Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture

The Science of Variation Group

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8–12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. Materials and methods: In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient sex, age, a description of radiographic fracture consolidation, fracture tenderness and duration of cast immobilization completed (8 versus 12 weeks). To assess the impact of clinical factors on recommendation to continue immobilization we calculated posterior probabilities and determined variable importance using a random forest algorithm. Multilevel logistic mixed regression analysis was used to identify surgeon characteristics associated with recommendation for additional cast immobilization. Results: Unclear fracture healing on radiographs, fracture tenderness and 8 (versus 12) weeks of completed cast immobilization were the most important factors influencing surgeons’ decision to recommend continued cast immobilization. Women surgeons (OR 2.96; 95% CI 1.28–6.81, p = 0.011), surgeons not specialized in orthopedic trauma, hand and wrist or shoulder and elbow surgery (categorized as ‘other’) (OR 2.64; 95% CI 1.31–5.33, p = 0.007) and surgeons practicing in the United States (OR 6.53, 95% CI 2.18–19.52, p = 0.01 versus Europe) were more likely to recommend continued immobilization. Conclusion: Adoption of shorter immobilization times for CT-confirmed nondisplaced scaphoid waist fractures may be hindered by surgeon attention to fracture tenderness and radiographic appearance.

Original languageEnglish (US)
Pages (from-to)2011-2018
Number of pages8
JournalArchives of Orthopaedic and Trauma Surgery
Volume141
Issue number11
Early online dateJul 24 2021
DOIs
StatePublished - Nov 2021

Bibliographical note

Funding Information:
Group authorship: The Science of Variation Group A. Peters, A. B. Spoor, Abhay Shrivastava, Aakash Chauhan, Adam Shafritz, Asif M. Ilyas, Anne J. H. Vochteloo, Andrew John Powell, Alberto P?rez Castillo, Alexandre Leme Godoy-Santos, Amparo Gomez Gelvez, Andrea Bauer, Antonio Barquet, Anze Kristan, Ante Prkic, Axel Jubel, Boj Mirck, B. E. Kreis, H. Brent Bamberger, William Dias Belangero, Bernard F. Hearon, Bradley Palmer, Brad Hyatt, Brian P. D. Wills, Henry Broekhuyse, Richard Buckley, Burak Altintas, Sean T. Campbell, Carl Ekholm, Carlos Henrique Fernandes, C. H. Fernandes, Carl Weiss, Christos Garnavos, Charles Metzger, Christopher J. Wilson, Chris Bainbridge, Christian Deml, Jesus Moreta, Conor Kleweno, Constanza L. Moreno-Serrano, Craig B. Ordway, Cyrus Klostermann, David Zeltser, David G. Dennison, Diederik O. Verbeek, Dan Polatsch, Camilo Jose Romero Barreto, Koroush Kabir, Mohamed Shafi, Juan M. Pati?o, Roger van Riet, Samir Sodha, Scott Duncan, Daniel C. Wascher, Edward F. Ibrahim, Efstathios G. Ballas, Edward Harvey, Edward K. Rodriguez, Emilia Stojkovska Pemovska, E. Walbeehm, Peter J. Evans, Ezequiel E. Zaidenberg, Fred O?Brien, Franz Josef Seibert, Frank W. Bloemers, Gladys Cecilia Zambrano Caro, Gregory DeSilva, George Babis, George Pianka, Michael Githens, Giselly Miranda Ver?ssimo, Grant E. Garrigues, Guido Fierro, Holger Durchholz, Jeremy Hall, Hal McCutchan, Michael Nancollas, Colby Young, Greg P. Watchmaker, Gary M. Pess, Lewis B. Lane, Harold Alonso Villamizar, Ippokratis Pountos, Hervey L. Kimball, Eric P. Hofmeister, Iain McGraw, Konul Erol, J.F. Di Giovanni, Jacob W. Brubacher, Jan Biert, Jason C. Fanuele, Jason D. Tavakolian, Jack Choueka, Jose Eduardo Grandi Ribeiro, Jose Eduardo Grandi Ribeiro Filho, Joseph M. Conflitti, J. M. R Roiz, John Munyak, James F. Nappi, Job N. Doornberg, John M. Erickson, Jorge G. Boretto, Joel M. Post, Jorge Rubio, John A. Scolaro, John Taras, Julio Domenech, Julio Sandoval, Jeffrey Wint, Katherine Celeste Faust, Ken Butters, Kyle Jeray, Karl-Josef Prommersberger, Kagan Ozer, G. A. Kraan, Kyle J. Chepla, L. M. S. J. Poelhekke, Ladislav Mica, Lawrence Weiss, Lars Adolfsson, Lars C. Borris, Louis Christopher Grandizio, Leon Elmans, Naquira Escobar Luis Felipe, L. W. van der Plaat, M. Verhofstad, Marcos Sanmartin-Fernandez, Mario Di Micoli, Matej Kastelec, Maurizio Calcagni, Max Talbot, Maarten W. G. A. Bronkhorst, John A. McAuliffe, Michael Behrman, M. Quell, Michael Nakashian, Minoo Patel, Matthew Bengard, M. Jason Palmer, Michael Prayson, Matthias Knobe, Marinis Pirpiris, Minos Tyllianakis, Michael W. Grafe, Neal Chen, Nelson Elias, Ngozi M. Akabudike, Nathan A. Hoekzema, Nicholas L. Shortt, Nikolaos Kanakaris, Nikolas H. Kazmers, Nina Lightdale-Miric, Jim Calandruccio, Ole Brink, Martin Richardson, Jose A. Ortiz Jr, Pascal F. W. Hannemann, P. V. van Eerten, Prashanth Inna, Peter Althausen, Panagiotis Lygdas, Nata Parnes, Paul A. Martineau, Prosper Benhaim, Philip Forno, Pradeep Choudhari, Peter Hahn, Peter Fedele Townsend, Peter Giannoudis, Paul Guidera, Philipp Muhl, Philipp Streubel, Peter Jebson, Patrick W. Owens, Tamir Pritsch. Paul J. Scibetta Jr., Rob Nelissen, Robert Haverlag, R. H. van Leerdam, Ramon de Bedout, Sergio Rowinski, Reid W. Draeger,R. Fricker, Richard Wallensten, Richard S. Gilbert, Marco Rizzo, Richard Jenkinson, Robert E. Van Demark Jr, Craig Rodner, Rachel S. M. D. Rohde, Richard S. Page, David Ruch, Vani J. Sabesan, Stephen A. Kennedy. Niels W. L. Schep, Scott Mitchell, Sebastian Farr, Paul A. D. O. Sibley, Scott G. Kaar, S. A. Meylaerts, Steven L. Henry, Steven Meletiou, Steven J. Morgan, Marc Swiontkowski, T. Schepers, Thomas DeCoster, Taizoon Baxamusa, F. Thomas D. Kaplan, Thierry Begue, Thomas Mittlmeier, Thomas Rebele, T Apard, Tim Chesser, Tomo Havlif?ek, T. Rozental, Theodoros Tosounidis, H. Utkan Aydin, Vincenzo Giordano, Varun Kashyap Gajendran, Vasileios S. Nikolaou, Vincent Ruggiero, Warren C. Hammert, Yoram Weil, Wojciech Satora, Zsolt Balogh.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Cast
  • Decision-making
  • Fracture
  • Immobilization
  • Scaphoid

PubMed: MeSH publication types

  • Journal Article

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