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Stable Rates of Surgical Management for Distal Radius Fractures in Ontario: a 10-year Review
Kathleen Armstrong, MD, MSc1; Herb von Schroeder, MD, MSc1; Toni Zhong, MD, MHS1; Nancy Baxter, MD, PhD1; Anjie Huang, BComm2; Steve McCabe, MD, MSc1
1University of Toronto, Toronto, ON, Canada; 2Institute of Clinical & Evaluative Sciences, Toronto, ON, Canada

Objective: Open reduction and internal fixation (ORIF) management of distal radius fractures has become increasingly common. Amongst Medicare beneficiaries in the United States, the number of fractures treated with ORIF increased from 4% in 1997 to 17% in 2007. This was matched by a decrease in cast immobilization (from 83% to 74%). This shift is seen in other countries, such as Sweden and Finland, which have a single payer model similar to Canada. Systematic review comparing the four common methods of management found equivalent functional outcomes amongst patients age 60 and over. This has some authors questioning whether this shift is justified. The purpose of this study is to examine population trends in the treatment of distal radius fractures over a 10-year period in Ontario, Canada.
Methods: This is a population based, retrospective cohort study examining the treatment of distal radius fractures over a 10-year period (2004-2013). It utilizes the Canadian Institute for Health Information administrative discharge abstract database, National Ambulatory Care Reporting System and Ontario Health Insurance Plan billing data sources. Access is available at the Institute for Clinical Evaluative Sciences and datasets are linked using patient-specific encrypted identifiers. OHIP billing codes were used to categorize primary treatment modality as (1) cast immobilization, (2) cast immobilization with percutaneous pinning, (3) external fixation, (4) ORIF. We report on the yearly gross number of fractures, fracture treatment type, and frequency of fracture treatment type.
Results: Ontario has a population of 13.6 million, representing almost 40% of the entire Canadian population. On average, 22 290 distal radius fractures occur yearly amongst individuals 18 years and older. The rate of cast immobilization remained stable at 83.2% (range 82.1-84.1%) over the 10-year period. While the rate of ORIF increased from 7.1% in 2004 to 12.6% in 2013; this was matched by a decrease in the rates of cast immobilization with percutaneous pinning and external fixation. Rates of ORIF were influenced by patient age, sex and region.
Conclusions: This study shows that Ontario has experienced stable rates of non-operative and operative treatment over a 10-year period. The mix of operative treatment has shifted to favor ORIF. This once again points to the need for high-quality studies evaluating outcomes after operative and non-operative treatment of distal radius fractures. In the future, it would be interesting to evaluate what factor are driving the shift towards surgical management in some countries and not others.

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