Delayed fixation of distal radial fractures beyond three weeks after initial failed closed reduction increases the odds of reoperation.
Humans
Reoperation
/ statistics & numerical data
Middle Aged
Female
Male
Adult
Radius Fractures
/ surgery
Aged
Ontario
Adolescent
Closed Fracture Reduction
/ methods
Young Adult
Retrospective Studies
Time-to-Treatment
Time Factors
Fracture Fixation
/ methods
Fracture Fixation, Internal
/ methods
Treatment Failure
Journal
The bone & joint journal
ISSN: 2049-4408
Titre abrégé: Bone Joint J
Pays: England
ID NLM: 101599229
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
31
10
2024
Statut:
epublish
Résumé
We aimed to compare reoperations following distal radial fractures (DRFs) managed with early fixation versus delayed fixation following initial closed reduction (CR). We used administrative databases in Ontario, Canada, to identify DRF patients aged 18 years or older from 2003 to 2016. We used procedural and fee codes within 30 days to determine which patients underwent early fixation (≤ seven days) or delayed fixation following CR. We grouped patients in the delayed group by their time to definitive fixation (eight to 14 days, 15 to 21 days, and 22 to 30 days). We used intervention and diagnostic codes to identify reoperations within two years. We used multivariable regression to compare the association between early versus delayed fixation and reoperation for all patients and stratified by age (18 to 60 years and > 60 years). We identified 14,960 DRF patients, 8,339 (55.7%) of whom underwent early surgical fixation (mean 2.9 days (SD 1.8)). In contrast, 4,042 patients (27.0%) underwent delayed fixation between eight and 14 days (mean 10.2 days (SD 2.2)), 1,892 (12.7%) between 14 and 21 days (mean 17.5 days (SD 1.9)) and 687 (4.6%) > 21 days (mean 24.8 days (SD 2.4)) post-fracture. Patients who underwent delayed fixation > 21 days post-fracture had a higher odds of reoperation (odds ratio (OR) 1.33 (95% CI 1.11 to 1.79) vs early fixation). This worsened for patients aged > 60 years (OR 1.69 (95% CI 1.11 to 2.79)). We found no difference in the odds of reoperation for patients who underwent delayed fixation within eight to 14 or 15 to 21 days post-fracture (vs early fixation). These data suggest that DRF patients with fractures with unacceptable reduction following CR should be managed within three weeks to avoid detrimental outcomes. Prospective studies are required to confirm these findings.
Identifiants
pubmed: 39481449
doi: 10.1302/0301-620X.106B11.BJJ-2023-1349.R1
pii: BJJ-2023-1349.R1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1257-1262Subventions
Organisme : Orthopaedic Trauma Association
Informations de copyright
© 2024 The British Editorial Society of Bone & Joint Surgery.
Déclaration de conflit d'intérêts
L. L. Nowak reports institutional funding via the Orthopaedic Trauma Association Resident Grant, related to this study. M. D. McKee reports royalties or licenses from Stryker, LOWW, Wolters-Kluwer, and Springer, consulting fees from Stryker and Exactech, and is a member of the American Shoulder and Elbow Surgeons nominating committee, all of which are unrelated to this study. E. Schemitsch reports institutional grants from Stryker, Smith & Nephew, Zimmer Biomet and Depuy Synthes, royalties or licenses from Stryker and ITS, consulting fees from Stryker, Smith & Nephew, Amgen, and Sanofi, all of which are unrelated to this study.
Références
Court-Brown CM , Caesar B . Epidemiology of adult fractures: a review . Injury . 2006 ; 37 ( 8 ): 691 – 697 . 10.1016/j.injury.2006.04.130 16814787
Makhni EC , Ewald TJ , Kelly S , Day CS . Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment . J Hand Surg Am . 2008 ; 33 ( 8 ): 1301 – 1308 . 10.1016/j.jhsa.2008.04.031 18929192
Kong L , Kou N , Wang Y , Lu J , Tian D , Zhang B . The necessity of restoration of radiologic parameters by closed reduction in elderly patients with distal radius fractures . Med Sci Monit . 2019 ; 25 : 6598 – 6604 . 10.12659/MSM.915824 31477682
He B , Tian X , Ji G , Han A . Comparison of outcomes between nonsurgical and surgical treatment of distal radius fracture: a systematic review update and meta-analysis . Arch Orthop Trauma Surg . 2020 ; 140 ( 8 ): 1143 – 1153 . 10.1007/s00402-020-03487-3 32468170
Azad A , Kang HP , Alluri RK , Vakhshori V , Kay HF , Ghiassi A . Epidemiological and treatment trends of distal radius fractures across multiple age groups . J Wrist Surg . 2019 ; 8 ( 4 ): 305 – 311 . 10.1055/s-0039-1685205 31404224
Mc Colgan R , Dalton DM , Cassar-Gheiti AJ , Fox CM , O’Sullivan ME . Trends in the management of fractures of the distal radius in Ireland . Bone Joint J . 2019 ; 101-B ( 12 ): 1550 – 1556 . 10.1302/0301-620X.101B12.BJJ-2018-1615.R3 31786993
