Management Preferences of Geriatric Distal Radius Fractures: Insights From an American Society for Surgery of the Hand Surgeon Survey.

Abstract

Purpose: Distal radius fractures (DRFs) are common among the elderly. American Academy of Orthopaedic Surgeons Guidelines maintain a strong recommendation for nonsurgical treatment of these injuries, but acknowledge the importance of a patient-centered approach when making treatment decisions. This study aimed to characterize current practice trends and identify factors associated with treatment decisions for geriatric DRFs among members of the American Society for Surgery of the Hand. We hypothesized that fracture pattern and surgeon factors would be associated with surgeons' treatment decisions for geriatric DRFs.

Methods: In 2025, a survey containing a clinical scenario of a 72-year-old patient sustaining a DRF with six different fracture patterns was distributed to American Society for Surgery of the Hand members. Surgeons' demographic data were collected, in addition to their preferred management (nonsurgical vs operative treatment) for each fracture. Respondents were also surveyed on injury/patient factors that would increase their likelihood to pursue operative treatment. Associations between variables were determined by chi-square or Fisher exact tests.

Results: A total of 636 surveys were reviewed (response rate 13%), with 563 (89%) completed by orthopedic-trained hand surgeons. Surgeon's preferred treatment was associated with fracture pattern (P < .001). For a displaced extra-articular fracture, 88% of surgeons preferred operative treatment. Surgeons' practice setup (P = .045) and their years in practice (P = .003) influenced the management of displaced extra-articular fractures. Acute carpal tunnel syndrome, volar shear fracture patterns, and type I open injuries were the top three factors to influence a surgeon's likelihood to operate.

Conclusions: Our findings suggest a discordance between current clinical practice guidelines and surgeon preferences for treatment of geriatric DRFs.

Clinical relevance: Understanding current practice patterns can inform decision-making frameworks that align with evidence-based care while supporting individualized treatment strategies for geriatric DRFs.