PDF(Pubmed)
Abstract：
National guidelines for treatment of distal radius fractures (DRFs) were presented in Sweden in 2021. In the guidelines, a fast-track is recommended for 4 subgroups of highly unstable DRFs. Regardless of the results of the closed reduction these are recommended for surgery within 1 week of injury. This study aims to evaluate the potential consequences of the newly presented national guidelines on incidence of surgical interventions.
In all, 1,609 patients (1,635 DRFs) with primary radiographs after a DRF between 2014 and 2017 at two Swedish hospitals were included in a retrospective cohort study. An estimation was made of the percentage of patients in the historical pre-guidelines cohort, that would have been recommended early primary surgery according to the new national guidelines compared to treatment implemented without the support of these guidelines.
On a strict radiological basis, 32% (516 out of 1635) of DRFs were classified into one of the 4 defined subgroups. At 9-13 days follow-up, cast treatment was converted into delayed primary surgery in 201 cases. Out of these, 56% (112 out of 201) fulfilled the fast-track criteria and would with the new guidelines have been subject to early primary surgery.
The fast-track regimen in the new guidelines, has a high likelihood of identifying the unstable fractures benefitting from early primary surgery. If the proposed Swedish national guidelines for DRF treatment are implemented, a greater proportion of fractures would be treated with early primary surgery, and a delayed surgery avoided in the majority of cases. The potential benefits in relation to possible costs when using the fast-track criteria in every day practice are still unknown.
In all, 1,609 patients (1,635 DRFs) with primary radiographs after a DRF between 2014 and 2017 at two Swedish hospitals were included in a retrospective cohort study. An estimation was made of the percentage of patients in the historical pre-guidelines cohort, that would have been recommended early primary surgery according to the new national guidelines compared to treatment implemented without the support of these guidelines.
On a strict radiological basis, 32% (516 out of 1635) of DRFs were classified into one of the 4 defined subgroups. At 9-13 days follow-up, cast treatment was converted into delayed primary surgery in 201 cases. Out of these, 56% (112 out of 201) fulfilled the fast-track criteria and would with the new guidelines have been subject to early primary surgery.
The fast-track regimen in the new guidelines, has a high likelihood of identifying the unstable fractures benefitting from early primary surgery. If the proposed Swedish national guidelines for DRF treatment are implemented, a greater proportion of fractures would be treated with early primary surgery, and a delayed surgery avoided in the majority of cases. The potential benefits in relation to possible costs when using the fast-track criteria in every day practice are still unknown.
摘要：
2021年在瑞典提出了治疗桡骨远端骨折（DRF）的国家指南。在准则中,建议对4个高度不稳定的DRF亚组进行快速跟踪。无论闭合复位的结果如何，建议在受伤后1周内进行手术。这项研究旨在评估新提出的关于外科手术发生率的国家指南的潜在后果。
总之,在一项回顾性队列研究中，纳入了2014年至2017年间在两家瑞典医院进行DRF检查后的1,609名患者（1,635名DRF）的主要X光片。对历史指南前队列中患者的百分比进行了估计，与在没有这些指南支持的情况下实施的治疗相比，根据新的国家指南，这将被建议进行早期初次手术。
在严格的放射学基础上，32%(1635个中的516个)的DRF被分为4个定义的亚组之一。随访9-13天,201例转换为延迟的原发性手术。在这些中，56％（201个中的112个）符合快速通道标准，并且在新指南下将接受早期初次手术。
新指南中的快速治疗方案，有很高的可能性确定不稳定的骨折受益于早期的初级手术。如果拟议的瑞典DRF治疗国家指南得到实施，更大比例的骨折将通过早期初次手术治疗，在大多数情况下避免了延迟手术。在日常实践中使用快速通道标准时，与可能的成本有关的潜在收益仍然未知。
总之,在一项回顾性队列研究中，纳入了2014年至2017年间在两家瑞典医院进行DRF检查后的1,609名患者（1,635名DRF）的主要X光片。对历史指南前队列中患者的百分比进行了估计，与在没有这些指南支持的情况下实施的治疗相比，根据新的国家指南，这将被建议进行早期初次手术。
在严格的放射学基础上，32%(1635个中的516个)的DRF被分为4个定义的亚组之一。随访9-13天,201例转换为延迟的原发性手术。在这些中，56％（201个中的112个）符合快速通道标准，并且在新指南下将接受早期初次手术。
新指南中的快速治疗方案，有很高的可能性确定不稳定的骨折受益于早期的初级手术。如果拟议的瑞典DRF治疗国家指南得到实施，更大比例的骨折将通过早期初次手术治疗，在大多数情况下避免了延迟手术。在日常实践中使用快速通道标准时，与可能的成本有关的潜在收益仍然未知。
