Analysis of Postoperative Complications and Related Factors Affecting Prognosis in 50 Patients with Distal Radius Fractures.

OBJECTIVE: To explore the postoperative complications of distal radius fractures and analyze the related factors that affect its prognosis.
METHODS: The clinical data of 50 patients with distal radius fractures admitted to our hospital from October 2016 to September 2019 were retrospectively analyzed. All patients were followed up for 6-12 months, and their postoperative complications were recorded. Collect general patient information and related clinical data. During the follow-up process, Gartland and Werley wrist function scoring system was used to evaluate the prognosis of patients' joint function. Univariate analysis and multiple logistic regression models were used to analyze the related factors that affected the prognosis of patients.
RESULTS: 15 patients with postoperative complications were found during the follow-up period, with an incidence rate of 30.00%. Univariate analysis showed that the patient's age, cause of injury, AO classification, shortened deformity, whether it was osteoporosis, surgical method, whether it was combined with other fractures on the same side, whether it was comminuted fracture, and the time to start postoperative exercise were all related to the distal radius. The prognosis of fractures is related (P < 0.05). Multivariate logistic analysis showed that age, AO classification, surgical method, whether it was combined with other fractures on the same side, whether it was comminuted fracture, and the time to start postoperative exercise were the independent factors affecting the prognosis of distal radius fractures (P < 0.05).
CONCLUSION: The postoperative complications of distal radius fractures are higher. The prognosis is related to the patient's age, AO classification, surgical method, whether it is combined with other fractures on the same side, whether it is comminuted fracture, and the time to start postoperative exercise. Therefore, choosing an appropriate surgical method and starting exercise in time can effectively improve the recovery of the patient's wrist function and reduce the occurrence of complications.

1. Introduction

Distal radius fracture is one of the most common fractures. It refers to a fracture within 3 cm of the articular surface of the lower end of the radius, which is mostly caused by direct or indirect violence [1-3]. Fractures of the distal radius often occur in adolescents and elderly people. Adolescents are prone to accidental collisions and fractures due to their frequent participation in strenuous exercise. Because of osteoporosis, the elderly are more prone to fractures and often comminuted fractures than teenagers when they are traumatized [4-6]. Fractures of the distal radius have complex morphology and are easily involved in their adjacent articular surfaces. Improper treatment can easily lead to carpal tunnel syndrome, dislocation of the radioulnar joint, traumatic arthritis, and other complications, resulting in chronic wrist pain, stiffness, weakness, deformity, and other symptoms, seriously affecting the normal hand function of patients [7-9]. At present, the main surgical methods for the treatment of distal radius fractures include closed reduction and external fixation and open reduction and internal fixation. However, the effect of surgery is affected by many factors, and there are many complications after surgery. Therefore, analyzing the relevant factors that affect the postoperative recovery of patients with distal radius fractures can help improve the prognosis of surgical treatment and reduce the incidence of complications [10-12]. This study retrospectively analyzed the clinical data of 50 patients with distal radius fractures admitted to our hospital, observed their complications, and analyzed related factors that affect the postoperative prognosis of the patients. The specific report is as follows.

2. Materials and Methods

2.1. Patients

A retrospective analysis of the clinical data of 50 patients with distal radius fractures admitted to our hospital from October 2016 to September 2019. There were 28 males and 22 females, aged from 16 to 68 years old, with an average age of (44.68 ± 12.24) years old. Causes of injury: fall from height (8 cases), fall injury (20 cases), traffic injuries (9 cases), hit injuries (6 cases), and others (7 cases). According to the fracture AO classification, there are type A (18 cases), type B (15 cases), and type C (17 cases). The selected surgical methods are internal fixation (29 cases) and external fixation (21 cases). Inclusion criteria: all met the diagnostic criteria for distal radius fractures; all were fresh distal radius fractures within 2 weeks; all were closed fractures. Exclusion criteria: patients with old fractures, patients with severe medical diseases, patients with severe motor nerve dysfunction, patients with severe mental illness, and patients with follow-up loss.

2.2. Methods

All patients were treated with open reduction and internal fixation: patients were placed in supine position and given brachial plexus anesthesia. Surgical approach was performed to stretch the flexor carpi radialis, flexor thumb, and median nerve to protect the radial artery and expose the fracture end. After fracture reduction, fracture shortening deformity, ulnar deviation angle, and palpal angle were corrected. The T-shaped plate was used for compression fixation, and anterior muscle was repaired and sutured layer by layer.

