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

Anne Eva J. Bulstra; 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; The Science of Variation Group; Christopher J. Wilson; Job N. Doornberg

doi:10.1007/s00402-021-04062-0

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

Anne Eva J. Bulstra, 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, The Science of Variation Group, Christopher J. Wilson, Job N. Doornberg

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

40 Downloads (Pure)

Abstract

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.

Original language	English
Pages (from-to)	2011-2018
Number of pages	8
Journal	Archives of Orthopaedic and Trauma Surgery
Volume	141
Issue number	11
DOIs	https://doi.org/10.1007/s00402-021-04062-0
Publication status	Published - Nov 2021

Bibliographical note

Funding Information:
Group authorship: The Science of Variation Group A. Peters, A. B. Spoor, Abhay Shrivastava, Aakash Chauhan, Adam Shafritz, Asif M. Ilyas, Anne J. H. Vochteloo, Andrew John Powell, Alberto P?rez Castillo, Alexandre Leme Godoy-Santos, Amparo Gomez Gelvez, Andrea Bauer, Antonio Barquet, Anze Kristan, Ante Prkic, Axel Jubel, Boj Mirck, B. E. Kreis, H. Brent Bamberger, William Dias Belangero, Bernard F. Hearon, Bradley Palmer, Brad Hyatt, Brian P. D. Wills, Henry Broekhuyse, Richard Buckley, Burak Altintas, Sean T. Campbell, Carl Ekholm, Carlos Henrique Fernandes, C. H. Fernandes, Carl Weiss, Christos Garnavos, Charles Metzger, Christopher J. Wilson, Chris Bainbridge, Christian Deml, Jesus Moreta, Conor Kleweno, Constanza L. Moreno-Serrano, Craig B. Ordway, Cyrus Klostermann, David Zeltser, David G. Dennison, Diederik O. Verbeek, Dan Polatsch, Camilo Jose Romero Barreto, Koroush Kabir, Mohamed Shafi, Juan M. Pati?o, Roger van Riet, Samir Sodha, Scott Duncan, Daniel C. Wascher, Edward F. Ibrahim, Efstathios G. Ballas, Edward Harvey, Edward K. Rodriguez, Emilia Stojkovska Pemovska, E. Walbeehm, Peter J. Evans, Ezequiel E. Zaidenberg, Fred O?Brien, Franz Josef Seibert, Frank W. Bloemers, Gladys Cecilia Zambrano Caro, Gregory DeSilva, George Babis, George Pianka, Michael Githens, Giselly Miranda Ver?ssimo, Grant E. Garrigues, Guido Fierro, Holger Durchholz, Jeremy Hall, Hal McCutchan, Michael Nancollas, Colby Young, Greg P. Watchmaker, Gary M. Pess, Lewis B. Lane, Harold Alonso Villamizar, Ippokratis Pountos, Hervey L. Kimball, Eric P. Hofmeister, Iain McGraw, Konul Erol, J.F. Di Giovanni, Jacob W. Brubacher, Jan Biert, Jason C. Fanuele, Jason D. Tavakolian, Jack Choueka, Jose Eduardo Grandi Ribeiro, Jose Eduardo Grandi Ribeiro Filho, Joseph M. Conflitti, J. M. R Roiz, John Munyak, James F. Nappi, Job N. Doornberg, John M. Erickson, Jorge G. Boretto, Joel M. Post, Jorge Rubio, John A. Scolaro, John Taras, Julio Domenech, Julio Sandoval, Jeffrey Wint, Katherine Celeste Faust, Ken Butters, Kyle Jeray, Karl-Josef Prommersberger, Kagan Ozer, G. A. Kraan, Kyle J. Chepla, L. M. S. J. Poelhekke, Ladislav Mica, Lawrence Weiss, Lars Adolfsson, Lars C. Borris, Louis Christopher Grandizio, Leon Elmans, Naquira Escobar Luis Felipe, L. W. van der Plaat, M. Verhofstad, Marcos Sanmartin-Fernandez, Mario Di Micoli, Matej Kastelec, Maurizio Calcagni, Max Talbot, Maarten W. G. A. Bronkhorst, John A. McAuliffe, Michael Behrman, M. Quell, Michael Nakashian, Minoo Patel, Matthew Bengard, M. Jason Palmer, Michael Prayson, Matthias Knobe, Marinis Pirpiris, Minos Tyllianakis, Michael W. Grafe, Neal Chen, Nelson Elias, Ngozi M. Akabudike, Nathan A. Hoekzema, Nicholas L. Shortt, Nikolaos Kanakaris, Nikolas H. Kazmers, Nina Lightdale-Miric, Jim Calandruccio, Ole Brink, Martin Richardson, Jose A. Ortiz Jr, Pascal F. W. Hannemann, P. V. van Eerten, Prashanth Inna, Peter Althausen, Panagiotis Lygdas, Nata Parnes, Paul A. Martineau, Prosper Benhaim, Philip Forno, Pradeep Choudhari, Peter Hahn, Peter Fedele Townsend, Peter Giannoudis, Paul Guidera, Philipp Muhl, Philipp Streubel, Peter Jebson, Patrick W. Owens, Tamir Pritsch. Paul J. Scibetta Jr., Rob Nelissen, Robert Haverlag, R. H. van Leerdam, Ramon de Bedout, Sergio Rowinski, Reid W. Draeger,R. Fricker, Richard Wallensten, Richard S. Gilbert, Marco Rizzo, Richard Jenkinson, Robert E. Van Demark Jr, Craig Rodner, Rachel S. M. D. Rohde, Richard S. Page, David Ruch, Vani J. Sabesan, Stephen A. Kennedy. Niels W. L. Schep, Scott Mitchell, Sebastian Farr, Paul A. D. O. Sibley, Scott G. Kaar, S. A. Meylaerts, Steven L. Henry, Steven Meletiou, Steven J. Morgan, Marc Swiontkowski, T. Schepers, Thomas DeCoster, Taizoon Baxamusa, F. Thomas D. Kaplan, Thierry Begue, Thomas Mittlmeier, Thomas Rebele, T Apard, Tim Chesser, Tomo Havlif?ek, T. Rozental, Theodoros Tosounidis, H. Utkan Aydin, Vincenzo Giordano, Varun Kashyap Gajendran, Vasileios S. Nikolaou, Vincent Ruggiero, Warren C. Hammert, Yoram Weil, Wojciech Satora, Zsolt Balogh.

