF in Delayed Distal Radius Fracture Management: A Single Surgeon's Five Year Experience
Clifford Thomas Pereira, MD; James Rough, MD; Mark Sugi, MD; Prosper Benhaim, MD;
UCLA

Introduction: Traditionally delayed distal radius fractures (DRFs), i.e. over 4 weeks post-injury, are treated with corrective osteotomy due to assumed technical difficulties in recreating the fracture secondary to callus formation. We report a five-year single-surgeon series of delayed DRFs that were treated by ORIF rather than osteotomy.

Methods: A retrospective chart review after IRB approval, was performed on patients with DRF requiring ORIF (2007-2012) at our institute. Patients were divided into an early group (EG) (surgery performed <4 weeks post-injury) and delayed group (DG) (surgery performed ≥4 weeks). Demographics, injury pattern, intra-operative parameters and pre and postoperative x-ray data. Subjective and objective functional data was determined using DASH questionnaire and hand therapist assessments.

Results: From 2007-2012, 178 patients (EG=54, DG=124) underwent ORIF. One patient in DG required an osteotomy and was excluded from the study. The remaining DG patients underwent ORIFs at 39.4±10 days (range: 28-76 days) post-injury. Both groups had similar age, gender, racial demographics and injury patterns (intra-articular fractures - EG = 61.4%, DG = 65.2%, fracture dislocations - EG = 4.9%, DG = 5.2%). Intra-operatively the Orbay maneuver was performed significantly more frequently in DG (55.8%) compared to EG (38.8%) (p<0.05). Both groups had minimal blood loss and no intra-operative complications. Tourniquet times were also not significantly different (EG = 91.6±23.1 minutes, DG = 98.6±23.2 minutes). Preoperative and postoperative x-ray findings were not statistically significant in both groups (Table 1). Post-operative DASH questionnaire and hand therapy data showed no statistical difference between groups except for a significantly improved wrist flexion in EG (Table 2).

Table 1: Preoperative and Postoperative Radiographic Findings

Preop Dorsal Angulation

(Degrees)

Postop Volar Tilt

(Degrees)

Preop Ulnar Variance

(mm)

Postop Ulnar Variance

(mm)

Preop Radial Tilt

(Degrees)

Postop Radial Tilt

(Degrees)

Early Group

13.9±10.1

5.4±6.8

0.45±1.1

-0.13±0.47

18.7±5.6

18.9±3.9

Delayed Group

10.5±10.2

5.8±5.9

0.6±1.7

-0.16±0.55

17.2±5.1

20.9±3.9

Table 2: Range of movement and DASH (*p<0.05)

Pronation

Supination

Wrist Flexion

Wrist Extension

DASH

Early Group

65.3±17.8

49.6±22.1

66.7±5.8 *

31.5±11.8

17.8±18.6

Delayed Group

51.3±17.4

38.2±22.8

23.8±12.7

27.3±17.0

19.3±18.6

Conclusions: There was no significant difference found in intraoperative technique, operative time, and postoperative radiological features and subjective and objective wrist function in patients treated early versus late. Despite current beliefs that ORIFs in delayed DRFs are technically not possible and warrant a correctional osteotomy with possible bone graft, our series indicates that ORIFs are indeed a viable option in DRFs as late as 8 weeks.


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