Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer.
Steven Ferree, Quirine M J van der Vliet, Femke Nawijn, Abhiram R Bhashyam, Roderick M Houwert, Luke P H Leenen, Falco Hietbrink
Author Information
Steven Ferree: Department of surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: sferree@diakhuis.nl.
Quirine M J van der Vliet: Utrecht Traumacenter, Utrecht, The Netherlands. Electronic address: Q.M.J.vanderVliet@umcutrecht.nl.
Femke Nawijn: Department of surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: f.nawijn@students.uu.nl.
Abhiram R Bhashyam: Harvard Combined Orthopaedics Residency Program, Boston, MA, United States. Electronic address: abhashyam@partners.org.
Roderick M Houwert: Department of surgery, University Medical Centre Utrecht, The Netherlands; Utrecht Traumacenter, Utrecht, The Netherlands. Electronic address: r.m.houwert@umcutrecht.nl.
Luke P H Leenen: Department of surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: l.p.h.leenen@umcutrecht.nl.
Falco Hietbrink: Department of surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: f.hietbrink@umcutrecht.nl.
INTRODUCTION: For several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF. METHODS: This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system. RESULTS: A total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients. CONCLUSION: Higher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients.
