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Outcomes Following Operative Treatment of Open Fractures of the Distal Radius: A Case Control Study
Brendan J. Mackay, MD1; Nicole M. Montero, MD1; Nader Paksima, DO2; Kenneth A. Egol, MD2;
1New York University Hospital for Joint Diseases, 2New York University

Abstract

Introduction: While there is a robust amount of research on open long bone fractures, there is little outcome data on open distal radius fractures. The purpose of this study is to report radiographic, clinical, and patient-based functional outcomes following contemporary operative treatment of patients who sustained an open distal radius fracture and compare them to a similar group of patients treated operatively for closed distal radius fractures.

Materials and Methods: Over five years, 601 patients with a distal radius fracture presented to our academic medical center, including one Level 1 trauma hospital, and were prospectively enrolled in an upper extremity trauma database. Patients with open distal radius fractures underwent irrigation, debridement, and operative fixation within 24 hours of presentation. Closed distal radius fractures requiring operative fixation were treated electively. Retrospective review of the database identified eighteen open fractures of the distal radius (11grade I, 6 grade II, 1 grade IIIa). The open fracture patients were individually matched with eighteen closed distal radius fracture patients who underwent surgical fixation based on age, sex, injury to dominant extremity, fracture pattern, and method of fracture fixation. Clinical, radiographic, patient-based functional outcomes, and complications were recorded at routine postoperative intervals.

Results: Follow-up was greater than 77% in both groups at all time points. The open and closed groups were similar in regards to age, gender, BMI, race, tobacco use, income, employment status, hand dominance, injury to dominant extremity, mechanism of injury, fracture classification, method of fracture fixation, and presence of concomitant injury. Postoperative complication and return to the OR rates were similar between the open and closed groups. Union rates and radiographic alignment one year postoperatively were independent of wound status. At final follow-up, range of motion parameters, grip strengths, DASH indices, and subjective pain scores were similar between both groups.

Discussion: Open distal radius fractures treated with early debridement and fixation achieved similar outcomes to surgically treated closed fractures of the distal radius when followed for a year or more postoperatively.


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