Original Title: Evaluering af non-operativ behandling af distal radiusfraktur hos patienter over 65 år

Authors' objectives: The Danish National Clinical Guideline on the treatment of distal radial fractures has expired and since then, new evidence suggests clinical outcomes for both non-surgical and surgical treatment are comparable. Incidentally, a general increase in the use of surgical treatment of distal radius fractures is reported, which is associated with greater resource consumption compared to non-surgical treatment. The DHTC wished to assess the current evidence on the topic to recommend the preferred choice of treatment for distal radius fractures for patients over 65 years.

Authors' results and conclusions: Clinical effect and safety: based on the included studies, the Expert Committee assesses no clinically significant relevant differences in the chosen outcomes. However, the Expert Committee notes a relatively large spread in the results, indicating heterogeneity in the patient groups. Overall, the assessment concludes that non-surgical treatment may be equivalent to surgical treatment among patients over 65 with a dorsally displaced radius fracture. Patient perspective: No clear preference between treatment options was identified in the patient population based on the included literature. However, two important factors were identified for patients in their preference for treatment: autonomy and insecurity. Organizational implications: Based on the mapping of the care pathways for non-surgical and surgical treatment of distal radius fractures, these, in terms of the number of controls and rehabilitation courses, are deemed comparable. The differences between the two treatment alternatives are primarily the surgical procedure performed for patients receiving surgical treatment. The Expert Committee notes that there is variation in care pathways between regions, hospitals, and patients that are not included in the present study. This means that additional differences may occur between the two treatment courses. By rescheduling half of the surgeries currently performed on distal radius fractures in patients over 65 years, there is a potential to gain surgical capacity equivalent to approximately 1000 surgeries every year. The Expert Committee emphasizes that any gain in staff time and surgical capacity is expected to contribute to the promotion of timeliness in surgical treatments within the orthopedic surgical specialty and help reduce waiting lists and the number of sub-acute and planned surgeries that are canceled and rescheduled. Concerning the question of task relocation through increased use of non-surgical treatment, it has not been possible to identify relevant literature or evidence that could contribute to the answer. Health economics: Results show that non-surgical treatment is associated with a cost saving of approximately DKK 9,900 per patient. Sensitivity analyses do not change the conclusion that non-surgical treatment is cost-saving compared to surgical treatment. The budget impact analysis indicates that implementing a positive recommendation of non-surgical treatment, resulting in 50% of the surgeries performed today being converted to non-surgical treatment, will result in a total budget impact of approximately DKK -43 million over five years. Sensitivity analyses show the size of the budget impact depends on the proportion of surgical treatments carried out under current clinical practice and the proportion of surgeries that are expected to be converted to non-surgical treatment. Due to variations between regions and hospitals, the Expert Committee emphasizes that the potential associated with increasing the proportion of non-surgical treatments may have been fully or partially fulfilled before the present assessment.

Project Status: Completed

Year Published: 2024

URL for published report: https://behandlingsraadet-classic.azureedge.net/media/wtbcc025/summary-of-recommendation-distal-radius-fractures.pdf

URL for additional information: https://behandlingsraadet-classic.azureedge.net/media/mqqhc4qc/evalueringsrapport.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Denmark

Organisation Name: The Danish Health Technology Council

Contact Address: Niels Jernes Vej 6a, 9220 Aalborg

Contact Name: Nikolaj Hellmuth Skak

Contact Email: nsp@behandlingsraadet.dk