Fracture related infection (FRI) is a challenging complication to manage in an orthoplastic setting. Consensus guidelines have been created to standardise the diagnosis of FRI and comprise confirmatory and suggestive criteria. In this study, the aim is to assess the diagnostic criteria and management of FRI with a particular focus on soft tissue reconstruction. A retrospective study to identify the outcomes of FRI in the lower limb over a five year period at a Major Trauma Centre. Fracture specific information that was analysed includes: open versus closed, fractured bone(s) and site, initial fracture management, method of diagnosis and soft tissue management.Introduction
Materials & Methods
The aim of this study is to compare functional, clinical and radiological outcomes in K-wire fixation versus volar fixed-angle plate fixation in unstable, dorsally angulated distal radius fractures. Fifty-four adult patients with an isolated closed, unilateral, unstable, distal radius fracture were recruited to participate in the study. Only dorsally displaced fractures with no articular comminution were included. Patients were randomised to have their fracture treated with either closed reduction and K-wire fixation (3 wires) or fixed-angle volar plating. Both groups were immobilised in a below elbow cast for six weeks. The wires removed in the outpatients at six weeks and both groups were referred for physiotherapy. Independent clinical review was performed at three and six months post injury. Functional scoring was performed using the DASH and Gartland and Werley scoring systems. Radiographs were evaluated by an independent orthopaedic surgeon. Twenty-five patients were treated with a plate and twenty-nine with wires. There were no complications in the plate group. There were 9 complications in the K-wire group with 3 patients requiring a second operation (1 corrective osteotomy for malunion, 1 median nerve decompression and 1 retrieval of a migrated wire). The remaining complications included: 5 pin site infections (3 treated with early pin removal and 2 with oral antibiotics only), and 1 superficial radial nerve palsy. There were no tendon ruptures. Both groups scored satisfactory functional results with no statistical difference. There was a statistically significant difference in the radiological outcomes with the plate group achieving better results. We conclude that in unstable dorsally angulated distal radius fractures volar fixed-angle plate fixation is able to achieve comparable functional results to K-wire fixation with better radiological results and fewer complications. This has resulted in a change in our clinical practice.
