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Early Complications after Open Treatment of Distal Radius Fractures
Cameron W. Schick, MD; Christopher Martin, MD; Yubo Gao, PhD; Andrew Pugely, MD; Apurva Shah, MD, MBA; Brian Adams, MD
Orthopaedic Surgery, University of Iowa, Iowa City, IA

Introduction: Distal radius fractures are the most common fracture of the upper extremity with open reduction internal fixation representing a common treatment modality. The purpose of this investigation was to identify the incidence of and risk factors for thirty-day post-operative morbidity and mortality following open treatment of closed distal radius fractures in a multicenter cohort.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) prospectively collects thirty-day morbidity and mortality data from over 480 hospitals across the United States. The ACS NSQIP was retrospectively queried using Current Procedural Terminology (CPT) codes, which identified 1,673 cases of closed distal radius fracture with open treatment between 2005 and 2011. Post-operative complications were separated into categories of minor morbidity, major morbidity or mortality, and any complication. Risk factors were identified using univariate and multivariate analyses.

Results: The overall incidence of having any early complication was 2.93% (49 patients). Major morbidity was 2.09% (35 patients), which included 4 patient deaths (0.24%), and minor morbidity was 0.84% (14 patients). The most common major morbidity was a return to the operating room (16 patients). The most common minor complication was urinary tract infection (6 patients). Risk factors for any complication identified in the univariate analysis included cardiopulmonary disease, recent chemotherapy, decreased hematocrit, dependent functional status, black race, and American Society of Anesthesiologists (ASA) Physical Status class of III or IV (p<0.05 for each). The multivariate analysis demonstrated ASA class III or IV (OR 3.01, 95% CI 1.06-8.60), dependent functional status (OR 4.37, 95% CI 1.38-13.83), hypertension (OR 4.09, 95% CI 1.34-12.52), and myocardial infarction/congestive heart failure (OR 13.78, 95% CI 1.21-157.64) to be significant risk factors for any early complication.

Conclusions: The incidence of early complication following open treatment for closed distal radius fractures is low. In the setting of an isolated injury to the distal radius, the data presented here should be useful for providing prognostic information for patients during informed consent for what is considered to be an elective procedure. Surgeons must consider risk of morbidity and mortality when considering surgery for patients with significant cardiopulmonary disease, increased ASA class, or poor functional status.

Level of Evidence: Prognostic Level II.

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