International Survey: Factors Associated With Operative Treatment of Distal Radius Fractures and Implications for the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria
| Autor: | David Ring, Tom J. Crijns, Teun Teunis, James C Kyriakedes, Blaine T. Bafus |
|---|---|
| Přispěvatelé: | Graduate School, AMS - Sports & Work |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Cross-sectional study International Cooperation Appropriate Use Criteria law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Fracture Fixation Statistical significance medicine Humans Orthopedics and Sports Medicine Practice Patterns Physicians' Societies Medical Aged 030222 orthopedics business.industry General surgery 030208 emergency & critical care medicine General Medicine Odds ratio Evidence-based medicine Middle Aged Wrist Injuries Confidence interval United States Cross-Sectional Studies Orthopedics Health Care Surveys Orthopedic surgery Practice Guidelines as Topic Surgery Female business Radius Fractures |
| Zdroj: | Journal of orthopaedic trauma, 33(10), e394-e402. Lippincott Williams and Wilkins |
| ISSN: | 1531-2291 0890-5339 |
| Popis: | OBJECTIVES: Through an international survey, we assessed whether deciding to operatively treat an intra-articular distal radius fracture (DRF) is guided by identifiable patient and surgeon factors. In addition, we compared surgeons' treatment decisions with the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria (AUC) treatment recommendations. METHODS: This cross-sectional survey asked 224 surgeons to operatively or nonoperatively treat 28 hypothetical patients with radiographs of an intra-articular DRF. We randomized patient age (50/70 years), gender, mechanism of injury, activity level, and OTA/AO fracture type. We classified 6 fractures as "nonclinically significant displacement" and 22 as "potentially clinically significant displacement." Multilevel logistic regression analysis was performed. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Statistical significance was P < 0.05. RESULTS: Patient factors independently associated with surgery included younger age (OR 6.7, P = 0.003), clinically significant fracture displacement (type B: OR 122, CI, 20-739, P < 0.001; type C: OR 59, CI, 12-300, P < 0.001), normal activity level (OR 5.0, P < 0.001), and high-energy mechanisms (OR 1.3, P = 0.002). Surgeon factors associated with recommending surgery included practicing outside the United States (Europe: OR 2.6, P < 0.001; "other": OR 4.8, P < 0.001). Hand surgeons most often selected surgery, as compared to orthopaedic trauma surgeons (OR 2.3, P = 0.001) and "other orthopaedists" (OR 2.2, P = 0.022). Thirty-seven percent of treatment decisions for patients with normal activity levels were rated by AUC recommendations as "rarely appropriate," which included 91% disagreement for 70-year-olds with nonclinically significant displacement. CONCLUSIONS: Surgeons use patient age and fracture displacement to make treatment recommendations for intra-articular DRF. We recommend that the AUC be updated to include these clinical factors as essential components in its algorithm. LEVEL OF EVIDENCE: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|