Conference Coverage

Rheumatoid Arthritis Linked to Higher Short- and Long-Term Complications After Distal Radius ORIF

Miranda Manier, BA

Key Highlights

  • Rheumatoid arthritis (RA) significantly increases both short-term and long-term complications after distal radius fracture open reduction and internal fixation.
  • Patients with RA had higher odds of serious adverse events, including surgical site infection, pulmonary embolism, and deep vein thrombosis.
  • Long-term risks such as tendon rupture, complex regional pain syndrome, and wrist stiffness were elevated in patients with RA.
  • Medication use within the year before surgery was associated with improved outcomes compared with no medication use.

Patients with rheumatoid arthritis (RA) undergoing distal radius fracture open reduction and internal fixation (ORIF) face significantly greater risks of adverse outcomes, according to data presented by Ismail Ajjawi and colleagues at the American Society of Plastic Surgeons meeting. Compared with patients without RA, those with the condition demonstrated higher odds of both serious and minor complications within 90 days of surgery as well as increased long-term complications, including tendon rupture and CRPS.

ORIF is a common surgical approach to treat distal radius fractures. However, RA complicates recovery because of impaired healing capacity, compromised bone quality, systemic comorbidities, and medication-related effects. Despite the prevalence of both conditions, the extent to which RA contributes to increased surgical risk had not been fully characterized, warranting further investigation.

Researchers used the M165Ortho PearlDiver Mariner Database (2010-2022) to identify patients who underwent distal radius ORIF. Exclusions included patients with neoplasm, infection, or polytrauma. The study matched patients with RA to patients who did not have RA in a 1:4 ratio based on age, sex, and Elixhauser Comorbidity Index (ECI). Patients with RA were further stratified by whether they had received RA medications within the year preceding surgery. Outcomes included both short-term complications, defined as 90-day serious adverse events (eg, deep vein thrombosis, pulmonary embolism, sepsis, surgical site infection, cardiac events) and minor adverse events (eg, urinary tract infection, acute kidney injury, pneumonia, wound dehiscence). Long-term outcomes assessed within 2 years included tendon rupture, CRPS, and wrist diagnoses within 3 to 6 months of surgery.

Among 344,115 patients who underwent distal radius ORIF, 13,978 had RA. After matching, the final analysis included 13,651 patients with RA and 54,439 patients who did not have RA. Within the RA group, 10,663 patients had taken RA-related medications within one year of surgery, while 2,988 had not. Patients with RA had higher odds of 90-day serious adverse events (odds ratio [OR], 1.61; P < .001) and minor adverse events (OR, 1.35; P < .001). Specific risks included surgical site infection (OR, 2.16), pulmonary embolism (OR, 2.12), deep vein thrombosis (OR, 1.68), urinary tract infection (OR, 1.55), and acute kidney injury (OR, 1.76), all statistically significant. Long-term complications were also elevated, including tendon rupture (OR, 2.33), CRPS (OR, 1.24), and wrist stiffness (OR, 1.15). Notably, patients with RA who were not on medications demonstrated worse outcomes than those on treatment, with higher rates of tendon rupture (OR, 2.55 vs 2.28) and surgical site infection (OR, 2.07 vs 1.93).

 “RA patients undergoing distal radius fracture ORIF face significantly higher odds of both short-term and long-term complications,” Ajjawi and colleagues concluded. “These findings emphasize the importance of tailored perioperative management and careful monitoring for this high-risk population. The fact that medications use appeared to correlate with improved surgical outcomes suggests that control of the underlying disease helps mitigate its effects.”

Reference
Ajjawi I, Colen D, Diatta F, Kammien A, Rancu A. Rheumatoid arthritis increases odds of short-term and long-term adverse events following distal radius fracture open reduction and internal fixation. Poster presented at: American Society of Plastic Surgeons 94th Annual Meeting; October 9-12, 2025; New Orleans, LA. Accessed September 22, 2025. https://www.plasticsurgerythemeeting.com/