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Background: Over 450,000 distal radius fractures occur annually in the United States. No studies have been performed looking specifically at polytrauma patients who sustain distal radius fractures. We sought to determine variables affecting management of distal radius fractures in polytrauma patients.

Methods:An IRB-approved review of trauma patients from 2008-2011 was performed. Records for patients with distal radius fractures were examined, assessing age, gender, GCS, ISS, mechanism, type, and characteristics of injury, as well as operative repair. A logistic regression was performed using SPSS 15.0.

Results:The database identified 12,054 patients: 434 sustaining a distal radius fracture. Fractures were sustained in 282 falls (65.0%), 128 MVC (29.5%), and 24 other subtypes (5.5%) (assaults, bicycle accidents, explosives, etc) with no statistically significant difference in operative repair based on mechanism (p=0.465). 285 patients (65.7%) underwent surgery for distal radius fractures. In univariate analysis, younger age was the only statistically significant demographic predictor of surgical intervention (p=0.003) (Table 1). In both univariate analysis and logistic regression, intra-articular fractures, displacement, comminution, and concomitant ulnar fractures were statistically significantly associated with operative repair (Tables 2 & 3). Displacement was the most likely variable to be associated with surgical intervention (OR=12.761, 95% CI[7.219, 22.556]) (p<0.001) (Table 3).

Table1. Patient Characteristics

	Surgery (n=285)	No Surgery (n=149)	p
Age, yr	46.89 ± 26.73	55.09 ± 29.25	0.003
Male/Female	140 (68.3%)/145 (63.3%)	65 (31.7%)/84 (36.7%)	0.276
GCS	14.42 ± 2.16	14.23 ± 2.60	0.452
ISS	13.94 ± 9.28	13.33 ± 8.37	0.498
Blood Alcohol Level (mg/dL)	38.45 ± 81.69	70.36 ± 103.85	0.079

Table2. Fracture Characteristics

	Surgery (n=285)	No Surgery (n=149)	p
Open/Closed	48 (92.3%)/237 (62.0%)	4 (7.7%)/145 (38.0%)	<0.001
Intra-articular (n=176)	147 (83.5%)	29 (16.5%)	<0.001
Displaced (n=277)	244 (88.1%)	33 (11.9%)	<0.001
Comminuted (n=208)	174 (83.7%)	34 (16.3%)	<0.001
Concomitant Ulnar Fracture (n=229)	193 (84.3%)	36 (15.7%)	<0.001

Table 3. Logistic Regression of Likelihood for Operative Management. (n=434, p<0.001)

Independent Variables	p value	Adjusted OR [95% CI]
Open	1.0 (reference)
Closed	0.143	0.380 [0.104,1.385]
Intra-articular	<0.001	3.096 [1.649, 5.809]
Displaced	<0.001	12.761 [7.219, 22.558]
Comminuted	0.005	2.364 [1.303,4.290]
Concomitant Ulnar Fracture	<0.001	2.858 [1.616, 5.053]

Conclusions:

In polytrauma patients, surgery for distal radius fractures is associated with younger age, intra-articular, displaced, and comminuted fractures, as well as concomitant ulnar fractures. Displaced fractures were almost 13 times more likely to undergo surgical intervention than non-displaced fractures. Gender and mechanism of injury are not predictive of surgical intervention.