Findings Suggests Type I Open Distal Radius Fractures Can Be Managed Similarly to Closed Injuries

A study of patients with type I open distal radius fractures (DRFs) found no superficial or deep infections or other wound-related complications. The study also found no differences in early complication rates based on time to surgical debridement. These findings were presented at the AAOS 2025 Annual Meeting by Eric Taleghani, MD, orthopaedic surgery resident at the University of Cincinnati College of Medicine.

Type I open DRFs differ from higher-grade DRFs in many ways, including injury characteristics, infection risk, complication rates, and reoperation rates. Evidence is limited regarding the optimal management of type I DRFs. Although smaller, retrospective studies have found a low risk of infection in low-grade open DRFs, not many studies to date have explored whether these injuries require urgent debridement and fixation.

“Standard-of-care management for open fractures typically comprises emergent IV antibiotic administration, followed by urgent operative irrigation and debridement. However, no conclusive guidelines exist for the appropriate timing or necessity of operative irrigation and debridement for Gustilo-Anderson type I open distal radius fracture,” Dr. Taleghani told AAOS Now. Recent survey data indicate that many hand and upper-extremity surgeons would consider nonoperative management, a finding that surprised the current research team and prompted them to conduct the current study.

The researchers performed a retrospective review of 71 open DRF cases at a single level 1 trauma center over a 10-year period to compare short-term complication rates, with a focus on the timing of management of type I fractures. The primary outcome measure was superficial and deep infection rates in all patients with minimum 6-month follow-up (average follow-up was 16.7 months).

Their analysis found a higher rate of deep infection (30 percent) and a higher average number of revision surgeries (three) in the type III cohort compared with the type II (4 percent, 0.6) and type I (0 percent, 0.39) cohorts.

When examining the 63 type I fractures (minimum follow-up of 3 months), the researchers found zero infections. There were no differences in other complications or the number of revisions among patients who were definitively managed within 24 hours, 24 to 72 hours, or more than 72 hours. Furthermore, two of the patients were managed nonoperatively, without complications.

The researchers had expected that there would be no difference in rates of infection based on time to surgical debridement, but they were surprised to find an infection rate of 0 percent in the entire type I open distal radius cohort. They said this supports the idea that type I open DRFs have a similar risk profile to closed injuries and can be managed similarly.

“The results of this study add to the growing body of evidence that type I open distal radius fractures have a low risk of developing infection or other wound-related complications. These injuries could potentially be managed similarly to closed injuries with regard to surgical timing, as long as the wound is cleaned and antibiotics are administered at the time of presentation in the emergency department. This treatment approach would benefit patients and health systems,” Dr. Taleghani said.

Given the fact that only two patients in the study were managed entirely nonoperatively, and both achieved fracture union without complication, the researchers are prospectively collecting data on patients with type I open DRFs who are managed nonoperatively and plan to conduct a matched cohort analysis in the future.

Dr. Taleghani’s coauthors of “Timing of Type 1 Open Distal Radius Fracture Fixation Does Not Affect Early Complication Rates” are James C. Rex, MD; Samuel K. Gerak, BA; John Velasquez, MS, BA; Kathryn Marie Rost, BS; and Sonu A. Jain, MD.

Keightley Amen, BA, ELS, is a freelance writer for AAOS Now.