Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture.
Introduction: Data 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...
| Publicado en: | Archives of Orthopaedic & Trauma Surgery Vol. 141; no. 11; pp. 2011 - 2019 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Springer Nature
Nov2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=152902303&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 152902303 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09368051 NNG jtl: Archives of Orthopaedic & Trauma Surgery issn: 09368051 maglogo: N pubinfo: dt: Nov2021 vid: 141 iid: 11 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 152902303 152902303 NLM34302522 152902303 10.1007/s00402-021-04062-0 NLM34302522 152902303 ppf: 2011 ppct: 8 formats: tig: atl: Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture. aug: au: Bulstra, Anne Eva J. Crijns, Tom J. Janssen, Stein J. Buijze, Geert A. Ring, David Jaarsma, Ruurd L. Kerkhoffs, Gino M. M. J. Obdeijn, Miryam C. Doornberg, Job N. The Science of Variation Group Peters, A. Spoor, A. B. Shrivastava, Abhay Chauhan, Aakash Shafritz, Adam Ilyas, Asif M. Vochteloo, Anne J. H. Powell, Andrew John Castillo, Alberto Pérez Godoy-Santos, Alexandre Leme affil: Department of Orthopedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Flinders Drive, Bedford Park, 5042, Adelaide, South Australia, Australia sug: subj: Carpal Bones Surgery Fractures Surgeons Carpal Bones Fractures Surgery Orthopedic Fixation Devices Tomography, X-Ray Computed Fracture Fixation Female Human Female ab: Introduction: Data 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 Methods: In 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.Results: Unclear 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.Conclusion: Adoption of shorter immobilization times for CT-confirmed nondisplaced scaphoid waist fractures may be hindered by surgeon attention to fracture tenderness and radiographic appearance. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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