Validation of the Clavien-Dindo Classification System for Complications Following Open Reduction and Internal Fixation of Distal Radius Fractures.

Abstract

The study aims to classify complications of open reduction and internal fixation (ORIF) of distal radius fractures, to determine risk factors of complications, and to validate a Clavien-Dindo scale modified for distal radius ORIF (mCD-DR). Patients undergoing distal radius ORIF at a single institution were retrospectively reviewed. Demographics, comorbidities, surgery length, and complications were collected. Complications were graded using the mCD-DR: Grade 1 is deviation from standard postoperative requirements, grade 2 requires additional pharmacologic management or monitoring, grade 3 requires procedural intervention, grade 4 includes life-threatening medical problems, and grade 5 is death. Two reviewers blindly graded complications, and agreement was determined using Cohen kappa coefficient. Logistic regression assessed predictors of complications. A total of 160 patients were included: 112 (70.0%) women and 48 (30.0%) men. Sixty patients (37.5%) experienced a total of 67 complications. There were 25 (33.3%) grade 1, 12 (16.0%) grade 2, and 38 (50.7%) grade 3 complications. The most common complications were removal of hardware (22.7%), wrist injections (17.3%), and hand or wrist stiffness (9.3%). Blinded grading demonstrated near-perfect intra- and interrater agreement, with kappa coefficients of 0.95 to 0.97 and 0.87 to 0.95, respectively. Regression analysis revealed that longer surgeries, moderate Charlson Comorbidity Index, above-median age, and use of general anesthesia were predictive of complications. The mCD-DR identified an overall complication rate of 37.5% following distal radius ORIF, with grade 3 complications being the most common. Near-perfect agreement was observed among raters, demonstrating the reliability of the scale for classifying complications following distal radius ORIF.