Rates of Corrective Osteotomy After Distal Radius Fractures Treated Nonsurgically and Surgically

Abstract

Purpose: Distal radius fractures commonly occur and can be a major cause of morbidity in the aging population; yet the rates of osteotomy for malunited fractures have not been described for nonsurgical and surgical treatment. We hypothesized that the rate of corrective osteotomy would be lower in fractures treated surgically compared with nonsurgically. Methods: Using the PearlDiver patient record program, we used Current Procedural Terminology coding to identify 48,815 patients within the Humana database from 2007 to 2015 who sustained a distal radius fracture. Rates of osteotomy after both nonsurgical treatment and open reduction internal fixation (ORIF) of distal radius fractures were evaluated and stratified by age and gender. We analyzed the cost of treatment for each group. Osteotomy rates were compared between groups using chi-square test of significance. Results: The rates of osteotomy with nonsurgical treatment compared with ORIF were significantly different (0.5% vs 0.3%). The rate of osteotomy for patients aged more than 50 years was significantly higher than that for patients aged less than 50 years regardless of treatment (0.3% vs 0.1%). In men, the rate of osteotomy for nonsurgical treatment compared with ORIF was not significantly different. However, in women, the rate of osteotomy for nonsurgical treatment compared with ORIF was significantly different (0.59% vs 0.30%). The average cost per patient (regardless of outcome) for nonsurgical treatment was $477 and the average cost for ORIF was $1,309. If an osteotomy was required after nonsurgical treatment, the average overall cost was $4,152. If an osteotomy was required after ORIF, the average overall cost was $5,965. Conclusions: Osteotomy after distal radius fracture infrequently occurs but is seen more frequently in fractures treated nonsurgically. Female patients are more likely to undergo an osteotomy after nonsurgical treatment of a distal radius fracture than are males. This information can be used to counsel patients when making shared decisions regarding treatment. Type of study/level of evidence: Therapeutic III. Key words: distal radius fracture, malunion, osteotomy