Document Type : RESEARCH PAPER
Authors
1
Orthopedic surgery ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
2
Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 99 Brookline Ave, Boston, Massachusetts 02215, USA.
3
Center for Advance Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School
4
Iran. Urmia
5
Department of orthopedic surgery, Imam Khomeini hospital, joint reconstruction research center, TUMS, Tehran, Iran
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Tehran University of Medical Sciences; Joint Reconstruction Research Center
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Orthopedic department, imam khomeini hospital, tehran university of medical sciences
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Babak Shojaie, MD,FA,FEBHS Department of plastic and reconstructive surgery, Klinikum Bremen Mitte ,Göttingen University of medical Science, Bremen Germany
9
Rothman Orthopaedic Institute - Hand, Wrist, Elbow, & Microvascular Surgery Sidney Kimmel Medical College at Thomas Jefferson University Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA
10.22038/abjs.2025.81032.3696
Abstract
Objectives: We aimed to assess the impact of post-reduction radiographic evaluation on treatment decisions by fellowship-trained hand and general orthopedic surgeons. We also evaluated the trend in distal radius fracture treatment between hand surgeons and general orthopedic surgeons.
Methods: We collected postero-anterior (PA) and lateral radiographs of a consecutive series of 72 patients with six potential treatment options, to be reviewed by the surgeons in three steps. First, they reviewed the patients' age, sex, laterality, hand dominance and pre-reduction radiographs. Two weeks later, they reviewed post-reduction PA and lateral radiographs of the same patients in different order. Finally, after another two weeks, they reviewed the pre-reduction and post-reduction PA and Lateral radiographs of the patients simultaneously.
Results: A total of 1,080 responses were analyzed without missing data. Treatment plans remained consistent across pre-reduction, post-reduction, and simultaneous presentations, indicating that post-reduction radiographs did not improve treatment agreement. Fellowship-trained hand surgeons were significantly more likely to select internal fixation than general orthopedic surgeons (P<0.001). Within-group agreement was low (Kappa=0.2), reflecting substantial variability in treatment choices. Intra-observer reliability between pre- and post-reduction presentations was nearly perfect (Kappa=0.9, P=0.402). Treatment decisions remained unchanged for 70% of hand surgeons and 72% of general orthopedic surgeons, while 13% opted for more invasive and 16% for less invasive approaches. The final treatment decisions in simultaneous presentations closely resembled those in post-reduction presentations for general orthopedic surgeons and pre-reduction presentations for hand surgeons, though the differences were not statistically significant.
Conclusion: Although there is a significant trend among hand surgeons toward internal fixation for distal radius fractures, there is great variance among hand surgeons and general orthopedic surgeons about the recommended treatment method for distal radius fractures. Additionally, post-reduction radiographs did not improve variation among surgeons.
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