Open fractures of the distal radius: the effects of delayed debridement and immediate internal fixation on infection rates and the need for secondary procedures

Abstract

Purpose: There are few clinical data evaluating the outcome of surgery for open distal radius fractures based on treatment method. Specifically, the major contributing factors to infection are largely unknown. The purpose of this study is to determine the effect of early versus delayed debridement and the choice of initial external versus internal fixation on infection rates and the need for secondary procedures.

Methods: Thirty-two patients with open distal radius fractures were identified from a database. Ten debridements were early (<6 h after hospital admission), and 22 debridements were delayed (>6 h after hospital admission). There were 10 treating surgeons for the 32 patients in this study. Based on the attending surgeon's preference and experience, 20 fractures were treated with external fixation, 7 with plating, and 5 with planned staged conversion from external fixation to plating. The cohort included 19 grade I, 11 grade II, and 3 grade IIIA open injuries.

Results: There were no infections, regardless of the time to debridement or the use of immediate plating. Other complications requiring secondary procedures occurred more frequently in patients treated with a planned staged conversion from external fixation to plating than in the patients treated with either external fixation or plating.

Conclusions: We did not encounter infections for grade I and grade II open distal radius fractures, and infections do not appear to be related to either the time to debridement or the initial type of fracture fixation. Plating might be safe at the initial debridement, but temporary external fixation with a staged conversion to plating increases the risk of complications, which necessitates corrective secondary procedures.

Type of study/level of evidence: Therapeutic III.