Publisher Copyright:
© 2021, The Author(s).

Keywords

Cast
Decision-making
Fracture
Immobilization
Scaphoid

Access to Document

10.1007/s00402-021-04062-0Licence: CC BY

Published versionFinal published version, 687 KBLicence: CC BY

Cite this

Bulstra, A. E. J., Crijns, T. J., Janssen, S. J., Buijze, G. A., Ring, D., Jaarsma, R. L., Kerkhoffs, G. M. M. J., Obdeijn, M. C., Doornberg, J. N., The Science of Variation Group, Wilson, C. J., & Doornberg, J. N. (2021). Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture. Archives of Orthopaedic and Trauma Surgery, 141(11), 2011-2018. https://doi.org/10.1007/s00402-021-04062-0

@article{1119fad171ed42b8915d286c21c6094b,

title = "Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture",

abstract = "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{\textquoteright} 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 {\textquoteleft}other{\textquoteright}) (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.",

keywords = "Cast, Decision-making, Fracture, Immobilization, Scaphoid",

author = "Bulstra, {Anne Eva J.} and Crijns, {Tom J.} and Janssen, {Stein J.} and Buijze, {Geert A.} and David Ring and Jaarsma, {Ruurd L.} and Kerkhoffs, {Gino M.M.J.} and Obdeijn, {Miryam C.} and Doornberg, {Job N.} and {The Science of Variation Group} and A. Peters and Spoor, {A. B.} and Abhay Shrivastava and Aakash Chauhan and Adam Shafritz and Ilyas, {Asif M.} and Vochteloo, {Anne J.H.} and Powell, {Andrew John} and Castillo, {Alberto P{\'e}rez} and Godoy-Santos, {Alexandre Leme} and Gelvez, {Amparo Gomez} and Andrea Bauer and Antonio Barquet and Anze Kristan and Ante Prkic and Axel Jubel and Boj Mirck and Kreis, {B. E.} and Bamberger, {H. Brent} and Belangero, {William Dias} and Hearon, {Bernard F.} and Bradley Palmer and Brad Hyatt and Wills, {Brian P.D.} and Henry Broekhuyse and Richard Buckley and Burak Altintas and Campbell, {Sean T.} and Carl Ekholm and Fernandes, {Carlos Henrique} and Fernandes, {C. H.} and Carl Weiss and Christos Garnavos and Charles Metzger and Wilson, {Christopher J.} and Chris Bainbridge and Christian Deml and Jesus Moreta and Conor Kleweno and Moreno-Serrano, {Constanza L.} and Ordway, {Craig B.} and Cyrus Klostermann and David Zeltser and Dennison, {David G.} and Verbeek, {Diederik O.} and Dan Polatsch and Barreto, {Camilo Jose Romero} and Koroush Kabir and Mohamed Shafi and Pati{\~n}o, {Juan M.} and {van Riet}, Roger and Samir Sodha and Scott Duncan and Wascher, {Daniel C.} and Ibrahim, {Edward F.} and Ballas, {Efstathios G.} and Edward Harvey and Rodriguez, {Edward K.} and Pemovska, {Emilia Stojkovska} and E. Walbeehm and Evans, {Peter J.} and Zaidenberg, {Ezequiel E.} and Fred O{\textquoteright}Brien and Seibert, {Franz Josef} and Bloemers, {Frank W.} and Caro, {Gladys Cecilia Zambrano} and Gregory DeSilva and George Babis and George Pianka and Michael Githens and Ver{\'i}ssimo, {Giselly Miranda} and Garrigues, {Grant E.} and Guido Fierro and Holger Durchholz and Jeremy Hall and Hal McCutchan and Michael Nancollas and Colby Young and Watchmaker, {Greg P.} and Pess, {Gary M.} and Lane, {Lewis B.