Risk Factors for Delayed Closure Following ORIF of Adult Both-Bone Forearm Fractures: A Multicenter Retrospective Study

BACKGROUND: Delayed wound closure after open reduction and internal fixation (ORIF) of diaphyseal both-bone forearm fractures is an important soft tissue consideration. This study evaluated its incidence and associated risk factors. METHODS: A retrospective cohort study was performed at 2 level 1 trauma centers including adult patients (≥18 years) who underwent ORIF for diaphyseal both-bone forearm fractures (AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen / Orthopaedic Trauma Association) 2R2, 2U2) from 2010 to 2025. Delayed wound closure was defined as unplanned return to the operating room for definitive closure or soft-tissue coverage. Demographic, injury, and perioperative variables were analyzed. Multivariable Firth-penalized logistic regression was used to identify independent predictors. RESULTS: Among 292 patients (mean age, 41.6 years; 56.8% male), delayed wound closure occurred in 14 (4.8%). All patients requiring delayed closure were male (100% vs 54.7%) and more frequently had Gustilo-Anderson type III open fractures (42.9% vs 3.3%), nerve injury (21.4% vs 3.7%), and vascular injury (14.3% vs 0%). Operative time was longer in patients requiring delayed closure (median, 176 vs 127 minutes). On multivariable analysis, prolonged operative time was independently associated with delayed closure (adjusted odds ratio, 7.7; 95% CI, 1.8-71.7). CONCLUSIONS: Delayed wound closure after ORIF of both-bone forearm fractures occurred in fewer than 5% of patients and was independently associated with longer operative time, suggesting that delayed closure is associated with more complex operative courses and evolving soft-tissue considerations. Surgeons should counsel patients on the potential need for staged wound management.