Surgeon Preferences and Outcome Predictions for Displaced Distal Radius Fractures in Elderly Patients: A Survey of 151 Surgeons Making 4,832 Treatment Predictions Based on Patient Profiles and Radiographs.

Purpose: Vital elderly patients with substantially displaced intra-articular distal radius fractures often undergo surgical treatment, while those with notable comorbidities or less severe fractures are generally treated nonsurgically. As guidelines leave room for interpretation, surgeons must rely on intuition and experience when making treatment decisions. This study explores surgeons' treatment preferences, expectations regarding outcomes, and their ability to predict functional outcomes. Methods: An online survey was conducted among Dutch trauma and orthopedic surgeons. Participants evaluated 16 patient profiles derived from a randomized controlled trial comparing surgery with cast immobilization. Each profile included patient characteristics and radiographs. Surgeons, blinded to the actual treatments and outcomes, indicated their treatment preference and predicted the expected outcomes for both treatment options. Results: A total of 151 surgeons made 4,832 treatment outcome predictions. Participants generally preferred surgical treatment for certain patient profiles and expected more favorable outcomes after surgery than after cast immobilization. However, only 51.5% of outcome predictions corresponding to the actual treatment were correct. No significant differences in predictive accuracy were observed between hand and wrist specialists, other consultants(not specifically hand and wrist specialists), and residents. Conclusions: Orthopedic and trauma surgeons, regardless of subspecialty or experience, demonstrated limited ability to predict functional outcomes for elderly patients with displaced distal radius fractures based on written information and radiographs. With only 51.5% of predictions correct, accuracy did not meaningfully exceed chance. Surgeons generally favored surgical treatment and expected better outcomes than with casting. Type of study/level of evidence: Prognostic V.