Patterns of CT use and surgical intervention in upper limb periarticular fractures at a level-1 trauma centre

Abstract

Objectives: The universal availability of CT scanners has led to lower thresholds for imaging despite significant financial costs and radiation exposure. We hypothesised that this recent trend has increased the use of CT for upper limb periarticular fractures and led to more frequent operative management.

Method: A 5-year retrospective study (01/07/2005-30/06/2010) was performed on all adult patients with upper extremity periarticular fractures (OTA: 11, 13, 21 and 23) admitted to a level-1 trauma centre. Patients were identified from the institution's prospectively maintained OTA classification database.

Results: A total of 1734 upper extremity periarticular fractures were identified in 1651 patients. 65% (1132/1734) were operated on. 32% (557/1734) had CT imaging and 78% (431/557) of these had operative management. CT use for all fractures and ages showed no change (0.56%/year, p = 0.210, r(2) = 0.457). Operative intervention increased at a rate of 2.17%/year (p = 0.004, r(2) = 0.959). Within each fracture type, CT rates showed no change. Operative management of proximal humerus and distal radius fractures became more frequent (6.30%/year, p = 0.002, r(2) = 0.969 and 0.96%/year, p = 0.046, r(2) = 0.784 respectively). Fractures around the elbow showed no change. In patients younger than 55 years, only proximal humerus fractures had more frequent imaging (3.17%/year, p = 0.023, r(2) = 0.866). In patients over 55 the frequency of CT scanning did not increase, but they were more frequently operated on (4.09%/year, p = 0.012, r(2) = 0.907). In older patients the rate of surgical intervention increased in all but the distal humerus region, Proximal humerus (6.19%/year, p = 0.015, r(2) = 0.894), proximal forearm (4.57%/year, p = 0.007, r(2) = 0.931) and distal radius (2.70%/year, p = 0.002, r(2) = 0.871).

Conclusion: During the examined 5-year period no increases of in CT imaging frequency were observed. The significantly increased number of operations among older patients is unlikely to be driven by imaging frequency.