Distal Radius Fractures: AAOS Appropriate Use Criteria versus Actual Management at a Level One Trauma Center: Level 4 Evidence

Abstract

Consulting Fee: Synthes, Axogen, Stryker (Hoyen)Ownership Interest: Stocks in Axogen Inc (Bafus) The AAOS Appropriate Use Criteria (AUC) for distal radius fractures recommends a higher frequency of operative management of distal radius fractures than is actually performed by a group of hand fellowship-trained orthopaedic surgeons at a high-volume, level one urban trauma center. Between August 2011 to August 2012, 829 patients presented with wrist fractures to our trauma center (identified by ICD-9 codes). We retrospectively reviewed these patients in the electronic medical record (EMR), and 112 patients met our inclusion criteria. Patients were excluded if they were younger than 16 years of age, had other significant injuries, had a delayed presentation, or were not seen by our orthopaedic hand surgeons. These 112 patients were evaluated using the AUC web-based application, which takes into account each patient’s AO/OTA fracture type (A, B, or C), mechanism of injury (high vs. low energy), activity level (normal, high functional, independent, or homebound), ASA status (1-3 or 4), and the presence of select associated injuries into its treatment recommendation. Statistical analyses included chi-square tests and post-hoc Z-tests, and statistical significance was set at a P-value of less than 0.05. Of the 112 patients, 64 (57%) received treatment that would have matched the AAOS AUC recommendation. After grouping fractures into AO/OTA type A, B, and C, actual management matched the AUC recommendation 100% of the time (42/42, p55 year olds as compared to 16-40 year olds. Within the follow-up period, there was no crossover between the treatment groups. Following or not following AUC treatment recommendations would not have resulted in a statistically significant difference in the incidence of major complications. •To our knowledge, this is the first clinical application of an AAOS AUC in the literature.•AAOS AUC favors surgery for all intraarticular distal radius fractures.•Actual treatment recommendations at our high-volume, level one urban trauma center were dependent on intraarticular fracture displacement.•Treating clinicians may find a modified AUC that includes intraarticular fracture displacement as a variable more useful.View Large Image Figure ViewerDownload Hi-res image Download (PPT)