} and Villamizar, {Harold Alonso} and Ippokratis Pountos and Kimball, {Hervey L.} and Hofmeister, {Eric P.} and Iain McGraw and Konul Erol and {Di Giovanni}, {J. F.} and Brubacher, {Jacob W.} and Jan Biert and Fanuele, {Jason C.} and Tavakolian, {Jason D.} and Jack Choueka and Ribeiro, {Jose Eduardo Grandi} and Filho, {Jose Eduardo Grandi Ribeiro} and Conflitti, {Joseph M.} and Roiz, {J. M.R.} and John Munyak and Nappi, {James F.} and Doornberg, {Job N.} and Erickson, {John M.} and Boretto, {Jorge G.} and Post, {Joel M.} and Jorge Rubio and Scolaro, {John A.} and John Taras and Julio Domenech and Julio Sandoval and Jeffrey Wint and Faust, {Katherine Celeste} and Ken Butters and Kyle Jeray and Prommersberger, {Karl Josef} and Kagan Ozer and Kraan, {G. A.} and Chepla, {Kyle J.} and Poelhekke, {L. M.S.J.} and Ladislav Mica and Lawrence Weiss and Lars Adolfsson and Borris, {Lars C.} and Grandizio, {Louis Christopher} and Leon Elmans and {N{\'a}quira Escobar}, {Luis Felipe} and {van der Plaat}, {L. W.} and M. Verhofstad and Marcos Sanmartin-Fernandez and {Di Micoli}, Mario and Matej Kastelec and Maurizio Calcagni and Max Talbot and Bronkhorst, {Maarten W.G.A.} and McAuliffe, {John A.} and Michael Behrman and M. Quell and Michael Nakashian and Minoo Patel and Matthew Bengard and Palmer, {M. Jason} and Michael Prayson and Matthias Knobe and Marinis Pirpiris and Minos Tyllianakis and Grafe, {Michael W.} and Neal Chen and Nelson Elias and Akabudike, {Ngozi M.} and Hoekzema, {Nathan A.} and Shortt, {Nicholas L.} and Nikolaos Kanakaris and Kazmers, {Nikolas H.} and Nina Lightdale-Miric and Jim Calandruccio and Ole Brink and Martin Richardson and {Ortiz Jr}, {Jose A.} and Hannemann, {Pascal F.W.} and {van Eerten}, {P. V.} and Prashanth Inna and Peter Althausen and Panagiotis Lygdas and Nata Parnes and Martineau, {Paul A.} and Prosper Benhaim and Philip Forno and Pradeep Choudhari and Peter Hahn and Townsend, {Peter Fedele} and Peter Giannoudis and Paul Guidera and Philipp Muhl and Philipp Streubel and Peter Jebson and Owens, {Patrick W.} and Tamir Pritsch and {Scibetta Jr}, {Paul J.} and Rob Nelissen and Robert Haverlag and {van Leerdam}, {R. H.} and {de Bedout}, Ramon and Sergio Rowinski and Draeger, {Reid W.} and R. Fricker and Richard Wallensten and Gilbert, {Richard S.} and Marco Rizzo and Richard Jenkinson and {Van Demark Jr}, {Robert E.} and Craig Rodner and Rohde, {Rachel S.M.D.} and Page, {Richard S.} and David Ruch and Sabesan, {Vani J.} and Kennedy, {Stephen A.} and Schep, {Niels W.L.} and Scott Mitchell and Sebastian Farr and Sibley, {Paul A.D.O.} and Kaar, {Scott G.} and Meylaerts, {S. A.} and Henry, {Steven L.} and Steven Meletiou and Morgan, {Steven J.} and Marc Swiontkowski and T. Schepers and Thomas DeCoster and Taizoon Baxamusa and Kaplan, {F. Thomas D.} and Thierry Begue and Thomas Mittlmeier and Thomas Rebele and T. Apard and Tim Chesser and Tomo Havlif{\c c}ek and T. Rozental and Theodoros Tosounidis and {Utkan Aydin}, H. and Vincenzo Giordano and Gajendran, {Varun Kashyap} and Nikolaou, {Vasileios S.} and Vincent Ruggiero and Hammert, {Warren C.} and Yoram Weil and Wojciech Satora and Zsolt Balogh",

