JHS - 2026-08-19 - Journal Article
Management Preferences of Geriatric Distal Radius Fractures: Insights From an American Society for Surgery of the Hand Surgeon Survey.
Zaidi Z, Dbeis A, Lee Y, Discordia A, Apel P, Vaughn N
Topics
Key Takeaway
88% of ASSH hand surgeons preferred operative treatment for displaced extra-articular distal radius fractures in a 72-year-old patient, directly contradicting AAOS strong recommendation for nonsurgical management in geriatric DRFs.
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Summary
This 2025 ASSH member survey presented 636 hand surgeons with a 72-year-old patient across six DRF fracture patterns to characterize treatment preferences and identify drivers of operative decision-making. Fracture pattern was the dominant driver of treatment choice (P<.001), with 88% preferring ORIF for displaced extra-articular fractures; practice setting (P=.045) and years in practice (P=.003) also influenced decisions for this pattern. Acute carpal tunnel syndrome, volar shear fractures, and type I open injuries were the top three patient/injury factors increasing operative likelihood, revealing systematic guideline-practice discordance.
Key Limitation
A 13% response rate from ASSH members severely limits generalizability and likely skews results toward surgeons with higher operative thresholds, inflating the apparent guideline-practice gap.
Original Abstract
PURPOSE
Distal radius fractures (DRFs) are common among the elderly. American Academy of Orthopaedic Surgeons Guidelines maintain a strong recommendation for nonsurgical treatment of these injuries, but acknowledge the importance of a patient-centered approach when making treatment decisions. This study aimed to characterize current practice trends and identify factors associated with treatment decisions for geriatric DRFs among members of the American Society for Surgery of the Hand. We hypothesized that fracture pattern and surgeon factors would be associated with surgeons' treatment decisions for geriatric DRFs.
METHODS
In 2025, a survey containing a clinical scenario of a 72-year-old patient sustaining a DRF with six different fracture patterns was distributed to American Society for Surgery of the Hand members. Surgeons' demographic data were collected, in addition to their preferred management (nonsurgical vs operative treatment) for each fracture. Respondents were also surveyed on injury/patient factors that would increase their likelihood to pursue operative treatment. Associations between variables were determined by chi-square or Fisher exact tests.
RESULTS
A total of 636 surveys were reviewed (response rate 13%), with 563 (89%) completed by orthopedic-trained hand surgeons. Surgeon's preferred treatment was associated with fracture pattern (P < .001). For a displaced extra-articular fracture, 88% of surgeons preferred operative treatment. Surgeons' practice setup (P = .045) and their years in practice (P = .003) influenced the management of displaced extra-articular fractures. Acute carpal tunnel syndrome, volar shear fracture patterns, and type I open injuries were the top three factors to influence a surgeon's likelihood to operate.
CONCLUSIONS
Our findings suggest a discordance between current clinical practice guidelines and surgeon preferences for treatment of geriatric DRFs.
CLINICAL RELEVANCE
Understanding current practice patterns can inform decision-making frameworks that align with evidence-based care while supporting individualized treatment strategies for geriatric DRFs.