Timing of Type I Open Distal Radius Fracture Fixation Does Not Affect Early Complication Rates.

PURPOSE: There is limited published evidence regarding the optimal management of type I open fractures of the distal radius. The purpose of this study was to compare short-term complication rates among open fractures of the distal radius, with attention to the timing of management of type I fractures. Our hypothesis was that there would not be a temporal association between treatment and infection for type I open distal radius fractures (DRFs).

METHODS

A retrospective review of all open DRFs at a single level-1 trauma center over a 10-year period was performed. Patients were grouped based on Gustilo Anderson open fracture classification. The primary outcome measures were superficial and deep infection rates in all patients with a minimum of 6-month follow-up. A subgroup analysis was performed for Gustilo Anderson type I injuries with a 3-month follow-up based on time to surgery.

RESULTS

Seventy-one patients with open DRFs were included for analysis with an average follow-up of 16.7 months. There was a higher rate of deep infection (30%) and average number of revision surgeries (3.0) in the type III cohort compared with both type II (4% and 0.6) and type I (0% and 0.39) cohorts. A subgroup analysis of 63 type I fractures with a minimum of 3-month follow-up revealed zero infections, with no difference in other complications or number of revision surgeries among patients definitively managed within 24 hours, 24-72 hours, and greater than 72 hours. Two patients were managed nonoperatively, without complication.

CONCLUSIONS

Type I open DRFs differ from higher grade DRFs with regard to demographics and injury characteristics, along with infection, complication, and reoperation rates. With no infections in the type I DRF cohort and no difference in complication rates based on time to debridement, our data suggest that it is safe to manage type I open DRFs similarly to closed injuries regarding surgical timing.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.