Short-term complications following distal humerus open reduction and internal fixation

Area of Science:

• Orthopedic Surgery
• Trauma Surgery

Background:

• Distal humerus fractures (DHFs) represent about 2% of adult fractures.
• Nonoperative treatments can lead to functional deficits; thus, open reduction and internal fixation (ORIF) is a common primary treatment for DHFs.
• While ORIF offers satisfactory outcomes, complication rates can be as high as 30%, necessitating analysis of isolated ORIF outcomes.

Purpose of the Study:

• To analyze short-term postoperative complications specifically following ORIF for DHFs.
• To identify risk factors associated with adverse events after DHF ORIF.

Main Methods:

• Utilized the American College of Surgeons National Surgery Quality Improvement Program database, querying CPT code 24579 for DHF ORIF.
• Excluded patients with missing data and analyzed outcomes including surgical site infection, wound dehiscence, return to the operating room (ROR), and any adverse event (AAE).
• Employed multivariate logistic regression and threshold analysis to identify risk factors and operative time thresholds for complications.

Main Results:

• A cohort of 833 patients undergoing DHF ORIF was analyzed, with an overall AAE rate of 5.2% within 30 days.
• Surgical site infection, ROR, and wound dehiscence rates were below 2%.
• Increased age (OR=1.03), operative time (OR=1.01), hospital length of stay (OR=1.2), and smoking (OR=2.07) were significant risk factors for AAE. An operative time threshold of 97.1 minutes was identified, with significantly higher complication rates (7.8% vs 1.4%) beyond this point.

Conclusions:

• ORIF for DHFs demonstrates favorable short-term complication rates.
• Patient age, smoking status, and prolonged operative time (especially exceeding 97 minutes) are significant factors associated with increased AAE risk.
• Targeted patient counseling and further research are recommended to refine understanding of DHF ORIF outcomes.