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Outcomes of Type I Open Distal Radius Fractures: A Comparison of Delayed and Urgent Open-Reduction Internal Fixation
Tyler W. Henry, BS1; Richard McEntee, BS2; Jonas Matzon, MD3; Kevin Lutsky, MD4
1Sidney Kimmel Medical College at Jefferson University, Philadelphia, PA; 2Thomas Jefferson University, Philadelphia, PA; 3Rothman Institute at Thomas Jefferson University, Philadelphia, PA; 4Rothman Orthopedics, Philadelphia, PA

Introduction:
Type I open distal radius fractures treated with open-reduction internal fixation (ORIF) have demonstrated minimal risk for infection, and may not require urgent surgical treatment. The purpose of this study was to evaluate the outcomes of patients with type I open distal radius fractures treated with delayed ORIF compared to urgent ORIF.
Materials & Methods:
All Gustilo-Anderson type I open distal radius fractures that had undergone ORIF using volar plating over a 5-year period were identified. Patients were stratified into those treated urgently within 24 hours and those scheduled for delayed surgery. Outcomes including functional scores, complications, re-operations, and radiographic measures were compared.
Results:
Twenty-four patients with type I open distal radius fractures were treated with ORIF using volar plating (Table 1). Seven patients were treated with delayed ORIF at a mean time from injury to surgery of seven days (Range: 2 15 days). Seventeen patients were treated with urgent ORIF within 24 hours of presentation to the emergency department. In the delayed treatment group, all seven patients were started on a course of oral antibiotics at the time of presentation that was continued through the time of surgery (5 Cephalexin, 1 Amoxicillin/Clavulanic acid, 1 Clindamycin). In the urgent treatment group, all seventeen patients received empiric intravenous antibiotics, and nine of those patients were continued on intravenous antibiotics for 48 hours. Following surgery, eight patients treated urgently were prescribed a course of oral antibiotics (6 Cephalexin, 2 Clindamycin). There were no infections in either group and a single re-operation in each group. The mean post-operative Quick-DASH score was 29 (Range: 0 77), and did not differ significantly between delayed (mean = 19) and urgent (mean = 38) treatment. Rate of complications, and radiographic measures did not differ significantly between the groups (Table 2).
Conclusions:
Type I open distal radius fractures appear amenable to delayed outpatient ORIF provided that the wound is clean at the time of initial presentation and that antibiotics are initiated appropriately. Prospective trials further evaluating the safety and efficacy of delayed ORIF appear warranted.


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