Clinical outcomes in distal radial fractures with ipsilateral arteriovenous fistulas
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(2019) 14:143
RESEARCH ARTICLE
Open Access
Clinical outcomes in distal radial fractures with ipsilateral arteriovenous fistulas Hao-Ming Chang1,2, Yi-Chuan Chou1,2,3, I-Ming Jou1,4,5, Jui-Ming Yang1,6, Ching-Hou Ma4,5*† and Po-Ting Wu1,2,7,8,9*†
Abstract Background: We evaluated the effects on arteriovenous fistula (AVF) function and clinical outcomes in patients given cast fixation, external skeletal fixation [ESF], or volar locking plate fixation [VLPF] for an ipsilateral distal radial fracture (DRF). Methods: Thirteen patients were assigned to the surgery group or the cast group; follow-up was ≥12 months. One-year clinical outcomes and serial AVF function and radiographic outcomes were recorded and analyzed. Results: All fractures were union and all AVFs were preserved with continuous hemodialysis. The surgery group had better immediately (radial inclination and articular step-off) and 1-year post-index procedure radiographic findings (radial height, radial inclination, volar tilting, ulnar variance, and articular step-off) and better 1-year functional outcomes (Mayo and QuickDASH score) than did the cast group. The VLPF subgroup had better QuickDASH scores and radiographic outcomes (radial inclination and ulnar variance) than did the ESF subgroup. Conclusions: One year after the index procedure, none of the treatment affected shunt function in DRFs ipsilateral to AVFs. ESF and VLPF yielded better functional and radiographic outcomes than did cast fixation in patients with ipsilateral DRFs and AVFs. Level of Evidence: III Keywords: Arteriovenous fistula, Volar locking plate, External fixation, Henry approach, Distal radius fracture, Hemodialysis patients
Background Upper extremity fractures ipsilateral to an arteriovenous fistula (AVF) in hemodialysis patients are not rare [1]. Surgical treatment options are still challenging and controversial because of the danger of hypervascularity, hemorrhaging, contraindications of using a pneumatic tourniquet [1], remodeled anatomy after shunt creation, and the potential effects of the type of treatment on the function of arteriovenous shunts. Only few case series have reported the clinical outcomes of surgical repair for distal radial fracture (DRF) ipsilateral to an AVF [1, 2]. In our clinical practice, in addition to cast fixation, surgical repairs—volar locking plate fixation (VLPF) and
external skeletal fixation (ESF)—are also feasible treatment options. Our search of the literature showed that no published study has compared the effects of VLPF, cast fixation, or ESF on ipsilateral AVF function. Therefore, we evaluated the effects of VLPF, cast fixation, and ESF on ipsilateral AVF function and clinical outcomes. We hypothesized that none of these treatments would affect the AVF function after the AVF had been carefully identified and the fracture was carefully managed before and during the procedure. We also hypothesized that surgical treatment would provide better clinical and radiographic outcomes in this population.
* Correspondence: [email protected]; a
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