Distal Radius Fracture Management: Surgeon Factors Markedly Influence Decision Making

Abstract

Introduction:It is our hypothesis that physician-specific variables affect the management of distal radius (DR) fractures in addition to patient-specific factors.Methods:A prospective cohort study was conducted evaluating treatment differences between Certificate of Additional Qualification hand surgeons (CAQh) and board-certified orthopaedic surgeons who treat patients at level 1 or level 2 trauma centers (non-CAQh). After institutional review board approval, 30 DR fractures were selected and classified (15 AO/OTA type A and B and 15 AO/OTA type C) to create a standardized patient data set. The patient-specific demographics and surgeon's information regarding the volume of DR fractures treated per year, practice setting, and years posttraining were obtained. Statistical analysis was done using chi-square analysis with a postanalysis regression model.Results:A notable difference was observed between CAQh and non-CAQh surgeons. Surgeons in practice longer than 10 years or who treat >100 DR fractures/year were more likely to choose surgical intervention and obtain a preoperative CT scan. The two most influential factors in decision making were the patients' age and medical comorbidities, with physician-specific factors being the third most influential in medical decision making.Discussion:Physician-specific variables have a notable effect on decision making and are critical for the development of consistent treatment algorithms for DR fractures.

Wrist & Hand

“…One such centre is Stanmore (UK), where authors published their work on the efficacy of arthroscopic capsular shift surgery in patients with atraumatic shoulder instability. 1 The study specifically sought to determine whether the surgical procedure leads to a reduction in pain and functional impairment in these complex patients. The research was carried out as a randomized, placebo-controlled clinical trial.…”

“…Authors from Irvine (California, USA) hypothesized that physician-specific variables affect the management of DRFs in addition to patient-specific factors. 1 They conducted a prospective cohort study to assess treatment differences between Certificate of Additional Qualification hand surgeons (CAQh) and board-certified orthopaedic surgeons treating patients at level 1 centres, or at level 2 trauma centres, who were referred to as non-CAQh. They aimed to identify how various factors, such as surgeon experience, practice setting, and years post-training, influenced the treatment decisions for DRFs.…”

Wrist Radiographic Indices and Patients’ Performance Following Three Surgical Methods for Management of Distal Radius Fractures: A Randomized Single-Blind Controlled Trial

“…Different surgical techniques and hardware have been introduced for the management of distal radial fractures. No one method can be used for all injuries, and, the surgeon should choose a proper approach based on the patient's condition [3,4]. These treatment approaches are expected to promote painfree movements of the wrist, the patient's ability to do his/her activities, and to prevent from degenerative articular changes in the future [5].…”