Medical economic study of outpatient versus inpatient surgical management of distal radius fractures.

INTRODUCTION: France aims to have more than 70% of its surgical procedures performed in an outpatient setting by 2022. HYPOTHESIS: The primary hypothesis of this study was that outpatient management of distal radius fractures with volar plating was more cost-effective than inpatient hospitalization. The secondary hypothesis was that more than 70% of these cases could be managed in an outpatient setting. MATERIALS AND METHODS: The series included 255 fractures that were operated on between February 2015 and February 2016. These were reviewed using 4 patient-specific criteria (age, ASA score, eligibility for an outpatient procedure, and anticoagulant therapy) and 4 injury-specific criteria (AO classification, open wound, nerve involvement, and other locations). Our outpatient rate was compared to the national rate and the net income was calculated according to the length of stay. RESULTS: Our series reported an outpatient rate of 77.25% with a mean age of 54years (19/95) and an inpatient rate of 22.75% with a mean age of 74 years (30/94). The national rate in 2018 was 34.8%. While outpatient procedures generated an operating profit of +€191.64, hospitalizations of 1 to 17 nights resulted in an operating loss. The overall economic assessment of the 255 fractures included in our series showed an operating loss of €22,113.78. DISCUSSION: Our primary hypothesis was confirmed since the outpatient management of distal radius fractures was more cost-effective than inpatient hospitalization. The secondary hypothesis was also confirmed since more than 70% of cases in our series were treated in an outpatient setting. CONCLUSION: Most distal radius fractures requiring a surgical intervention should be treated in an outpatient setting. LEVEL OF EVIDENCE: IV.

Conservative treatment of distal fractures after the age of 65: a review of literature.

The goal of this study was to evaluate the role of conservative treatment of distal radius fractures in the elderly since 2000. Our series included 22 articles, of which 3 reviews, 2 meta-analyses, 6 descriptive series of conservative treatment, 10 series comparing surgical and conservative treatments and 1 series comparing different types of conservative treatments. The reduction was performed by closed reduction in 7 cases and by traction in 3 cases. A short-arm cast was used in 8 cases and a long-arm cast in 4 cases for an average length of 6 weeks. The indications of conservative treatment were varied: AO type A fractures in 2 cases, type C fractures in 1 case, types A and C in 8 cases and types A, B and C in 3 cases. No article reported any significant difference between surgical and conservative treatments in terms of DASH or PRWE, whereas strength was sometimes improved when surgical treatment was used. Radiological results were always better after surgical treatment. The rate of complications varied greatly, greater, equally or lower compared to conservative treatment depending on the series. All in all, there is no consensus to assert that a conservative treatment is more justified than a surgical treatment to treat distal radius fractures after the age of 65. Most authors consider that the long-term clinical outcome is identical and that the radiological result is better after surgical treatment. The fact that the fixation of a distal radius fracture by a volar locking plate after 65 years speeds up the recovery remains to be proven.