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Timing of Type I Open Distal Radius Fracture Fixation Does Not Affect Early Complication Rates
Eric R Taleghani, MD; James Rex, MD; Samuel Gerak, BS; John Velasquez, BS; Kathryn Rost, BS; Sonu Jain, MD
University of Cincinnati, Cincinnati, OH
IntroductionThere is limited published evidence regarding the optimal management of open fractures of the distal radius, especially with respect to Gustilo-Anderson (GA) Type I open fractures. The purpose of this study was to compare short-term complication rates among open fractures of the distal radius, with specific attention to the timing of management of Type I fractures. Our hypothesis was that there would not be a temporal association between treatment and infection for Type I open distal radius fractures.
MethodsA retrospective review of all open distal radius fractures at a single Level 1 Trauma Center over a ten-year period was performed. Patients were grouped based on Gustilo-Anderson open fracture classification. The primary outcome measures were superficial and deep infection rates. An additional subgroup analysis was performed for Gustilo-Anderson Type I injuries based on time to surgery.
Results92 patients who sustained open distal radius fractures were included for analysis with average follow-up of 13 months—45 GA Type I, 34 Type II, and 13 Type III. Only one patient (Type I) was managed nonoperatively. A greater proportion of Type III injuries occurred in males (p=0.01), otherwise there were no significant differences in demographic characteristics among groups [Table 1]. There was a statistically significant difference in deep infection rate between Type III (38.5%) and both Type II (5.8%, p = 0.012) & Type I (0%, p = 0.001) fractures [Table 2]. There was no difference in deep infection rate between Type I and II injuries, and no difference in superficial infection rate among the three groups. Type III fractures also had a significantly higher rate of nonunion compared to Type I fractures (38.5% vs 8.9%, p = 0.026). Within the Type I group, there were zero superficial or deep infections, with no difference among patients surgically managed within 24 hours, between 24-72 hours, and greater than 72 hours [Table 3].
ConclusionThis study highlighted the severity of GA Type III open distal radius fractures in comparison to Type I and Type II injuries. Our data suggests an increased risk of infection and nonunion in these patients. Contrarily, the complication profile of Type I open fractures more closely resembles that of closed injuries, with no difference in outcomes based on urgent, intermediate, or delayed time to operative management. Further prospective data would help elucidate whether Type I open distal radius fractures need to be managed similarly to other open long bone fractures.
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