Variation in the Treatment of Distal Radius Fractures in the United States: 2010 to 2015

Abstract

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.

Some observations on the management of displaced unstable intra articular fractures of the distal end of radius by open reduction and internal fixation

“…[4,31,32,33,34,35,36] We have compared, in present study the functional results of 25 patients with unstable comminuted displaced intra articular fractures of distal radius with other studies like Lee et al (1992), Jupitar et al (1993), Hove et al (1997), Nienstedt et al (1999), and Cataleno (1997), and found comparable results in respect of age, sex and dominant side involvement as these fractures usually occurs in young labors males with high energy trauma. [23,37,38,39] The most common fracture in our study was volar Barton where as in other studies its comminuted intra articular fracture. The time to operate, approach and implant used is similar to other studies.…”

“…In accordance with value-based care initiatives, treatment decisions should be made to combine patient needs with financial implications on the health system (39).…”

Nonoperative treatment versus volar locking plate fixation for elderly patients with distal radial fracture: a systematic review and meta-analysis

“…The inclusion criteria were as follows: (1) randomized controlled trials (RCTs) or prospective or retrospective controlled studies, (2) participants aged above 50 years and with distal radial fractures, (3) patients treated surgically with VLP or nonoperation treatment with casting, (4) reported outcomes including wrist function, radiographic assessment, and complications in follow-up, (5) follow-up of at least 12 months.…”

Incidence for volar locking plate removal following distal radius fracture surgery

“…The treatment of distal radius fractures is a major public health concern, since fall-related DRFs seem to increase in the working population [10,11]. The most common treatment for distal radius fracture is non-operative cast immobilization, although there are injuries that require surgical treatment [12,13]. Main indications for surgery are unstable dislocated DRF and comminuted intra-articular fracture, especially in young people, as it has been found that surgical treatment has a positive effect on the functional outcome in short-term follow-ups [14][15][16].…”

“…Main indications for surgery are unstable dislocated DRF and comminuted intra-articular fracture, especially in young people, as it has been found that surgical treatment has a positive effect on the functional outcome in short-term follow-ups [14][15][16]. The most common surgical techniques used for the treatment of DRFs are external fixation, percutaneous pinning and open reduction internal fixation (ORIF) [12]. During the past decade, operative treatment has increased due to the development of new surgical techniques [13,[17][18][19].…”