Mulders MAM , van Eerten PV , Goslings JC , Schep NWL . Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries . Orthop Traumatol Surg Res . 2017 ; 103 ( 6 ): 905 – 909 . 10.1016/j.otsr.2017.01.017 28428037
Walenkamp MMJ , Aydin S , Mulders MAM , Goslings JC , Schep NWL . Predictors of unstable distal radius fractures: a systematic review and meta-analysis . J Hand Surg Eur Vol . 2016 ; 41 ( 5 ): 501 – 515 . 10.1177/1753193415604795 26420817
Jung H-W , Hong H , Jung HJ , et al. Redisplacement of distal radius fracture after initial closed reduction: analysis of prognostic factors . Clin Orthop Surg . 2015 ; 7 ( 3 ): 377 – 382 . 10.4055/cios.2015.7.3.377 26330962
Howard M , Curtis A , Everett S , Harries L , Donaldson O , Sheridan B . Does a delay in surgery for distal radial fractures affect patient outcome? J Hand Surg Eur Vol . 2021 ; 46 ( 1 ): 69 – 74 . 10.1177/1753193420941319 32715903
No authors listed . Fractures (non-complex): assessment and management: NICE guideline [NG38] . National Institute for Health and Care Excellence . 2016 . https://www.nice.org.uk/guidance/ng38 ( date last accessed 20 August 2024 ).
Malige A , Konopitski A , Nwachuku CO , Matullo KS . Distal radius fractures in diabetic patients: an analysis of surgical timing and other factors that affect complication rate . Hand (N Y) . 2022 ; 17 ( 4 ): 764 – 771 . 10.1177/1558944720944262 32940062
MacFarlane RJ , Miller D , Wilson L , et al. Functional outcome and complications at 2.5 years following volar locking plate fixation of distal radius fractures . J Hand Microsurg . 2015 ; 7 ( 1 ): 18 – 24 . 10.1007/s12593-014-0155-1 26078498
Lee SJ , Stenquist DS , Collins JE , et al. Radiographic outcomes and complications of delayed fixation of distal radius fractures . Hand (N Y) . 2022 ; 17 ( 4 ): 748 – 753 . 10.1177/1558944720930301 32686498
Weil YA , Mosheiff R , Firman S , Liebergall M , Khoury A . Outcome of delayed primary internal fixation of distal radius fractures: a comparative study . Injury . 2014 ; 45 ( 6 ): 960 – 964 . 10.1016/j.injury.2014.02.011 24731691
Juurlink D , Preyra C , Croxford R , et al. Canadian Institute for Health Information Discharge Abstract Database: A Validation Study . ICES . 2006 . https://www.ices.on.ca/publications/research-reports/canadian-institute-for-health-information-discharge-abstract-database-a-validation-study/ ( date last accessed 20 August 2024 ).
Yoon AP , Wang C , Speth KA , Wang L , Chung KC , WRIST Group . Modifiable factors associated with chronic pain 1 year after operative management of distal radius fractures: a secondary analysis of a randomized clinical trial . JAMA Netw Open . 2020 ; 3 ( 12 ): e2028929 . 10.1001/jamanetworkopen.2020.28929 33337492
Hooper RC , Zhou N , Wang L , Shauver MJ , Chung KC , Wrist and Radius Injury Surgical Trial Group . An analysis of the impact of timing and technique on outcomes after surgery for distal radius fractures: the wrist and radius injury surgical trial collaborative study . Plast Reconstr Surg . 2021 ; 148 ( 5 ): 1053 – 1062 . 10.1097/PRS.0000000000008416 34546187
Ashdown T , Morris J , Mckeon S , Clough OT , Little M , Anakwe RE . Surgical fixation of fractures of the distal radius within 2 weeks reduces postoperative finger stiffness . J Hand Surg Eur Vol . 2021 ; 46 ( 1 ): 64 – 68 . 10.1177/1753193420936591 32615831
Sirniö K , Leppilahti J , Ohtonen P , Flinkkilä T . Early palmar plate fixation of distal radius fractures may benefit patients aged 50 years or older: a randomized trial comparing 2 different treatment protocols . Acta Orthop . 2019 ; 90 ( 2 ): 123 – 128 . 10.1080/17453674.2018.1561614 30669897
Bae JY , Yoon JO , Choi SW , Kim JK . Comparison of outcomes between partially healed and acute metaphyseally malaligned distal radial fracture treated by palmar locking plate fixation . J Orthop Sci . 2017 ; 22 ( 6 ): 1049 – 1053 . 10.1016/j.jos.2017.08.007 28838705
Yamashita K , Zenke Y , Sakai A , Oshige T , Moritani S , Maehara T . Comparison of functional outcome between early and delayed internal fixation using volar locking plate for distal radius fractures . J UOEH . 2015 ; 37 ( 2 ): 111 – 119 . 10.7888/juoeh.37.111 26073500
Charlson ME , Pompei P , Ales KL , MacKenzie CR . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation . J Chronic Dis . 1987 ; 40 ( 5 ): 373 – 383 . 10.1016/0021-9681(87)90171-8 3558716
Papaioannou A , Morin S , Cheung AM , et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in canada: summary . CMAJ . 2010 ; 182 ( 17 ): 1864 – 1873 . 10.1503/cmaj.100771 20940232
Goel V , Williams JI , Anderson GM , Blackstien-Hirsch P , Fooks C , Naylor CD . Patterns of Health Care in Ontario: The ICES Practice Atlas . 2nd edition . Ontario, Canada , 1996 .
