桡骨远端骨折初次闭合复位失败后超过三周仍延迟固定,会增加再次手术的几率。

IF 4.9 1区 医学 Q1 ORTHOPEDICS Bone & Joint Journal Pub Date : 2024-11-01 DOI:10.1302/0301-620X.106B11.BJJ-2023-1349.R1
Lauren L Nowak, Joel Moktar, Patrick Henry, Taylor Dejong, Michael D McKee, Emil H Schemitsch
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引用次数: 0

摘要

目的:我们旨在比较桡骨远端骨折(DRF)后的再手术情况,在初次闭合复位(CR)后采用早期固定与延迟固定进行处理:我们利用加拿大安大略省的行政数据库,确定了 2003 年至 2016 年期间年龄在 18 岁或以上的桡骨远端骨折患者。我们使用 30 天内的手术和收费代码来确定哪些患者在 CR 后接受了早期固定(≤ 7 天)或延迟固定。我们根据患者接受明确固定的时间(8 至 14 天、15 至 21 天和 22 至 30 天)对延迟固定组的患者进行了分组。我们使用干预和诊断代码来识别两年内的再次手术。我们使用多变量回归法比较了所有患者早期固定与延迟固定和再次手术之间的关系,并按年龄(18 至 60 岁和 60 岁以上)进行了分层:我们发现了14960名DRF患者,其中8339人(55.7%)接受了早期手术固定(平均2.9天(SD 1.8))。相比之下,4,042 名患者(27.0%)在骨折后 8 至 14 天(平均 10.2 天(标清 2.2 天))、1,892 名患者(12.7%)在 14 至 21 天(平均 17.5 天(标清 1.9 天))以及 687 名患者(4.6%)在骨折后 21 天以上(平均 24.8 天(标清 2.4 天))接受了延迟固定。骨折后 21 天以上接受延迟固定的患者再次手术的几率更高(与早期固定相比,几率比(OR)为 1.33(95% CI 1.11 至 1.79))。年龄大于 60 岁的患者情况更糟(OR 1.69 (95% CI 1.11 to 2.79))。我们发现,在骨折后8至14天或15至21天内接受延迟固定的患者(与早期固定相比)再次手术的几率没有差异:这些数据表明,DRF 患者的骨折在 CR 术后出现不可接受的复位,应在三周内进行处理,以避免不良后果。需要进行前瞻性研究来证实这些发现。
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Delayed fixation of distal radial fractures beyond three weeks after initial failed closed reduction increases the odds of reoperation.

Aims: We aimed to compare reoperations following distal radial fractures (DRFs) managed with early fixation versus delayed fixation following initial closed reduction (CR).

Methods: We used administrative databases in Ontario, Canada, to identify DRF patients aged 18 years or older from 2003 to 2016. We used procedural and fee codes within 30 days to determine which patients underwent early fixation (≤ seven days) or delayed fixation following CR. We grouped patients in the delayed group by their time to definitive fixation (eight to 14 days, 15 to 21 days, and 22 to 30 days). We used intervention and diagnostic codes to identify reoperations within two years. We used multivariable regression to compare the association between early versus delayed fixation and reoperation for all patients and stratified by age (18 to 60 years and > 60 years).

Results: We identified 14,960 DRF patients, 8,339 (55.7%) of whom underwent early surgical fixation (mean 2.9 days (SD 1.8)). In contrast, 4,042 patients (27.0%) underwent delayed fixation between eight and 14 days (mean 10.2 days (SD 2.2)), 1,892 (12.7%) between 14 and 21 days (mean 17.5 days (SD 1.9)) and 687 (4.6%) > 21 days (mean 24.8 days (SD 2.4)) post-fracture. Patients who underwent delayed fixation > 21 days post-fracture had a higher odds of reoperation (odds ratio (OR) 1.33 (95% CI 1.11 to 1.79) vs early fixation). This worsened for patients aged > 60 years (OR 1.69 (95% CI 1.11 to 2.79)). We found no difference in the odds of reoperation for patients who underwent delayed fixation within eight to 14 or 15 to 21 days post-fracture (vs early fixation).

Conclusion: These data suggest that DRF patients with fractures with unacceptable reduction following CR should be managed within three weeks to avoid detrimental outcomes. Prospective studies are required to confirm these findings.

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来源期刊
Bone & Joint Journal
Bone & Joint Journal ORTHOPEDICS-SURGERY
CiteScore
9.40
自引率
10.90%
发文量
318
期刊介绍: We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
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