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The Open Fracture of Elderly Women: A Cohort Study of Open Distal Radius and Ulna Fractures

Arvidsson, Linnea LU ; Christiansson, Sofia ; Landgren, Marcus ; Abramo, Antonio LU ; Juréus, Jan LU and Tägil, Magnus LU (2026) FESSH Congress in Basel, 2026
Abstract (Swedish)
Introduction: Combined distal radius and distal metaphyseal ulna fractures (DRUFs) are relatively uncommon, representing approximately 5% of all distal radius fractures, and predominantly affect elderly women. Previous studies have demonstrated that DRUFs are associated with poorer outcomes than isolated distal radius fractures, regardless of fracture classification, age, sex, or comorbidities. Open fractures also appear more frequent in this subgroup, despite most injuries being low-energy in nature. The Lund Distal Radius Fracture Registry enables detailed study of this rare patient population.

Aim: To describe treatment approaches, complications, and functional outcomes (DASH) in patients with open combined distal radius and... (More)
Introduction: Combined distal radius and distal metaphyseal ulna fractures (DRUFs) are relatively uncommon, representing approximately 5% of all distal radius fractures, and predominantly affect elderly women. Previous studies have demonstrated that DRUFs are associated with poorer outcomes than isolated distal radius fractures, regardless of fracture classification, age, sex, or comorbidities. Open fractures also appear more frequent in this subgroup, despite most injuries being low-energy in nature. The Lund Distal Radius Fracture Registry enables detailed study of this rare patient population.

Aim: To describe treatment approaches, complications, and functional outcomes (DASH) in patients with open combined distal radius and ulna fractures.
Materials and Methods: All patients with a DRUF between 2003 and 2018 were identified through a regional quality registry for distal radius fractures, which includes one-year DASH scores. A retrospective chart review classified open injuries according to the Gustilo–Anderson system and documented the trauma energy level, treatment methods, antibiotic use, and complications.

Results:
Among 259 identified DRUF patients, 41 (16%) sustained open fractures. The mean age was 76 years (SD 14, range 32–98), and 37 (90%) were women. Twenty-five patients underwent surgery, of whom 17 (68%) received open reduction and internal fixation of both the radius and ulna.

Thirty-one patients (76%) completed the one-year DASH questionnaire, yielding a median score of 29 (IQR 7–43). According to the Gustilo–Anderson classification, 35 fractures were grade I, five grade II, and one grade III (a <1 cm wound but considered high energy). Thirty-five injuries were low-energy, five intermediate-energy, and one high-energy.

Initial intravenous antibiotics were administered in 32 cases. Four patients received only oral antibiotics, without any preceding intravenous administration. One patient received no antibiotics, and information was missing in four cases. Two patients had arterial injuries. Three patients had persistent ulnar nerve impairment, including one with motor involvement. No patient developed an infection.

Four patients underwent unplanned reoperations, all involving removal of osteosynthesis material; in one case, a symptomatic pseudarthrosis was treated simultaneously. One additional patient developed a symptomatic pseudarthrosis after plate fixation of both bones but declined further surgery.

Conclusion:
In conclusion open DRUFs are relatively frequent within this fracture pattern and are typically caused by low-energy mechanisms, with Gustilo–Anderson type I being the most common. Antibiotic use was extensive, and no infections occurred. Vascular and nerve injuries were present in a subset of cases (12%). Functional outcomes were modest, reflected by a high median DASH score. Open DRUFs appear to represent “the open fracture of elderly women”.
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Contribution to conference
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FESSH Congress in Basel, 2026
conference dates
2026-06-03 - 2026-06-06
language
English
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yes
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a0e31979-946c-46d8-bf85-30705b828c8c
alternative location
https://fessh2026.com/site/program/
date added to LUP
2026-01-29 16:06:30
date last changed
2026-10-06 15:34:52
@misc{a0e31979-946c-46d8-bf85-30705b828c8c,
  abstract     = {{Introduction: Combined distal radius and distal metaphyseal ulna fractures (DRUFs) are relatively uncommon, representing approximately 5% of all distal radius fractures, and predominantly affect elderly women. Previous studies have demonstrated that DRUFs are associated with poorer outcomes than isolated distal radius fractures, regardless of fracture classification, age, sex, or comorbidities. Open fractures also appear more frequent in this subgroup, despite most injuries being low-energy in nature. The Lund Distal Radius Fracture Registry enables detailed study of this rare patient population.<br/><br/>Aim: To describe treatment approaches, complications, and functional outcomes (DASH) in patients with open combined distal radius and ulna fractures.<br/>Materials and Methods: All patients with a DRUF between 2003 and 2018 were identified through a regional quality registry for distal radius fractures, which includes one-year DASH scores. A retrospective chart review classified open injuries according to the Gustilo–Anderson system and documented the trauma energy level, treatment methods, antibiotic use, and complications.<br/><br/>Results:<br/>Among 259 identified DRUF patients, 41 (16%) sustained open fractures. The mean age was 76 years (SD 14, range 32–98), and 37 (90%) were women. Twenty-five patients underwent surgery, of whom 17 (68%) received open reduction and internal fixation of both the radius and ulna.<br/><br/>Thirty-one patients (76%) completed the one-year DASH questionnaire, yielding a median score of 29 (IQR 7–43). According to the Gustilo–Anderson classification, 35 fractures were grade I, five grade II, and one grade III (a &lt;1 cm wound but considered high energy). Thirty-five injuries were low-energy, five intermediate-energy, and one high-energy.<br/><br/>Initial intravenous antibiotics were administered in 32 cases. Four patients received only oral antibiotics, without any preceding intravenous administration. One patient received no antibiotics, and information was missing in four cases. Two patients had arterial injuries. Three patients had persistent ulnar nerve impairment, including one with motor involvement. No patient developed an infection.<br/><br/>Four patients underwent unplanned reoperations, all involving removal of osteosynthesis material; in one case, a symptomatic pseudarthrosis was treated simultaneously. One additional patient developed a symptomatic pseudarthrosis after plate fixation of both bones but declined further surgery.<br/><br/>Conclusion:<br/>In conclusion open DRUFs are relatively frequent within this fracture pattern and are typically caused by low-energy mechanisms, with Gustilo–Anderson type I being the most common. Antibiotic use was extensive, and no infections occurred. Vascular and nerve injuries were present in a subset of cases (12%). Functional outcomes were modest, reflected by a high median DASH score. Open DRUFs appear to represent “the open fracture of elderly women”.<br/>}},
  author       = {{Arvidsson, Linnea and Christiansson, Sofia and Landgren, Marcus and Abramo, Antonio and Juréus, Jan and Tägil, Magnus}},
  language     = {{eng}},
  month        = {{01}},
  title        = {{The Open Fracture of Elderly Women: A Cohort Study of Open Distal Radius and Ulna Fractures}},
  url          = {{https://fessh2026.com/site/program/}},
  year         = {{2026}},
}