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The Impact of Post-reduction Radiographs of Distal Radius Fractures on Treatment Decisions among Fellowship-trained
Seyed Hadi Kalantar1, Ahmadreza Afshar2, Mohammad Javad Shariyate3
1Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Objectives:
We aimed to assess the impact of post-reduction radiographic evaluation on treatment decisions by fellowship-trained hand and general orthopedic surgeons. We also evaluated the trend in distal radius fracture treatment between hand surgeons and general orthopedic surgeons.
Methods:
We collected postero-anterior (PA) and lateral radiographs of a consecutive series of 72 patients with six potential treatment options to be reviewed by the surgeons in three steps. First, they reviewed the patients' age, sex, laterality, hand dominance, and pre-reduction radiographs. Two weeks later, they reviewed the same patients' post-reduction PA and lateral radiographs in different order. Finally, after another two weeks, they reviewed the patients' pre-reduction and post-reduction PA and lateral radiographs simultaneously.
Results:
A total of 1,080 responses were analyzed without missing data. Treatment plans remained consistent across pre-reduction, post-reduction, and simultaneous presentations, indicating that post-reduction radiographs did not improve treatment agreement. Fellowship-trained hand surgeons were significantly more likely to select internal fixation than general orthopedic surgeons (P < 0.001). Within-group agreement was low (Kappa = 0.2), reflecting substantial variability in treatment choices. Intra-observer reliability between pre- and post-reduction presentations was nearly perfect (Kappa = 0.9, P = 0.402). Treatment decisions remained unchanged for 70% of hand surgeons and 72% of general orthopedic surgeons, while 13% opted for more invasive and 16% for less invasive approaches. The final treatment decisions in simultaneous presentations closely resembled those in post-reduction presentations for general orthopedic surgeons and pre-reduction presentations for hand surgeons, though the differences were not statistically significant.
Conclusion:
Although there is a significant trend among hand surgeons toward internal fixation for distal radius fractures, there is great variance among hand surgeons and general orthopedic surgeons about the recommended treatment method for distal radius fractures. Additionally, post-reduction radiographs did not improve variation among surgeons.
