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Feasibility of Outpatient Fixation of Distal Radius fractures: Focus on Post-operative Pain Control
Hilton P. Gottschalk, MD1; R. Bindra, MD2; Michael Bednar, MD2; Molly Moor, MPh1; Terry Light2; (1)Loyola University Medical Center, (2)Loyola Medical Center
Loyola University Medical Center, Maywood, IL, USA

Purpose: Internal fixation of distal radius fractures can be performed as an outpatient procedure in an ambulatory surgery setting.

Materials & Methods: A retrospective chart review was performed of all patients who underwent operative treatment for distal radius fractures at an ambulatory surgery center between January 2010 and December 2011. All patients were operated under general anesthesia with a brachial plexus block for post-operative pain control. Data recorded included age, sex, mechanism of injury, fracture type and method of fixation along with any adjunctive procedure. Outcome measures included postoperative pain score at days 1, 3 and 14; pain-related patient calls, number of emergency room visits, and hospital readmissions within 2 weeks of surgery.

Results: A total of 81 patients with an average age 55.5 years (range 15 – 87 years) were evaluated. Sixty-three fractures (77.8%) resulted from a fall from standing and 78 patients were treated with volar plating and the rest with other techniques. Visual analog scale pain scores at 1, 3 and 14 days post-operatively showed no differences between different fracture types. However median 3-day pain scores (6.5/10) were significantly higher when fixation was combined with additional procedures (scaphoid fracture fixation, carpal tunnel release, scapho-lunate ligament repair) than with radius fracture fixation alone (2/10, p<0.05). Two patients required admission for wound infection.

Conclusions: Supplementary regional block along with oral analgesics provides adequate postoperative pain control without need for hospital admission. Post-operative pain following adjunctive procedures along with fracture fixation appears to be worse within the first 2 weeks compared to isolated distal radius fixation. Patients with a higher grade of fracture do not experience more pain than patients with extra-articular fractures.

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