The Effect of Delayed Surgery on the Radiographic Outcomes of AO/OTA Type C3 Fractures
Jordyn T Farewell, MS1; Sofia Duque, BA1; Hembd Austin, MD2; Daniel Koehler, MD3; Ann Golden, MD3; Justin Davis, MD4; Douglas Sammer, MD1
1University of Texas Southwestern, Dallas, TX; 2Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX; 3UT Southwestern Medical Center, Dallas, TX; 4Southern Illinois University, Springfield, IL
Purpose
Distal radius fractures that present late often require delayed open reduction internal fixation (ORIF). Several studies demonstrate that the radiographic outcomes of early versus late ORIF for distal radius fractures are equivalent. Whether this applies to complete articular fractures with multi-fragmentary articular comminution (AO/OTA type C3 fractures) is not known. The purpose of this study is to compare the radiographic results of early versus delayed surgery for AO/OTA type C3 distal radius fractures.
Methods
All distal radius fractures treated surgically at a single hospital over a 2-year period were reviewed. Two independent reviewers evaluated the fractures, and those that were classified as AO/OTA type C3 fractures were included in the study. Measurements of volar tilt, radial inclination, ulnar variance, radial height, articular step-off, and articular diastasis were assessed on radiographs obtained at injury, and at the first and second post-operative visits. Fractures were divided into early or late surgery groups based on the length of time between initial injury and fixation (0 to 2 weeks, versus 3 to 5 weeks). A comparison of the radiographic outcomes of the two groups was performed.
Results
A total of 313 surgically treated distal radius fractures were identified. Forty-six AO/OTA C3 fractures were included in the study, with 30 in the early surgery group and 16 in the late surgery group. At the final study follow-up, post-operative radiographic measurements were not different in the early versus late groups, with the exception of ulnar variance which was -0.8 mm in the early group, compared to 1.2 mm in the late group. Average articular step-off and diastasis were both <1 mm at final follow-up in both groups.
Conclusions
This study found minimal post-operative radiographic differences in OA/OTA type C3 fractures that were operated on early versus late. These findings suggest that the radiographic outcomes of complete articular distal radius fractures with multi-fragmentary articular comminution are not substantially adversely affected by delayed surgery up to 5 weeks after injury.
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