An Economic Analysis of Direct Costs of Distal Radius Fixation and the Implications of a Disposable Distal Radius Kit

Lans, Jonathan; Westenberg, Ritsaart F.; Verhiel, Svenna H. W. L.; Garg, Rohit; Jupiter, Jesse B.; Chen, Neal C.

doi:10.1097/bot.0000000000002049

Cited by 4 publications

(4 citation statements)

References 26 publications

(55 reference statements)

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“…First, the findings of a retrospective analysis of a large database lack granularity. In the current treatment landscape, we estimate that more than 80% of distal radius fractures are treated with volar locking plate fixation alone 22 ; however, the Current Procedural Terminology codes used for this study are unable to further differentiate between various ORIF techniques, including dorsal plating, fragment-specific fixation, or wrist-spanning bridge plating. We have been unable to study surgeon technique, duration of immobilization, or rehabilitation protocols.…”

Section: Discussionmentioning

confidence: 98%

“…This is reflected by a trend toward shorter surgical time, although not clinically significant. During the 10year study period, there has been a growing shift toward volar locking plate fixation of these fractures, 22 leading to refinement of the surgical technique and technology and awareness of potential pitfalls such as plate prominence, 23 all of which may have contributed to improved outcomes. Our findings have identified areas for future improvement.…”

Section: Discussionmentioning

confidence: 99%

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Ten-year National Trends in Patient Characteristics and 30-day Outcomes of Distal Radius Fracture Open Reduction and Internal Fixation

Zhang¹,

Dyer²,

Earp³

et al. 2022

JAAOS Glob Res Rev

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Introduction: Despite increased utilization, recent temporal trends in patient comorbidities and episode-of-care outcomes for distal radius fracture open reduction and internal fixation (ORIF) have not been studied. The objective of this study was to assess 10-year national trends in (1) patient characteristics and comorbidities and (2) 30-day postoperative adverse outcomes for patients who underwent distal radius fracture ORIF using a large patient database. Methods: A retrospective study was conducted using the National Surgical Quality Improvement Program database by querying the procedural codes for distal radius fracture ORIF from January 1, 2011, to December 31, 2020. A cohort of 28,616 adult patients who underwent distal radius fracture ORIF during the study period was included. Baseline patient characteristics and 30-day postoperative outcome data were collected for each year of the study. Temporal trends from 2011 to 2020 for all variables were assessed using the twotailed Mann-Kendall trend test. Results: Of the 28,616 patients in the study cohort, the mean age was 56.4 years and 73.1% were female. Demographically, there was a trend toward higher body mass index, higher American Society of Anesthesiologists classification, and lower proportions of active smokers; functionally dependent patients; and patients with hypertension, chronic obstructive pulmonary disease, and bleeding disorder. There was a trend toward worse sepsis physiology and wound classification on presentation. There was a trend toward fewer blood transfusions, hospital readmissions, and revision surgeries; however, there was an increasing trend for the development of a superficial surgical site infection. Discussion: Ten-year national trends in distal radius fracture ORIF demonstrated improvements in several important patient comorbidities and the rates of readmission and revision surgery.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Ten-year National Trends in Patient Characteristics and 30-day Outcomes of Distal Radius Fracture Open Reduction and Internal Fixation

Zhang¹,

Dyer²,

Earp³

et al. 2022

JAAOS Glob Res Rev

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show abstract

mentioning

confidence: 99%

“…The advent of distal variable angle locking screws further enhanced the safety and effectiveness of volar locking plates. 6 Currently, more than 80% of distal radius fractures treated surgically use volar locking plate fixation, 7 with rates continuing to increase. 1 The modified Henry approach or flexor carpi radialis (FCR) sheath approach is commonly used for volar locking plate fixation of the distal radius.…”

mentioning

confidence: 99%

Role of Pronator Quadratus Repair in Volar Locking Plate Treatment of Distal Radius Fractures

