{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:03Z","timestamp":1787755623902,"version":"build-2784847793"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,10,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Treatment of Distal Radius Fractures has not been evaluated in clinical practice. We hypothesized that adhering to the distal radial fracture radiographic clinical practice guideline (CPG) improves outcomes and reduces costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We reviewed 266 patients with distal radial fractures treated at 1 institution. Based on CPG radiographic parameters (Recommendation 3), care was rated as \u201cappropriate\u201d or \u201cinappropriate.\u201d QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) scores were collected. The direct costs of distal radial fracture care were determined. Descriptive statistics and nonparametric tests were used to evaluate demographic characteristics and outcomes across groups. QuickDASH scores, grouped by postoperative time interval, were analyzed using linear mixed effect models to predict outcome trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In this study, 145 patients in the operative treatment group and 121 patients in the nonoperative treatment group were included. Of the 145 patients in the operative treatment group, 6 underwent an inappropriate surgical procedure, limiting any analyses of that group. Of the 121 patients in the nonoperative treatment group, 68 were treated inappropriately. For the patients in the nonoperative treatment group, appropriate care provided a significant outcome benefit by 1 year; the median QuickDASH score was 10.1 points for the appropriate treatment group and 19.5 points for the inappropriate treatment group (p = 0.05). The total direct costs for inappropriate nonoperative treatment were, on average, 60% higher than appropriate nonoperative treatment. In predictive models, patients with appropriate care in the operative treatment group and the nonoperative treatment group had better outcomes than patients with inappropriate nonoperative treatment at all time points after 29 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>When nonoperative distal radial fracture management was aligned with radiographic CPG criteria, patients in our cohort had improved patient-reported outcomes with lower costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.18.01245","type":"journal-article","created":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T06:17:32Z","timestamp":1571293052000},"page":"1829-1837","source":"Crossref","is-referenced-by-count":4,"title":["Adhering to Radiographic Clinical Practice Guidelines for Distal Radial Fracture Management Is Associated with Improved Outcomes and Lower Costs"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7688-957X","authenticated-orcid":false,"given":"Aviram M.","family":"Giladi","sequence":"first","affiliation":[{"name":"The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3149-7876","authenticated-orcid":false,"given":"Carew C.","family":"Giberson-Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1219-7870","authenticated-orcid":false,"given":"Amber M.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4922-5844","authenticated-orcid":false,"given":"Sameer","family":"Desale","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5003-0924","authenticated-orcid":false,"given":"Tamara D.","family":"Rozental","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"8","key":"bib1-20230811","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.2106\/JBJS.H.01297","article-title":"Trends in the United States in the treatment of distal radial fractures in the elderly","volume":"91","author":"Chung","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib2-20230811","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.jhsa.2011.02.005","article-title":"A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly","volume":"36","author":"Diaz-Garcia","year":"2011","journal-title":"J Hand Surg Am."},{"issue":"8","key":"bib3-20230811","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.jhsa.2011.05.017","article-title":"Current and future national costs to Medicare for the treatment of distal radius fracture in the elderly","volume":"36","author":"Shauver","year":"2011","journal-title":"J Hand Surg Am."},{"issue":"2","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.ocl.2007.01.002","article-title":"Distal radius fractures\u2014classification of treatment and indications for surgery","volume":"38","author":"Ilyas","year":"2007","journal-title":"Orthop Clin North Am."},{"issue":"9","key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.2106\/00004623-200709000-00025","article-title":"Management of distal radial fractures","volume":"89","author":"Chen","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib6-20230811","first-page":"233","article-title":"Internal fixation vs conservative treatment for displaced distal radius fractures: a meta-analysis of randomized controlled trials","volume":"22","author":"Yu","year":"2016","journal-title":"Ulus Travma Acil Cerrahi Derg."},{"issue":"9","key":"bib7-20230811","doi-asserted-by":"crossref","first-page":"786","DOI":"10.2106\/JBJS.17.00688","article-title":"Comparison of direct perioperative costs in treatment of unstable distal radial fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning","volume":"100","author":"Nandyala","year":"2018","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib8-20230811","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1016\/j.jhsa.2011.09.039","article-title":"An economic analysis of outcomes and complications of treating distal radius fractures in the elderly","volume":"36","author":"Shauver","year":"2011","journal-title":"J Hand Surg Am."