Scaphoid fractures likely more prevalent than previously thought

SEATTLE — Scaphoid fractures likely occur more frequently than previously believed, a speaker here said.
Christopher J. Dy, MD, MPH, and his colleagues searched a private commercial insurance beneficiary database for claims filed from 2006 to 2012 and identified treatment information for 8,923 closed scaphoid fractures. Subsequent claims regarding any additional treatment for nonunion or salvage procedures were also evaluated. Any changes in treatment frequency, revision procedures or salvage treatments were examined via trend analyses, while risk factors for nonunion were determined via multivariable regression analysis.

Scaphoid fracture incidence was estimated as 10.6 per 100,000 person-years, higher than the 1.5 per 100,000 person-years previously estimated. Such fractures were frequently treated with casting as opposed to surgical fixation (71% vs. 29%, respectively), though treatment with fixation significantly increased from 22.1% in 2006 to 34.1% in 2012. Nonunion occurred in 10.8% of fractures after surgical fixation and 3% of fractures after casting. Salvage procedures occurred in 0.29% of all scaphoid fracture cases. Investigators found younger patient age, male gender and surgical treatment significantly elevated the risk for nonunion.

“Our findings provide highly generalizable data from real world practice,” Dy concluded in his presentation. “Establishing a more accurate rate of nonunion treatment is specifically helpful to counsel patients and can provide an appropriate benchmark for quality assurance health policy, especially as pay-for-performance metrics emerge in the United States.” – by Christian Ingram

Reference:

Dy CJ, et al. Paper #8. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 10-12, 2015; Seattle.

Disclosure: Dy reports no relevant financial disclosures.