American Association for Hand Surgery
Theme: Beyond Innovation

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Staged Treatment of Complex Distal Radius Fractures: Outcomes and Complications
Sierra Green Phillips, MD1; Brooks Ficke, MD2; Erin F Ransom, MD1; Andrew Moon, MD1; Allison Hunter, MD1; Christopher Beaumont, MD1; Ashish Shah, MD1; Nileshkumar Chaudhari, MD1
1University of Alabama at Birmingham, Birmingham, AL, 2Resurgens Orthopaedics, Roswell, GA

Staged Treatment of Complex Distal Radius Fractures: Outcomes and Complications
Introduction: Distal radius fractures are common, but the results and complications of treatment with early external fixation and staged open reduction internal fixation have not been previously reported.
Methods: Patients receiving staged distal radius fracture treatment from 1/1/2008 to 12/31/2015 were identified via CPT code search. Patient/injury characteristics and complications were collected from the medical record.
Results: There were 50 fractures in 47 patients, with mean follow-up of 9.3 months. 38 were open and 45 were intra-articular. For definitive treatment, 41 received a volar approach and 9 a dorsal approach. 20 wrists experienced 1 or more complications, including 2 non-unions. 5 patients developed infections 1 Kirschner wire infection, 1 pin site infection, and 3 deep infections. All deep infections were in tobacco users. The rate of deep infection with volar approach was 2.4%, as compared to 22.2% with dorsal approach. Ex-fix pin sites overlapped radiographically with the plate in 20 fractures, with 3 deep infections in this group (15%) and no deep infections in the group without overlap. None of these differences reached statistical significance.
Conclusions: This protocol results in reliable healing of complex fractures, with a 96% union rate. However, 40% sustained complications. We conclude that this protocol is useful for temporizing complex fractures but caution that the complication rate is high. Since recent literature indicates that low-grade open distal radius fractures do not require emergent debridement and that immediate internal fixation is safe, complications might be avoided by restricting this protocol to complex or physiologically unstable patients.


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