London Health Sciences Centre, London, Canada.
Health Sciences North, Sudbury, Canada.
Bone Joint J. 2024 Nov 1;106-B(11):1257-1262. doi: 10.1302/0301-620X.106B11.BJJ-2023-1349.R1.
We aimed to compare reoperations following distal radial fractures (DRFs) managed with early fixation versus delayed fixation following initial closed reduction (CR).
We used administrative databases in Ontario, Canada, to identify DRF patients aged 18 years or older from 2003 to 2016. We used procedural and fee codes within 30 days to determine which patients underwent early fixation (≤ seven days) or delayed fixation following CR. We grouped patients in the delayed group by their time to definitive fixation (eight to 14 days, 15 to 21 days, and 22 to 30 days). We used intervention and diagnostic codes to identify reoperations within two years. We used multivariable regression to compare the association between early versus delayed fixation and reoperation for all patients and stratified by age (18 to 60 years and > 60 years).
We identified 14,960 DRF patients, 8,339 (55.7%) of whom underwent early surgical fixation (mean 2.9 days (SD 1.8)). In contrast, 4,042 patients (27.0%) underwent delayed fixation between eight and 14 days (mean 10.2 days (SD 2.2)), 1,892 (12.7%) between 14 and 21 days (mean 17.5 days (SD 1.9)) and 687 (4.6%) > 21 days (mean 24.8 days (SD 2.4)) post-fracture. Patients who underwent delayed fixation > 21 days post-fracture had a higher odds of reoperation (odds ratio (OR) 1.33 (95% CI 1.11 to 1.79) vs early fixation). This worsened for patients aged > 60 years (OR 1.69 (95% CI 1.11 to 2.79)). We found no difference in the odds of reoperation for patients who underwent delayed fixation within eight to 14 or 15 to 21 days post-fracture (vs early fixation).
These data suggest that DRF patients with fractures with unacceptable reduction following CR should be managed within three weeks to avoid detrimental outcomes. Prospective studies are required to confirm these findings.
我们旨在比较桡骨远端骨折（DRF）患者接受初始闭合复位（CR）后早期固定与延迟固定的再手术情况。
我们使用加拿大安大略省的行政数据库，从 2003 年至 2016 年确定年龄在 18 岁或以上的 DRF 患者。我们在 30 天内使用程序和费用代码来确定哪些患者接受了早期固定（≤7 天）或 CR 后延迟固定。我们将延迟组的患者按其最终固定时间（8 至 14 天、15 至 21 天和 22 至 30 天）进行分组。我们使用干预和诊断代码在两年内确定再手术。我们使用多变量回归来比较所有患者和按年龄（18 至 60 岁和>60 岁）分层的早期与延迟固定与再手术之间的关联。
我们确定了 14960 例 DRF 患者，其中 8339 例（55.7%）接受了早期手术固定（平均 2.9 天（SD 1.8））。相比之下，4042 例患者（27.0%）在骨折后 8 至 14 天（平均 10.2 天（SD 2.2））、1892 例（12.7%）在 14 至 21 天（平均 17.5 天（SD 1.9））和 687 例（4.6%）>21 天（平均 24.8 天（SD 2.4））接受延迟固定。骨折后接受延迟固定>21 天的患者再手术的可能性更高（优势比（OR）1.33（95%CI 1.11 至 1.79）与早期固定）。对于年龄>60 岁的患者，这一比例恶化（OR 1.69（95%CI 1.11 至 2.79））。我们没有发现骨折后 8 至 14 天或 15 至 21 天接受延迟固定的患者与早期固定相比，再手术的可能性有差异（OR 1.33（95%CI 1.11 至 1.79））。需要前瞻性研究来证实这些发现。
