International Survey: Factors Associated With Operative Treatment of Distal Radius Fractures and Implications for the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria.

Abstract:

OBJECTIVES:Through an international survey, we assessed whether deciding to operatively treat an intra-articular distal radius fracture (DRF) is guided by identifiable patient and surgeon factors. In addition, we compared surgeons' treatment decisions with the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria (AUC) treatment recommendations. METHODS:This cross-sectional survey asked 224 surgeons to operatively or nonoperatively treat 28 hypothetical patients with radiographs of an intra-articular DRF. We randomized patient age (50/70 years), gender, mechanism of injury, activity level, and OTA/AO fracture type. We classified 6 fractures as "nonclinically significant displacement" and 22 as "potentially clinically significant displacement." Multilevel logistic regression analysis was performed. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Statistical significance was P < 0.05. RESULTS:Patient factors independently associated with surgery included younger age (OR 6.7, P = 0.003), clinically significant fracture displacement (type B: OR 122, CI, 20-739, P < 0.001; type C: OR 59, CI, 12-300, P < 0.001), normal activity level (OR 5.0, P < 0.001), and high-energy mechanisms (OR 1.3, P = 0.002). Surgeon factors associated with recommending surgery included practicing outside the United States (Europe: OR 2.6, P < 0.001; "other": OR 4.8, P < 0.001). Hand surgeons most often selected surgery, as compared to orthopaedic trauma surgeons (OR 2.3, P = 0.001) and "other orthopaedists" (OR 2.2, P = 0.022). Thirty-seven percent of treatment decisions for patients with normal activity levels were rated by AUC recommendations as "rarely appropriate," which included 91% disagreement for 70-year-olds with nonclinically significant displacement. CONCLUSIONS:Surgeons use patient age and fracture displacement to make treatment recommendations for intra-articular DRF. We recommend that the AUC be updated to include these clinical factors as essential components in its algorithm. LEVEL OF EVIDENCE:Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

authors

Kyriakedes JC,Crijns TJ,Teunis T,Ring D,Bafus BT,Science of Variation Group.

doi

10.1097/BOT.0000000000001517

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

e394-e402

issue

10

eissn

0890-5339

issn

1531-2291

journal_volume

33

pub_type

杂志文章,随机对照试验
  • Predictors of reoperation following operative management of fractures of the tibial shaft.

    abstract:BACKGROUND:Accurate prediction of likelihood of reoperation in patients with tibial shaft fractures would facilitate optimal management. Previous studies were limited by small sample sizes and noncomprehensive examination of possible risk factors. OBJECTIVE:We conducted an observational study to determine which progno...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200305000-00006

    authors: Bhandari M,Tornetta P 3rd,Sprague S,Najibi S,Petrisor B,Griffith L,Guyatt GH

    更新日期:2003-05-01 00:00:00

  • Operating room efficiency: benefits of an orthopaedic traumatologist at a level II trauma center.

    abstract:OBJECTIVES:Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical servi...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3182a59d6b

    authors: Althausen PL,Kauk JR,Shannon S,Lu M,O'Mara TJ,Bray TJ

    更新日期:2014-05-01 00:00:00

  • Deep venous thrombosis complicating rupture of the medial head of the gastrocnemius muscle.

    abstract::Rupture of the medial head of the gastrocnemius muscle ("tennis leg") is an affliction generally associated with athletic activity. The diagnosis is made by careful history and physical examination. Although its findings are characteristic, previous reports have documented misdiagnosis of this lesion as thrombophlebit...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199406000-00016

    authors: Slawski DP

    更新日期:1994-01-01 00:00:00

  • Dual-purpose bone grafts improve healing and reduce infection.

    abstract:OBJECTIVE:To determine if a dual-purpose bone graft can regenerate bone and reduce infection in highly contaminated bone critical size defects in rats. METHODS:Biodegradable polyurethane (PUR) scaffolds were loaded with recombinant human bone morphogenetic protein-2 (BMP-2) and vancomycin (Vanc). The release kinetics ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31821f624c

    authors: Guelcher SA,Brown KV,Li B,Guda T,Lee BH,Wenke JC

    更新日期:2011-08-01 00:00:00

  • Innominosacral dissociation: mechanism of injury as a predictor of resuscitation requirements, morbidity, and mortality.

