Variation Among Pediatric Orthopaedic Surgeons When Diagnosing and Treating Pediatric and Adolescent Distal Radius Fractures

Background: Distal radius fractures are the most common injury in the pediatric population. The purpose of this study was to determine the variation among pediatric orthopaedic surgeons when diagnosing and treating distal radius fractures. Methods: Nine pediatric orthopaedic surgeons reviewed 100 sets of wrist radiographs and were asked to describe the fracture, prescribe the type of treatment and length of immobilization, and determine the next follow-up visit. kappa statistics were performed to assess the agreement with the chance agreement removed. Results: Only fair agreement was present when diagnosing and classifying the distal radius fractures (kappa=0.379). There was poor agreement regarding the type of treatment that would be recommended (kappa=0.059). There was no agreement regarding the length of immobilization (kappa=-0.004). Poor agreement was also present regarding when the first follow-up visit should occur (kappa=0.088), whether or not new radiographs should be obtained at the first follow-up visit (kappa=0.133), and if radiographs were necessary at the final follow-up visit (kappa=0.163). Surgeons had fair agreement regarding stability of the fracture (kappa=0.320). A subgroup analysis comparing various traits of the treatment immobilization showed providers only had a slight level of agreement on whether splint or cast immobilization should be used (kappa=0.072). There was poor agreement regarding whether long-arm or short-arm immobilization should be prescribed (kappa=-0.067). Twenty-three of the 100 radiographs were diagnosed as a torus/buckle fracture by all 9 surgeons. kappa analysis performed on all the treatment and management questions showed that each query had poor agreement. Conclusions: The interobserver reliability of diagnosing pediatric distal radius fractures showed only fair agreement. This study demonstrates that there is no standardization regarding how to treat these fractures and the length of immobilization required for proper fracture healing. Better classification systems of distal radius fractures are needed that standardize the treatment of these injuries. Level of Evidence: Level II.