No authors listed . Canadian Coding Standards for Version 2018 ICD-10-CA and CCI . Canadian Institute for Health Information | l’Institut Canadien d’Information sur la Santé . 2018 . https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf ( date last accessed 9 September 2024 ).
No authors listed . Data Quality Study of the 2015–2016 Discharge Abstract Database: A Focus on Hospital Harm . Canadian Institute for Health Information . 2016 . https://secure.cihi.ca/free_products/DAD_15_16_Reab_Report_EN.pdf ( date last accessed 20 August 2024 ).
Myderrizi N . Factors predicting late collapse of distal radius fractures . Malays Orthop J . 2011 ; 5 ( 3 ): 3 – 7 . 10.5704/MOJ.1111.006 25279027
Nesbitt KS , Failla JM , Les C . Assessment of instability factors in adult distal radius fractures . J Hand Surg Am . 2004 ; 29 ( 6 ): 1128 – 1138 . 10.1016/j.jhsa.2004.06.008 15576227
Chung KC , Cho HE , Kim Y , Kim HM , Shauver MJ , WRIST Group . Assessment of anatomic restoration of distal radius fractures among older adults: a secondary analysis of a randomized clinical trial . JAMA Netw Open . 2020 ; 3 ( 1 ): e1919433 . 10.1001/jamanetworkopen.2019.19433 31951273
Clement ND , Duckworth AD , Court-Brown CM , McQueen MM . Distal radial fractures in the superelderly: does malunion affect functional outcome? ISRN Orthop . 2014 ; 2014 : 189803 . 10.1155/2014/189803 24967123
Tuaño KR , Fisher MH , Lee N , et al. Analysis of postoperative distal radius fracture outcomes in the setting of osteopenia and osteoporosis for patients with comorbid conditions . J Hand Surg Glob Online . 2023 ; 5 ( 5 ): 601 – 605 . 10.1016/j.jhsg.2023.04.005 37790836
Hinds RM , Capo JT , Kakar S , Roberson J , Gottschalk MB . Early complications following osteosynthesis of distal radius fractures: a comparison of geriatric and nongeriatric cohorts . Geriatr Orthop Surg Rehabil . 2017 ; 8 ( 1 ): 30 – 33 . 10.1177/2151458516681636 28255508
Roh YH , Lee BK , Noh JH , Oh JH , Gong HS , Baek GH . Factors delaying recovery after volar plate fixation of distal radius fractures . J Hand Surg Am . 2014 ; 39 ( 8 ): 1465 – 1470 . 10.1016/j.jhsa.2014.04.033 24908556
Clayton RAE , Gaston MS , Ralston SH , Court-Brown CM , McQueen MM . Association between decreased bone mineral density and severity of distal radial fractures . J Bone Joint Surg Am . 2009 ; 91-A ( 3 ): 613 – 619 . 10.2106/JBJS.H.00486 19255221
Lee H-W , Kim K-T , Lee S , Yoon J-H , Kim J-Y . Fracture severity and triangular fibrocartilage complex injury in distal radius fractures with or without osteoporosis . J Clin Med . 2024 ; 13 ( 4 ): 992 . 10.3390/jcm13040992 38398305
Lichtman DM , Bindra RR , Boyer MI , et al. American academy of orthopaedic surgeons clinical practice guideline on: the treatment of distal radius fractures . J Bone Joint Surg Am . 2011 ; 93-A ( 8 ): 775 – 778 . 10.2106/JBJS.938ebo 21508285
Bell KR , White TO , Molyneux SG , Duckworth AD . Chapter 9 - predictors of instability and secondary displacement after conservatively managed distal radius fractures . In : Jupiter J , Chammas M . Distal Radius Fractures . Elsevier , 2021 : 85 – 93 . 10.1016/B978-0-323-75764-5.00022-6
Tantigate D , Salentijn D , Lin JD , Freibott CE , Strauch RJ , Rosenwasser MP . Sequential radiographic evaluation during closed treatment of distal radius fracture . J Orthop Trauma . 2020 ; 34 ( 1 ): e26 – e30 . 10.1097/BOT.0000000000001606 31464857