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Distal radial fractures treatment often matches appropriate use guidelines

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SEATTLE — For patients with distal radial fractures, treatment frequently aligns with the appropriate use criteria-based recommended treatment detailed by the American Academy of Orthopaedic Surgeons, according to data presented here.

James C. Kyriakedes, MD, and colleagues retrospectively reviewed 112 adult patients who presented with isolated acute distal radial fractures to a single trauma center between August 2011 and August 2012. Average patient age was 50 years. A web-based application, which was based on the American Academy of Orthopaedic Surgeons Appropriate Use Criteria (AUC), was used to recommend treatment based on the AO/OTA fracture type, energy level of injury, activity level, American Society of Anesthesiologists status and associated injuries for each patient.

Kyriakedes said AUC recommendations matched the actual treatment received for 64 patients (57%) in the study. When patients were grouped by AO/OTA fracture type, actual treatment matched the AUC recommendations 100% of the time for type A fractures. For patients with type B and type C fractures, there was 7% agreement and 50% agreement, respectively.

For surgeons who chose nonoperative management, he said there was agreement with the AUC 40% of the time. For surgeons who opted for surgery, there was agreement 100% of the time.

For type C fractures, researchers found that only age was an independent predictor of whether the patient would receive surgery. Patients 57 years and older were less likely to receive surgery, he said. There were no independent predictors of surgery for patients with type A and type B fractures.

Researchers determined the incidence of complications was not significantly different in actual treatment than if patients had followed AUC recommendations.

“Clinicians would likely find a modified AUC that includes age and intra-articular fracture displacement more useful,” Kyriakedes said. – by Christian Ingram

Reference:

Kyriakedes JC, et al. Paper #7. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 10-12, 2015; Seattle.

Disclosure: Kyriakedes reports no relevant financial disclosures.