Effectiveness and cost-effectiveness of surgery versus casting for elderly patients with D isplaced intra- A rticular type C distal R adius fractures: protocol of a randomised controlled T rial with economic evaluation (the DART study)

D P Ter Meulen, M A M Mulders, A A Kruiswijk, E J Kret, M E Slichter, J M van Dongen, G M M J Kerkhoffs, J C Goslings, Y V Kleinlugtenbelt, N W Willigenburg, N W L Schep, R W Poolman, DART Study Group, B A Twigt, A H van der Veen, Gjp Smits, E R Flikweert, Ebm Landman, Ejmm Verleisdonk, Kww Lansink, T Gosens, J W Colaris, B A van Dijkman, A J Dijkstra, M Rutgers, R G Zuurmond, S H van Helden, McQ Steinweg, N Oerlemans, B C van der Zwaard, S Romijn, Rjp van der Wal, J Vermeulen, C A Selles, P A Jawahier, B I Cleffken, D Haverkamp, A J Vochteloo, R Huis In 't Veld, R N van Veen, H R van den Berg, R Haverlag, M P Simons, A Rasker, Jpm Frölke, G A Kraan, Nmc Mathijssen, M R de Vries, N Sosef, A van Noort, I N Sierevelt, D P Ter Meulen, M A M Mulders, A A Kruiswijk, E J Kret, M E Slichter, J M van Dongen, G M M J Kerkhoffs, J C Goslings, Y V Kleinlugtenbelt, N W Willigenburg, N W L Schep, R W Poolman, DART Study Group, B A Twigt, A H van der Veen, Gjp Smits, E R Flikweert, Ebm Landman, Ejmm Verleisdonk, Kww Lansink, T Gosens, J W Colaris, B A van Dijkman, A J Dijkstra, M Rutgers, R G Zuurmond, S H van Helden, McQ Steinweg, N Oerlemans, B C van der Zwaard, S Romijn, Rjp van der Wal, J Vermeulen, C A Selles, P A Jawahier, B I Cleffken, D Haverkamp, A J Vochteloo, R Huis In 't Veld, R N van Veen, H R van den Berg, R Haverlag, M P Simons, A Rasker, Jpm Frölke, G A Kraan, Nmc Mathijssen, M R de Vries, N Sosef, A van Noort, I N Sierevelt

Abstract

Introduction: Current literature is inconclusive about the optimal treatment of elderly patients with displaced intra-articular distal radius fractures. Cast treatment is less invasive and less expensive than surgical treatment. Nevertheless, surgery is often the preferred treatment for this common type of distal radius fracture. Patients with a non-acceptable position after closed reduction are more likely to benefit from surgery than patients with an acceptable position after closed reduction. Therefore, this study aims to assess non-inferiority of functional outcomes after casting versus surgery in elderly patients with a non-acceptable position following a distal radius fracture.

Methods and analysis: This study is a multicentre randomised controlled trial (RCT) with a non-inferiority design and an economic evaluation alongside. The population consists of patients aged 65 years and older with a displaced intra-articular distal radius fracture with non-acceptable radiological characteristics following either inadequate reduction or redisplacement after adequate reduction. Patients will be randomised between surgical treatment (open reduction and internal fixation) and non-operative treatment (closed reduction followed by cast treatment). We will use two age strata (65-75 and >75 years of age) and a web-based mixed block randomisation. A total of 154 patients will be enrolled and evaluated with the patient-rated wrist evaluation as the primary outcome at 1-year follow-up. Secondary outcomes include the Disabilities of the Arm, Shoulder and Hand questionnaire, quality of life (measured by the EQ-5D), wrist range of motion, grip strength and adverse events. In addition, we will perform a cost-effectiveness and cost-utility analysis from a societal and healthcare perspective. Incremental cost-effectiveness ratios, cost-effectiveness planes and cost-effectiveness acceptability curves will be presented.

Ethics and dissemination: The Research and Ethics Committee approved this RCT (NL56858.100.16). The results of this study will be reported in a peer-reviewed journal. We will present the results of this study at (inter)national conferences and disseminate the results through guideline committees.

Trial registration number: Clinicaltrials.gov (NCT03009890). Dutch Trial Registry (NTR6365).

Keywords: clinical trials; hand & wrist; musculoskeletal disorders; orthopaedic & trauma surgery; trauma management.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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