Epidemiology, risk factor, and economic analysis of peripheral nerve injury following distal radius fractures.

Abstract

Purpose: Distal radius fractures (DRFs) are a common orthopaedic injury with a bimodal age and gender distribution, comprising male children after high-energy trauma and older women after low-energy falls. Complications like malunion, ligament ruptures, and nerve injuries can significantly impact recovery. This study aimed to address the gap in population-based data by analyzing the prevalence and risk factors for peripheral nerve injuries associated with DRFs.

Methods: The National Inpatient Sample database was used to analyze DRFs patients with associated ulnar, median, or radial nerve injuries. Patient demographics, comorbidities, and fracture characteristics were analyzed using chi-square tests and binary logistic regression to determine independent risk factors. Finally, independent sample t-tests assessed differences in average lengths of stay and total hospitalization charges between patients with and without ulnar, median, or radial nerve injuries.

Results: Between 2015 and 2020, 175,040 patients with DRFs were admitted to U.S. hospitals, with 0.24% experiencing ulnar nerve injury, 0.49% median nerve injury, and 0.08% radial nerve injury. Age, race, fracture morphology, and several comorbidities were identified as significant predictors of nerve injury. Open fractures notably increased the odds for all three nerve injuries. Protective factors included older age, intra-articular fractures, and comorbidities like diabetes and obesity. Peripheral nerve injuries were associated with longer hospital stays and increased total hospitalization costs.

Conclusions: Peripheral nerve injuries related to DRFs are rare but can significantly complicate treatment and recovery. This study investigated the prevalence of nerve injuries associated with DRFs and identified open fractures as the strongest predictor of ulnar, median, and radial nerve injuries at the wrist. Older age and intra-articular fractures were linked to a reduced risk of nerve involvement. These findings can help orthopaedic surgeons assess the risk of concurrent nerve injuries by considering key demographic and fracture morphology factors, allowing for more targeted evaluation and management.

Level of evidence: Level IV, Differential Diagnosis / Symptom Prevalence Study.