Abstract Title Nationwide Surgical Trends in Distal Radius Fixation in Medicare Beneficiaries: Increased Utilization by Plastic Surgeons and Subspecialty Hand Surgeons

Background In recent years, several randomized controlled trials have been published concerning the treatment of distal radius fractures (DRFs) in elderly patients. It remains unclear to what extent these studies have influenced clinical practice among different surgical specialties. This study aims to investigate both overarching trends and specialty-specific patterns in the surgical management of DRFs within the Medicare population.

Methods Utilizing data from the Centers for Medicare & Medicaid Services, between 2013 and 2022, all claims associated with surgical management of DRFs were identified (Current Procedural Terminology CPT codes: 25606, 25607, 25608, and 25609). The results were further categorized based on primary operator type (general orthopedist, general plastics, general surgeon, subspecialty hand surgeon) and place of service (inpatient, outpatient, other).

Results A total of 101,857 DRFs requiring surgical intervention were identified. Over a span of 10 years, the overall rate of distal radius fracture interventions (DRFIs) declined from 29.5 to 26.1 per 100,000 individuals, representing a 12% decrease. During this period, the utilization of closed reduction percutaneous pinning experienced a substantial 63% decrease, dropping from 4.8 to 1.8 per 100,000. Conversely, open treatment for distal radial intra-articular fractures of three or more fragments saw an 11% increase in utilization, rising from 10.0 to 11.1 per 100,000. After correction for the number of claims, general orthopedic and general surgeons experienced a notable decrease in utilization for DRFIs, 22% and 6% respectively, However, plastic surgeons and hand surgeons saw an increase in utilization for DRFIs, 74% and 13% respectively, over the same 10-year period. Additionally, there was an increasing shift towards outpatient DRFIs, with an 11% increase, whereas inpatient and other experienced a 17% and 36% decrease, respectively.

Conclusion Between 2013 and 2022, there has been a notable decline in surgical interventions for distal radius fractures (DRFIs) within the Medicare population. While general orthopedic surgeons traditionally led the provision of DRFIs, recent trends indicate a shifting landscape. We observe a diminishing procedure share among general orthopedic surgeons and general surgeons, accompanied by a rising utilization of plastic surgeons and hand surgeons in addressing DRFIs.