Feasibility and Reliability of Open Reduction Internal Fixation in Delayed Distal Radius Fracture Management

Abstract

Purpose: Current guidelines recommend that open reduction internal fixation (ORIF) for distal radius fractures (DRFs) be performed within 4 weeks of injury. Delayed DRF management (4 weeks or more) is traditionally subject to corrective osteotomy. We report a 5-year single-surgeon series of delayed DRFs that were treated by ORIF rather than osteotomy. Methods: We performed a retrospective review on all patients admitted to a single tertiary care center with a DRF requiring ORIF (2007–2012). Institutional review board approval was obtained. Patients were divided into an early group (EG) (surgery less than 4 weeks after injury) and delayed group (DG) (surgery after 4 or more weeks). Data collected included demographics, injury pattern, intraoperative parameters, and pre- and postoperative x-ray findings. Subjective and objective functional data were determined using a Disabilities of the Arm, Shoulder, and Hand questionnaire score and Mayo Wrist Score. Results: A total of 171 patients (EG = 54; DG = 117) underwent ORIF from 2007 to 2012 and met inclusion criteria. Both groups had similar age, gender, and racial demographics. Of these, 117 patients in the delayed group underwent ORIFs at 40 ± 13.9 days (range, 28–146 days) after injury. Preoperative fracture patterns were radiographically equivalent. A dorsal approach was required more frequently in the EG (7.4%) compared with DG (1.1%). The Orbay maneuver was performed at a significantly higher rate in the DG (55.8%) compared with the EG (38.8%). Blood loss, tourniquet times, intraoperative complications, radiographic parameters, articular incongruency rates, and Disabilities of the Arm, Shoulder, and Hand score, and Mayo Wrist Score were not statistically significant between groups. Conclusions: No significant differences were found in intraoperative technique, operative time, postoperative radiographs, and subjective outcome measures in patients treated with early versus late ORIF. Despite the current belief that primary ORIF in delayed DRF is technically impossible and warrants an osteotomy, our series indicates that ORIF is indeed a viable option in DRFs as late as 5 months after injury. Type of study/level of evidence: Therapeutic IV Key words: delayed internal fixation, distal radius fractures