All patients were followed up for 6–12 months by outpatient and telephone, and their postoperative complications were recorded. We collected general information such as the patient's gender and age, the cause of the patient's injury, AO classification, shortening deformity, whether osteoporosis is present, surgical method, whether the injured side is the dominant hand, whether it is combined with other fractures on the same side, whether it is comminuted fracture, the time from injury to operation, surgical approach, postoperative start exercise time, etc. During the follow-up, the Gartland and Werley wrist joint function scoring system was used to evaluate the prognosis of patients' joint function; subjective evaluation: no pain, 0 points; occasional pain, wrist weakness, and 2 points; occasional pain, wrist weakness, limited movement, and 4 points; persistent pain, limited movement, wrist deformity, and 6 points. Objective evaluation: dorsiflexion defect <45° and 5 points; ruler deviation defect <15° and 3 points; supination defect <50° and 2 points; palmar flexion defect <30° and 1 point; radial deviation defect <15° and 1 point; circular motion defects and 1 point; radioulnar joint pain and 1 point; pronation defects and 2 points. Complications: slight changes of arthritis, 1 points, with pain, 3 points, moderate changes, 2 points, with pain, 4 points, severe changes, 3 points, with severe pain, 5 points; median nerve complications, 1 point. 0–2 were excellent, 3–8 were good, 9–20 were fair, and ≥21 were poor. All patients were divided into excellent and good group (excellent + good) and fair and poor group (fair + poor) according to their prognosis.

2.3. Statistical Methods

The results of this experiment were statistically analyzed by SPSS 20.0 (SPSS Co., Ltd., Chicago, USA). Count data were expressed by rate, and chi-square test was used for their comparison between groups. Multivariate analysis adopts the multiple logistic regression model. P < 0.05 indicates that the difference is statistically significant.

3. Results

3.1. Postoperative Complications of Distal Radius Fractures

During the follow-up period, the wrist function score of 50 patients with radial fracture was (7.41 ± 4.26). A total of 15 patients with postoperative complications were found, and the incidence rate was 30.00%. Among them, carpal tunnel syndrome and traumatic arthritis are the most common ones, each accounting for 6.00%, as shown in Table 1.

Table 1

Postoperative complications of distal radius fractures (n).

Complications	Number of cases	Incidence (%)
Dislocation of the wrist joint	1	2.00
Dislocation of the lower radioulnar joint	1	2.00
Wrist rotation dysfunction	2	4.00
Carpal tunnel syndrome	3	6.00
Malunion	1	2.00
Stiff wrist	1	2.00
Wrist nerve injury	1	2.00
Extensor tendon rupture	1	2.00
Changes in hand grip strength and flexion and extension dysfunction	1	2.00
Traumatic arthritis	3	6.00
Total	15	30.00

3.2. Analysis of Single Factor Affecting the Prognosis of Distal Radius Fractures after Surgery

Univariate analysis showed that age, cause of injury, AO classification, shortening deformity, osteoporosis, surgical method, ipsilateral other fractures, comminuted fractures, and postoperative exercise time were all related to the postoperative prognosis of distal radius fracture (P < 0.05), as shown in Table 2.

Table 2

Univariate analysis of the prognosis of distal radius fractures after surgery (n, %).

Factors		Cases	Excellent and good (n = 35)	Fair and poor (n = 15)	χ2	P
Gender	Male	28	20 (71.43)	8 (28.57)	2.856	0.081
	Female	22	15 (68.18)	7 (31.82)
Age	≥60 years	19	11 (57.89)	8 (42.11)	4.935	0.042
	<60 years	31	24 (77.42)	7 (22.58)
Cause of injury	Fall from height	8	4 (50.00)	4 (50.00)	6.963	0.021
	Fall injury	20	16 (75.00)	4 (25.00)
	Traffic injury	9	6 (66.67)	3 (33.33)
	Hit wound	6	4 (66.67)	2 (33.33)
	Other reasons	7	5 (71.43)	2 (28.57)
AO type	A	18	16 (88.89)	2 (11.11)	7.264	0.018
	B	15	9 (60.00)	6 (40.00)
	C	17	10 (58.82)	7 (41.18)
Shortening deformity	>5 mm	20	10 (50.00)	10 (50.00)	5.251	0.037
	≤5 mm	30	25 (83.33)	5 (16.67)
Osteoporosis	Yes	28	17 (60.71)	11 (39.29)	4.865	0.043
	No	22	18 (81.82)	4 (18.18)
Surgical methods	Internal fixation	29	22 (75.86)	7 (24.14)	4.219	0.047
	External fixation	21	13 (61.90)	8 (38.10)
Dominant hand injury	Yes	28	20 (71.43)	8 (28.57)	1.269	0.108
	No	22	15 (68.18)	7 (31.82)
Other concurrent ipsilateral fracture	Yes	18	10 (55.56)	8 (44.44)	4.628	0.044
	No	32	25 (78.13)	7 (21.87)
Comminuted fracture	Yes	9	4 (44.44)	5 (55.56)	6.278	0.027
	No	41	31 (75.61)	10 (24.39)
Time from injury to surgery	≥3 h	20	15 (75.00)	5 (25.00)	3.225	0.059
	<3 h	30	20 (66.67)	10 (33.33)
Surgical approach	Dorsal	12	8 (66.67)	4 (33.33)	2.694	0.087
	Palm side	38	27 (71.05)	11 (28.95)
Start exercise time after operation	≤7 d	22	17 (27.27)	5 (22.73)	7.864	0.011
	8∼14 d	18	12 (66.67)	6 (33.33)
	>14 d	10	6 (60.00)	4 (40.00)

3.3. Analysis of Multiple Factors Affecting the Prognosis of Distal Radius Fractures after Surgery

Multivariate logistic analysis showed that age, AO classification, surgical method, whether it was combined with other fractures on the same side, whether it was comminuted fracture, and the time to start exercise after surgery were independent factors affecting the prognosis of distal radius fractures after surgery (P < 0.05), as shown in Tables 3 and 4.

