Influence of surgeon, patient and radiographic factors on distal radius fracture treatment

Neuhaus, Valentin; Bot, Arjan G.J.; Guitton, Thierry G.; Ring, David

doi:10.1177/1753193414555284

Cited by 26 publications

(22 citation statements)

References 26 publications

(31 reference statements)

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“…A full consensus about distal radius fracture management will probably never be possible, because surgeons will always have their preferences and expert-based strategies [24, 42, 43]. Additionally patient preferences play an important role in fracture management.…”

Section: Resultsmentioning

confidence: 99%

Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents

Mulders

Rikli

Goslings

et al. 2016

Eur J Trauma Emerg Surg

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PurposeClassification, the definition of an acceptable reduction and indications for surgery in distal radius fracture management are still subject of debate. The purpose of this study was to characterise current distal radius fracture management in Europe.MethodsDuring the European Congress of Trauma and Emergency Surgery (ECTES) 2015 a 20-question multiple-choice survey was conducted among the attending surgeons and residents of the hand and wrist session. Consensus was defined as more than 50 % identical answers (moderate consensus 50–75 % and high consensus more than 75 %).ResultsA total of 46 surgeons and residents participated in the survey. High consensus was found among both surgeons and residents for defining the AO/OTA classification as the preferred classification system. For the definition of an acceptable reduction, a moderate to high consensus could be determined. Overall, high consensus was found for non-operative treatment instead of operative treatment in dislocated extra- and intra-articular distal radius fractures with an acceptable closed reduction, regardless of age. We found high (surgeons) and moderate (residents) consensus on the statement that an intra-articular gap or step-off ≥2 mm, in patients younger than 65 years, is an absolute indication for ORIF. The same applied for ORIF in dislocated fractures without an acceptable closed reduction in patients younger than 75 years of age.ConclusionCurrent distal radius fracture management in Europe is characterised by a moderate to high consensus on the majority of aspects of fracture management.

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Section: Resultsmentioning

confidence: 99%

Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents

Mulders

Rikli

Goslings

et al. 2016

Eur J Trauma Emerg Surg

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“…It is likely that this only had a limited influence on our outcomes, as prior studies have shown that the influence of surgical experience on both assessment and treatment of distal radius fractures is limited. 18,19 The observation that surgical experience only accounts for 1% of the variability in treatment recommendation of wrist fractures supports this. 19 Furthermore, the Dutch group of surgeons consisted of fewer hand surgeons than the U.S. group.…”

Section: Discussionmentioning

confidence: 80%

Surgical Decision-Making in Median Neuropathy Associated with Distal Radius Fractures

et al. 2019

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Objectives A lack of conclusive evidence on the treatment of acute median neuropathy (AMN) in patients with distal radius fractures has led to inconsistent surgical guidelines and recommendations regarding AMN in distal radius fractures. There is a wide variation in surgical decision-making. We aimed to evaluate international differences between surgical considerations and practices related to carpal tunnel release (CTR) in the setting of distal radius fractures. Methods We approached surgeons who were a member of the Orthopaedic Trauma Association (United States) or of the Dutch Trauma Society (the Netherlands) and asked them to provide sociodemographic information and information on their surgical practice regarding CTR in the setting of distal radius fractures. After applying our exclusion criteria, our final cohort consisted of 127 respondents. Results Compared with Dutch surgeons, surgeons from the United States are more of the opinion that displaced distal radius fractures are at risk of developing acute carpal tunnel syndrome (ACTS), consider persistent paresthesia in the median nerve distribution after closed reduction to be a surgical emergency less often, and are more likely to perform a CTR if there are signs of ACTS in the setting of a distal radius fracture. Conclusion A lack of conclusive evidence has led to international differences in surgical practice regarding the treatment of ACTS in the setting of distal radius fractures. Future research should guide surgeons in making appropriate evidence-based decisions when performing CTR in the setting of distal radius fractures. Level of Evidence This is a Level V study.

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“…Our research also verified that volar tilt, ulnar variance, volar/dorsal metaphyseal comminution and intra‐articular displacement/step‐off were significant factors influencing the recommendation for operative treatment. In the absence of definitive evidence to direct treatment recommendations for distal radius fractures in the elderly, surgeons were strongly influenced by radiographic factors . We found that elderly patients with associated orthopaedic injuries requiring surgery ( P = 0.020) were more likely to undergo operative treatment of their distal radius fracture.…”

Section: Discussionmentioning

confidence: 84%

Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly

Yang

Xie

et al. 2019

ANZ Journal of Surgery

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Background: The treatment of senile distal radius fractures had not been clearly defined. The objective of this study was to identify the factors associated with the decision for operative treatment of displaced distal radius fractures in patients aged over 55 years. Methods: Data of 318 patients with displaced distal radius fractures were collected on patient-, fracture-and surgeon-related characteristics that were plausibly related to the decision for operation. Mean comparisons or chi-squared test were used for univariate analysis of the above-mentioned factors, and then multiple logistic regression was used to identify factors associated with the decision for operation. Results: Univariate analysis showed that age, osteoporosis, Charlson score, associated orthopaedic injuries requiring surgery, Orthopaedic Trauma Association (AO) and Fernandez classification, radial height, volar tilt, volar/dorsal comminution, ulnar variance, intra-articular displacement/step-off, associated distal radioulnar joint instability or radiocarpal joint dislocation and subspecialty of treating surgeons had statistically significant association with operative intervention. In the multivariate analysis, the predictors of operative intervention were younger patient age (P = 0.028), associated orthopaedic injuries requiring surgery (P = 0.020), higher AO classification (P = 0.037), higher Fernandez classification (P = 0.041), radial shortening >5 mm (P = 0.020), volar tilt > −10 (P = 0.020), volar/dorsal comminution (P = 0.020), ulnar variance >5 mm (P = 0.023), intra-articular displacement/step-off >2 mm (P = 0.004), associated distal radioulnar joint instability or radiocarpal joint dislocation (P = 0.047) and treatment by an upper extremity specialist (P = 0.038). Conclusion: The decision for surgery was predominantly influenced by the characteristics and severity of the fracture. Patients' age and treatment by an upper extremity specialist were also significant factors associated with a higher likelihood of operative intervention. © 2019 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E428-E432 ANZJSurg.com © 2019 Royal Australasian College of Surgeons E432Wu et al.

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Influence of surgeon, patient and radiographic factors on distal radius fracture treatment

Cited by 26 publications

References 26 publications

Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents

Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents

Surgical Decision-Making in Median Neuropathy Associated with Distal Radius Fractures

Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly

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