Trends in the Utilization of Computed Tomography in Operative Treatment of Distal Radius Fractures

Brian K Foster; Benchaa Boualam; R Parker Shea; Idorenyin F Udoeyo; A Michael Luciani; Joel C Klena; Louis C Grandizio

doi:10.1016/j.jhsg.2023.04.006

Trends in the Utilization of Computed Tomography in Operative Treatment of Distal Radius Fractures

J Hand Surg Glob Online. 2023 May 9;5(5):638-642. doi: 10.1016/j.jhsg.2023.04.006. eCollection 2023 Sep.

Authors

Brian K Foster¹, Benchaa Boualam¹, R Parker Shea¹, Idorenyin F Udoeyo¹, A Michael Luciani¹, Joel C Klena¹, Louis C Grandizio¹

Affiliation

¹ Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.

Abstract

Purpose: To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP).

Methods: We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020. Baseline demographics, injury, treatment characteristics, and the fellowship training of the 44 included surgeons were recorded. We compared cases with and without a preoperative CT, and an adjusted logistic regression model was generated to determine the odds of having a preoperative CT.

Results: A total of 1,204 operatively treated DRFs performed by 44 surgeons were included. CT utilization increased during the study period. Intra-articular fractures accounted for 76% of cases, and preoperative CT scans were ordered in 243 of 1240 cases (20%). Overall, isolated VLP was used in 83% of cases. Cases with a preoperative CT were more likely to be treated with an alternative method of fixation (such as dorsal plating). The adjusted logistic regression model demonstrated that male sex (OR 1.62; 95% CI: 1.16, 2.26), intra-articular fractures (OR 3.11; 95% CI: 1.87, 5.81), and associated fractures (OR 2.69; 95% CI: 1.82, 3.98) had a significantly increased odds of having a preoperative CT. Fellowship training was not associated with increased CT utilization overall, but hand surgeons were more likely to use a CT in Orthopaedic Trauma Association-C3 fractures.

Conclusions: Patient and injury characteristics are associated with CT utilization in operative DRFs. Preoperative CTs are associated with alternative fixation approaches, as cases with a CT were more likely to use fixation methods other than isolated VLP. The costs and benefits of CT scans must be carefully weighed against whether this modality adds value or improves outcomes in treating DRFs.

Level of evidence: Prognostic II.

Keywords: Computed tomography; Distal radius fracture; Orthopedic trauma; Volar plating; Wrist surgery.