Satisfaction with Alignment After Reduction of a Displaced Distal Radial Fracture.

Abstract

Alignment adequate to offer nonoperative treatment after reduction of a distal radial fracture is a matter of opinion. This study addressed factors associated with interobserver reliability of satisfaction with alignment after the reduction of a distal radial fracture. A survey sent to members of the Science of Variation Group divided the participants into 4 groups that each rated 24 sets of radiographs of adult patients with a distal radial fracture before and after manipulative reduction and cast or splint immobilization. This resulted in a total of 96 fractures rated by 111 participants. Observers indicated whether they were satisfied with the reduction, meaning that nonoperative treatment was an option, or not, meaning that they recommend surgery. The Fleiss kappa was used to measure reliability. There was fair reliability of satisfaction with reduction of a distal radial fracture (kappa, 0.34 [95% confidence interval (CI), 0.28 to 0.41]). No surgeon factors were associated with variations in reliability. Multivariable linear regression analysis indicated that every degree decrease in dorsal angulation of the distal part of the radius on the lateral radiograph increased satisfaction by a mean of 1% (beta, -0.01 [95% CI, -0.02 to -0.006]; p = 0.001); each millimeter decrease in the anterior-to-posterior distance between the dorsal and volar articular margins on the lateral radiograph increased satisfaction by 3% (beta, -0.03 [95% CI, -0.04 to -0.005]; p = 0.014), and each millimeter decrease in ulnar positive variance increased satisfaction by 6% (beta, -0.06 [95% CI, -0.08 to -0.03]; p < 0.001), accounting for 44% of the observed variation. Surgeons are influenced by radiographic deformity, but do not agree on adequate alignment after reduction of a distal radial fracture. Greater involvement of patients in decisions with regard to acceptable deformity has the potential to decrease treatment variation.