From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School.
Plast Reconstr Surg. 2018 Jul;142(1):34e-41e. doi: 10.1097/PRS.0000000000004454.
Distal radius fracture treatments provide similar functional outcomes. It has been hypothesized that the use of internal fixation is increasing because of physician preferences. The multisite randomized Wrist and Radius Injury Surgical Trial provides a unique opportunity to examine patient preferences in the absence of surgeon influence. The authors' objective was to investigate patient preference for internal fixation even after being informed of the equipoise among treatments.
The authors performed 30 semistructured interviews with older individuals, all older than 60 years, approached at their institution for the Wrist and Radius Injury Surgical Trial. The authors' sample included three groups: those with a preference for internal fixation (n = 11), those with preference for nonsurgical treatment (n = 6), and those without a preference who consented to surgical randomization (n = 13). We used grounded theory for data collection and analysis.
All participants indicated their chief concern was regaining full function. Patients based their preferences for internal fixation on multiple values, including obstacles to recovery, autonomy, aesthetics, and pain relief. Some patients who did not select internal fixation reflected on their experiences, questioning whether they would have had a potentially different outcome with internal fixation treatment.
Without evidence for a superior treatment, patients focus on factors that pertain to recovery rather than outcomes, with most preferring the volar locking plating system. To best align with patient values, physicians should focus their discussion with patients on aspects of the recovery period rather than functional outcomes. Evidence from the Wrist and Radius Injury Surgical Trial will provide high-level information about patient-reported, functional, and radiographic outcomes.
桡骨远端骨折的治疗方法提供了相似的功能结果。人们推测，由于医生的偏好，内固定的使用正在增加。多地点随机腕关节和桡骨损伤手术试验为研究患者在没有外科医生影响的情况下的偏好提供了独特的机会。作者的目的是调查患者对内固定的偏好，即使在治疗方法之间存在平衡的情况下。
作者对 30 名年龄均在 60 岁以上的个体进行了半结构化访谈，这些个体都是在其机构接受腕关节和桡骨损伤手术试验时被招募的。作者的样本包括三组：对内固定有偏好的患者（n=11）、对内固定有偏好的非手术治疗的患者（n=6）、无偏好但同意手术随机分组的患者（n=13）。我们使用扎根理论进行数据收集和分析。
所有参与者都表示他们最关心的是恢复全部功能。患者对内固定的偏好基于多个因素，包括恢复的障碍、自主性、美观和缓解疼痛。一些没有选择内固定的患者反思了他们的经历，质疑如果接受内固定治疗，他们是否会有不同的结果。
在没有证据表明治疗效果更好的情况下，患者关注与恢复相关的因素，而不是结果，大多数患者更喜欢掌侧锁定钢板系统。为了最好地与患者的价值观保持一致，医生应该将他们与患者的讨论重点放在恢复期间的各个方面，而不是功能结果上。腕关节和桡骨损伤手术试验的证据将提供关于患者报告的、功能的和影像学结果的高级别信息。
