I型桡骨远端开放性骨折固定时间不影响早期并发症发生率

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-01-01 DOI:10.1016/j.jhsg.2024.09.004

Eric R. Taleghani MD , James Rex MD , Samuel Gerak BA , John Velasquez MS , Kathryn Rost BS , Sonu A. Jain MD, FACS

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引用次数: 0

摘要

目的：关于I型桡骨远端开放性骨折的最佳治疗方法，已发表的证据有限。本研究的目的是比较桡骨远端开放性骨折的短期并发症发生率，并关注I型骨折的治疗时机。我们的假设是I型开放性桡骨远端骨折（DRFs）的治疗和感染之间不存在时间相关性。方法回顾性分析某一级创伤中心10年间所有开放性drf病例。根据Gustilo Anderson开放性骨折分型对患者进行分组。主要结局指标是所有患者至少6个月随访后的浅表和深部感染率。对Gustilo Anderson I型损伤进行亚组分析，并根据手术时间进行3个月的随访。结果71例开放性DRFs纳入分析，平均随访时间为16.7个月。与II型（4%和0.6）和I型（0%和0.39）队列相比，III型队列的深度感染率（30%）和平均翻修手术次数（3.0）更高。对63例I型骨折进行亚组分析，随访至少3个月，结果显示无感染，在24小时、24 - 72小时和大于72小时内确定治疗的患者中，其他并发症或翻修手术次数无差异。2例患者采用非手术治疗，无并发症。结论I型开放性DRFs在人口统计学特征、损伤特征、感染、并发症和再手术率等方面与高级别DRFs存在差异。在I型DRF队列中没有感染，基于清创时间的并发症发生率也没有差异，我们的数据表明，在手术时间方面，处理I型开放式DRF与处理闭合性损伤相似是安全的。研究类型/证据水平：治疗性

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Timing of Type I Open Distal Radius Fracture Fixation Does Not Affect Early Complication Rates

Purpose

There is limited published evidence regarding the optimal management of type I open fractures of the distal radius. The purpose of this study was to compare short-term complication rates among open fractures of the distal radius, with attention to the timing of management of type I fractures. Our hypothesis was that there would not be a temporal association between treatment and infection for type I open distal radius fractures (DRFs).

Methods

A retrospective review of all open DRFs at a single level-1 trauma center over a 10-year period was performed. Patients were grouped based on Gustilo Anderson open fracture classification. The primary outcome measures were superficial and deep infection rates in all patients with a minimum of 6-month follow-up. A subgroup analysis was performed for Gustilo Anderson type I injuries with a 3-month follow-up based on time to surgery.

Results

Seventy-one patients with open DRFs were included for analysis with an average follow-up of 16.7 months. There was a higher rate of deep infection (30%) and average number of revision surgeries (3.0) in the type III cohort compared with both type II (4% and 0.6) and type I (0% and 0.39) cohorts. A subgroup analysis of 63 type I fractures with a minimum of 3-month follow-up revealed zero infections, with no difference in other complications or number of revision surgeries among patients definitively managed within 24 hours, 24–72 hours, and greater than 72 hours. Two patients were managed nonoperatively, without complication.

Conclusions

Type I open DRFs differ from higher grade DRFs with regard to demographics and injury characteristics, along with infection, complication, and reoperation rates. With no infections in the type I DRF cohort and no difference in complication rates based on time to debridement, our data suggest that it is safe to manage type I open DRFs similarly to closed injuries regarding surgical timing.