Outcomes Following Surgical Fixation of Upper Extremity Fractures in Patients with Chronic Kidney Disease

Patricia K Wellborn; Alexander D Jeffs; Andrew D Allen; Nathaniel T Koutlas; Reid W Draeger; J Megan M Patterson; Andrew T Chen

doi:10.1016/j.jhsg.2023.12.009

Outcomes Following Surgical Fixation of Upper Extremity Fractures in Patients with Chronic Kidney Disease

J Hand Surg Glob Online. 2024 Feb 2;6(3):289-292. doi: 10.1016/j.jhsg.2023.12.009. eCollection 2024 May.

Authors

Patricia K Wellborn¹, Alexander D Jeffs¹, Andrew D Allen¹, Nathaniel T Koutlas¹, Reid W Draeger¹, J Megan M Patterson¹, Andrew T Chen¹

Affiliation

¹ The Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC.

Abstract

Purpose: Moderate to severe (stage III-IV) chronic kidney disease (CKD) and end stage renal disease (ESRD) have been shown to be independent risk factors for sustaining a fragility fracture. High rates of complications and mortality are associated with fracture fixation in patients with CKD, but existing literature is limited. It is unknown how CKD stage III-IV or ESRD affects outcomes in upper-extremity fractures. We hypothesize that patients with CKD stage III-IV or ESRD will have high complication rates after surgical fixation of upper extremity fractures.

Methods: We identified all patients between 2008 and 2018 who underwent operative fixation of an upper extremity fracture proximal to the distal radius with a diagnosis of CKD stage III-IV or ESRD at the time of injury. Those with an acute kidney injury at the time of injury or a history of a kidney transplant were excluded. Demographics, medical complications, and surgical complications were collected retrospectively. Data on readmissions within 90 days and mortality within 1 year were also collected.

Results: Thirty-five patients were identified. Three patients had ESRD. Fractures included two clavicle, twelve proximal humerus, one humeral shaft, ten distal humerus, five olecranon, two ulnar shaft, one radial shaft, and two both-bone forearm fractures. In total, 91.4% of fractures were closed injuries. Surgical complications occurred in 40% of patients. The reoperation rate was 11.4%, and all cases of reoperation involved hardware removal. The all-cause 90-day readmission rate was 34.3%. The 1-year mortality rate was 8.6%.

Conclusions: Surgical complications occurred in 40% of patients with CKD stage III-IV or ESRD who underwent fixation for an upper extremity fracture. It is important to counsel these patients regarding their high risk for complications. Further research is needed to investigate and identify how to mitigate risk.

Type of study/level of evidence: Prognostic IV.

Keywords: Chronic kidney disease; Fractures; Surgical outcomes; Trauma; Upper extremity.