Hand and wrist osteotomies in Sweden: a population-based study of 6911 interventions from 2008 to 2023

Elective osteotomy is a well-established treatment for malunited fractures and degenerative deformities of the wrist and hand. However, contemporary population-based evidence regarding temporal, demographic and regional trends is limited.

This nationwide observational study analysed all wrist and hand osteotomies in Sweden between 2008 and 2023 using data from the National Patient Register. Procedures were identified by NOMESCO codes for rotational/angular osteotomy (NDK59, NCK59) and lengthening/shortening osteotomy (NDK69, NCK69). Incidence rates were calculated per 100,000 inhabitants and stratified by sex, age and region. Predictive modelling was applied to estimate trends up to 2040.

A total of 6911 wrist and hand osteotomies were identified between 2008 and 2023, including rotational/angular osteotomies (NDK59: 2833; NCK59: 1276) and lengthening/shortening osteotomies (NDK69: 1682; NCK69: 1120). The annual incidence declined steadily across the study period. Women consistently accounted for more procedures than men across all osteotomy types. Incidence was highest among middle-aged and older adults, with younger patients representing a small proportion of cases. Substantial regional variation was observed throughout Sweden, with some regions carrying out several times more procedures than others. Forecast modelling predicts a continued decline to 2040.

The incidence of osteotomies of the wrist and hand in Sweden has declined markedly over the past 16 years, which may reflect improvements in primary fracture care. These findings reflect evolving surgical practices, demographic influences and systemic factors such as regional disparities. A continued decline in osteotomy procedures has major implications: as case volumes decrease, exposure for trainees diminishes, with fewer surgeons proficient in osteotomies, even though patients will continue to benefit from the procedure. Similar concerns have been raised in the context of other high-skill orthopaedic interventions. This might prompt centralization of complex cases and cross-border collaborations to ensure adequate surgical competence.

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