Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 10;10(9):e3273.
doi: 10.7759/cureus.3273.

Outcomes of Staged Treatment for Complex Distal Radius Fractures

Brooks Ficke  1 , Erin F Ransom  2 , Matthew C Hess  2 , Andrew S Moon  3 , Haley M McKissack  2 , Ashish Shah  2 , Nileshkumar Chaudhari  2
Affiliations

Outcomes of Staged Treatment for Complex Distal Radius Fractures

Brooks Ficke et al. Cureus. .

Abstract

Introduction Distal radius fractures are common, but the results and complications of treatment with early external fixation and staged open reduction internal fixation have not been previously reported. Materials and methods Patients who received staged distal radius fracture treatment from 1/1/2008 to 12/31/2015 at the University of Alabama at Birmingham were identified. Patient, injury, and treatment characteristics, as well as complications, were collected from the medical record. Results There were 50 fractures in 47 patients, with mean follow-up of 9.3 months. Thirty-eight were open and 45 were intra-articular. For definitive treatment, 41 received a volar approach and nine a dorsal approach. Twenty wrists experienced one or more complications, including two non-unions. Five patients developed infections - one Kirschner wire site infection, one external fixator (ex-fix) pin site infection, and three deep infections. All deep infections occurred in tobacco users. The rate of deep infection with volar approach was 2.4%, compared to 22.2% with dorsal approach. Ex-fix pin sites overlapped radiographically with the plate in 20 fractures, with three deep infections in this group (15%) and no deep infections in the group without overlap. None of these differences reached statistical significance. Conclusions This protocol results in reliable healing of complex fractures, with a 96% union rate. However, 40% sustained complications. We conclude that this protocol is useful for temporizing complex fractures but caution that the complication rate is high. Since recent literature indicates that low-grade open distal radius fractures do not require emergent debridement and that immediate internal fixation is safe, complications might be avoided by restricting this protocol to complex or physiologically unstable patients.

Keywords: damage control; delayed fixation; distal radius fracture; external fixation; staged treatment.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Lateral wrist X-ray demonstrating overlap of the volar plate with the track from the former pin site (white arrow).
See this image and copyright information in PMC

References

    1. Treatment strategies of distal radius fractures. Bales JG, Stern PJ. Hand Clin. 2012;28:177–184. - PubMed
    1. Factors associated with infection following open distal radius fractures. Glueck DA, Charoglu CP, Lawton JN. Hand. 2009;4:330–334. - PMC - PubMed
    1. Open fractures of the distal radius: the effects of delayed debridement and immediate internal fixation on infection rates and the need for secondary procedures. Kurylo JC, Axelrad TW, Tornetta P, Jawa A. J Hand Surg. 2011;36:1131–1134. - PubMed
    1. Safety of immediate open reduction and internal fixation of geriatric open fractures of the distal radius. Kaufman AM, Pensy RA, O’Toole RV, Eglseder WA. Injury. 2014;45:534–539. - PubMed
    1. Open fractures of the distal radius. Rozental TD, Beredjiklian PK, Steinberg DR, Bozentka DJ. J Hand Surg Am. 2002;27:77–85. - PubMed

LinkOut - more resources