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Campbell BR, Reyes AA, Neustein TM, Miller AJ. Outcomes of Volar Plating Distal Radius Fractures Based on Surgical Timing. Hand (N Y) 2023:15589447231198264. [PMID: 37715706 DOI: 10.1177/15589447231198264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
BACKGROUND While complexity of distal radius fractures varies, volar plating is the most prevalent surgical option in adult injuries. The time between date of injury and surgical intervention varies according to several factors, including the timing of presentation and the surgeon's availability. This study aims to understand the impact of a delay in surgical intervention on operative time, patient-reported outcomes, and reoperation rates. METHODS A retrospective review was performed on patients treated with volar plating of distal radius fractures from 2017 to 2020 at a single institution by multiple surgeons. Perioperative medical records were reviewed. Patients were divided into 2 groups using a cut-off date of surgery performed 12 days after injury. Descriptive analyses were used to compare demographics, fracture characteristics, operative information, and outcome data including postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores and reoperation rates between groups. RESULTS A total of 257 patients were included. There was no difference in age, gender, smoking status, fracture type, or postoperative QuickDASH scores between groups. Patients fixed at 12 days or more after injury had a higher rate of reoperation, higher American Society of Anesthesiologists scores, and more surgeon experience. CONCLUSIONS Volar distal radius fixation at 12 or more days after injury had no discernible differences with fracture type, operative time, or tourniquet time; however, a higher rate of reoperation was found in this group compared to earlier intervention. These data may provide important prognostic information that can be used to educate patients who present in a delayed fashion.
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Affiliation(s)
- Benjamin R Campbell
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ariana A Reyes
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Andrew J Miller
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, Philadelphia, PA, USA
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Zhang H, Liu M, Duan SY, Liang HR, Xu RD, Cai ZC. Surgical options for distal radius fractures of type C in elderly patients over 65 years old: a comparison of external fixation with Kirschner wires and volar locking plate. J Orthop Surg Res 2023; 18:669. [PMID: 37689739 PMCID: PMC10493013 DOI: 10.1186/s13018-023-04162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND ue to the lack of consensus on the optimal surgical treatment for distal radius fractures (DRF) in elderly patients over 65 years old, the purpose of this study was to compare the efficacy of external fixation (EF) with Kirschner wires and volar locking plate (VLP) in the treatment of DRF through a retrospective cohort study. We hypothesized that there would be no significant difference in overall complications and functional recovery between the two methods. METHODS We retrospectively analyzed 62 patients over 65 years old who underwent surgical treatment for C-type DRF between 2019 and 2022. Based on the different treatment methods, they were divided into the EF group and the VLP group. General data, inpatient data, and postoperative complications during follow-up were recorded. The X-ray images before surgery, after surgery, and at the last follow-up were analyzed, and the results of wrist motion range, Gartland-Werley wrist joint score, and DASH score were evaluated 6 months after surgery for both groups. RESULT Thirty patients underwent closed reduction and external fixation combined with Kirschner wire fixation, while 32 underwent open reduction and VLP fixation. The EF group had significantly shorter operation time, intraoperative blood loss, injury-to-surgery time, and hospital stay compared to the VLP group (all p < 0.001). At the last follow-up, the radiographic parameters (ulnar variance and radial inclination) and wrist joint function (wrist dorsiflexion and forearm supination) were better in the VLP group than in the EF group (p = 0.04, p = 0.01, p = 0.001, p = 0.02, respectively). However, there was no significant difference in overall Gartland-Werley wrist joint score, DASH score, and incidence of postoperative complications between the two groups (p = 0.31, p = 0.25, p = 0.47, respectively). CONCLUSION For patients aged 65 and above with distal radius fractures (DRF) of type C, VLP and external fixation with Kirschner wires yield comparable functional outcome and complications rate at the short term. However, VLP allowed restoration of better radiological parameters.
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Affiliation(s)
- He Zhang
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - Man Liu
- School of Basic Medical Sciences, Shenyang Medical College, 146 Huanghe North Street, Shenyang, 110034, Liaoning, China
| | - Si-Yu Duan
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - Hai-Rui Liang
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - Rong-Da Xu
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - Zhen-Cun Cai
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China.
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Julian KR, Truong NM, Leversedge C, Kwong JW, Rosinski A, Kamal RN, Shapiro LM. Does Time to Surgery for Distal Radius Fractures Impact Clinical and Radiographic Outcomes? A Systematic Literature Review. CURRENT ORTHOPAEDIC PRACTICE 2023; 34:229-235. [PMID: 38264709 PMCID: PMC10802167 DOI: 10.1097/bco.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Distal radius fractures are one of the most common upper extremity fractures across all age groups. Although the American Academy of Orthopaedic Surgery (AAOS) Clinical Practice Guidelines have defined recommendations for the treatment of distal radius fractures, the optimal time to surgery was not included. There remains relatively little guidance or consensus regarding the optimal timing of surgical intervention for distal radius fractures and the impact of time to surgery on outcomes. As such, the purpose of this investigation is to systematically review clinical and radiographic outcomes associated with time to surgical management of distal radius fractures.
