Defining displacement thresholds for surgical intervention for distal radius fractures - A Delphi study

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Johnson, Nick
Leighton, Paul
Pailthorpe, Charles
Dias, Joseph
Adams, S
Aiyenuro, O
Amirfeyz, R
Atroshi, I
Bebbington, A
Bhowal, B
Bindra, R
Bostock, S
Brinsden, MD
Brown, DJ
Campbell, D
Chojnowski, A
Compson, J
Costa, ML
Desmukh, S
Downing, ND
Eardley, W
Eckersley, R
Forward, DP
Giddins, G
Grewal, R
Hobby, JL
Kakar, S
Kopylov, P
Lewis, C
Logan, AJ
McArthur, J
McEachan, JE
McQueen, MM
Milner, S
Miranda, S
Murphy, A
Ng, A
Osterman, AL
Patil, S
Punwar, S
Reed, MR
Riddick, A
Schuind, F
Talwalkar, SC
Tan, S
Tang, JB
White, C
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2019
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Abstract

Distal radius fractures are very common yet controversy exists regarding which require treatment and is reflected by significant variation in surgical intervention rate. Evidence regarding which fractures would benefit from intervention is varied and largely poor quality. This study had three aims; identify which radiographic parameters are clinically important; quantify the threshold of displacement at which intervention should occur and investigate which patient factors influence the decision to intervene. A modified three round Delphi study was carried out and responses were qualitatively analysed. The Delphi panel was composed of three groups of national and international expert surgeons: hand and wrist surgeons, trauma surgeons, and international researchers. 46 participants initially agreed to take part. 43 completed the first round and all then completed three rounds. Participants were asked questions based around case vignettes in patients of three ages (38, 58, 75 years). For all age groups ulnar variance was ranked as the most important extra-articular parameter, step was ranked as the most important intra-articular parameter. Agreed thresholds were the same for all parameters for patients aged 38 and 58. Surgeons would intervene with +2 mm ulnar variance, 10 degrees dorsal tilt, 2mm step and 3mm gap. In patients aged 75 the agreed thresholds were 20 degrees dorsal tilt, 3mm step and 4mm gap, consensus was not achieved for ulnar variance.

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PLOS ONE
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14
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1
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© 2019 Johnson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Orthopaedics
Surgery
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