Study finds adverse events common after diaphyseal forearm fracture surgery
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Key takeaways:
- Results showed a 31% overall adverse event rate for patients undergoing surgery for diaphyseal forearm fractures.
- These procedures may warrant special consideration and personnel.
According to published results, adverse events are common after diaphyseal forearm fracture surgery, thus these procedures may require special consideration and personnel.
Henri Vasara, MD, and colleagues performed a retrospective, multicenter study of data on 470 patients who underwent surgery for a diaphyseal forearm fracture between 2009 and 2019. According to the study, 202 patients had both-bone fractures; 164 patients had isolated ulnar fractures; and 104 patients had isolated radial fractures.
Investigators found 31% of patients (n = 146) had at least one adverse event, which investigators defined as “any deviation from the normal postoperative course” after surgery, with 18% of all patients (n = 83) requiring additional surgery at a median follow-up of 12.3 weeks. Common major adverse events included plate and screw-related issues (6%), nonunion (5%), persistent nerve injuries (4%) and refractures (4%).
Vasara and colleagues found high BMI, Gustilo-Anderson type-II open fractures, both-bone fractures, isolated radial fractures and procedures performed by junior residents were risk factors for adverse events. They also noted none of the surgeons included in the study would qualify as “high-volume” surgeons.
“We recommend concentrating these operations in a limited team of surgeons, restricting inexperienced surgeons from operating on these fractures without supervision and performing the complex cases with another surgeon, especially in both-bone and open fractures,” the researchers wrote in the study.
Perspective
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Anna N. Miller, MD, FAAOS, FACS, FAOA
I appreciate the efforts of this Finnish group of authors in evaluating complications after radius and ulna fractures. They have found several factors that influence an increase in complications, including radius/ulna combined and radius fractures greater than isolated ulna fractures. In addition, BMI, type-II open fractures and operations performed by junior residents (less than 3 years in training) were associated with increased complications. We have previously evaluated the association of compartment syndrome with forearm fractures, and it was interesting that the authors did not evaluate this as one of their outcomes. Although the authors recommend specialization of these injuries into high-volume centers with experienced surgeons, training of future specialists will need to be taken into account.
Reference:
Saiz AM Jr, et al. J Orthop Trauma. 2020;doi:10.1097/BOT.0000000000001702.
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