Variations in the Preferred Treatment of Pediatric Forearm Fractures Among Practicing Orthopaedic Surgeons

Abstract

Background: Forearm fractures are common childhood injuries. Controversy remains on the optimal treatment for certain fractures. The goal of this study was to determine variation in the treatment of pediatric forearm fractures based on fracture patterns, patient demographics, and surgeon characteristics. Methods: A survey was distributed to orthopedic surgeons consisting of 48 different cases of pediatric forearm fractures with possible treatment options. Each case included patient age and radiographs at three different time intervals: initial injury, post reduction, and first office follow-up. Respondents were asked if they would recommend non-surgical management, surgery with intramedullary nailing, or surgery with plate/screw fixation. Surgeon demographic data was also collected. The primary model investigated the effect of the attributes on the surgeon’s decision to operate. Results: 48 of 55 surgeons responded. Surgery was chosen as preferred treatment in 43% of the presented scenarios. Coronal plane angulation at first follow-up was associated with the greatest increase in marginal probability of operative treatment. For each degree increase in angulation, respondents were 5.2% more likely to operate on a patient. For each additional year of patient age, operative treatment probability increased by 3.9%. Surgeons’ sex, age, years in practice, and fellowship type were not associated with variations in treatment preferences. Conclusions: Our study demonstrates significant variability in treatment recommendations amongst orthopedic surgeons with regard to pediatric forearm fractures. Patient age and coronal plane angulation at first follow-up increased the probability of choosing operative treatment among respondents. Surgeon characteristics did not predict treatment recommendations.