Abstract
Introduction: We present the world’s largest current series of open distal radial fractures (ODRF), aiming to describe the epidemiology and outcomes of these injuries.
Methods: Patients with ODRF treated at the Edinburgh Orthopaedic Trauma unit between 1990 and 2009 were identified from computer records. All patients aged over 13 with juxta-articular and metaphyseal fractures were included – diaphyseal injuries were excluded. The following information was retrieved from notes and radiographs: patient demographics; co-morbidities; mechanism of injury; AO classification; other injuries; time to A& E treatment; time until surgery; antibiotic use; Gustillo and Anderson (GA) grade; surgical treatment; complications; further surgery; functional outcome.
Results: 201 patients were included. The average age was 65.5 years, 75% were female. 69% resulted from simple falls, 15% falls from height, 6% sporting injuries and 9% from road traffic accidents. 73 % were GA-1, 26% were GA-2, 1% GA-3. The commonest fracture pattern was AO 23-C2. 41% underwent definitive debridement within 6 hours, 46% in 6 to 24 hours, 13% waited longer. 30% were treated by ORIF, 38% with non-bridging fixator, 29% by bridging fixator and 3% by MUA and plaster. 43% of wounds were closed primarily, 47% were left open, 8% required delayed closure, 2% required skin grafting. Follow-up averaged 16.5 weeks. 14% suffered superficial infections, 1.3% suffered deep infection. Predictors of infection included primary closure and the use of an external fixator. Functional outcome was variable.
Discussion: Most open distal radial fractures occur in elderly women after a simple fall. Serious infection rates are low.
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Author: Samuel Molyneux, United Kingdom
E-mail: sgmolyneux@googlemail.com