    abstract:OBJECTIVES:To assess mechanism of injury as a clinical course predictor in patients with complete anterior and posterior pelvic ring disruptions [innominosacral dissociation (ISD)]. DESIGN:Retrospective review of radiographs and medical data. SETTING:R Adams Cowley Shock Trauma Center, Baltimore, Maryland, statewide ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199702000-00002

    authors: Whitbeck MG Jr,Zwally HJ 2nd,Burgess AR

    更新日期:1997-02-01 00:00:00

  • The accuracy of fine wire tensioners: a comparison of five tensioners used in hybrid and ring external fixation.

    abstract:OBJECTIVES:To compare the accuracy of 5 commonly available fine wire tensioners used in hybrid and ring external fixation. DESIGN:A laboratory investigation. SETTING:The testing of 5 commonly available tensioners was performed with a servohydraulic test frame (MTS Bionix 858, Minneapolis, MN). MAIN OUTCOME MEASUREME...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200403000-00006

    authors: Roberts CS,Antoci V,Antoci V Jr,Voor MJ

    更新日期:2004-03-01 00:00:00

  • Surgical Fixation of Periprosthetic Humerus Fractures Using an Extension Plate: Surgical Technique and Report of 5 Cases.

    abstract::Periprosthetic fractures after shoulder arthroplasty occur in up to 2% of patients. In patients with stable components who fail or cannot undergo nonoperative management, stable fixation is required. We present a new technique to obtain proximal fixation around the humeral component using a 4.5-mm large fragment plate...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000935

    authors: Schoch B,Mehta S,Namdari S

    更新日期:2017-12-01 00:00:00

  • The Size of Intramedullary Fixation Affects Endochondral-Mediated Angiogenesis During Fracture Repair.

    abstract:OBJECTIVES:To explore the effect of intramedullary pin size on the biology of a healing fracture, specifically endochondral angiogenesis. We hypothesized that fracture fixation with a smaller pin would permit greater interfragmentary strain resulting in increased total amount of vascular endothelial growth factor withi...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001555

    authors: Yuasa M,Saito M,Blum DM,Hysong AA,Egawa S,Uppuganti S,Yoshii T,Okawa A,Schwartz HS,Moore-Lotridge SN,Nyman JS,Schoenecker JG

    更新日期:2019-10-01 00:00:00

  • Inflammatory cytokine and chemokine expression is associated with heterotopic ossification in high-energy penetrating war injuries.

    abstract:OBJECTIVE:Heterotopic ossification (HO) develops frequently after modern high-energy penetrating war injuries. The purpose of this prospective study was to identify and characterize the unique cytokine and chemokine profile associated with the development of HO as it pertained to the systemic inflammatory response afte...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31825d60a5

    authors: Evans KN,Forsberg JA,Potter BK,Hawksworth JS,Brown TS,Andersen R,Dunne JR,Tadaki D,Elster EA

    更新日期:2012-11-01 00:00:00

  • Economic Impact of Nonmodifiable Risk Factors in Orthopaedic Fracture Care: Is Bundled Payment Feasible?

    abstract:OBJECTIVES:To determine whether bundled payments are feasible in the orthopaedic fracture setting, and the potential economic implications of this reimbursement structure. DESIGN:Prospective. SETTING:Multicenter. PATIENTS/PARTICIPANTS:Between 2004 and 2014, a total of 23,643 operatively treated patients with fractur...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000742

    authors: Mahure SA,Hutzler L,Yoon RS,Bosco JA

    更新日期:2017-03-01 00:00:00

  • The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression.

    abstract:OBJECTIVE:A new device for the treatment of intertrochanteric fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intraoperative compression and rotational stability of the head/neck fragment has been developed. The aim of this study was to describe the results using this device for ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 临床试验,杂志文章

    doi:10.1097/BOT.0b013e31819211b2

    authors: Ruecker AH,Rupprecht M,Gruber M,Gebauer M,Barvencik F,Briem D,Rueger JM

    更新日期:2009-01-01 00:00:00

  • Incidence of deep-vein thrombosis in patients with fractures of the lower extremity distal to the hip.

    abstract::Our purpose was to determine the incidence of deep-vein thrombosis (DVT) in patients who have had early operative fixation of fractures of the lower extremity distal to the hip. There is a high incidence of distal thrombosis in patients who have undergone early operative fixation of lower-extremity fractures. The inci...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199605000-00002

    authors: Abelseth G,Buckley RE,Pineo GE,Hull R,Rose MS

    更新日期:1996-01-01 00:00:00

  • Management of distal humerus fractures with minifragment fixation.