Zhang

Meyer

Earp

et al. 2022

J Am Acad Orthop Surg

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Distal radius fractures are the most common type of upper extremity fractures, and their incidence is increasing. There has been a rise in the surgical treatment of distal radius fractures, primarily with volar locking plate fixation. Although this procedure is commonly done among orthopaedic surgeons, the role of pronator quadratus repair after fixation remains controversial. The pronator quadratus serves as a secondary forearm pronator and a dynamic stabilizer of the distal radioulnar joint. Aside from a functional role, repair of the pronator quadratus has been proposed to serve as a biologic barrier between the volar locking plate and the flexor tendons to minimize tendon irritation. In this narrative review, we discuss the current treatment trends, the surgical approach for volar locking plate treatment of distal radius fractures, and the anatomy and function of the pronator quadratus. We discuss the case for and against the repair of the pronator quadratus, both for function and prevention of flexor tendon irritation and rupture. The preponderance of high-level evidence demonstrates no benefit to pronator quadratus repair for pain relief or function. The current evidence does not conclusively support or refute pronator quadratus repair as a biologic barrier from the flexor tendons. Distal radius fractures are the most common fractures of the upper extremity, with an incidence of 16.2 per 10,000 people. These fractures are bimodally distributed across age groups and account for approximately 25% of fractures in pediatric patients and 18% of fractures in geriatric patients. 1 A recent literature synthesis of the epidemiology of distal radius fractures suggests that the incidence of these fractures is increasing worldwide. 2 These injuries are associated with notable morbidity to the patient and economic burden to the healthcare system. [3][4][5] Although most distal radius fractures may be treated nonoperatively, there are a number of surgical indications. These include open fractures, partial articular shear fractures and fracture-dislocations, die-punch fractures, concomitant fractures, unacceptable fracture parameters in a young or active elderly patient, subsequent loss of reduction after initial closed reduction, or anticipated loss of reduction based on fracture characteristics. 6 Surgical

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Effects of Economic Well-Being on Outcomes at One Year after Volar Plate Fixation of Distal Radius Fractures

Zhang

Hall

Ostergaard

et al. 2022

J Hand Surg Asian-Pac Vol

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Background: The objective of this study was to determine whether economic well-being is associated with patient-reported functional outcomes and range of motion 1 year following volar plate fixation of distal radius fracture. Methods: A retrospective study was performed on 200 patients with distal radius fractures treated with volar plate fixation at two Level 1 trauma centres from 2006 to 2017 with 1-year clinical follow-up using a previously published cohort. The economic well-being of patients was assessed using the Distressed Communities Index (DCI). Our outcome variables were patient-reported functional outcomes assessed by QuickDASH score and wrist and forearm range of motion 1 year after surgery. The analysis of variance (ANOVA) test was used to compare outcome variables across pre-established tiers of economic well-being. Results: The mean QuickDASH score at 1 year following distal radius fracture volar plate fixation was 10.8 and ranged from 7.3 to 12.2 across tiers of economic well-being. QuickDASH score and wrist range of motion were not significantly different across all tiers of economic well-being. However, wrist flexion–extension arc at 1 year following surgery was significantly decreased in the economically at-risk group compared with the remaining cohort. Conclusions: Patient-reported functional outcomes 1 year after volar plate fixation of distal radius fracture are similar across tiers of economic well-being. Economically disadvantaged patients are at risk for poorer wrist motion following distal radius fracture surgery, though it is not clear if this difference is clinically significant. Level of Evidence: Level II (Prognostic)

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An Economic Analysis of Direct Costs of Distal Radius Fixation and the Implications of a Disposable Distal Radius Kit

Cited by 4 publications

References 26 publications

Ten-year National Trends in Patient Characteristics and 30-day Outcomes of Distal Radius Fracture Open Reduction and Internal Fixation

Ten-year National Trends in Patient Characteristics and 30-day Outcomes of Distal Radius Fracture Open Reduction and Internal Fixation

Role of Pronator Quadratus Repair in Volar Locking Plate Treatment of Distal Radius Fractures

Effects of Economic Well-Being on Outcomes at One Year after Volar Plate Fixation of Distal Radius Fractures

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