Tuaño Krystle R, Fisher Marlie H, Lee Nayun, Khatter Neil J, Le Elliot, Washington Kia M, Iorio Matthew L
Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Denver, CO.
Medical Scientist Training Program, University of Colorado Anschutz Medical Campus, Aurora, CO.
J Hand Surg Glob Online. 2023 May 20;5(5):601-605. doi: 10.1016/j.jhsg.2023.04.005. eCollection 2023 Sep.
Distal radius fractures (DRFs) are among the most common orthopedic injuries, especially in the elderly. A wide variety of approaches have been advocated as successful treatment modalities; yet, there remains variability in practice patterns of DRF in patients with osteoporosis and osteopenia. Using large data set analysis, we sought to determine the risk profile of operative fixation of DRF in patients with low bone mineral density.
A commercially available health care database, PearlDiver, was queried for all patients who underwent open reduction internal fixation of DRFs between 2010 and 2020. The study population was divided into groups based on the presence or absence of osteopenia or osteoporosis and was further classified by patients who were receiving bisphosphonate therapy. Complication rates were calculated, including rates of malunion, surgical site infection, osteomyelitis, hardware failure, and hardware removal. Five-year future fragility fractures were defined in hip, vertebrae, humerus, and wrist fractures. Chi-square analysis and logistic regression were performed to determine an association between these comorbidities and various postoperative complications.
A total of 152,926 patients underwent open reduction internal fixation of a DRF during the study period. Chi-square analysis of major complications at 3 months showed a statistically significant increase in malunion in patients with osteopenia ( = .05) and patients with osteoporosis ( = .05) who underwent open reduction internal fixation. Logistic regression analysis at 12 months after surgery demonstrated that osteopenia was associated with an increased risk of hardware failure ( < .0001), hardware removal ( < .0001), surgical site infection ( < .0001), and malunion ( = .004). Osteoporosis was associated with a significantly increased risk of hardware failure ( = .01), surgical site infection ( < .0001), and malunion ( < .0001).
We demonstrated, using large data set analysis, that DRF patients with osteopenia and osteoporosis are predicted to be at increased risk of multiple postoperative complications, and thus, bone density should be strongly considered in treatment planning for these patients.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
桡骨远端骨折（DRF）是最常见的骨科损伤之一，在老年人中尤为常见。已有多种方法被倡导为成功的治疗方式；然而，骨质疏松症和骨质减少症患者的DRF治疗模式仍存在差异。通过大数据集分析，我们试图确定低骨密度患者DRF手术固定的风险概况。
查询商业可用的医疗保健数据库PearlDiver，获取2010年至2020年间接受DRF切开复位内固定术的所有患者。研究人群根据是否存在骨质减少症或骨质疏松症进行分组，并进一步按接受双膦酸盐治疗的患者进行分类。计算并发症发生率，包括畸形愈合率、手术部位感染率、骨髓炎、内固定失败率和内固定取出率。将髋部、脊椎、肱骨和腕部骨折定义为五年后未来脆性骨折。进行卡方分析和逻辑回归，以确定这些合并症与各种术后并发症之间的关联。
在研究期间，共有152,926例患者接受了DRF切开复位内固定术。对3个月时主要并发症的卡方分析显示，接受切开复位内固定术的骨质减少症患者（P = 0.05）和骨质疏松症患者（P = 0.05）的畸形愈合率在统计学上显著增加。术后12个月的逻辑回归分析表明，骨质减少症与内固定失败风险增加相关（P < 0.0001）、内固定取出风险增加相关（P < 0.0001）、手术部位感染风险增加相关（P < 0.0001）以及畸形愈合风险增加相关（P = 0.004）。骨质疏松症与内固定失败风险显著增加相关（P = 0.01）、手术部位感染风险增加相关（P < 0.0001）以及畸形愈合风险增加相关（P < 0.0001）。
通过大数据集分析，我们证明骨质疏松症和骨质减少症的DRF患者预计术后发生多种并发症的风险增加，因此，在为这些患者制定治疗计划时应充分考虑骨密度。
研究类型/证据水平：预后性研究III级。