},{"issue":"2","key":"bib9-20230811","doi-asserted-by":"crossref","first-page":"218","DOI":"10.3122\/jabfm.2016.02.150233","article-title":"Lack of agreement on distal radius fracture treatment","volume":"29","author":"Bruce","year":"2016","journal-title":"J Am Board Fam Med."},{"issue":"8","key":"bib10-20230811","doi-asserted-by":"crossref","first-page":"775","DOI":"10.2106\/JBJS.938ebo","article-title":"American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of distal radius fractures","volume":"93","author":"Lichtman","year":"2011","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib11-20230811","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.cps.2012.10.006","article-title":"Measuring outcomes in hand surgery","volume":"40","author":"Giladi","year":"2013","journal-title":"Clin Plast Surg."},{"issue":"1","key":"bib12-20230811","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.hcl.2008.10.001","article-title":"The use of economic evaluation in hand surgery","volume":"25","author":"Thoma","year":"2009","journal-title":"Hand Clin."},{"issue":"3","key":"bib13-20230811","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1177\/1558944715627305","article-title":"Linking of the American Academy of Orthopaedic Surgeons distal radius fracture clinical practice guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF core sets for hand conditions","volume":"11","author":"Esakki","year":"2016","journal-title":"Hand (N Y)."},{"issue":"6","key":"bib14-20230811","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1007\/s11999-014-3530-0","article-title":"High methodologic quality but poor applicability: assessment of the AAOS guidelines using the AGREE II instrument","volume":"472","author":"Sabharwal","year":"2014","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib15-20230811","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1001\/jamasurg.2017.1572","article-title":"Appropriateness, health care reform, and the surgeon: perspectives from the surgical outcomes club","volume":"152","author":"Weissman","year":"2017","journal-title":"JAMA Surg."},{"issue":"6","key":"bib16-20230811","doi-asserted-by":"crossref","first-page":"e005961","DOI":"10.1161\/JAHA.117.005961","article-title":"Impact of the publication of appropriate use criteria on utilization rates of myocardial perfusion imaging studies in Ontario, Canada: a population-based study","volume":"6","author":"Roifman","year":"2017","journal-title":"J Am Heart Assoc."},{"issue":"3","key":"bib17-20230811","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.hcl.2014.04.007","article-title":"Clinical practice guidelines: what are they and how should they be disseminated?","volume":"30","author":"Graham","year":"2014","journal-title":"Hand Clin."},{"issue":"9","key":"bib18-20230811","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.6004\/jnccn.2018.7036","article-title":"Impact of nonconcordance with NCCN guidelines on resource utilization, cost, and mortality in de novo metastatic breast cancer","volume":"16","author":"Rocque","year":"2018","journal-title":"J Natl Compr Canc Netw."},{"issue":"1","key":"bib19-20230811","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification compendium-2018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib20-20230811","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.jhsa.2012.01.028","article-title":"The effects of pain, supination, and grip strength on patient-rated disability after operatively treated distal radius fractures","volume":"37","author":"Swart","year":"2012","journal-title":"J Hand Surg Am."},{"issue":"5","key":"bib21-20230811","first-page":"1038","article-title":"Development of the QuickDASH: comparison of three item-reduction approaches","volume":"87","author":"Beaton","year":"2005","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib23-20230811","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.2106\/JBJS.I.00879","article-title":"Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases","volume":"92","author":"Kamerlink","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib24-20230811","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.2106\/JBJS.H.01478","article-title":"Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial","volume":"91","author":"Rozental","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib25-20230811","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.otsr.2017.01.017","article-title":"Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries","volume":"103","author":"Mulders","year":"2017","journal-title":"Orthop Traumatol Surg Res."},{"issue":"4","key":"bib26-20230811","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jhsa.2016.02.001","article-title":"A unified approach to outcomes assessment for distal radius fractures","volume":"41","author":"Waljee","year":"2016","journal-title":"J Hand Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.18.01245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:45:29Z","timestamp":1787751929000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.18.01245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,16]]},"references-count":25,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.18.01245","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,16]]}}}