Analysis of variation in the surgical treatment of patients with distal radial fractures in the Netherlands

Walenkamp, Monique M. J.; Mulders, Marjolein A. M.; Goslings, J. Carel; Westert, Gert P.; Schep, Niels W. L.

doi:10.1177/1753193416651577

Cited by 29 publications

(29 citation statements)

References 19 publications

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“…Studies in the US 69,125,126 and in the Netherlands 127 found large regional variation in the incidence of treatment methods for DRFs. After adjusting for factors that possibly influence the choice of surgical method, such as proportion of hand surgeons, academic level of the clinic, age, gender and race, the region remained as a strong predictor for the choice of treatment 125 .…”

Section: Regional Variationmentioning

confidence: 99%

“…Our finding of a large regional variation (adjusted for age and gender) in surgical treatment care of DRFs are supported by several authors. Walenkamp et al 127 reported that operative and non-operative treatment proportions differed largely among regions in the Netherlands. In the US, Fanuele et al 69 and Chung et al 125 found evidence of large regional differences regarding surgical treatment methods as well as surgical rates.…”

Section: Study Imentioning

confidence: 99%

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Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

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Wahlgren

Olsson

et al. 2019

The Journal of Bone and Joint Surgery

103

120

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Background: The usage of volar locking plate fixation for distal radial fractures has increased in older patient populations, despite the fact that surgical treatment in the elderly population has not clearly been proven to be superior to nonoperative treatment. The purpose of the present study was to compare nonoperative treatment with volar locking plate fixation with regard to clinical outcome for elderly patients with dorsally displaced distal radial fractures. Methods: In this study, 140 patients were randomly allocated to nonoperative treatment with a plaster splint (n = 72) or volar locking plate fixation (n = 68). The outcome variables were the Patient-Rated Wrist Evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, EuroQol-5 Dimensions (EQ-5D) score, range of motion, grip strength, radiographic outcomes, and complications. Evaluation was performed at 3 and 12 months by unblinded observers. Results: At 3 months, 122 patients were evaluated, and at 12 months, 119 patients were evaluated. At 3 months, the volar locking plate group, compared with the nonoperative treatment group, had a better median PRWE score (10.3 compared with 35.5 points; p = 0.002), DASH score (14.4 compared with 29.2 points; p = 0.016), and grip strength (71.0% of the uninjured hand compared with 53.9%; p < 0.001). Significant differences in favor of the volar locking plate group remained at 12 months; compared with the nonoperative treatment group, the volar locking plate group had a better median PRWE score (7.5 points compared with 17.5 points; p = 0.014), DASH score (8.3 points compared with 19.9 points; p = 0.028), and grip strength (96.8% compared with 80.0%; p = 0.001). Radiographic measurements favored volar locking plate fixation at 3 and 12 months. Complication rates were similar, with 11% major complications in the nonoperative group compared with 14% major complications in the volar locking plate group (p = 0.606) and 11% minor complications in the nonoperative group compared with 20% minor complications in the volar locking plate group (p = 0.197). Conclusions: The PRWE scores, DASH scores, and grip strength were better for the volar locking plate group compared with the nonoperative group at 3 and 12 months. The complication rates were similar. Our results imply that there is a benefit for the elderly patient with an unstable dorsally displaced distal radial fracture to be treated with a volar locking plate. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Section: Regional Variationmentioning

confidence: 99%

Section: Study Imentioning

confidence: 99%

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

Saving

Wahlgren

Olsson

et al. 2019

The Journal of Bone and Joint Surgery

103

120

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“…Local traditions and personal preferences on behalf of the surgeon largely affect the choice of treatment [ 26 , 27 ]. Large regional variation has been shown to exist in the treatment regimens for distal radius fractures in the US [ 13 , 28 , 29 ] and in the Netherlands [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Distal radius fractures—Regional variation in treatment regimens

et al. 2018

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ObjectivesAfter recent technical innovations of fracture surgery implants, treatment traditions are changing for distal radius fractures, the most common orthopaedic injury. The aim of this study was to determine if the choice of surgical method for treatment of distal radius fractures differ between healthcare regions in Sweden.MethodThe study was based on all (n = 22 378) adult patients who were registered with a surgical procedure due to a distal radius fracture during 2010–2013 in Sweden. Consecutive data was collected from the Swedish National Patient Registry.ResultsThe proportions of use of surgical method varied among the 21 healthcare regions between 41% and 95% for internal fixation, between 2.3% and 44% for percutaneous fixation and between 0.6% and 19% for external fixation. Differences between regions were statistically significant in all but 6 comparisons when controlled for age and gender. Incidence rates of surgical treatment of a distal radius fracture varied between 4.2 and 9.2/10 000 person-years.ConclusionWe conclude that there is a large variation in operative management of distal radius fractures between Swedish healthcare regions.

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“…Since it is expected that a preference for certain surgical options may vary according to the healthcare institution type (7), the secondary aim was to examine the surgical trends according to the healthcare institution type.…”

Section: Introductionmentioning

confidence: 99%

National Surgical Trends for Distal Radius Fractures in Korea

Lee

Kim

et al. 2017

J Korean Med Sci

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The objective of this study was to investigate national surgical trends for distal radius fractures (DRFs) in Korea and analyze healthcare institution type-specific surgical trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2011 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes and procedure codes were used to identify patients aged ≥ 20 years with newly diagnosed DRFs. A total of 459,388 DRFs occurred from 2011 to 2015. The proportion of DRF cases treated by surgery tended to increase over time, from 32.6% in 2011 to 38.3% in 2015 (P < 0.001). Open reduction with internal fixation (ORIF) using a plate steadily gained in popularity each year, increasing from 39.2% of overall surgeries in 2011 to 60.9% in 2015. The type of surgery for DRFs differed depending on the type of healthcare institution. ORIF (91%) was the most popular procedure in tertiary hospitals, whereas percutaneous pinning (58%) was most popular in clinics. In addition, general hospitals and hospitals with 30–100 beds used external fixation more frequently than tertiary hospitals and clinics did. Overall, our findings indicate that surgical treatment of DRF, particularly ORIF, continues to increase, and that the component ratio of operation codes differed according to the healthcare institution type.

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Analysis of variation in the surgical treatment of patients with distal radial fractures in the Netherlands

Abstract: III.

Cited by 29 publications

References 19 publications

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

Distal radius fractures—Regional variation in treatment regimens

National Surgical Trends for Distal Radius Fractures in Korea

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