Patients (operative, n = 129) and controls (nonsurgical, n = 129) were identified from a prospective clinical and operating room database. They were matched on fracture severity (AO-A/B/C1 vs AO-C2/C3), sex, age, and energy of injury. Data on complications were extracted from medical charts using a validated complications checklist, and radiologic data were collected for all patients. Functional outcomes (Patient-Related Wrist Evaluation) at 1 year were available in only a subset of patients. We determined differences in complication and reoperation rates using a chi-square test.
A significant number of patients experienced complications in the operative group (operative = 37 of 129; nonsurgical = 22 of 129). The most common complication was median neuropathy (n = 8 operative; n = 14 nonsurgical), followed by surgical site infections (n = 16 operative; 12 of 16 were pin site infections) and complex regional pain syndrome (n = 4 operative; 3 nonsurgical). The complication rate in patients treated with volar plate was 22% (16 of 74), for dorsal plate it was 50% (2 of 4), for external fixation it was 42% (16 of 38), and for percutaneous pinning it was 23% (3 of 13). The number of patients requiring reoperations was similar in both groups (11 [9%] operative; 7 [5%] nonsurgical). Our secondary radiologic and functional outcomes demonstrate that despite a higher incidence of malunion in nonsurgical patients (nonsurgical: 69% vs operative: 29%), a subset of patients from both groups (n = 140) had minimal pain and disability at 1 year (Patient-Related Wrist Evaluation operative: 16.9 ± 23.2; nonsurgical: 15.7 ± 17.5).
In a study matching fracture severity, sex, age, and energy of injury, we found that elderly patients with distal radius fractures who underwent surgery had higher complication rates than those treated nonsurgically.
Therapeutic III.