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

2021; Springer Science+Business Media; Volume: 141; Issue: 11 Linguagem: Inglês

10.1007/s00402-021-04062-0

1434-3916

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, Anja Peters, Andy B. Spoor, Abhay Shrivastava, Aakash Chauhan, Adam B. Shafritz, Asif M. Ilyas, Anne J. H. Vochteloo, Andrew Powell, Alberto Pérez Castillo, Alexandre Leme Godoy‐Santos, Amparo Gómez Gélvez, Andrea S. Bauer, Antonio Barquet, Anže Kristan, Ante Prkić, A. Jubel, B. Mirck, B.E. Kreis, H. Brent Bamberger, William Dias Belangero, Bernard F. Hearon, Bradley A. Palmer, Brad T. Hyatt, Brian P.D. Wills, Henry M. Broekhuyse, Richard Buckley, Burak Altıntaş, Sean T. Campbell, Carl Ekholm, Carlos Henrique Fernandes, Carlos Henrique Fernandes, Carl B. Weiss, Christos Garnavos, Charles Metzger, Christopher Wilson, Chris Bainbridge, Christian Deml, Jesús Moreta, Conor P. Kleweno, Constanza L. Moreno-Serrano, Craig B. Ordway, Cyrus Klostermann, David Zeltser, David G. Dennison, Diederik O. Verbeek, Dan Polatsch, Camilo Jose Romero Barreto, Koroush Kabir, Mohamed Shafi, Juan Martín Patiño, Roger van Riet, Samir Sodha, Scott F. M. Duncan, Daniel C. Wascher, Edward Ibrahim, Efstathios G. Ballas, Edward J. Harvey, Edward K. Rodriguez, Emilia Stojkovska Pemovska, Erik T. Walbeehm, Peter J. Evans, Ezequiel Ernesto Zaidenberg, Fred O’Brien, F. J. Seibert, Frank W. Bloemers, Gladys Cecilia Zambrano, Gregory L. DeSilva, George C. Babis, George Pianka, Michael Githens, Giselly Miranda Veríssimo, Grant E. Garrigues, Guido Fierro, Holger Durchholz, Jeremy A. Hall, Hal McCutchan, Michael Nancollas, Colby Young, Greg P. Watchmaker, Gary M. Pess, Lewis Lane, Harold Alonso Villamizar, Ippokratis Pountos, Hervey L. Kimball, Eric P. Hofmeister, Iain McGraw, Konul Erol, J.F. Di Giovanni, Jacob W. Brubacher, J. Biert, Jason C. Fanuele, Jason D. Tavakolian, Jack Choueka, Jose Eduardo Grandi Ribeiro, José Eduardo Grandi Ribeiro Filho, Joseph Conflitti, J.M. Rodríguez Roiz, John Munyak, James F. Nappi, Job N. Doornberg, John Erickson, Jorge G. Boretto, Joel M. Post, Jorge Rubio, John A. Scolaro, John S. Taras, Julio Doménech, Julio Sandoval, Jeffrey Wint, Katherine C. Faust, Ken Butters, Kyle J. Jeray, Karl-Josef Prommersberger, Kağan Özer, Gerald Kraan, Kyle J. Chepla, L.M.S.J. Poelhekke, Ladislav Mica, Lawrence E. Weiss, Lars Adolfsson, Lars C. Borris, Louis C. Grandizio, L. Elmans, Luis Felipe Náquira Escobar, Laurens W. van der Plaat, M.H.J. Verhofstad, M. Sanmartín-Fernández, Mario Di Micoli, Matej Kastelec, Maurizio Calcagni, Max Talbot, M.W.G.A. Bronkhorst, John A. McAuliffe, Michael J. Behrman, M. Quell, Michael N. Nakashian, Minoo Patel, Matthew Bengard, M. Jason Palmer, Michael J. Prayson, Matthias Knobe, Marinis Pirpiris, Minos Tyllianakis, Michael Grafe, Neal C. Chen, Nelson Elias, Ngozi M. Akabudike, Nathan Hoekzema, Nicholas L. Shortt, Nikolaos K. Kanakaris, Nikolas H. Kazmers, Nina Lightdale-Miric, Jim Calandruccio, Ole Brink, Martin Richardson, José Alfredo Soto Ortíz, Pascal F. W. Hannemann, Percy van Eerten, Prashanth Inna, Peter L. Althausen, P. Lygdas, Nata Parnes, Paul A. Martineau, Prosper Benhaim, Philip Forno, Pradeep Choudhari, Peter Hahn, Peter Townsend, Peter V. Giannoudis, Paul M. Guidera, Philipp Muhl, Philipp N. Streubel, Peter Jebson, Patrick Owens, Tamir Pritsch, Paul J. Scibetta, Rob G. H. H. Nelissen, Robert Haverlag, Roderick H. van Leerdam, Ramon de Bedout, Sergio Rowinski, Reid W. Draeger, Renato Fricker, Richard Wallensten, Richard S. Gilbert, Marco Rizzo, Richard Jenkinson, Robert E. Van Demark, Craig M. Rodner, Rachel S. Rohde, Richard S. Page, David S. Ruch, Vani J. Sabesan, Stephen A. Kennedy, Niels W. L. Schep, Scott Mitchell, Sebastian Farr, Paul A. Sibley, Scott G. Kaar, S.A.G. Meylaerts, Steven L. Henry, Steven Meletiou, Steven J. Morgan, M.F. Swiontkowski, Tim Schepers, Thomas A. DeCoster, Taizoon Baxamusa, F. Thomas D. Kaplan, Thierry Bégué, Thomas Mittlmeier, Thomas Rebele, Thomas Apard, Tim Chesser, Tomo Havlifçek, Tamara D. Rozental, Theodoros H. Tosounidis, Hasan Utkan Aydın, Vincenzo Giordano, Varun K. Gajendran, Vasileios S. Nikolaou, Vincent Ruggiero, Warren C. Hammert, Yoram A. Weil, Wojciech Satora, Zsolt J. Balogh,

Medical Malpractice and Liability Issues

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