Concurrent Proximal Fractures Are Rare in Distal Forearm Fractures: A National Cross-sectional Study

Area of Science:

• Orthopedic Surgery
• Emergency Medicine
• Radiology

Background:

• Distal forearm fractures (DFF) are common emergency department visits.
• Clinicians often order imaging above and below the fracture site to detect associated injuries.
• The incidence of associated proximal fractures (APF) and current imaging practices for DFF are not well-characterized.

Purpose of the Study:

• To determine the incidence of APF in patients with DFF.
• To evaluate current imaging practices for DFF in a national sample of emergency departments.
• To estimate the financial impact of additional imaging in DFF cases.

Main Methods:

• Utilized the 2013 National Emergency Department Sample database.
• Employed International Classification of Diseases, 9th edition codes for DFF and APF.
• Analyzed Current Procedural Terminology codes for imaging studies and conducted weighted analyses for national estimates and cost projections.

Main Results:

• An estimated 297,755 emergency department visits involved DFF in 2013, with only 1.6% having APF.
• APF incidence was lower in females but higher in metropolitan teaching hospitals and Level 1 trauma centers.
• Approximately 40% of DFF patients received non-wrist radiographs, and 19% had non-wrist/non-forearm imaging, costing nearly $3.6 million.

Conclusions:

• The incidence of APF in distal forearm fractures is low, despite frequent proximal imaging.
• Identifying specific risk factors for APF through mechanism and physical exam could optimize imaging strategies.
• Reducing unnecessary imaging can lead to significant healthcare cost savings.