title: Variability in orthopedic surgeon treatment preferences for nondisplaced scaphoid fractures: A cross-sectional survey.
abstract: OBJECTIVE
  The absence of a best practice treatment standard contributes to clinical variation in medicine. Often in the absence of evidence, a standard of care is developed and treatment protocols are implemented. The purpose of this study was to examine whether the standard of care for the treatment of nondisplaced scaphoid fractures is uniform among orthopedic surgeons.
  
  
  METHODS
  A survey of orthopedic surgeons actively practicing in the US or abroad was conducted to elicit preferred treatment strategies for nondisplaced scaphoid fractures. The surgeons were recruited at orthopedic conferences, clinical visits, and via email. The survey included demographic questions along with a short clinical vignette. The option for fracture management included surgical versus nonsurgical treatment. For those who chose nonsurgical treatment, type/duration of immobilization was recorded. Cost analysis was performed to estimate direct and indirect costs of various treatment options.
  
  
  RESULTS
  A total of 494 orthopedic surgeons completed the survey. The preference for surgical treatment was preferred in 13% of respondents. Hand/upper extremity specialists were significantly more likely to operate compared with generalists (p = 0.0002). Surgeons younger than forty-five were nearly twice as likely to choose surgery (p = 0.01). There was no clear consensus on duration of immobilization as 30% of surgeons chose 6 weeks, 33% selected 8 weeks, and 27% opted for 12 weeks. Total cost of surgery was 49% greater than that of nonoperative treatment. With each additional week of immobilization for nonoperative treatment, the total costs of surgical treatment near that of nonoperative treatment.
  
  
  CONCLUSIONS
  There exist clear trends in how specific demographic groups choose to treat the nondisplaced scaphoid fracture. Whether these trends are the result of generational gaps or additional subspecialty training remains difficult to determine, but there is need to pursue a more consistent approach that benefits the patients and the health care system as a whole.
authors.affiliation: Georgetown University Hospital, 3800 Reservoir Rd, NW, Washington, DC 20007, United States.
authors.forename: Megan Carroll
authors.initials: MC
authors.lastname: Paulus
authors.affiliation: Georgetown University School of Medicine, 3900 Reservoir Rd, NW, Washington, DC 20007, United States.
authors.forename: Jake
authors.initials: J
authors.lastname: Braunstein
authors.affiliation: Georgetown University Medical Center, 4000 Reservoir Rd, NW, Washington, DC 20007, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Merenstein
authors.affiliation: Orthopaedic Foot & Ankle Center of Washington, 2922 Telestar Ct, Falls Church, VA 22042, United States.
authors.forename: Steven
authors.initials: S
authors.lastname: Neufeld
authors.affiliation: Georgetown University School of Medicine, 3900 Reservoir Rd, NW, Washington, DC 20007, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Narvaez
authors.affiliation: Georgetown University School of Nursing and Health Studies, 3700 Reservoir Rd, NW, Washington, DC 20007, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Friedland
authors.affiliation: Georgetown University School of Nursing and Health Studies, 3700 Reservoir Rd, NW, Washington, DC 20007, United States.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bruce
authors.affiliation: Georgetown University School of Medicine, 3900 Reservoir Rd, NW, Washington, DC 20007, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Pfaff
keywords: Cost analysis; Nondisplaced; Scaphoid fracture; Treatment