note = "Funding Information: Group authorship: The Science of Variation Group A. Peters, A. B. Spoor, Abhay Shrivastava, Aakash Chauhan, Adam Shafritz, Asif M. Ilyas, Anne J. H. Vochteloo, Andrew John Powell, Alberto P?rez Castillo, Alexandre Leme Godoy-Santos, Amparo Gomez Gelvez, Andrea Bauer, Antonio Barquet, Anze Kristan, Ante Prkic, Axel Jubel, Boj Mirck, B. E. Kreis, H. Brent Bamberger, William Dias Belangero, Bernard F. Hearon, Bradley Palmer, Brad Hyatt, Brian P. D. Wills, Henry Broekhuyse, Richard Buckley, Burak Altintas, Sean T. Campbell, Carl Ekholm, Carlos Henrique Fernandes, C. H. Fernandes, Carl Weiss, Christos Garnavos, Charles Metzger, Christopher J. Wilson, Chris Bainbridge, Christian Deml, Jesus Moreta, Conor Kleweno, Constanza L. Moreno-Serrano, Craig B. Ordway, Cyrus Klostermann, David Zeltser, David G. Dennison, Diederik O. Verbeek, Dan Polatsch, Camilo Jose Romero Barreto, Koroush Kabir, Mohamed Shafi, Juan M. Pati?o, Roger van Riet, Samir Sodha, Scott Duncan, Daniel C. Wascher, Edward F. Ibrahim, Efstathios G. Ballas, Edward Harvey, Edward K. Rodriguez, Emilia Stojkovska Pemovska, E. Walbeehm, Peter J. Evans, Ezequiel E. Zaidenberg, Fred O?Brien, Franz Josef Seibert, Frank W. Bloemers, Gladys Cecilia Zambrano Caro, Gregory DeSilva, George Babis, George Pianka, Michael Githens, Giselly Miranda Ver?ssimo, Grant E. Garrigues, Guido Fierro, Holger Durchholz, Jeremy Hall, Hal McCutchan, Michael Nancollas, Colby Young, Greg P. Watchmaker, Gary M. Pess, Lewis B. Lane, Harold Alonso Villamizar, Ippokratis Pountos, Hervey L. Kimball, Eric P. Hofmeister, Iain McGraw, Konul Erol, J.F. Di Giovanni, Jacob W. Brubacher, Jan Biert, Jason C. Fanuele, Jason D. Tavakolian, Jack Choueka, Jose Eduardo Grandi Ribeiro, Jose Eduardo Grandi Ribeiro Filho, Joseph M. Conflitti, J. M. R Roiz, John Munyak, James F. Nappi, Job N. Doornberg, John M. Erickson, Jorge G. Boretto, Joel M. Post, Jorge Rubio, John A. Scolaro, John Taras, Julio Domenech, Julio Sandoval, Jeffrey Wint, Katherine Celeste Faust, Ken Butters, Kyle Jeray, Karl-Josef Prommersberger, Kagan Ozer, G. A. Kraan, Kyle J. Chepla, L. M. S. J. Poelhekke, Ladislav Mica, Lawrence Weiss, Lars Adolfsson, Lars C. Borris, Louis Christopher Grandizio, Leon Elmans, Naquira Escobar Luis Felipe, L. W. van der Plaat, M. Verhofstad, Marcos Sanmartin-Fernandez, Mario Di Micoli, Matej Kastelec, Maurizio Calcagni, Max Talbot, Maarten W. G. A. Bronkhorst, John A. McAuliffe, Michael Behrman, M. Quell, Michael Nakashian, Minoo Patel, Matthew Bengard, M. Jason Palmer, Michael Prayson, Matthias Knobe, Marinis Pirpiris, Minos Tyllianakis, Michael W. Grafe, Neal Chen, Nelson Elias, Ngozi M. Akabudike, Nathan A. Hoekzema, Nicholas L. Shortt, Nikolaos Kanakaris, Nikolas H. Kazmers, Nina Lightdale-Miric, Jim Calandruccio, Ole Brink, Martin Richardson, Jose A. Ortiz Jr, Pascal F. W. Hannemann, P. V. van Eerten, Prashanth Inna, Peter Althausen, Panagiotis Lygdas, Nata Parnes, Paul A. Martineau, Prosper Benhaim, Philip Forno, Pradeep Choudhari, Peter Hahn, Peter Fedele Townsend, Peter Giannoudis, Paul Guidera, Philipp Muhl, Philipp Streubel, Peter Jebson, Patrick W. Owens, Tamir Pritsch. Paul J. Scibetta Jr., Rob Nelissen, Robert Haverlag, R. H. van Leerdam, Ramon de Bedout, Sergio Rowinski, Reid W. Draeger,R. Fricker, Richard Wallensten, Richard S. Gilbert, Marco Rizzo, Richard Jenkinson, Robert E. Van Demark Jr, Craig Rodner, Rachel S. M. D. Rohde, Richard S. Page, David Ruch, Vani J. Sabesan, Stephen A. Kennedy. Niels W. L. Schep, Scott Mitchell, Sebastian Farr, Paul A. D. O. Sibley, Scott G. Kaar, S. A. Meylaerts, Steven L. Henry, Steven Meletiou, Steven J. Morgan, Marc Swiontkowski, T. Schepers, Thomas DeCoster, Taizoon Baxamusa, F. Thomas D. Kaplan, Thierry Begue, Thomas Mittlmeier, Thomas Rebele, T Apard, Tim Chesser, Tomo Havlif?ek, T. Rozental, Theodoros Tosounidis, H. Utkan Aydin, Vincenzo Giordano, Varun Kashyap Gajendran, Vasileios S. Nikolaou, Vincent Ruggiero, Warren C. Hammert, Yoram Weil, Wojciech Satora, Zsolt Balogh. Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = nov,

