Evidence map›Paper›PMID 34302522›Full record

ArticleArchives of orthopaedic and trauma surgery2021

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

Anne Eva J Bulstra, Tom J Crijns, Stein J Janssen, Geert A Buijze, David Ring, Ruurd L Jaarsma, Gino M M J Kerkhoffs, Miryam C Obdeijn, Job N Doornberg, Science of Variation Group

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In one paragraph

Article in Archives of orthopaedic and trauma surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
1.0field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 5 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 4 countries.

Anne Eva J BulstraDepartment of Orthopedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia. a.e.bulstra@amsterdamumc.nl.ORCID http://orcid.org/0000-0002-4446-1824
Tom J CrijnsDepartment of Surgery and Perioperative Care, Dell Medical School, Health Discovery Building, The University of Texas at Austin, 6706, 1701 Trinity Street, Austin, TX78712, USA.
Stein J JanssenAmsterdam UMC, Location AMC, Department of Orthopedic Surgery, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Geert A BuijzeClinique Générale Annecy, Hand and Upper Limb Surgery, 4, Chemin de La Tour La Reine, 74000, Annecy, France.
David RingDepartment of Surgery and Perioperative Care, Dell Medical School, Health Discovery Building, The University of Texas at Austin, 6706, 1701 Trinity Street, Austin, TX78712, USA.
Ruurd L JaarsmaDepartment of Orthopedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia.
Gino M M J KerkhoffsAmsterdam UMC, Location AMC, Department of Orthopedic Surgery, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Miryam C ObdeijnDepartment of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Job N DoornbergDepartment of Orthopedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia.
Science of Variation Group
Flinders University · AUAmsterdam University Medical Centers · NLLaboratoire d'Annecy de Physique Théorique · FRThe University of Texas at Austin · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionData 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

methodsIn 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.

resultsUnclear 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.

conclusionAdoption of shorter immobilization times for CT-confirmed nondisplaced scaphoid waist fractures may be hindered by surgeon attention to fracture tenderness and radiographic appearance.

Indexed as

Fractures, BoneScaphoid BoneSurgeonsCasts, SurgicalFemaleFracture Fixation, InternalHumansTomography, X-Ray ComputedCastDecision-makingFractureImmobilizationScaphoid

Identifiers

PMID34302522
PMCPMC8497306
OpenAlexW3184483158

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.