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J Hand Microsurg 2023; 15(05): 351-357
DOI: 10.1055/s-0042-1749460
Original Article

Variations in Treatment and Costs for Distal Radius Fractures in Patients Over 55 Years of Age: A Population-Based Study

Lauren M. Shapiro
1   Department of Orthopaedic Surgery, University of California, San Francisco, California, United States
,
Michelle Xiao
2   Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
,
Thompson Zhuang 
2   Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
,
David S. Ruch
3   Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States
,
Marc J. Richard
3   Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States
,
Robin N. Kamal 
2   Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
› Author Affiliations Funding This work was supported by an Orthopaedic Research and Education Foundation (OREF) Mentored Clinician Scientist Grant to R.N.K. and a National Institutes of Health K23AR073307–01 to R.N.K. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. No other authors received any funding related to this research and no benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
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Abstract

Objective To evaluate the rate of surgery for symptomatic malunion after nonoperatively treated distal radius fractures in patients aged 55 and above, and to secondarily report differences in demographics, geographical variation, and utilization costs of patients requiring subsequent malunion correction.

Methods We identified patients aged 55 and above who underwent nonoperative treatment for a distal radius fracture between 2007 and 2016 using the IBM MarketScan database. In the nonoperative cohort, we identified patients who underwent malunion correction between 3 months and 1 year after distal radius fracture. The primary outcome was rate of malunion correction. Multivariable logistic regression controlling for sex, region, and Elixhauser Comorbidity Index (ECI) was used. We also report patient demographics, geographical variation, and utilization cost.

Results The rate of subsequent malunion surgery after nonoperative treatment was 0.58%. The cohort undergoing malunion surgery was younger and had a lower ECI. For every 1-year increase in age, there was a 6.4% decrease in odds of undergoing surgery for malunion, controlling for sex, region, and ECI (odds ratio = 0.94 [0.93–0.95]; p < 0.01). The southern United States had the highest percentage of patients initially managed operatively (30.7%), the Northeast had the lowest (22.0%). Patients who required a malunion procedure incurred higher costs compared with patients who did not ($7,272 ± 8,090 vs. $2,209 ± 5,940; p < 0.01).

Conclusion The rate of surgery for symptomatic malunion after initial nonoperative treatment for distal radius fractures in patients aged 55 and above is low. As younger and healthier patients are more likely to undergo malunion correction with higher associated costs, surgeons may consider offering this cohort surgical treatment initially.

Keywords

distal radius fracture - elderly - malunion - nonoperative - variation

Supplementary Material



Publication History

Article published online:
05 July 2022

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