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Chronic Kidney Disease Adversely Impacts Outcomes Following Distal Upper Extremity Fracture Repair: A Dual-Cohort Study
Daniel Villarreal Acha, MS
1, Zuhair Zaidi, BS
1, Muhammad Harirah, MD
2, Berkay Basagaoglu, MD
2, Muaz Wahid, BS
2, Amber McCranie, BS
3, Michael Nissan, MD
2, Richard Samade, M.D/Ph.D
3; Jennifer Kargel, MD
4(1)University of Texas Southwestern, Dallas, TX, (2)UT Southwestern, Dallas, TX, (3)UT Southwestern Medical Center, Dallas, TX, (4)Plastic Surgery, Division of Hand Surgery, University of Texas Southwestern, Dallas, TX
IntroductionChronic kidney disease (CKD) is known to impair bone healing and increase surgical risks, but its effect on distal upper extremity fracture repair remains poorly characterized. This study evaluates the impact of CKD on healing time, complication rates, and reoperation following distal forearm and hand fracture fixation. We further validate findings using a national database and explore management strategies tailored to this population.
Materials & MethodsA retrospective review of 91 adult patients who underwent surgical fixation of distal upper extremity fractures at a Level 1 academic medical center (2013-2023) was conducted. Twenty-nine patients with CKD (stages I-IV and ESRD) were compared to 62 matched controls without CKD. Outcomes included time to radiographic union, postoperative complications (edema, weakness, sensory changes), revision surgeries, and mortality. Healing was defined by bridging callus across three cortices on radiographs, confirmed independently by two hand surgeons. A secondary analysis using the TriNetX national database (n=2,907 CKD vs. matched controls) assessed 90-day postoperative complication risks.
Results
Patients with CKD demonstrated significantly delayed fracture healing compared to controls (68.4 ± 9.2 vs. 50.6 ± 8.0 days; p < 0.0001). Postoperative complications were more frequent in CKD patients, including edema (p < 0.0001), weakness (p < 0.0001), and sensory changes. Three CKD patients required revision surgery for hardware failure or nonunion, including cases with delayed wound healing and complex regional pain syndrome (CRPS). No control patients developed CRPS or required revision.
In the TriNetX cohort, CKD patients had increased risk of postoperative edema (4.74% vs. 2.67%, p = 0.0001; OR 1.81), weakness (4.67% vs. 1.59%, p = 0.0001; OR 3.03), and revision surgery (8.18% vs. 6.54%, p = 0.0179; OR 1.27). Superficial surgical site infection was more frequent in CKD patients (1.036% vs. 0.623%) but did not reach statistical significance (p = 0.086).
Conclusions
CKD is associated with significantly prolonged healing time, higher complication rates, and increased risk of revision surgery following distal upper extremity fracture repair. The findings from both institutional and national data support a need for CKD-specific surgical planning, including enhanced preoperative optimization, cautious intraoperative technique, and vigilant postoperative follow-up. Early identification and multidisciplinary care can help mitigate risks and improve outcomes in this growing, high-risk population.
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