No abstract

Key Points Question Do rates or types of complications after distal radius fractures depend on treatment type? Findings In this secondary analysis of a randomized clinical trial of 304 adults from 24 health systems, the method of treatment participants received was associated with the rate or type of complications. Compared with participants who received internal fixation, participants who received any other treatments experienced complications at significantly higher rates. Meaning Choice of distal radius fracture treatment method in older patients should be specific to individual goals to minimize complication risks and improve outcomes.

Background: It remains unknown whether treatment trends for distal radius fracture (DRF) have changed in light of value-based care initiatives during recent years. We aimed to characterize modern practice patterns for DRF management. Methods: We used 2009–2015 Truven MarketScan databases to extract data on several variables comprising of demographic characteristics, geographic location, and comorbidities for patients receiving treatment for a DRF. Regression analysis and Joinpoint analysis were used to assess trends over the study period. We analyzed the association of patient factors with type of treatment provided using logistic regression modeling. Results: Among all 499,766 eligible encounters, the rate of internal fixation fluctuated around 13%. Casting/splinting remained the most frequent treatment across all populations. Treatment trends varied by age; children and adolescents were treated almost exclusively with closed treatment (mean: 97%), yet rates of internal fixation increased among adults and elderly patients. Patients age 55 to 64 were most likely to undergo internal fixation (OR: 1.89; 95%CI:1.82–1.96). Higher median household income also significantly increased one’s odds of receiving internal fixation (p<0.001). Despite declining rates of external fixation and percutaneous pinning, regional variations among surgical modalities persist. Conclusion: The increased use of internal fixation for the treatment of distal radius fractures may be slowing. Treatment type continues to differ widely across demographic groups, underscoring the need for standardization. In accordance with value-based care initiatives, treatment decisions should be made to combine patient needs with financial implications on the health system. Comparative effectiveness data to derive optimal management strategies are still warranted.

for the FRANCHISE Group IMPORTANCE Optimal treatment for traumatic digit amputation is unknown.OBJECTIVE To compare long-term patient-reported and functional outcomes between patients treated with revision amputation or replantation for digit amputations.