Feasibility and Reliability of Open Reduction Internal Fixation in Delayed Distal Radius Fracture Management

Abstract

Purpose: Current guidelines recommend that open reduction internal fixation (ORIF) for distal radius fractures (DRFs) be performed within 4 weeks of injury. Delayed DRF management (4 weeks or more) is traditionally subject to corrective osteotomy. We report a 5-year single-surgeon series of delayed DRFs that were treated by ORIF rather than osteotomy. Methods: We performed a retrospective review on all patients admitted to a single tertiary care center with a DRF requiring ORIF (2007e2012). Institutional review board approval was obtained. Patients were divided into an early group (EG) (surgery less than 4 weeks after injury) and delayed group (DG) (surgery after 4 or more weeks). Data collected included demographics, injury pattern, intraoperative parameters, and pre-and postoperative x-ray findings. Subjective and objective functional data were determined using a Disabilities of the Arm, Shoulder, and Hand questionnaire score and Mayo Wrist Score. Results: A total of 171 patients (EG ¼ 54; DG ¼ 117) underwent ORIF from 2007 to 2012 and met inclusion criteria. Both groups had similar age, gender, and racial demographics. Of these, 117 patients in the delayed group underwent ORIFs at 40 ± 13.9 days (range, 28e146 days) after injury. Preoperative fracture patterns were radiographically equivalent. A dorsal approach was required more frequently in the EG (7.4%) compared with DG (1.1%). The Orbay maneuver was performed at a significantly higher rate in the DG (55.8%) compared with the EG (38.8%). Blood loss, tourniquet times, intraoperative complications, radiographic parameters, articular incongruency rates, and Disabilities of the Arm, Shoulder, and Hand score, and Mayo Wrist Score were not statistically significant between groups. Conclusions: No significant differences were found in intraoperative technique, operative time, postoperative radiographs, and subjective outcome measures in patients treated with early versus late ORIF. Despite the current belief that primary ORIF in delayed DRF is technically impossible and warrants an osteotomy, our series indicates that ORIF is indeed a viable option in DRFs as late as 5 months after injury. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Distal radius fractures (DRFs) are the most common fractures presenting to the emergency department worldwide and comprise almost one-sixth of all fracture cases. 1 The goal of DRF management is to obtain accurate anatomic reduction and fracture stabilization in the short term, with minimal degenerative changes and adequate pain-free motion, allowing return to preinjury activities in the long term. Closed reduction and casting is a mainstay of treatment for DRF, and multiple variables must be considered in determining surgical indications. 1 These include patient factors, fracture alignment (both before and after reduction), radiographic and clinical features of instability, and the presence of associated injuries. 2 In particular, time since injury is an important c...

Time to surgical management of distal radius fractures: effects on health care utilization and functional outcomes

“… 15 Furthermore, patients who underwent open reduction and internal fixation for distal radius fracture 4 or more weeks postinjury demonstrated comparable outcomes as those who underwent open reduction and internal fixation within 4 weeks. 27 Weil and colleagues compared outcomes for distal radius fractures treated with open reduction and internal fixation within or beyond 21 days after injury; they highlighted that DASH scores and radiographic findings were similar and not statistically different between the groups. 20 They suggested that delaying primary open reduction and internal fixation may generate predictable results for patients who presented late.…”

The Use of Montage Bone Putty in Assisting in the Maintenance of Reduction in Comminuted Distal Radius Fractures

“…All surgeries were done without the need for corrective osteotomy; as described previously by our group, we routinely perform reduction and fixation in patients who present in a delayed fashion to great success. 17…”

Conservatively treated distal radius fractures. Who is referred?

“…The majority of DRFs are treated conservatively with closed reduction and cast immobilisation (Lee et al, 2019;Rundgren et al, 2020). Surgical treatment commonly involves open reduction and internal fixation for difficult to reduce, or unstable fractures (Lee et al, 2019).…”

“…The majority of DRFs are treated conservatively with closed reduction and cast immobilisation (Lee et al, 2019;Rundgren et al, 2020). Surgical treatment commonly involves open reduction and internal fixation for difficult to reduce, or unstable fractures (Lee et al, 2019). Future research could establish HT treatment numbers and duration for patients treated surgically with open reduction and internal fixation and compare them with the results of HT treatments received following closed reduction of DRF.…”