Trends in Treatment Decisions for Distal Radius Fractures: The Effect of a Guideline Change.

Abstract

The 2022 American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand (AAOS/ASSH) guideline discourages routine operative fixation of distal radius fractures (DRF) in patients aged 65 years or older. This study examined the impact of this recommendation on operative management patterns in this population. A retrospective, quasi-experimental before-after study was conducted, including all DRF diagnoses among patients aged 65 years or older at a tertiary medical center during 2012 to 2024. Annual age-standardized and sex-standardized DRF incidence and surgery rates were estimated. Multivariable logistic regression evaluated postguideline versus preguideline odds of surgery and model-based projection compared expected with observed postguideline surgery rates. During the study period, 3,137 DRF cases were diagnosed with stable incidence. Surgery rates significantly increased among patients aged 65 to 69 years from 9% to 16% after guideline publication, whereas rates were unchanged in patients aged 70 years or older. Patients aged 65 to 69 years were nearly twice as likely to undergo operative management in the postguideline versus preguideline period. Model-based projection among patients aged 65 to 69 years predicted a postguideline surgery rate of 11%, whereas the observed rate of 16% represented a 44% relative increase. Despite a guideline discouraging operative management of DRF at ages ≥65 years, surgery rates did not decline, and increased in those aged 65 to 69 years, highlighting the limitations of an age-only treatment threshold. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.