The outcome for surgical fixation of distal radial fractures in patients with idiopathic Parkinson’s disease: a cohort study

Abstract

Introduction Idiopathic Parkinson’s disease (PD) is a progressive neurologic disorder causing postural instability and unsteady gait. These patients are at increased risk for fractures and have inferior outcomes after treatment. Several studies have evaluated the incidence and outcome of PD patients after hip fractures. However, there are limited studies assessing the outcome of upper extremity fractures in these patients. In this study, we evaluated the outcome of PD patients that received surgical intervention for distal radial fractures (DRF). We hypothesize that these patients have an inferior outcome after surgery in comparison with non-PD patients. Methods Between May 2005 and May 2017, we retrospectively reviewed all of the patients with DRF and subsequently underwent open reduction and internal fixation (ORIF) at a level 1 trauma center. All of the surgeries were performed by fellowship-trained orthopedic surgeons. The inclusion criteria include patients with a definitive diagnosis of PD, non-pathological DRF, and a minimum follow-up of 1 year or up until the time of treatment failure was noted. Each PD patient was matched for age and gender to 3 non-PD patients. The primary objective was to determine the failure rate after surgical fixation for DRF. The secondary outcomes include time to treatment failure, reoperation rate, readmission rate, length of hospital stay, and postoperative complications. Results A total of 88 patients were included in this study (23 PD, 65 non-PD patients). All underwent ORIF and received standard postoperative follow-ups. The overall treatment failure rate in PD was 39.1% vs. 4.6% in the non-PD group (p < 0.05). The time to treatment failure were 9.11 ± 3.86 weeks and 14.67 ± 5.8 weeks for PD and non-PD, respectively (p < 0.05). PD patients had a significantly higher rate of failure when k-wires and ESF were used (p < 0.05%), while loss of reduction was the most common mode of failure in PD (44.4%). The length of hospital stay for PD was 5.3 ± 4.69 days compared with 3.78 ± 0.96 days for non-PD (p = 0.01). There were 3 PD patients readmitted within 30 days after surgery, and 1 patient had pneumonia after the surgery. Conclusion This study revealed that patients with PD have a high treatment failure rate despite surgical intervention for DRF. PD patients had a longer hospital stay and had a shorter time to treatment failure. In treating PD patients complicated with DRF, the surgeon must take into consideration the complex disease course of PD and the associated comorbidities such as osteoporosis, frail status, and frequent falls. Rehabilitation and disposition plans should be discussed in advance and longer hospital stays should be expected. Level of evidenceLevel IV, retrospective cohort study

Surgical outcome of upper extremity fractures in patients with Parkinson’s disease

“…Primary, DRFs have a very low nonunion or malunion rate (0.2–10%), but this study revealed very high failure rates for PD patients (15.8%) 12 , 18 . In a previous study conducted by our group, the treatment failure rate after DRF in PD can be as high as 39%, with loss of reduction and malunion of fracture being the two most frequent mechanisms 12 . When compared with non-PD patients, k-wires and external fixation appeared to have inferior results for PD, while plating of the radius had similar success rates.…”

“…delayed functional recovery, longer hospital stays, and increased revision surgeries) in comparison with non-PD patients after orthopaedic procedures 6 , 7 , 10 , 11 . In current literature, there are very few studies evaluating the outcome for upper extremity fractures (UEF) that occurred in PD 12 – 15 . Our team recently reported the outcome of distal radial fractures after surgical fixation for PD 12 .…”

“…In current literature, there are very few studies evaluating the outcome for upper extremity fractures (UEF) that occurred in PD 12 – 15 . Our team recently reported the outcome of distal radial fractures after surgical fixation for PD 12 . In agreement with fractures that occurred in other bones, PD patients had a significantly higher treatment failure rate despite appropriate surgical management of distal radial fractures.…”

“…Since PD patients have rigidity, tremor and unsteady gait, absolute stability of the fracture should be achieved in order to facilitate healing. Therefore, fixation methods that achieve absolute stability such as plating should be considered when treating these patients 12 .…”

Letter to the Editor regarding “Parkinson's disease and hip fractures: Are complications and mortality rates increased?”

“…For example, Chou et al [2] evaluated the outcomes after surgery for distal radius fracture in which all underwent open reduction and internal fixation (ORIF). The treatment failure rate was 39.1% (PD) and 4.6% (non-PD).…”