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Affiliation(s)
- Kaitlyn R Julian
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Nicole M Truong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Chelsea Leversedge
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street Redwood City, CA
| | - Jeffrey W Kwong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Alexander Rosinski
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program 450 Stanyan Street San Francisco, CA 94117
| | - Robin N Kamal
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street MC: 6342 Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
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Tankersley MP, Zhuang T, Julian K, Fernandez A, Kamal RN, Shapiro LM. Disparities in Treatment of Closed Distal Radius Fractures in Patients Aged 18-64 Years and ≥65 Years by Insurance Type. J Hand Surg Am 2023; 48:566-574. [PMID: 37029034 PMCID: PMC10278954 DOI: 10.1016/j.jhsa.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/03/2023] [Accepted: 03/03/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Type of and time to definitive treatment for distal radius fractures can influence the outcomes. The impact of social determinants of health (eg, insurance type) on distal radius fracture care remains unknown despite having health equity implications. Thus, we evaluate the association between insurance type and rate of surgery, the time to surgery, and the complication rate for distal radius fractures. METHODS We conducted a retrospective cohort study using the PearlDiver Database. We identified adults with closed distal radius fractures. Patients were divided into subgroups by age (18-64 years, 65+ years) and further stratified on the basis of the insurance type (Medicare Advantage, Medicaid-managed care, and commercial). The primary outcome was the rate of surgical fixation. Secondary outcomes included the time to surgery and 12-month complication rates. Logistic regression modeling was used to calculate the odds ratios for each outcome, adjusting for age, sex, geographic region, and comorbidities. RESULTS In patients aged ≥65 years, a lower proportion of Medicaid patients underwent surgery within 21 days of diagnosis compared with Medicare or commercially insured patients (12.1% vs 15.9% or 17.5%, respectively). Complication rates did not differ between Medicaid and other insurance types. In patients aged <65 years, fewer Medicaid patients underwent surgery compared with commercially insured patients (16.2% vs 21.1%). However, in this younger group, Medicaid patients had higher adjusted odds of malunion/nonunion (adjusted odds ratio [aOR] = 1.39 [95% CI, 1.31-1.47]) and subsequent repair (aOR = 1.38 [95% CI, 1.25-1.53]). DISCUSSION Although older Medicaid patients experienced lower surgical rates, this may not lead to differential clinical outcomes. However, Medicaid patients aged <65 years experienced lower surgical rates that correlated with the increased rates of malunion or nonunion. CLINICAL RELEVANCE In younger patients with a closed distal radius fracture and Medicaid insurance, system and patient-directed efforts should be considered to address delayed time to surgery and a higher odds for malunion/nonunion.
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Affiliation(s)
- Morgan P Tankersley
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Thompson Zhuang
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Kaitlyn Julian
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA
| | - Alicia Fernandez
- Department of Medicine, University of California at San Francisco, San Francisco, CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA.
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Grier AJ, Chen KJ, Paul AV, Green CL, Richard MJ, Ruch DS, Pidgeon TS. Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures. Hand (N Y) 2023:15589447231174642. [PMID: 37243339 DOI: 10.1177/15589447231174642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes. METHODS We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication. RESULTS Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%). CONCLUSIONS Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery.
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Affiliation(s)
| | - Kallie J Chen
- University Hospitals Cleveland Medical Center, OH, USA
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Khan S, Persitz J, Shrouder-Henry J, Khan M, Chan A, Paul R. Effect of Time-To-Surgery on Distal Radius Fracture Outcomes: A Systematic Review. J Hand Surg Am 2023; 48:435-443. [PMID: 36890081 DOI: 10.1016/j.jhsa.2022.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 03/10/2023]
Abstract
PURPOSE It remains unclear whether time-to-surgery for distal radius fractures affects clinical, functional, or radiographic outcomes or health care costs/use. This systematic review investigated the outcomes of early versus delayed surgery for closed, isolated distal radius fractures in adult patients. METHODS A comprehensive search of MEDLINE, Embase, and CINAHL databases was completed for all original case series, observational studies, and randomized controlled trials reporting clinical outcomes of both early and delayed surgically-treated distal radius fractures from database inception to July 01, 2022. A consistent threshold of two weeks was used to define early versus delayed treatment arms. RESULTS Nine studies, including 16 intervention arms and 1,189 patients (858 early, 331 delayed), were included. Mean age was 58 years (range, 33-76). At more than one year, the frequency-weighted mean Disabilities of the Arm, Shoulder, and Hand score was 4 in the early group (n = 208; range, 1-17) and 21 in the delayed group (n = 181; range, 4-27). Range of motion, grip strength, and radiographic outcomes were comparable. The pooled mean complication rate (7% vs 5%) and revision rate (3.6% vs 1%) were very low in both groups. CONCLUSIONS A delay in time-to-surgery greater than two weeks for distal radius fractures may be associated with inferior patient-reported outcomes. Early surgery was associated with improved long-term Disabilities of the Arm, Shoulder, and Hand scores. On the basis of the available evidence, range of motion, grip strength, and radiographic outcomes are similar. The complication and revision rates were very low in both groups and comparable. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Shawn Khan
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Jonathan Persitz
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | - Moin Khan
- Sports Medicine and Shoulder Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Andrea Chan
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Paul
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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