doi = "10.1007/s00402-021-04062-0",

language = "English",

volume = "141",

pages = "2011--2018",

journal = "Archives of Orthopaedic and Trauma Surgery",

issn = "0936-8051",

publisher = "Springer Verlag",

number = "11",

}

Bulstra, AEJ, Crijns, TJ, Janssen, SJ, Buijze, GA, Ring, D, Jaarsma, RL, Kerkhoffs, GMMJ, Obdeijn, MC, Doornberg, JN, The Science of Variation Group, Wilson, CJ & Doornberg, JN 2021, 'Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture', Archives of Orthopaedic and Trauma Surgery, vol. 141, no. 11, pp. 2011-2018. https://doi.org/10.1007/s00402-021-04062-0

TY - JOUR

T1 - Factors associated with surgeon recommendation for additional cast immobilization of a CT-verified nondisplaced scaphoid waist fracture

AU - Bulstra, Anne Eva J.

AU - Crijns, Tom J.

AU - Janssen, Stein J.

AU - Buijze, Geert A.

AU - Ring, David

AU - Jaarsma, Ruurd L.

AU - Kerkhoffs, Gino M.M.J.

AU - Obdeijn, Miryam C.

AU - Doornberg, Job N.

AU - The Science of Variation Group

AU - Peters, A.

AU - Spoor, A. B.

AU - Shrivastava, Abhay

AU - Chauhan, Aakash

AU - Shafritz, Adam

AU - Ilyas, Asif M.

AU - Vochteloo, Anne J.H.

AU - Powell, Andrew John

AU - Castillo, Alberto Pérez

AU - Godoy-Santos, Alexandre Leme

AU - Gelvez, Amparo Gomez

AU - Bauer, Andrea

AU - Barquet, Antonio

AU - Kristan, Anze

AU - Prkic, Ante

AU - Jubel, Axel

AU - Mirck, Boj

AU - Kreis, B. E.

AU - Bamberger, H. Brent

AU - Belangero, William Dias

AU - Hearon, Bernard F.

AU - Palmer, Bradley

AU - Hyatt, Brad

AU - Wills, Brian P.D.

AU - Broekhuyse, Henry

AU - Buckley, Richard

AU - Altintas, Burak

AU - Campbell, Sean T.

