Do Orthopedic Trauma Surgeons Adhere to AAOS Guidelines when Treating Distal Radius Fractures?

Background: The American Academy of Orthopedic Surgeons (AAOS) has provided Clinical Practice Guidelines (CPG) and Appropriate Use Criteria (AUC) regarding management of distal radius fractures. The purpose of this study was to evaluate current practices in management of distal radius fractures among orthopedic trauma surgeons and to examine adherence to the AAOS criteria. Methods: An online survey was posted and distributed via the Orthopaedic Trauma Association (OTA) website. Information collected included demographics, injury management, and case based questions. For all cases, surgeons were asked to select their treatment of choice given the same fracture in a 25-year-old patient and a 65-year-old patient. Results were compared between surgeons with < 10 years of practice experience and those with > 10 years of experience. Results: There was a total of 51 survey respondents. 45% had <10 years in practice, while 55% had > 10 years in practice. All respondents reported routine use of preoperative radiographs, while 26% reported routine use of preoperative computed tomography (CT) scans. 73% of respondents reported that they perform operative adjunct fixation of associated ligamentous injuries at the time of distal radius fracture fixation. No one used wrist arthroscopy or fixed associated ulnar styloid fractures. 69% did not allow any range of motion in the immediate postoperative period, while the remainder allowed active and/ or passive ROM. 20% routinely used Vitamin C for Complex Regional Pain Syndrome (CRPS) prophylaxis postoperatively. 59% routinely used physical and/ or occupational therapy postoperatively. For case-based scenarios, respondents generally tended towards operative fixation in younger patients compared to older patients with the same fracture type. Surgeons with < 10 years in practice and those with > 10 years in practice varied significantly in terms of preoperative imaging and operative fixation of associated ligamentous injuries at the time of fracture fixation. Conclusions: When compared to the AAOS CPG and AUC, orthopedic trauma surgeons generally followed accepted treatment guidelines. Differing practices between surgeons with <10 years in practice compared to those with >10 years in practice may be reflective of what is taught in residency training programs.