Practice Variation Among Hispanic American Orthopedic Surgeons in the Management of Geriatric Distal Radius Fracture

Edwin G Rosado; Gerardo Olivella; Eduardo J Natal-Albelo; Gabriel J Echegaray; Lenny L Rivera; Carlos A Guevara; Larry M Alejandro; Arnaldo Martínez-Rivera; Norman Ramírez; Christian A Foy

doi:10.1177/2151459320969378

Practice Variation Among Hispanic American Orthopedic Surgeons in the Management of Geriatric Distal Radius Fracture

Geriatr Orthop Surg Rehabil. 2020 Nov 19:11:2151459320969378. doi: 10.1177/2151459320969378. eCollection 2020.

Affiliations

¹ Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
² Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
³ Pediatric Orthopaedic Surgery Department, Mayagüez Medical Center, Mayagüez, Puerto Rico.

Abstract

Introduction: There is a controversy in the management of distal radius fractures (DRF) and its criteria for surgical intervention on geriatric patients. The American Academy of Orthopedic Surgeons (AAOS) developed evidence-based guidelines for treatment of DRF. The aim of this study was to evaluate the current practice of Hispanic orthopedic surgeons in the management of geriatric DRF and examine their adherence to AAOS guidelines based on years of surgical experience.

Material & methods: A survey was emailed to all orthopedic surgeons who live in Puerto Rico and treated DRF in their daily practice. Responses concerning demographic, management and clinical scenarios were evaluated. For each clinical scenario, treatment of choice was selected with the same fracture in a geriatric and young adult patient. Comparison between years of surgical experience and adherence to the AAOS guidelines was performed.

Results: A total of 65 surgeons responded the survey with 65% having >15 years in practice. A high consensus with AAOS guidelines for DRF was found. Use of preoperative radiographs was reported in all respondents, with an additional 12% routine use of preoperative computed tomography scans. Seventy-seven percent of respondents did not allow any range of motion (ROM) at immediate postoperative period, while 23% allowed active or passive ROM. Use of postoperative therapy was reported in 72.3%. Correlation between years of surgical experience showed a higher use of Vitamin C postoperatively for prophylaxis of Complex Regional Pain Syndrome among surgeons <15 years (P = 0.01). A general consensus trend toward operative fixation was noted among geriatric and young adult patients with the same fracture type in all clinical scenarios.

Discussion and conclusions: This survey demonstrates a practice variation toward surgical management of geriatric DRF among Hispanic orthopedic surgeons; despite their compliance with the AAOS AUC guidelines. The geriatric DRF management does not vary significantly among years of surgical experience.

Keywords: American academy of orthopedic surgeons; Hispanics; appropriate use criteria; clinical practice guidelines; geriatric distal radius fractures.