Idiopathic Parkinson’s disease (PD) is a progressive neurologic disorder causing postural instability and unsteady gait. These patients are at increased risk for fractures and have inferior outcomes after treatment. Several studies have evaluated the incidence and outcome of PD patients after hip fractures. However, there are limited studies assessing the outcome of upper extremity fractures in these patients. In this study, we evaluated the outcome of PD patients that received surgical intervention for distal radial fractures (DRF). We hypothesize that these patients have an inferior outcome after surgery in comparison with non-PD patients. Between May 2005 and May 2017, we retrospectively reviewed all of the patients with DRF and subsequently underwent open reduction and internal fixation (ORIF) at a level 1 trauma center. All of the surgeries were performed by fellowship-trained orthopedic surgeons. The inclusion criteria include patients with a definitive diagnosis of PD, non-pathological DRF, and a minimum follow-up of 1 year or up until the time of treatment failure was noted. Each PD patient was matched for age and gender to 3 non-PD patients. The primary objective was to determine the failure rate after surgical fixation for DRF. The secondary outcomes include time to treatment failure, reoperation rate, readmission rate, length of hospital stay, and postoperative complications. A total of 88 patients were included in this study (23 PD, 65 non-PD patients). All underwent ORIF and received standard postoperative follow-ups. The overall treatment failure rate in PD was 39.1% vs. 4.6% in the non-PD group (p < 0.05). The time to treatment failure were 9.11 ± 3.86 weeks and 14.67 ± 5.8 weeks for PD and non-PD, respectively (p < 0.05). PD patients had a significantly higher rate of failure when k-wires and ESF were used (p < 0.05%), while loss of reduction was the most common mode of failure in PD (44.4%). The length of hospital stay for PD was 5.3 ± 4.69 days compared with 3.78 ± 0.96 days for non-PD (p = 0.01). There were 3 PD patients readmitted within 30 days after surgery, and 1 patient had pneumonia after the surgery. This study revealed that patients with PD have a high treatment failure rate despite surgical intervention for DRF. PD patients had a longer hospital stay and had a shorter time to treatment failure. In treating PD patients complicated with DRF, the surgeon must take into consideration the complex disease course of PD and the associated comorbidities such as osteoporosis, frail status, and frequent falls. Rehabilitation and disposition plans should be discussed in advance and longer hospital stays should be expected. Level of evidenceLevel IV, retrospective cohort study

中文翻译：

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特发性帕金森病患者patients骨远端骨折的外科手术治疗结果：一项队列研究

特发性帕金森氏病（PD）是一种进行性神经系统疾病，引起姿势不稳定和步态不稳。这些患者发生骨折的风险增加，并且治疗后结果较差。几项研究评估了髋部骨折后PD患者的发生率和预后。但是，评估这些患者上肢骨折的结果的研究有限。在这项研究中，我们评估了接受手术治疗的radial骨远端骨折（DRF）的PD患者的结局。我们假设与非PD患者相比，这些患者手术后的结局较差。在2005年5月至2017年5月之间，我们回顾性检查了所有DRF患者，随后在1级创伤中心进行了切开复位内固定（ORIF）。所有的手术都是由受过研究金培训的整形外科医生进行的。纳入标准包括明确诊断为PD，非病理性DRF且至少随访1年或直至治疗失败的患者。每个PD患者的年龄和性别均与3名非PD患者相匹配。主要目的是确定DRF手术固定后的失败率。次要结果包括治疗失败的时间，再次手术率，再入院率，住院时间和术后并发症。本研究共纳入88位患者（23位PD，65位非PD患者）。所有患者均接受了ORIF并接受了标准的术后随访。PD的总治疗失败率为39.1％，而非PD组为4.6％（p <0.05）。治疗失败的时间为9.11±3。PD和非PD分别为86周和14.67±5.8周（p <0.05）。使用k-wire和ESF时，PD患者的失败率显着更高（p <0.05％），而减少损失是PD中最常见的失败模式（44.4％）。PD的住院时间为5.3±4.69天，而非PD的住院时间为3.78±0.96天（p = 0.01）。手术后30天内重新入院的PD患者3例，手术后有肺炎1例。这项研究表明，尽管对DRF进行了手术干预，但PD患者的治疗失败率很高。PD患者的住院时间更长，治疗失败的时间也更短。在治疗PD合并DRF的患者时，外科医生必须考虑PD的复杂病程以及相关的合并症，例如骨质疏松症，身体虚弱，经常摔倒。康复和处置计划应事先进行讨论，并应预期住院时间更长。证据级别第四级回顾性队列研究