Skin laceration during closed reduction of distal radius fracture in the elderly: an underappreciated complication.

Abstract

Background: Distal radius fractures are common osteoporotic injuries in elderly patients. Dermatoporosis, an age-related cutaneous insufficiency often associated with corticosteroid use and malnutrition, is frequently overlooked in these cases despite its clinical relevance during fracture management.

Materials and methods: A 72-year-old underweight woman with chronic obstructive pulmonary disease and long-term corticosteroid use presented with an extra-articular Colles-type distal radius fracture after a trivial fall. Closed reduction under hematoma block was attempted. During disimpaction, a 5 × 2-cm dorsal wrist skin laceration occurred without communication with the fracture hematoma, necessitating abandonment of the procedure. Definitive treatment consisted of gentle closed reduction and percutaneous K-wire fixation under brachial plexus block, with primary closure of the skin laceration using horizontal mattress sutures.

Result: The wound healed uneventfully; sutures were removed at 3 weeks and K-wires at 6 weeks, followed by early wrist mobilization.

Conclusion: Skin tearing during closed reduction of distal radius fractures can occur in elderly patients with fragile skin because of dermatoporosis. Recognition of this condition, adoption of gentle reduction techniques, and meticulous soft-tissue management are essential to reduce wound-related complications and optimize outcomes in this vulnerable population.