急诊与延迟手术治疗开放性桡骨远端骨折：一项多中心回顾性研究

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-05-22 DOI:10.1016/j.jhsg.2025.03.006

Luke Latario MD , Matthew DeFazio MD , Matthew Poorman MD , Alan Shi MD , Eric Swart MD , Marci Jones MD

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引用次数: 0

摘要

目的对低能量开放性桡骨远端骨折手术治疗的紧迫性存在争议。两家医疗中心改变了做法，不再将所有开放性桡骨远端骨折紧急进行手术清创。本研究的目的是提供初步数据，以评估这是否与不可接受的高感染率有关。方法对55例桡骨远端开放性骨折54例患者进行回顾性分析。患者在急诊科接受冲洗和闭合复位，随后在24小时内或出院后进行彻底的闭合治疗或手术治疗，包括手术冲洗、清创和固定。主要结局指标为感染，次要结局为并发症或二次手术。结果55例患者中有4例出现感染（7.2%）。低能损伤组无感染。24例患者在发病后2天或更长时间进入手术室或非手术治疗，只有1例术后感染（4.2%）。所有感染都是高能量机制损伤，至少有一个额外的危险因素：吸烟、多发创伤或2型古斯蒂洛·安德森损伤。结论：这些数据表明，在这个小病例系列中，低能量损伤机制和1型损伤的患者，延迟正式手术清创与感染风险升高无关。未来需要更大样本量的前瞻性研究来明确评估一些开放性桡骨远端骨折模式是否不需要紧急手术清创。研究类型/证据水平

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Urgent Versus Delayed Surgical Treatment of Open Distal Radius Fractures: A Multicenter Retrospective Study

Purpose

Controversy exists on the urgency of operative treatment for low energy open distal radius fractures. Two medical centers shifted practice and no longer take all open distal radius fractures emergently to the operating for debridement. The purpose of this study is to provide preliminary data to evaluate if this is associated with unacceptably high infection rates.

Methods

A retrospective chart review was performed for 55 open distal radius fractures in 54 patients at two level one trauma centers. Patients underwent irrigation and closed reduction in the emergency department followed by definitive closed treatment or operative treatment with surgical irrigation, debridement, and fixation, either within 24 hours or after discharge. The main outcome measure was infection, with secondary outcomes of complications or secondary procedures.

Results

In this cohort, 4 of 55 patients experienced infections (7.2%.) There were no infections in low energy injuries. Twenty-four patients went to the operating room 2 or more days from presentation or were treated nonoperatively with only 1 postoperative infection (4.2%). All infections were in high energy mechanism injuries with at least one additional risk factor: smoking, polytrauma, or Gustilo Anderson type 2 injury.

Conclusions

These data suggest that in patients with low energy injury mechanisms and type 1 injuries, delay in formal operative debridement is not associated with an elevated infection risk in this small case series. Future prospective studies with larger sample sizes are needed to definitively evaluate whether some open distal radius fracture patterns may not require emergent operative debridement.