AU - Ekholm, Carl

AU - Fernandes, Carlos Henrique

AU - Fernandes, C. H.

AU - Weiss, Carl

AU - Garnavos, Christos

AU - Metzger, Charles

AU - Wilson, Christopher J.

AU - Bainbridge, Chris

AU - Deml, Christian

AU - Moreta, Jesus

AU - Kleweno, Conor

AU - Moreno-Serrano, Constanza L.

AU - Ordway, Craig B.

AU - Klostermann, Cyrus

AU - Zeltser, David

AU - Dennison, David G.

AU - Verbeek, Diederik O.

AU - Polatsch, Dan

AU - Barreto, Camilo Jose Romero

AU - Kabir, Koroush

AU - Shafi, Mohamed

AU - Patiño, Juan M.

AU - van Riet, Roger

AU - Sodha, Samir

AU - Duncan, Scott

AU - Wascher, Daniel C.

AU - Ibrahim, Edward F.

AU - Ballas, Efstathios G.

AU - Harvey, Edward

AU - Rodriguez, Edward K.

AU - Pemovska, Emilia Stojkovska

AU - Walbeehm, E.

AU - Evans, Peter J.

AU - Zaidenberg, Ezequiel E.

AU - O’Brien, Fred

AU - Seibert, Franz Josef

AU - Bloemers, Frank W.

AU - Caro, Gladys Cecilia Zambrano

AU - DeSilva, Gregory

AU - Babis, George

AU - Pianka, George

AU - Githens, Michael

AU - Veríssimo, Giselly Miranda

AU - Garrigues, Grant E.

AU - Fierro, Guido

AU - Durchholz, Holger

AU - Hall, Jeremy

AU - McCutchan, Hal

AU - Nancollas, Michael

AU - Young, Colby

AU - Watchmaker, Greg P.

AU - Pess, Gary M.

AU - Lane, Lewis B.

AU - Villamizar, Harold Alonso

AU - Pountos, Ippokratis

AU - Kimball, Hervey L.

AU - Hofmeister, Eric P.

AU - McGraw, Iain

AU - Erol, Konul

AU - Di Giovanni, J. F.

AU - Brubacher, Jacob W.

AU - Biert, Jan

AU - Fanuele, Jason C.

AU - Tavakolian, Jason D.

AU - Choueka, Jack

AU - Ribeiro, Jose Eduardo Grandi

AU - Filho, Jose Eduardo Grandi Ribeiro

AU - Conflitti, Joseph M.

AU - Roiz, J. M.R.

AU - Munyak, John

AU - Nappi, James F.

AU - Doornberg, Job N.

AU - Erickson, John M.

AU - Boretto, Jorge G.

AU - Post, Joel M.

AU - Rubio, Jorge

AU - Scolaro, John A.

AU - Taras, John

AU - Domenech, Julio

AU - Sandoval, Julio

AU - Wint, Jeffrey

AU - Faust, Katherine Celeste

AU - Butters, Ken

AU - Jeray, Kyle

AU - Prommersberger, Karl Josef

AU - Ozer, Kagan

AU - Kraan, G. A.

AU - Chepla, Kyle J.

AU - Poelhekke, L. M.S.J.

AU - Mica, Ladislav

AU - Weiss, Lawrence

AU - Adolfsson, Lars

AU - Borris, Lars C.

AU - Grandizio, Louis Christopher

AU - Elmans, Leon

AU - Náquira Escobar, Luis Felipe

AU - van der Plaat, L. W.

AU - Verhofstad, M.

AU - Sanmartin-Fernandez, Marcos

AU - Di Micoli, Mario

AU - Kastelec, Matej

AU - Calcagni, Maurizio

AU - Talbot, Max

AU - Bronkhorst, Maarten W.G.A.

AU - McAuliffe, John A.

AU - Behrman, Michael

AU - Quell, M.

AU - Nakashian, Michael

AU - Patel, Minoo

AU - Bengard, Matthew

AU - Palmer, M. Jason

AU - Prayson, Michael

AU - Knobe, Matthias

AU - Pirpiris, Marinis

AU - Tyllianakis, Minos

AU - Grafe, Michael W.

AU - Chen, Neal

AU - Elias, Nelson

AU - Akabudike, Ngozi M.

AU - Hoekzema, Nathan A.

AU - Shortt, Nicholas L.

AU - Kanakaris, Nikolaos

AU - Kazmers, Nikolas H.

AU - Lightdale-Miric, Nina

AU - Calandruccio, Jim

AU - Brink, Ole

AU - Richardson, Martin

AU - Ortiz Jr, Jose A.

