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

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Infectious Disease Prevention

Background:

• The optimal timing for operative intervention in low-energy open distal radius fractures remains debated.
• Some trauma centers have revised protocols, moving away from emergent surgical debridement for all such cases.

Purpose of the Study:

• To investigate whether delaying operative debridement for open distal radius fractures is associated with increased infection rates.
• To provide preliminary data guiding clinical decision-making in managing these injuries.

Main Methods:

• A retrospective review of 55 open distal radius fractures in 54 patients from two level-one trauma centers.
• Patients received initial irrigation and closed reduction in the ED, followed by delayed or nonoperative treatment.
• Infection rates were the primary outcome, with complications and secondary procedures as secondary outcomes.

Main Results:

• Overall infection rate was 7.2% (4 of 55 patients).
• No infections occurred in low-energy injuries.
• A single infection (4.2%) was observed in patients treated nonoperatively or with delayed surgery (≥2 days post-presentation).
• All infections were associated with high-energy mechanisms and additional risk factors (smoking, polytrauma, Gustilo Anderson type 2).

Conclusions:

• Delaying formal operative debridement for low-energy, type 1 open distal radius fractures appears safe in this series, with no increased infection risk.
• Larger prospective studies are warranted to confirm these findings and refine treatment guidelines for specific fracture patterns.