DRAFFT Impact Study DIS Dr J Fennelly Dr

DRAFFT Impact Study - DIS Dr J Fennelly, Dr G Neal-Smith,

Background • Distal radius fractures are one of the most common injuries seen by the trauma and orthopaedic team. • Around 10% of women experience this injury by the age of 90 in the Western world. • Management methods include: • Non-operative via plaster • Surgical fixation: K-wiring or plating

Background NICE guidance (point 1. 4. 3): The UK DRAFFT trial - No difference between Kirschner wires and volar locking plates for dorsally displaced distal radius fractures - Kirschner-wire fixation is less expensive and quicker to perform

DRAFFT Impact Study Part 1: Audit Aims and Objectives 1. To assess the compliance in the surgical management of distal radius fractures 2. To gain insight into surgical management trends of acute adult distal radius fractures nationally

DRAFFT Impact Study Part 2: Questionnaire Aim and Objective: 1. To gain an insight into the impact of the DRAFFT study and its results on the decision making processes of surgeons involved in the management of distal radius fractures

Part 1: Methods • National Study: Simultaneous local audits, with identical protocols, at various centres in UK. • Data Collection Period: The last 20 distal radius fractures managed operatively at the trust’s orthopaedic department in 2017. • Patient age; Patient gender; Side of injury; Date and time of diagnosis; AO fracture classification & Frykman fracture classification; Distance from radiocapal joint >3 cm; Open/Closed injury; Fracture angulation; Polytrauma; Operation date and time • Data Collection Tool: • Standardised, locked Excel spreadsheet.

Part 1: Analysis Data from registered institutions will be collated analysed: • Percentage compliance with current NICE guidelines (point 1. 4. 3) per hospital. • Subgroup analysis will be performed on patients who meet DRAFFT trial inclusion criteria • Only descriptive statistics will be used.

Part 2: Methods Strategy Consultants complete short questionnaire on distal radius fracture management Validation The questionnaire has been validated using the ‘Think Aloud’ process Data to be collected includes: • Years of experience managing distal radius fractures • Knowledge or involvement in DRAFFT trial • Impact of DRAFFT upon their clinical practice Part 2: Analysis Qualitative analysis on different consultant surgical opinions

Presentation • Data will be made available to all contributing institutions. • Local presentation - to identify precise matters of potential improvement locally • Regional/National presentation- epidemiological data and audit standards achieved presented at orthopaedic meetings ensuring wide dissemination. • Individual trusts may request a comparative analysis of their local standards against the regional/national standard.

Recommendations to local institutions, following discussion, to facilitate change in practice in accordance with guidelines. Future repeat of audit. Costs No local costs should be incurred through the routine collection of audit data for national standards.

Deadlines • July 2018 - Proposed start of data collection • August 2018 - Proposed date for presentation of results: Forum: Local M+M meeting / Regional Meeting - Proposed finish date: i. e. after report / final action plan

With many thanks to The National Orthopaedic Trainee Collaboratives • The Birmingham Orthopaedic Network • Ox. Scar

References Nice. org. uk. (2016). [online] Available at: https: //www. nice. org. uk/guidance/ng 38/documents/fracturesfull-guideline 2 [Accessed 14 Jun. 2018] Costa, M. , Achten, J. , Parsons, N. , Rangan, A. , Edlin, R. , Brown, J. and Lamb, S. (2011). UK DRAFFT - A randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius. BMC Musculoskeletal Disorders, 12(1).