Impact of Dialysis on Complication Rates Following Surgical Fracture Fixation in the Hand and Wrist

Patients with end-stage renal disease (ESRD) requiring dialysis are at increased risk for postoperative complications due to immune dysfunction, impaired healing, and vascular fragility. While dialysis has been studied in various surgical contexts, limited data exist on outcomes following hand fracture fixation. This study evaluates complication rates in dialysis-dependent versus nondialysis patients undergoing surgical fixation of distal radius, metacarpal, and phalangeal fractures.

A retrospective cohort analysis was performed using the PearlDiver Mariner database to identify adults who underwent open reduction and internal fixation (ORIF) for distal radius, metacarpal, or phalangeal fractures. Patients were stratified by dialysis status. Complications, including infection, hematoma, delayed healing, and revision, were assessed at 30 days, 90 days, and 1 year. Rates were compared between groups, with subgroup and univariate logistic regression analyses conducted to evaluate associations between dialysis and outcomes..

Dialysis-dependent patients had significantly higher complication rates. For distal radius ORIF, complication rates were 16.72% in dialysis patients versus 5.3% in controls (P < .001), with infection rates of 12.67% versus 3.63% (P < .001). Metacarpal ORIF showed a complication rate of 21.77% versus 10.48% (P = .016), largely due to infection (16.94% vs 4.03%, P = .001). Phalanx ORIF showed no difference in overall complications, but infection was more common in dialysis patients (17.65% vs 0%, P = .001). Regression confirmed increased complication odds in dialysis patients.

Dialysis-dependent patients undergoing hand fracture fixation face significantly higher complication rates, primarily due to infection, highlighting the need for specialized perioperative management.