Introduction Fractures of the distal radius are common, in woman > 65 years, due to low energy trauma. Treatment has consisted of reduction and cast for 5 weeks, or surgery with reduction and fixation by a volar plates. After one year, patients report similar outcome, regardless the treatment received.¹ The risk for complications and reoperations differ,² and a shared decision making tools was developed.

Methods A shared-decision making (SDM) tool for patients > 65 years, diagnosed and treated at orthopedic department in Kolding, and implemented in the outpatient clinic.

The tool was developed,³ according to the following steps.

Literature search; Patient interviews; Creating the Shared Decision-making tool with balanced information; Pilot test; Education of medical staff; Implementation in clinical practice; Patient and Doctor satisfaction was measured after 3 months and 1 year.

Results The SDM tool was used at the following visit in the outpatient clinic. If a displacement was observed, the SDM tool was used in the conversation and patients were encouraged to state their preference of treatment and choose between casting or surgery. A survey conducted after 3 months, shows high rates of satisfaction, patients scored 22,6 (20–25), doctors 20.7 (10–25). After 1 year patients scored 22.2 (19–25) and doctors 22.8 (18–25).

Discussion Patients stated that they were happy with the SDM tool, and that it stated the different complications that could occur after casting or surgery. Young doctors, with < 2 years of orthopedic training stated that the SDM tool helped them thru the conversation and reminded them to ask for the patients priorities and preferences.⁴ Orthopedic Surgeons with > 10 years of experience felt less ‘guided’ and more restricted in the conversation with patients.

Conclusion A SDM tool helps and facilitates the conversation with patients, and both doctors and patients are satisfied with the tool.

References

1. Hasselund, et al. Cast imobillisation is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures. Bone Joint 2021;103-B(2):247–255.

2. Selles, et al. Volar plate fixation versus cast immobilization in acceptably reduced intra-articular distal radial fractures: a randomized controlled trial. J Bone Joint Surg Am. 2021;00:1–7.

3. Elwyn, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012 Oct;27(10):1361–7.

4. Tonelli MR, Sullivan MD. Person-centered shared decision making. J Eval Clin Pract. 2019 Dec;25(6):1057–1062.