Table 3

Assignment for multivariate analysis of factors.

Factors	Variables	Assignment
Age	X 1	<60 years = 0 and ≥60 years = 1
Cause of injury	X 2	Fall from height = 0, fall injury = 1, traffic injury = 2, hit wound = 3, and other reasons = 4
AO type	X 3	A = 0, B = 1, and C = 2
Shortening deformity	X 4	≤5 mm = 0 and >5 mm = 1
Osteoporosis	X 5	No = 0 and yes = 1
Surgical methods	X 6	Internal fixation = 0 and external fixation = 1
Other concurrent ipsilateral fracture	X 7	No = 0 and yes = 1
Comminuted fracture	X 8	No = 0 and yes = 1
Start exercise time after operation	X 9	≤7 d = 0, 8∼14 d = 1, and >14 d = 2

Table 4

Analysis of multiple factors affecting the prognosis of distal radius fractures after surgery.

Factors	B	SE	Wald	df	Sig.	Exp (B)
Age	1.126	0.768	4.581	1	0.043	1.732
Cause of injury	0.158	0.175	2.981	1	0.061	1.681
AO type	0.842	0.526	5.156	1	0.039	1.522
Shortening deformity	0.158	0.204	1.825	1	0.072	1.208
Whether osteoporosis	0.205	0.182	2.024	1	0.155	1.382
Surgical methods	0.914	0.586	7.286	1	0.008	1.986
Whether concurrent fractures on the same side	1.422	0.481	4.689	1	0.045	2.455
Whether comminuted fracture	1.826	1.028	6.554	1	0.014	1.892
Start exercise time after operation	1.756	1.284	8.561	1	≤0.001	3.058

4. Discussion

The distal radius is located between the compact bone and the cancellous bone. Fractures in this part will cause the height of the radius and uneven articular surface, which directly affects the movement function of the wrist joint [13-15]. The wrist joint is one of the joints with the highest frequency and the widest range of human activities, and it undertakes a large number of human activities in daily life. Improper treatment will seriously affect the quality of life of patients [16-18]. Therefore, it is extremely important to explore the relevant factors that affect the prognosis of patients with distal radius fractures and to better restore wrist joint function.

The results of this study showed that a total of 15 patients with postoperative complications were found during the follow-up period, with an incidence rate of 30.00%. Among them, carpal tunnel syndrome and traumatic arthritis are the most common ones, each accounting for 6.00%. The reason is that bleeding after a fracture and local injection of anesthetic drugs will cause the pressure in the carpal tunnel to increase and oppress the median nerve, leading to carpal tunnel syndrome. The bone mass and quality of the distal radius are low, so the fracture degree of fracture is relatively large, and the bone blood supply and repair ability are also poor, resulting in difficulty in reduction and traumatic arthritis [19-21].

The results of this study showed that patients' age, injury causes, AO classification, shortening deformity, osteoporosis, surgical method, ipsilateral other fractures, comminuted fractures, and postoperative exercise time were all related to the postoperative prognosis of distal radius fractures. Multivariate logistic analysis showed that age, AO classification, operation method, ipsilateral other fractures, comminted fractures, and postoperative exercise time were independent factors influencing the prognosis of distal radius fractures. The reason is that the older the patient, the more serious the calcium loss in the body, the osteoporosis, and the worse the body function and recovery function, and other complications often occur after treatment, which greatly increases the complexity, thus leading to a poor prognosis [22-24]. Patients with different AO classifications have different surgical difficulties. The more complex the AO classification, the more severe the bone damage, the greater the difficulty of the operation, and the wider the scope, which greatly increases the difficulty of reduction and the degree of functional recovery and affects the prognosis. Compared with external fixation, internal fixation can reduce the fracture site more accurately, better restore the structure and function of the wrist joint, and thus can improve the prognosis [25, 26]. For patients with other fractures on the same side, the stability of their bones needs to be considered during the treatment process. If the control is not strong enough, the degree of healing will be seriously affected. After postoperative fixation and stability, timely exercise can maintain the mobility of the wrist joint and help the recovery of wrist joint function [27, 28].

5. Conclusion

The postoperative complication rate of distal radius fractures is relatively high. The prognosis is related to the patient's age, AO classification, surgical method, whether it is combined with other fractures on the same side, whether it is comminuted fracture, and the time to start exercise after surgery. Therefore, choosing a suitable surgical method and starting exercise in time can effectively improve the patient's wrist function recovery and reduce the occurrence of complications.