Foster Brian K, Boualam Benchaa, Shea R Parker, Udoeyo Idorenyin F, Luciani A Michael, Klena Joel C, Grandizio Louis C
Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
J Hand Surg Glob Online. 2023 May 9;5(5):638-642. doi: 10.1016/j.jhsg.2023.04.006. eCollection 2023 Sep.
To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP).
We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020. Baseline demographics, injury, treatment characteristics, and the fellowship training of the 44 included surgeons were recorded. We compared cases with and without a preoperative CT, and an adjusted logistic regression model was generated to determine the odds of having a preoperative CT.
A total of 1,204 operatively treated DRFs performed by 44 surgeons were included. CT utilization increased during the study period. Intra-articular fractures accounted for 76% of cases, and preoperative CT scans were ordered in 243 of 1240 cases (20%). Overall, isolated VLP was used in 83% of cases. Cases with a preoperative CT were more likely to be treated with an alternative method of fixation (such as dorsal plating). The adjusted logistic regression model demonstrated that male sex (OR 1.62; 95% CI: 1.16, 2.26), intra-articular fractures (OR 3.11; 95% CI: 1.87, 5.81), and associated fractures (OR 2.69; 95% CI: 1.82, 3.98) had a significantly increased odds of having a preoperative CT. Fellowship training was not associated with increased CT utilization overall, but hand surgeons were more likely to use a CT in Orthopaedic Trauma Association-C3 fractures.
Patient and injury characteristics are associated with CT utilization in operative DRFs. Preoperative CTs are associated with alternative fixation approaches, as cases with a CT were more likely to use fixation methods other than isolated VLP. The costs and benefits of CT scans must be carefully weighed against whether this modality adds value or improves outcomes in treating DRFs.
Prognostic II.
确定与手术治疗桡骨远端骨折（DRF）术前计算机断层扫描（CT）使用相关的患者、外科医生和损伤特征。此外，我们旨在确定术前CT是否与单纯掌侧锁定钢板固定（VLP）以外的治疗方法相关。
我们回顾性分析了2016年至2020年在我们医疗系统中接受手术治疗的所有成年DRF患者。记录了44名纳入外科医生的基线人口统计学、损伤情况、治疗特征以及专科培训情况。我们比较了有和没有术前CT的病例，并建立了调整后的逻辑回归模型以确定进行术前CT检查的几率。
共纳入44名外科医生进行的1204例手术治疗的DRF病例。在研究期间，CT的使用有所增加。关节内骨折占病例的76%，1240例中有243例（20%）进行了术前CT扫描。总体而言，83%的病例采用了单纯VLP固定。术前进行CT检查的病例更有可能采用其他固定方法（如背侧钢板固定）。调整后的逻辑回归模型显示，男性（比值比[OR]1.62；95%置信区间[CI]：1.16，2.26）、关节内骨折（OR 3.11；95% CI：1.87，5.81）和合并骨折（OR 2.69；95% CI：1.82，3.98）进行术前CT检查的几率显著增加。总体而言，专科培训与CT使用增加无关，但手外科医生在治疗骨科创伤协会（OTA）-C3型骨折时更有可能使用CT。
患者和损伤特征与手术治疗DRF时CT的使用相关。术前CT与其他固定方法相关，因为进行CT检查的病例更有可能使用除单纯VLP以外的固定方法。必须仔细权衡CT扫描的成本和益处，以确定这种检查方式在治疗DRF时是否增加了价值或改善了治疗结果。
预后性II级。
