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Study finds infection and nonunion uncommon in open distal radius fracture treatment
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BOSTON — Infection and nonunion are uncommon in the treatment of open distal radius fractures regardless of fixation type or time to debridement, according to a study presented here.
John C. Kurylo, MD, presented his group’s findings at the 2010 Annual Meeting of the American Society for Surgery of the Hand.
Open distal radius fractures are more likely to be displaced and have an associated ulnar fracture when compared with closed injuries, representing a higher-energy injury pattern, Kurylo further reported.
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“The purpose of our study was to determine the fracture characteristics of open distal radius fractures,” he said. “This was done in comparison to a closed-fracture cohort. Additionally, we investigated the time of initial debridement, as well as the type of fixation — be it internal or external — and the role that it played in the patient developing infection, nonunion, or malunion.”
Study methods and parameters
Kurylo’s team identified 40 consecutive patients with 41 open distal radius fractures from a prospective orthopedic trauma database. Nine of these patients were lost to follow-up. Among the 32 remaining open fractures, Kurylo reported, 10 had early – less than 6 hours – debridement and 22 were delayed.
Among the open injuries, 19 were grade 1, 11 were grade 2 and two were grade 3A. Twenty of the fractures were treated with open fixation, seven with plating and five with planned conversion from external fixation to plating, Kurylo said.
He said the different fixation cohorts were comparable in age, fracture pattern, and grade of open injury. Each open fracture was matched with three closed-fracture controls by patient age, intra-articular involvement, and date of injury. The fractures were then assessed for displacement, dorsal comminution and associated ulna fractures.
Likely no advantage
The group found that open fractures were more likely than closed fractures to be displaced and have an associated ulna fracture. Kurylo reported that dorsal comminution was similar in both groups, and there were no infections or nonunions regardless of the fixation used or operative debridement timing.
The study noted that four patients treated with external fixation required secondary procedures, including revision for secondary fracture at a pin site, removal of a symptomatic broken half-pin and an ulnar shortening.
“Likely no advantage exists between open reduction or internal fixation, however these two groups were too small for a statistical comparison,” Kurylo concluded. “Additionally, conversion from an external fixator to a plate may lead to more scarring and tendon adhesion.”
Reference:
Kurylo JC, Axelrad TW, Tornetta P, Jawa A. Open distal radius fractures: Injury characteristics and the effects of time to debridement and type of stabilization. Paper 3. Presented at the 2010 Annual Meeting of the American Society for Surgery of the Hand. Oct. 7-9, 2010. Boston, Mass.
Based on these data in the manuscript provided, the conclusion was a definitive treatment can be performed at initial irrigation with confidence and infection and nonunion are uncommon regardless of fixation type or time to debridement.
My concern is the study is significantly underpowered for the primary outcome of infection after open fractures, or even time to debridement. There are no infections seen, and only two type-2 wounds. Despite this, there are a lot of things we can take home, understand and learn about the use of external fixation in this cohort.
— Alexander Y. Shin, MD
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