Scientific Article|Articles in Press

Incidence of Infection in Operatively Treated Distal Radius Fractures After Conversion From External to Internal Fixation

Published:August 02, 2022DOI:


      The purpose of this study was to report the incidence of infection after conversion from external fixation (EF) to internal fixation (IF) of distal radius fractures and to evaluate the relationship between infection and secondary variables, including time to conversion from EF to IF, internal hardware overlapping EF pin sites, and definitive fixation with a dorsal-spanning bridge plate.


      A retrospective review was performed at 2 level 1 trauma centers including all patients aged ≥18 years from 2006 to 2019 with a distal radius fracture treated initially with EF followed by subsequent IF. The patients were excluded from analysis if they had <10 weeks of clinical follow-up, a history of prior distal radius surgery, or evidence of infection before EF to IF conversion. Patient demographic data, mechanism of injury, presence of hardware overlapping pin sites, and timing to definitive fixation were obtained from the medical records. Infection was defined as positive intraoperative cultures or documented return to the operating room for debridement after IF.


      A total of 64 fractures in 61 patients with a median age of 50 years (range, 18–75 years) were included. Infections developed in 6 patients (6 of 64 fractures). The incidence of infection was higher in patients with a time to conversion from EF to IF of >14 days (infection in 2 of 5 patients vs 4 of 59 patients). The incidence of infection was similar in patients with and without hardware overlapping EF pin sites (3 of 27 vs 3 of 37, respectively).


      Infections occurred in 6 of 64 distal radius fractures following conversion from EF to IF, and delay in conversion of >14 days was associated with an increased infection risk.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Karl J.W.
        • Olson P.R.
        • Rosenwasser M.P.
        The epidemiology of upper extremity fractures in the United States, 2009.
        J Orthop Trauma. 2015; 29: e242-e244
        • Brogan D.M.
        • Richard M.J.
        • Ruch D.
        • Kakar S.
        Management of severely comminuted distal radius fractures.
        J Hand Surg Am. 2015; 40: 1905-1914
        • Wang W.L.
        • Ilyas A.M.
        Dorsal bridge plating versus external fixation for distal radius fractures.
        J Wrist Surg. 2020; 9: 177-184
        • Ficke B.
        • Ransom E.F.
        • Hess M.C.
        • et al.
        Outcomes of staged treatment for complex distal radius fractures.
        Cureus. 2018; 10: e3273
        • Natoli R.M.
        • Baer M.R.
        • Bednar M.S.
        Conversion of external fixation to open reduction and internal fixation for complex distal radius fractures.
        Orthop Traumatol Surg Res. 2016; 102: 339-343
        • Harwood P.J.
        • Giannoudis P.V.
        • Probst C.
        • Krettek C.
        • Pape H.C.
        The risk of local infective complications after damage control procedures for femoral shaft fracture.
        J Orthop Trauma. 2006; 20: 181-189
        • Della Rocca G.J.
        • Crist B.D.
        External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of the femoral and tibial shaft.
        J Am Acad Orthop Surg. 2006; 14: S131-S135
        • Bhandari M.
        • Zlowodzki M.
        • Tornetta III, P.
        • Schmidt A.
        • Templeman D.C.
        Intramedullary nailing following external fixation in femoral and tibial shaft fractures.
        J Orthop Trauma. 2005; 19: 140-144
        • Shah C.M.
        • Babb P.E.
        • McAndrew C.M.
        • et al.
        Definitive plates overlapping provisional external fixator pin sites: is the infection risk increased?.
        J Orthop Trauma. 2014; 28: 518-522
        • American College of Surgeons National Surgical Quality Improvement Program
        Surgical Risk Calculator.
        Date accessed: January 9, 2022
        • Horst K.
        • Andruszkow H.
        • Weber C.
        • et al.
        Standards of external fixation in prolonged applications to allow safe conversion to definitive extremity surgery: the Aachen algorithm for acute ex fix conversion.
        Injury. 2015; 46: S13-S18