Resource Utilization in the Management of Distal Radial Fracture

In a survey- and scenario-based experiment, we addressed the factors associated with surgeon recommendations for specific distal radius fracture treatment options, including patient financial insecurity and insurance coverage.

One hundred sixty-two surgeons were with presented seven sets of radiographs of dorsally displaced fractures, accompanied by a scenario with randomized elements regarding the patient and circumstances of the injury. Surgeons then rated the likelihood they would offer reduction and cast immobilization, percutaneous Kirschner wire fixation, and volar plate fixation. Patient factors were randomized in each scenario, including age, sex, specific distal radius fracture radiographs, financial status "I (never/sometimes) have enough money to buy food," family support "I (have/don't have) a close circle of friends or family," and insurance status. We constructed multilevel mixed-effects linear regression models to measure the sources of variation in the likelihood to recommend each of the three treatment options.

Offers of cast immobilization and percutaneous Kirschner wire fixation were more likely when patients were sometimes worried about having enough money, and for one specific fracture. Recommendations for cast immobilization were also associated with limited insurance and older age. The likelihood of offering volar plate fixation was higher when a patient had a close circle of friends and lower in the presence of financial concerns.

Surgeon recommendations vary according to patient financial insecurity and insurance coverage.

Patient financial concerns might become a more routine topic of inquiry, particularly in the United States, where out of pocket costs can be notable and are increasing.