AU - Hannemann, Pascal F.W.

AU - van Eerten, P. V.

AU - Inna, Prashanth

AU - Althausen, Peter

AU - Lygdas, Panagiotis

AU - Parnes, Nata

AU - Martineau, Paul A.

AU - Benhaim, Prosper

AU - Forno, Philip

AU - Choudhari, Pradeep

AU - Hahn, Peter

AU - Townsend, Peter Fedele

AU - Giannoudis, Peter

AU - Guidera, Paul

AU - Muhl, Philipp

AU - Streubel, Philipp

AU - Jebson, Peter

AU - Owens, Patrick W.

AU - Pritsch, Tamir

AU - Scibetta Jr, Paul J.

AU - Nelissen, Rob

AU - Haverlag, Robert

AU - van Leerdam, R. H.

AU - de Bedout, Ramon

AU - Rowinski, Sergio

AU - Draeger, Reid W.

AU - Fricker, R.

AU - Wallensten, Richard

AU - Gilbert, Richard S.

AU - Rizzo, Marco

AU - Jenkinson, Richard

AU - Van Demark Jr, Robert E.

AU - Rodner, Craig

AU - Rohde, Rachel S.M.D.

AU - Page, Richard S.

AU - Ruch, David

AU - Sabesan, Vani J.

AU - Kennedy, Stephen A.

AU - Schep, Niels W.L.

AU - Mitchell, Scott

AU - Farr, Sebastian

AU - Sibley, Paul A.D.O.

AU - Kaar, Scott G.

AU - Meylaerts, S. A.

AU - Henry, Steven L.

AU - Meletiou, Steven

AU - Morgan, Steven J.

AU - Swiontkowski, Marc

AU - Schepers, T.

AU - DeCoster, Thomas

AU - Baxamusa, Taizoon

AU - Kaplan, F. Thomas D.

AU - Begue, Thierry

AU - Mittlmeier, Thomas

AU - Rebele, Thomas

AU - Apard, T.

AU - Chesser, Tim

AU - Havlifçek, Tomo

AU - Rozental, T.

AU - Tosounidis, Theodoros

AU - Utkan Aydin, H.

AU - Giordano, Vincenzo

AU - Gajendran, Varun Kashyap

AU - Nikolaou, Vasileios S.

AU - Ruggiero, Vincent

AU - Hammert, Warren C.

