Perioperative management of distal radius fractures

Insulin dependence as an independent predictor of complications following surgical treatment of distal radius fracture

PURPOSE

Diabetes mellitus (DM) is a well-established risk factor for postoperative complications. Distal radius fractures (DRFs) are a common orthopedic injury and often require open reduction and internal fixation (ORIF). The rise of ORIF utilization warrants investigation into factors that may expose patients to postoperative complications following DRF ORIF.

METHODS

We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for cases of DRF ORIF between 2015 and 2021. Cases were stratified into cohorts based on diabetes mellitus (DM) status. The DM cohort was further stratified into non-insulin-dependent DM (NIDDM) and insulin-dependent DM (IDDM) groups. Bivariate logistic regression was performed to compare patient demographics, comorbidities, and 30-day postoperative complications. Multivariate logistic regressions were performed to identify associations between diabetes mellitus status and postoperative complications.

RESULTS

A total of 27,761 cases of DRF ORIF were identified from 2015 to 2021. After exclusion criteria were applied, 25,971 cases remained, of which 2169 (8.4%) cases had DM and 23,802 (91.6%) cases were free of DM. Within the DM cohort, there were 1392 cases in the NIDDM subgroup and 777 cases in the IDDM subgroup. Relative to the cohort without diabetes, the IDDM cohort was independently associated with sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off mechanical ventilation, readmission, and nonhome discharge.

CONCLUSION

Having IDDM was independently associated with higher rates of postoperative sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off ventilation, readmission, and nonhome discharge when compared to the cohort without diabetes following DRF ORIF.

LEVEL OF EVIDENCE

Level III; Retrospective cohort comparison; Prognosis study.

Improvement, Validation, and Analysis of Colles Fracture Treated with an Integrated Retainer Pad Splint

Objective

To observe the effectiveness and safety of the Colles fracture treated with the integrated retainer pad splint and to compare the clinical and radiological outcomes of the integrated retainer pad splint and the traditional bamboo curtain splint in the treatment of the Colles fracture.

Methods

A total of 100 patients with Colles fractures were randomly divided into two groups: the treatment group was fixed with the integrated retainer pad splint (IS), and the control group was fixed with the traditional bamboo curtain splint (TS).The range of wrist motion was measured at follow-up examinations, and volar inclination, ulnar deviation, and radial height were measured on radiographs. Regular follow-up wrist imaging examinations and functional examinations were performed before reduction, after reduction, and at the 1st, 3rd, 5^th, and 8th weeks. The two groups were compared in terms of convenience, fracture healing time, X-ray data of volar inclination, ulnar deviation, radial height, and wrist joint function. The relevant data were analyzed with SPSS 25.0 statistical software.

Results

There were no notable differences in gender, age, and injured side between IS and TS groups. In terms of operation time, IS was better than the TS group (P < 0.05), and the operation time in the IS group was shorter. On the basis of X-ray data of volar inclination, ulnar deviation, and radial height measured on radiographs, the difference between the IS and TS groups was statistically significant (P < 0.05), which showed that the IS group was more stable in fracture fixation and had less reduction loss during the treatment process. At the 8th week of treatment, the wrist Gartland–Werley score of the two groups showed that the two fixation methods are equivalent in restoring wrist joint function (P > 0.05); however, in terms of the excellent and good rate of wrist joint function, the IS group scored 96% was higher than the TS group (80%).

Conclusion

Compared with the traditional bamboo curtain splint, the integrated retainer pad splint is more convenient and stable, and it has less reduction loss during the treatment. Repair of the Colles fracture using the integrated retainer pad splint with external fixation results in nearly normal return of function, which is significantly better than using the traditional bamboo curtain splint.