Distal radius fractures-Regional variation in treatment regimens.

Jenny Saving,Sari Ponzer,Cecilia Mellstrand Navarro,Anders Enocson,Robert Daniel Blank

doi:10.1371/journal.pone.0207702

Abstract

ObjectivesAfter recent technical innovations of fracture surgery implants, treatment traditions are changing for distal radius fractures, the most common orthopaedic injury. The aim of this study was to determine if the choice of surgical method for treatment of distal radius fractures differ between healthcare regions in Sweden.MethodThe study was based on all (n = 22 378) adult patients who were registered with a surgical procedure due to a distal radius fracture during 2010–2013 in Sweden. Consecutive data was collected from the Swedish National Patient Registry.ResultsThe proportions of use of surgical method varied among the 21 healthcare regions between 41% and 95% for internal fixation, between 2.3% and 44% for percutaneous fixation and between 0.6% and 19% for external fixation. Differences between regions were statistically significant in all but 6 comparisons when controlled for age and gender. Incidence rates of surgical treatment of a distal radius fracture varied between 4.2 and 9.2/10 000 person-years.ConclusionWe conclude that there is a large variation in operative management of distal radius fractures between Swedish healthcare regions.

Highlights

For a distal radial fracture, the most common of all fractures, there is no consensus regarding optimal treatment [1]
We conclude that there is a large variation in operative management of distal radius fractures between Swedish healthcare regions
The proportion of pin fixation only (PF) ranged from 2.3% (Orebro) to 44% (Norrbotten)

Summary

Introduction

For a distal radial fracture, the most common of all fractures, there is no consensus regarding optimal treatment [1]. External fixation (EF) constitutes a scaffold of metal kept outside the skin for 6 weeks during fracture healing. It is held in place by metal rods in the radial diaphysis and second metacarpal bone and establishes a traction over the wrist, aligning the fractured bones. Reported complications after EF and/or pinning are superficial nerve palsy, pin tract infection and loss of fracture reduction [5, 6]. The skin is opened at the volar side of the wrist, the median nerve and the radial artery are retracted, and the fracture is exposed, reduced and fixed by a plate held in place by screws. The complication rate has been reported to be high including median nerve palsy, tendon irritation and tendon rupture [8, 9]

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