AU - Weil, Yoram

AU - Satora, Wojciech

AU - Balogh, Zsolt

N1 - Funding Information: Group authorship: The Science of Variation Group A. Peters, A. B. Spoor, Abhay Shrivastava, Aakash Chauhan, Adam Shafritz, Asif M. Ilyas, Anne J. H. Vochteloo, Andrew John Powell, Alberto P?rez Castillo, Alexandre Leme Godoy-Santos, Amparo Gomez Gelvez, Andrea Bauer, Antonio Barquet, Anze Kristan, Ante Prkic, Axel Jubel, Boj Mirck, B. E. Kreis, H. Brent Bamberger, William Dias Belangero, Bernard F. Hearon, Bradley Palmer, Brad Hyatt, Brian P. D. Wills, Henry Broekhuyse, Richard Buckley, Burak Altintas, Sean T. Campbell, Carl Ekholm, Carlos Henrique Fernandes, C. H. Fernandes, Carl Weiss, Christos Garnavos, Charles Metzger, Christopher J. Wilson, Chris Bainbridge, Christian Deml, Jesus Moreta, Conor Kleweno, Constanza L. Moreno-Serrano, Craig B. Ordway, Cyrus Klostermann, David Zeltser, David G. Dennison, Diederik O. Verbeek, Dan Polatsch, Camilo Jose Romero Barreto, Koroush Kabir, Mohamed Shafi, Juan M. Pati?o, Roger van Riet, Samir Sodha, Scott Duncan, Daniel C. Wascher, Edward F. Ibrahim, Efstathios G. Ballas, Edward Harvey, Edward K. Rodriguez, Emilia Stojkovska Pemovska, E. Walbeehm, Peter J. Evans, Ezequiel E. Zaidenberg, Fred O?Brien, Franz Josef Seibert, Frank W. Bloemers, Gladys Cecilia Zambrano Caro, Gregory DeSilva, George Babis, George Pianka, Michael Githens, Giselly Miranda Ver?ssimo, Grant E. Garrigues, Guido Fierro, Holger Durchholz, Jeremy Hall, Hal McCutchan, Michael Nancollas, Colby Young, Greg P. Watchmaker, Gary M. Pess, Lewis B. Lane, Harold Alonso Villamizar, Ippokratis Pountos, Hervey L. Kimball, Eric P. Hofmeister, Iain McGraw, Konul Erol, J.F. Di Giovanni, Jacob W. Brubacher, Jan Biert, Jason C. Fanuele, Jason D. Tavakolian, Jack Choueka, Jose Eduardo Grandi Ribeiro, Jose Eduardo Grandi Ribeiro Filho, Joseph M. Conflitti, J. M. R Roiz, John Munyak, James F. Nappi, Job N. Doornberg, John M. Erickson, Jorge G. Boretto, Joel M. Post, Jorge Rubio, John A. Scolaro, John Taras, Julio Domenech, Julio Sandoval, Jeffrey Wint, Katherine Celeste Faust, Ken Butters, Kyle Jeray, Karl-Josef Prommersberger, Kagan Ozer, G. A. Kraan, Kyle J. Chepla, L. M. S. J. Poelhekke, Ladislav Mica, Lawrence Weiss, Lars Adolfsson, Lars C. Borris, Louis Christopher Grandizio, Leon Elmans, Naquira Escobar Luis Felipe, L. W. van der Plaat, M. Verhofstad, Marcos Sanmartin-Fernandez, Mario Di Micoli, Matej Kastelec, Maurizio Calcagni, Max Talbot, Maarten W. G. A. Bronkhorst, John A. McAuliffe, Michael Behrman, M. Quell, Michael Nakashian, Minoo Patel, Matthew Bengard, M. Jason Palmer, Michael Prayson, Matthias Knobe, Marinis Pirpiris, Minos Tyllianakis, Michael W. Grafe, Neal Chen, Nelson Elias, Ngozi M. Akabudike, Nathan A. Hoekzema, Nicholas L. Shortt, Nikolaos Kanakaris, Nikolas H. Kazmers, Nina Lightdale-Miric, Jim Calandruccio, Ole Brink, Martin Richardson, Jose A. Ortiz Jr, Pascal F. W. Hannemann, P. V. van Eerten, Prashanth Inna, Peter Althausen, Panagiotis Lygdas, Nata Parnes, Paul A. Martineau, Prosper Benhaim, Philip Forno, Pradeep Choudhari, Peter Hahn, Peter Fedele Townsend, Peter Giannoudis, Paul Guidera, Philipp Muhl, Philipp Streubel, Peter Jebson, Patrick W. Owens, Tamir Pritsch. Paul J. Scibetta Jr., Rob Nelissen, Robert Haverlag, R. H. van Leerdam, Ramon de Bedout, Sergio Rowinski, Reid W. Draeger,R. Fricker, Richard Wallensten, Richard S. Gilbert, Marco Rizzo, Richard Jenkinson, Robert E. Van Demark Jr, Craig Rodner, Rachel S. M. D. Rohde, Richard S. Page, David Ruch, Vani J. Sabesan, Stephen A. Kennedy. Niels W. L. Schep, Scott Mitchell, Sebastian Farr, Paul A. D. O. Sibley, Scott G. Kaar, S. A. Meylaerts, Steven L. Henry, Steven Meletiou, Steven J. Morgan, Marc Swiontkowski, T. Schepers, Thomas DeCoster, Taizoon Baxamusa, F. Thomas D. Kaplan, Thierry Begue, Thomas Mittlmeier, Thomas Rebele, T Apard, Tim Chesser, Tomo Havlif?ek, T. Rozental, Theodoros Tosounidis, H. Utkan Aydin, Vincenzo Giordano, Varun Kashyap Gajendran, Vasileios S. Nikolaou, Vincent Ruggiero, Warren C. Hammert, Yoram Weil, Wojciech Satora, Zsolt Balogh. Publisher Copyright: © 2021, The Author(s).

PY - 2021/11

Y1 - 2021/11

N2 - 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.

AB - 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.

KW - Cast

KW - Decision-making

KW - Fracture

KW - Immobilization

KW - Scaphoid

UR - http://www.scopus.com/inward/record.url?scp=85111622717&partnerID=8YFLogxK

U2 - 10.1007/s00402-021-04062-0

DO - 10.1007/s00402-021-04062-0

M3 - Article

C2 - 34302522

AN - SCOPUS:85111622717

SN - 0936-8051

VL - 141

SP - 2011

EP - 2018

JO - Archives of Orthopaedic and Trauma Surgery

JF - Archives of Orthopaedic and Trauma Surgery

IS - 11

ER -

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

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