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Demographics and Complication Rates Following Open Treatment of Midshaft Forearm Fractures in the Medicare Population
Robert C Maciel, MS; Kent T Yamaguchi, MD; Andrew R Jensen, MD; Jason Ghodasra, MD; Anthony D'Oro, BS; Jeffrey Wang, MD; Frank A Petrigliano, MD
UCLA, Los Angeles, CA
Introduction: Midshaft forearm fractures are relatively common and exhibit a bimodal distribution with peaks in adolescent males and post-menopausal women. The purpose of this study is to investigate the association between risk factors and complication rates after open reduction internal fixation in the Medicare population.
Materials & Methods: We identified all Medicare patients undergoing ORIF for midshaft fractures of the radius, ulna, or both between 2007-2012 by cross-referencing the corresponding CPT and ICD-9 codes. Patients were stratified by diagnoses of osteoporosis, type 2 diabetes (T2DM), tobacco-use, and obesity. Outcomes studied were 90-day rates of surgical-site infections (SSIs), osteomyelitis, wound complications, neurovascular injury, compartment syndrome, 1-year rates of malunion, DRUJ instability, and complex regional pain syndrome. Odds ratios and confidence intervals were determined and chi-squared tests for association conducted between each risk factor and outcome of interest with statistical significance set at p<0.05.
Results: 7,417 patients within the Medicare database underwent ORIF for midshaft forearm fractures, 30.9% of whom were treated for both-bone, 35.2% for isolated radial shaft and 35.2% for isolated ulnar shaft fractures; 26.0% of patients had osteoporosis, 25.3% had T2DM, 17.1% used tobacco, and 10.0% were obese. Complication rates as a whole and as a product of their respective groups are reported in Table 1. Osteoporosis, T2DM, and tobacco-use were each associated with significantly increased odds of malunion at 1-year. Additionally, diagnoses of tobacco-use and obesity were associated with significantly increased odds of SSIs. Interestingly, diabetic patients were significantly less likely to experience a DRUJ dislocation within 1 year.
Conclusion: To our knowledge, this is the largest study evaluating demographics and complication rates in Medicare patients undergoing ORIF for midshaft forearm fractures. The reversible factors of tobacco-use and obesity are associated with increased odds of post-operative SSIs while osteoporosis, T2DM, and tobacco-use are associated with increased odds of malunion. In conclusion, patient demographics should be closely examined when determining treatment for midshaft forearm fractures in order to optimize patient outcomes.
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