Abstract
Objective To evaluate the rate of surgery for symptomatic malunion after nonoperatively treated
distal radius fractures in patients aged 55 and above, and to secondarily report differences
in demographics, geographical variation, and utilization costs of patients requiring
subsequent malunion correction.
Methods We identified patients aged 55 and above who underwent nonoperative treatment for
a distal radius fracture between 2007 and 2016 using the IBM MarketScan database.
In the nonoperative cohort, we identified patients who underwent malunion correction
between 3 months and 1 year after distal radius fracture. The primary outcome was
rate of malunion correction. Multivariable logistic regression controlling for sex,
region, and Elixhauser Comorbidity Index (ECI) was used. We also report patient demographics,
geographical variation, and utilization cost.
Results The rate of subsequent malunion surgery after nonoperative treatment was 0.58%. The
cohort undergoing malunion surgery was younger and had a lower ECI. For every 1-year
increase in age, there was a 6.4% decrease in odds of undergoing surgery for malunion,
controlling for sex, region, and ECI (odds ratio = 0.94 [0.93–0.95]; p < 0.01). The southern United States had the highest percentage of patients initially
managed operatively (30.7%), the Northeast had the lowest (22.0%). Patients who required
a malunion procedure incurred higher costs compared with patients who did not ($7,272 ± 8,090
vs. $2,209 ± 5,940; p < 0.01).
Conclusion The rate of surgery for symptomatic malunion after initial nonoperative treatment
for distal radius fractures in patients aged 55 and above is low. As younger and healthier
patients are more likely to undergo malunion correction with higher associated costs,
surgeons may consider offering this cohort surgical treatment initially.
Keywords
distal radius fracture - elderly - malunion - nonoperative - variation