    abstract::Minifragment implants provide several advantages for the stabilization of distal humerus fractures. Compared with small fragment implants, minifragment implants may provide enhanced fracture fixation because a greater number of screws can be placed into the distal fragments. In addition, minifragment plates are easier...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/01.bot.0000157908.45939.d7

    authors: Russell GV Jr,Jarrett CA,Jones CB,Cole PA,Gates J

    更新日期:2005-08-01 00:00:00

  • Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test.

    abstract:OBJECTIVE:To report our experience with computed tomography (CT) scans to detect traumatic arthrotomies of the knee (TAK) joint based on the presence of intra-articular air. DESIGN:Retrospective review. SETTING:Level I trauma center. PATIENTS:Sixty-two consecutive patients (63 knees) underwent a CT scan of the knee ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31828219bc

    authors: Konda SR,Davidovitch RI,Egol KA

    更新日期:2013-09-01 00:00:00

  • False positive indium-111 white blood cell scan in a closed clavicle fracture.

    abstract::Aggressive treatment of the multiply injured patient often requires early fixation of many fractures, some of which may be open. Often, patients develop postoperative fevers requiring a thorough workup to rule out infection. Recently, indium-111 white blood cell (WBC) imaging has become a valuable adjunct in the diagn...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:

    authors: Friedman RJ,Gordon L

    更新日期:1988-01-01 00:00:00

  • Predrilling does not improve the pullout strength of external fixator pins: a biomechanical study.

    abstract:OBJECTIVES:External fixator pins are thought to have improved pullout strength if inserted into both cortices and if pilot holes are drilled. We tested these hypotheses and investigated effects of osteoporosis and pin location on pin pullout strength. METHODS:Self-drilling external fixator pins were inserted using 4 t...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3182511ed7

    authors: Oliphant BW,Kim H,Osgood GM,Golden RD,Hawks MA,Hsieh AH,OʼToole RV

    更新日期:2013-02-01 00:00:00

  • Late salvage of failed open reduction and internal fixation of posterior wall fractures of the acetabulum.

    abstract:OBJECTIVES:The purpose of this study was to review the outcome of late revision surgery in a series of patients with posterior wall fractures having recurrent hip instability after failed initial open reduction and internal fixation. DESIGN:Retrospective analysis of consecutive patients. SETTING:Level 1 trauma center...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31819a07cf

    authors: Dean DB,Moed BR

    更新日期:2009-03-01 00:00:00

  • Donor Site Morbidity After Anterior Iliac Bone Graft Harvesting.

    abstract:OBJECTIVES:The objective of this study was to evaluate donor site morbidity associated with anterior iliac crest bone graft harvesting for orthopaedic trauma reconstructions. DESIGN:Retrospective case series. SETTING:Level 1 trauma center. PATIENTS:Forty-Six consecutive patients who had undergone anterior iliac cres...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000551

    authors: Shin SR,Tornetta P 3rd

    更新日期:2016-06-01 00:00:00

  • Slow rebound of cancellous bone after mainly steroid-induced osteoporosis in ovariectomized sheep.

    abstract:OBJECTIVES:A sheep model of osteoporosis suitable for implant testing for osteoporotic fractures was evaluated with regard to normalization of hormonal status and possible rebound of bone mineral density subsequent to the termination of steroid application. DESIGN:Osteoporosis was induced in 10 aged, female white alpi...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200501000-00005

    authors: Goldhahn J,Jenet A,Schneider E,Lill CA

    更新日期:2005-01-01 00:00:00

  • Talar revascularization after a complete talar extrusion.

    abstract::We present a rare case of complete talar extrusion after trauma. Treatment of this severe injury remains controversial as a result of the lack of congruent evidence-based literature, associated high complication rate with primary repair, and difficulty in objectively assessing long-term outcomes. Recent small sampled ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e318210f236

    authors: Gerken N,Yalamanchili R,Yalamanchili S,Penagaluru P,Md EM,Cox G

    更新日期:2011-11-01 00:00:00

  • Do Safe Radiographic Sacral Screw Pathways Exist in a Pediatric Patient Population and Do They Change With Age?

    abstract:OBJECTIVES:Iliosacral screw pathways in the first (S1) and second (S2) sacral segments are commonly used for adult pelvic ring stabilization. We hypothesize that radiographically "safe" pathways exist in pediatric patients. SETTING:Academic level I Trauma Center. PATIENTS:All patients between ages 2 and 16 years with...

    journal_title:Journal of orthopaedic trauma

    pub_type: 临床试验,杂志文章

    doi:10.1097/BOT.0000000000000421

    authors: Burn M,Gary JL,Holzman M,Heydemann JA,Munz JW,Galpin M,Ambrose CG,Achor TS,Kumaravel M

