gms | German Medical Science

Objectives: Fracture of the distal radius is one of the most common fractures in Norway with ca. 30 percent of all fractures. According to the actual incidence-rate there are 10.000 distal radius fractures in Norway per year. Although current surgical treatment concepts use a more aggressive plating strategy, there is to date no treatment consensus. In a very controlled setting in a Norwegian health district (110.000 inhabitants, one trauma hospital) a prospective protocol was implemented to document the operative treatment of distal radius fractures in this geographic entity with special focus on treatment costs.

Methods: Main outcome measure was the q- DASH at 3, 6 and 12 months. Mean treatment costs were calculated with respect to individual hardware used, pre-/peri- and postoperative costs (CAT-scan, xray, polyclinic follow-up) hospital stay and patient-travelling. These were compared to the individual coded DRG-income per patient and transferred from NOK to Euro.

450 patients with distal radius fractures were surgically treated between November 2010 and July 2013. In all patients with intraarticular fractures preoperative CAT-scan was performed. All patients were followed for a minimum of one year. In addition to standard demographic data, all fractures were classified after OTA/ AO, standard range of motion, grip strength, quick-DASH, intra- and postoperative complications and a radiologic score in all, specific parameters related to fragment-specific-plating, dry arthroscopy and intra- and postoperative gaps - and steps were recorded in intraarticular fractures. All costs and income related to the treatment period were recorded.

Results: The average age in the cohort was 52 years (16 to 87 years). The majority of patients did receive a volar plate osteosynthesis. 53 complications were recorded in the cohort. 35 patients suffered from moderate postoperative dystrophy and there were 4 superficial infection (no deep infection). 16 patients were operated secondary to a complication (>4 %). Mean qDASH was 16.5, mean GS was 70 % of GS of the un- injured contralateral side. The mean cost-income balance was negative with a mean of -500 € per patient (range 300 to 1500 €).

Conclusions: A differentiated operative treatment concept gives good patient- and surgeon-related results with a moderate to low complication rate but is far from cost- effective. A correction of the DRG- value controlled income in this treatment setup is necessary in order to use agressive plating in this fracture entity efficiently.