Operative Treatment of Distal Radius Fractures in Patients With Parkinson Disease

Abstract

Background: Owing to the many unique disease characteristics of Parkinson disease (PD)-namely resting tremors, muscular rigidity, and poor bone quality-we hypothesized that this patient population would have inferior outcomes with surgical management of acute distal radius fractures (DRFs) compared with the literature available on the general population.

Methods: This is a retrospective observational study performed at a single, level 1, academic center from 2001 to 2020 capturing all adult patients with an isolated, acute, and closed DRF that ultimately underwent operative treatment. International Classification of Diseases 10 codes were used to identify 30 patients for manual chart review. Several patient and fracture characteristics were accounted for and complications, reoperations, and failures of surgical intervention were recorded.

Results: There was a total of 7/30 failures (23%), 6/30 reoperations (20%), and 12 complications in 9/30 wrists (complication rate, 30%) at a mean latest follow-up of 11 months (1.2-158 months). Of the 7 failures, 5 were due to loss of reduction, and 2 of them were deep infections with mean time to failure of 8.3 weeks (range, 11 days-5.2 months).

Conclusions: This study found a high rate of complications, reoperations, and early failure despite a short follow-up period and a small cohort of patients with PD treated surgically for a DRF. We recommend locked plating if suitable for the fracture type and early involvement of a multidisciplinary team to assist with medical optimization of PD to increase chances of a successful outcome.

Keywords: Parkinson disease; distal radius fracture; open reduction and internal fixation; osteoporosis.

Figure 1.

(a) ORIF with VLP for an acute left DRF in a 79-year-old man with PD and no other medical comorbidities. Patient returned for routine follow-up at postoperative day 12 for suture removal and repeat radiographs. (b) Radiographs demonstrate diaphyseal screw pullout (2 proximal locking and 1 distal cortical) with significant loss of fracture reduction. Note. ORIF = open reduction and internal fixation; VLP = volar locked plate; DRF = distal radius fracture; PD = Parkinson disease.