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 Aims and Objectives Part 1: Audit Aims and Objectives To assess the compliance in the surgical management of distal radius fractures To gain insight into surgical management trends of acute adult distal radius fractures nationally (Collaborative national audit project) at a local, regional and national level. in light of the DRAFFT study.

DRAFFT Impact Study Aim and Objective: 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 >3cm; Open/Closed injury; Fracture angulation; Polytrauma; Operation; Operation date and time Data Collection Tool: Standardised, locked Excel spreadsheet. Collaborators in each participating trust will collect data using a locked, coded Excel spreadsheet. No patient identifiable data will be gathered. The recruitment data collection period is ​the last 20 patients of 2017 (i.e. working backwards from 31/12/17)​. All acute adult distal radius fractures managed operatively working back from this date will be included in the study. Recommendations for this include: Trauma databases - On-call patient admissions list Theatre logbooks/lists Clinical coding Retrospectively collect data using spreadsheet provided, most of the data will be available from: ​PACS/ Radiology systems ​On-call lists ​If unable to collect all information. Also consider Operation notes Electronic Clinic letters Discussion with treating clinician

Part 1: Analysis Data from registered institutions will be collated and 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. ​https://www.ncbi.nlm.nih.gov/books/NBK276570/ Inclusion criteria:

Part 2: Methods Part 2: Analysis 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 What is this questionnaire? The questionnaire is designed to supplement the findings of the audit to help us gain an insight into how decisions are made in the operative management of distal radius fractures. The audit assesses current practice whereas the questionnaire assesses the decision makers. Is the questionnaire validated? Yes - we used a process known as ‘Think Aloud’ to validate the questionnaire. This is a methodology that has been used previously in the literature as well as in one of the papers on the ProFHER trial: https://online.boneandjoint.org.uk/doi/full/10.1302/2046-3758.610.BJR-2017-0170 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.

Costs Recommendations 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 OxScar

References Nice.org.uk. (2016). [online] Available at: https://www.nice.org.uk/guidance/ng38/documents/fractures-full-guideline2 [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).