JHS - 2026-04-02 - Journal Article
Resource Utilization in the Management of Distal Radial Fracture.
Razi A, Brinkman N, Odenijuis K, Ring D, Ramtin S, Science of Variation Group
Topics
Key Takeaway
Surgeon likelihood of recommending volar plate fixation decreased and cast/K-wire fixation increased when patients reported financial insecurity, independent of fracture pattern in 162 surveyed surgeons.
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Summary
162 surgeons evaluated 7 radiographic DRF scenarios with randomized patient factors including financial insecurity, insurance status, age, sex, and social support, then rated likelihood of recommending cast, K-wire, or VLP fixation. Financial insecurity ('sometimes worried about food') independently increased likelihood of recommending cast and K-wire fixation and decreased likelihood of recommending VLP. Limited insurance coverage was independently associated with increased cast immobilization recommendations.
Key Limitation
Survey-based vignettes cannot confirm that stated preferences translate to actual operative decisions, and the surgeon sample's practice setting and payer mix distribution are not reported, limiting generalizability.
Original Abstract
PURPOSE
In a survey- and scenario-based experiment, we addressed the factors associated with surgeon recommendations for specific distal radius fracture treatment options, including patient financial insecurity and insurance coverage.
METHODS
One hundred sixty-two surgeons were with presented seven sets of radiographs of dorsally displaced fractures, accompanied by a scenario with randomized elements regarding the patient and circumstances of the injury. Surgeons then rated the likelihood they would offer reduction and cast immobilization, percutaneous Kirschner wire fixation, and volar plate fixation. Patient factors were randomized in each scenario, including age, sex, specific distal radius fracture radiographs, financial status "I (never/sometimes) have enough money to buy food," family support "I (have/don't have) a close circle of friends or family," and insurance status. We constructed multilevel mixed-effects linear regression models to measure the sources of variation in the likelihood to recommend each of the three treatment options.
RESULTS
Offers of cast immobilization and percutaneous Kirschner wire fixation were more likely when patients were sometimes worried about having enough money, and for one specific fracture. Recommendations for cast immobilization were also associated with limited insurance and older age. The likelihood of offering volar plate fixation was higher when a patient had a close circle of friends and lower in the presence of financial concerns.
CONCLUSIONS
Surgeon recommendations vary according to patient financial insecurity and insurance coverage.
CLINICAL RELEVANCE
Patient financial concerns might become a more routine topic of inquiry, particularly in the United States, where out of pocket costs can be notable and are increasing.