Clinical outcomes in distal radial fractures with ipsilateral arteriovenous fistulas

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