Epidemiology and treatment of surgical infections after distal radius fractures: a systematic review

Abstract

Introduction

Distal radius fractures (DRFs) are among the most frequent injuries treated by orthopaedic surgeons. Although postoperative infection is uncommon, it represents a clinically relevant complication that may affect outcomes. This systematic review aimed to evaluate the incidence, subtypes, and treatment of infections following surgical management of DRFs.

Materials and methods

A systematic search of MEDLINE/PubMed and Cochrane Library was performed from inception to June 2024, following PRISMA guidelines. English-language longitudinal studies (prospective or retrospective) reporting infection after DRF surgery were included. Case reports, meta-analyses, animal studies, and articles without relevant outcomes were excluded. Extracted data included infection incidence, classification, microbiological findings, and reported management.

Results

Fifty-five studies met inclusion criteria, encompassing 6499 patients and 6451 procedures. A total of 341 infections were reported (5.3%). Superficial surgical site infections accounted for 22.6% of cases, deep infections for 12.0%, and pin-tract infections for 61.0%. Infection rates differed by fixation method: approximately 2.0% for open reduction and internal fixation, 12.0% for Kirschner-wire fixation, and 13.9% for external fixation. Microbiological confirmation was reported only in a minority of studies; when available, Staphylococcus aureus was the most frequently isolated organism. Management strategies ranged from oral antibiotics and local wound care for superficial infections to intravenous antibiotics with debridement and hardware removal for severe cases.

Conclusions

Infections following DRF surgery are relatively rare but vary across fixation techniques, with pin-tract infections predominating in percutaneous and external constructs. The heterogeneity of infection definitions and the scarcity of microbiological reporting limit comparability between studies. Standardized SSI/FRI classification and more consistent documentation are needed to improve evidence-based prevention and treatment strategies.