{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:51:56Z","timestamp":1790826716497,"version":"4.1.0"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Wrist Surg"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Evidence suggests that there is substantial and unexplained surgeon-to-surgeon variation in recommendation of operative treatment for fractures of the distal radius. We studied (1) what factors are associated with recommendation for operative treatment of a fracture of the distal radius and (2) which factors are rated as the most influential on recommendation of operative treatment.<\/jats:p><jats:p>\n          Methods\u2003One-hundred thirty-one upper extremity and fracture surgeons evaluated 20 fictitious patient scenarios with randomly assigned factors (e.g., personal, clinical, and radiologic factors) for patients with a fracture of the distal radius. They addressed the following questions: (1) Do you recommend operative treatment for this patient (yes\/no)? We determined the influence of each factor on this recommendation using random forest algorithms. Also, participants rated the influence of each factor\u2014excluding age and sex\u2014 on a scale from 0 (not at all important) to 10 (extremely important).<\/jats:p><jats:p>\n          Results\u2003Random forest algorithms determined that age and angulation were having the most influence on recommendation for operative treatment of a fracture of the distal radius. Angulation on the lateral radiograph and presence or absence of lunate subluxation were rated as having the greatest influence and smoking status and stress levels the lowest influence on advice to patients.<\/jats:p><jats:p>\n          Conclusions\u2003The observation that\u2014other than age\u2014personal factors have limited influence on surgeon recommendations for surgery may reflect how surgeon cognitive biases, personal preferences, different perspectives, and incentives may contribute to variations in care. Future research can determine whether decision aids\u2014those that use patient-specific probabilities based on predictive analytics in particular\u2014might help match patient treatment choices to what matters most to them, in part by helping to neutralize the influence of common misconceptions as well as surgeon bias and incentives.<\/jats:p><jats:p>\n          Level of Evidence\u2003There is no level of evidence for the study.<\/jats:p>","DOI":"10.1055\/s-0041-1725962","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:01:53Z","timestamp":1615507313000},"page":"316-321","source":"Crossref","is-referenced-by-count":7,"title":["Factors Associated with a Recommendation for Operative Treatment for Fracture of the Distal Radius"],"prefix":"10.1055","volume":"10","author":[{"given":"David W.G.","family":"Langerhuizen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stein J.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost T.P.","family":"Kortlever","sequence":"additional","affiliation":[{"name":"Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ring","sequence":"additional","affiliation":[{"name":"Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gino M.M.J.","family":"Kerkhoffs","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruurd L.","family":"Jaarsma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job N.","family":"Doornberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic & Trauma Surgery, Flinders University, Flinders Medical Centre, Adelaide, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.injury.2010.11.011","article-title":"Practice variation in common fracture presentations: a survey of orthopaedic surgeons","volume":"42","author":"U 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Karhade","year":"2019","journal-title":"Neurosurgery"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1007\/s11999-016-4706-6","article-title":"Greater tuberosity fractures: does fracture assessment and treatment recommendation vary based on imaging modality?","volume":"474","author":"S J Janssen","year":"2016","journal-title":"Clin Orthop Relat Res"},{"issue":"17","key":"ref9","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.2106\/JBJS.L.00586","article-title":"Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT","volume":"95","author":"W E Bruinsma","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref10","first-page":"3","article-title":"The random forest algorithm for statistical learning with applications in Stata","volume":"20","author":"R Y Zou","year":"2018","journal-title":"Stata 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