Displaced Distal Radius Fracture Treatment: A Survey of POSNA Membership
| Autor: | Andrew G. Georgiadis, Jamie K. Burgess, Joseph A. Janicki, Walter H. Truong |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Sedation medicine.medical_treatment Pediatrics 03 medical and health sciences 0302 clinical medicine Surveys and Questionnaires medicine Humans Orthopedics and Sports Medicine Prospective Studies Practice Patterns Physicians' Child Reduction (orthopedic surgery) 030222 orthopedics business.industry Orthopedic Surgeons General Medicine Odds ratio Confidence interval Sagittal plane Orthopedics medicine.anatomical_structure Child Preschool Coronal plane North America Pediatrics Perinatology and Child Health Physical therapy Female Distal radius fracture Reduction treatment medicine.symptom Radius Fractures business |
| Zdroj: | Journal of Pediatric Orthopaedics. 40:e827-e832 |
| ISSN: | 0271-6798 |
| Popis: | Background Distal radius fractures (DRFs) are the most common pediatric orthopaedic fracture, of which 20% are displaced injuries. Displaced metaphyseal DRFs are often treated with sedated or anesthetized reduction. The necessity of reduction treatment of displaced fractures to achieve good clinical outcomes is unclear. The purpose of this investigation was to determine the treatment preferences for DRFs among pediatric orthopaedic surgeons and to determine whether they were uncertain enough in their decisions to randomize treatment. Methods Twenty-eight DRF scenarios in children aged 3 to 10 years were constructed in an electronic survey to represent a spectrum of age, angulation in sagittal and coronal planes, and displacement. The survey was disseminated to the full membership of the Pediatric Orthopaedic Society of North America (POSNA). Respondents could select either a treatment of (a) attempt anatomic reduction with sedation or (b) nonsedated immobilization. Respondents also denoted whether they would be willing to randomize the treatment of each injury scenario. Patient, fracture, and surgeon characteristics were analyzed to develop predictors of treatment recommendations and willingness to randomize treatment. Results A total of 319 surgeons responded (23% of POSNA membership). Respondents were a characteristic representation of POSNA membership (well distributed by years in practice, 78% academic, 91% whose work is >80% pediatrics, and 84% work with residents). Predictors of sedated reduction were complete displacement [odds ratio (OR), 9.23; 95% confidence interval (CI), 2.27-37.51; P=0.002] and coronal angulation (per 1-degree increase, OR, 1.09; 95% CI, 1.02-1.17; P=0.016), Willingness to randomize was inversely related to larger coronal plane angulation (per 1-degree increase, OR, 0.96; 95% CI, 0.93-0.99; P=0.01). A majority of surgeons were willing to randomize 7 of the 8 scenarios involving complete displacement and shortening, and >64% of surgeons were willing to randomize 5 of these 8 scenarios. Conclusions POSNA members recommend sedated reduction of DRFs primarily based on existence of complete displacement. Although most completely displaced DRFs would undergo reduction, most surgeons would be willing to randomize the treatment of these injuries. This suggests that most POSNA members do not know whether their recommended treatment for displaced DRFs is necessary or correct. This survey establishes the groundwork for a randomized, prospective trial comparing nonsedated immobilization with sedated/anesthetized reduction in the treatment of displaced pediatric DRFs. Levels of evidence Level II-survey study. |
| Databáze: | OpenAIRE |
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