Treatment of Open Distal Radius Fractures: Effects of Surgical Timing
Rick Tosti, MD1; Andrew Baron, MD2; Myles Dworkin, MD3; A. Lee Osterman, MD3
1Orthopaedic Surgery and Sports Medicine, Philadelphia Hand Center, King of Prussia, PA; 2Philadelphia Hand to Shoulder Center, King of Prussia, PA; 3Thomas Jefferson University, Philadelphia, PA
While traditional research has suggested that infection rates in open fractures may be reduced if surgical debridement is performed within 6-hours of the injury, recent studies have discovered that emergent debridement may not influence outcome particularly for low-grade injuries in the upper extremity. The purpose of this study was to determine the effect of surgical timing of open distal radius fractures on outcomes with a null hypothesis that no differences would be observed in the rates of infection or union between those debrided before or after 24 hrs.
A retrospective review of an institutional database analyzed patients treated between 2009 and 2019. All patients with open distal radius fractures treated operatively with at least 3 months of follow-up care were included. Group A was defined as those who received an initial debridement within 24 hrs, and Group B was those who received a debridement after 24 hrs. The primary outcome was development of postoperative infection. Secondary outcomes were rates of union and reoperation.
A total of 55 patients were included in the study. The average age was 55.5 (+ 20 years) and the median follow-up was 6 months (IQR: 4.5, 13). The most common mechanism of injury was fall. The median time to treatment was 1 day (IQR: 0, 3) and ranged from 0 to 20 days. Thirty-five (63.5%) patients were treated more than 24 hours after initial injury while 20 (36.5%) underwent surgery within 24 hours. Open fractures classified by the Gustilo and Anderson criteria were as follows: Group A had 22% in grade I, 39% in grade II, and 39% in grade III. Group B had 70% in grade I, 27% in grade II, and 3% in grade III. Infections occurred in 25% of cases treated within 24hrs and 14% in those treated after 24 hrs; this difference was not statistically different (p=0.32). No significant differences were found in rates of union or reoperation. A univariate analysis found that men were more likely to have an infection and increased body mass index had a higher odds of nonunion.
Most patients with high-grade injuries were treated emergently. The timing of surgical debridement 24 hours after the injury did not appear to increase the risk of infection, nonunion, or reoperation in open distal radius fractures.
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