Skip to main content
Journal cover image

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

Publication ,  Journal Article
Bulstra, AEJ; Crijns, TJ; Janssen, SJ; Buijze, GA; Ring, D; Jaarsma, RL; Kerkhoffs, GMMJ; Obdeijn, MC; Doornberg, JN; Science of Variation Group,
Published in: Arch Orthop Trauma Surg
November 2021

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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Arch Orthop Trauma Surg

DOI

EISSN

1434-3916

Publication Date

November 2021

Volume

141

Issue

11

Start / End Page

2011 / 2018

Location

Germany

Related Subject Headings

  • Tomography, X-Ray Computed
  • Surgeons
  • Scaphoid Bone
  • Orthopedics
  • Humans
  • Fractures, Bone
  • Fracture Fixation, Internal
  • Female
  • Casts, Surgical
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bulstra, A. E. J., Crijns, T. J., Janssen, S. J., Buijze, G. A., Ring, D., Jaarsma, R. L., … Science of Variation Group, . (2021). Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture. Arch Orthop Trauma Surg, 141(11), 2011–2018. https://doi.org/10.1007/s00402-021-04062-0
Bulstra, Anne Eva J., 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, and Job N. Science of Variation Group. “Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture.Arch Orthop Trauma Surg 141, no. 11 (November 2021): 2011–18. https://doi.org/10.1007/s00402-021-04062-0.
Bulstra AEJ, Crijns TJ, Janssen SJ, Buijze GA, Ring D, Jaarsma RL, et al. Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture. Arch Orthop Trauma Surg. 2021 Nov;141(11):2011–8.
Bulstra, Anne Eva J., et al. “Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture.Arch Orthop Trauma Surg, vol. 141, no. 11, Nov. 2021, pp. 2011–18. Pubmed, doi:10.1007/s00402-021-04062-0.
Bulstra AEJ, Crijns TJ, Janssen SJ, Buijze GA, Ring D, Jaarsma RL, Kerkhoffs GMMJ, Obdeijn MC, Doornberg JN, Science of Variation Group. Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture. Arch Orthop Trauma Surg. 2021 Nov;141(11):2011–2018.
Journal cover image

Published In

Arch Orthop Trauma Surg

DOI

EISSN

1434-3916

Publication Date

November 2021

Volume

141

Issue

11

Start / End Page

2011 / 2018

Location

Germany

Related Subject Headings

  • Tomography, X-Ray Computed
  • Surgeons
  • Scaphoid Bone
  • Orthopedics
  • Humans
  • Fractures, Bone
  • Fracture Fixation, Internal
  • Female
  • Casts, Surgical
  • 3202 Clinical sciences