Feasibility and Reliability of Open Reduction and Internal Fixation in Delayed Distal Radius Fractures
Jason H Ghodasra, M.D., M.S.C.I.; Christopher Lee, MD; Kent T Yamaguchi, M.D.; Clifford T Pereira, MD; Prosper Benhaim, MD; David Geffen School of Medicine at UCLA, Los Angeles, CA
Introduction: Current guidelines recommend open reduction and internal fixation (ORIF) for distal radius fractures (DRFs) be performed within 4 weeks of injury. Unfortunately, innate difficulties within certain healthcare systems result in delayed treatment of patients. Delayed DRF management (4 weeks and over) is traditionally subject to corrective osteotomy, with assumed technical difficulties in recreating the fracture secondary to callus formation. We report a five-year series of delayed DRFs that were treated by ORIF rather than osteotomy.
Materials & Methods: A retrospective review was performed for distal radius fractures requiring open reduction internal fixation (ORIF) at a single institution over a 5-year period. Patients were divided into an early group (EG, surgery performed <4 weeks of injury) and delayed group (DG, surgery performed >4 weeks). Patient demographics, injury pattern, intra-operative parameters, and pre- and post-operative x-ray were evaluated. Post-operative radiographs were analyzed at an early (>1 week post-operation) and late time point (>5 weeks post-operation). Subjective and objective functional data were determined using DASH and Mayo scores.
Results: A total of 198 patients underwent ORIF. Of these, 173 patients (EG=54, DG=119) were performed by the senior author. Two in the DG required osteotomies and were excluded from subsequent analysis. The remaining 117 patients underwent ORIFs at 40±13.9 days (range: 28-146 days) post-injury. Both groups had similar age, gender, and racial demographics. Pre-operative fracture patterns were radiographically equivalent, with similar intra-articular fracture rates (EG=58.4%, DG=65.2%), fracture dislocation rates (EG=4.9%, DG=5.2%) and ulnar styloid fracture rates (EG=35.2%, DG=29.9%). Intra-operatively, the dorsal approach was required more frequently in the EG (7.4%) compared to DG (1.1%). The Orbay radius pronation maneuver was performed at a significantly higher rate in DG (55.8%) compared to EG (38.8%). Both groups had minimal (<10ml) blood loss and no intra-operative complications. Tourniquet times were not significantly different (EG=91.6±23.1 minutes, DG=98.6±23.2 minutes). There were no statistical differences in ulnar variance, radial tilt, or volar tilt on radiographs. Articular incongruency rates were similar at the early time point (ED=2.6%, DG=3.1%) and the late time point (ED=2%, DG=2.7%). DASH and Mayo wrist scores were also not significantly different.
Conclusions: There was no significant difference found in intraoperative technique, operative time, and post-operative radiographic results in patients treated with early versus late ORIF. Subjective and objective outcome measures were similar between groups. ORIF of delayed distal radius fracture may be a feasible and reliable method of treatment as late as 5 months after injury.
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