    更新日期:2016-01-01 00:00:00

  • Treatment of Periprosthetic Humerus Fractures With Open Reduction and Internal Fixation.

    abstract::Periprosthetic humerus fractures are relatively uncommon occurrence that can be difficult to manage nonoperatively. Locking plate technology has enhanced the surgical management of these fractures. However, adequate fixation around the stem remains of some concern. We describe an osteosynthesis technique using a locki...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000646

    authors: Kurowicki J,Momoh E,Levy JC

    更新日期:2016-11-01 00:00:00

  • Shoulder Arthrodesis.

    abstract:PURPOSE:The purpose of this video is to demonstrate the surgical technique of a shoulder arthrodesis for a patient with multidirectional instability and multiple failed previous surgeries. METHODS:A 25-year-old woman with a long history of left shoulder multidirectional instability in the setting of Ehlers-Danlos synd...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001212

    authors: Legato JM,OʼConnell M,Fuller DA

    更新日期:2018-08-01 00:00:00

  • Removal of a broken Synthes proximal spiral blade.

    abstract::Use of cephalomedullary nails is an option for treatment of subtrochanteric femur fractures. However, the magnitude of bending forces in this area of the femur often can lead to implant failure before union. We report on a case of hardware failure of a specific device (Synthes spiral blade) and a method for removal. ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199803000-00010

    authors: Stover MD,Lin I,Bosse MJ

    更新日期:1998-03-01 00:00:00

  • Evidence gaps in the global decade of road traffic safety.

    abstract::Road traffic accidents are a leading cause of global mortality. In March 2010, the United Nations General Assembly and the World Health Organization (WHO) officially proclaimed 2011-2020 as the "Decade of Action for Road Safety." Researchers must focus on vulnerable road users and low- and middle-income countries (LMI...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000103

    authors: Evaniew N,Godin K,Schemitsch EH,Bhandari M

    更新日期:2014-01-01 00:00:00

  • Extra-articular malunions of the scapula: a comparison of functional outcome before and after reconstruction.

    abstract:OBJECTIVE:To assess surgical and functional results after corrective reconstruction of malunited, scapula neck or body fractures in patients who presented with chronic pain, limited range of motion, weakness, and gross deformity of the shoulder. DESIGN:Case series. SETTING:Level I teaching trauma center. PATIENTS:Be...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31820af67f

    authors: Cole PA,Talbot M,Schroder LK,Anavian J

    更新日期:2011-11-01 00:00:00

  • A biomechanical study of three wiring techniques for cerclage-plating.

    abstract::Transverse fractures at the distal tip of a well-fixed femoral prosthesis are difficult to stabilize using plates and screws due to the presence of the underlying intramedullary stem. The attachment of plates using cerclage wires obviates the need for screws, but the stability provided by cerclage plating is a clinica...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199505000-00004

    authors: Stevens SS,Irish AJ,Vachtsevanos JG,Csongradi J,Beaupré GS

    更新日期:1995-01-01 00:00:00

  • Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years.

    abstract:OBJECTIVES:To compare failure rates between short and long cephalomedullary nails used for the treatment of intertrochanteric hip fractures in patients over 65 years of age. DESIGN:Retrospective cohort study. Data were collected from medical records and radiographs. SETTING:Three level 1 trauma centers. PATIENTS/PAR...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000036

    authors: Kleweno C,Morgan J,Redshaw J,Harris M,Rodriguez E,Zurakowski D,Vrahas M,Appleton P

    更新日期:2014-07-01 00:00:00

  • Hexapod Stacked Transport for Tibial Infected Nonunions With Bone Loss: Long-Term Functional Outcomes.

    abstract:OBJECTIVES:To analyze long-term functional outcomes in patients with posttraumatic infected tibial nonunions having undergone bone transport with hexapod external fixator. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PATIENTS/PARTICIPANTS:Thirty-eight patients with infected nonunions of the tibi...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001005

    authors: Napora JK,Weinberg DS,Eagle BA,Kaufman BR,Sontich JK

    更新日期:2018-01-01 00:00:00

  • Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures.

    abstract:OBJECTIVES:The aim of this study was analyze modes of mechanical failure in a consecutive cohort of patients and establish possible risk factors. DESIGN:This was a retrospective cohort study. SETTING:The study was conducted at an academic level-1 trauma center. PATIENTS:Twenty-nine patients (mean age 56 years, range...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e318251930d

    authors: Streubel PN,Moustoukas MJ,Obremskey WT

    更新日期:2013-01-01 00:00:00