AUC ASSUMPTIONS AND DISCLAIMER
The following assumptions clarified the interpretation of the clinical scenarios presented in the Treatment of Distal Radius Fractures Appropriate Use Criteria. This standardization ensures that those responsible for rating the appropriateness of a scenario and those reading these scenarios are using the same parameters to address the scenario.
Before these AUC are consulted, it is assumed that:
1. The patient is healthy enough to undergo surgery if indicated.
2. An adequate physical exam of the patient has been conducted.
3. Adequate radiographs have been obtained and examined by the clinician.
4. The patient history is available and has been reviewed by the clinician.
5. The patient has given adequate and informed consent.
6. The surgeon is trained and capable of performing all operative techniques with equal effectiveness.
7. The fracture is not so complex, and/or the patient’s comorbidities or social situation such a factor, as to represent an exception to these scenarios (e.g. C3.3 fracture that might be optimally treated with a distraction plate).
8. There is not a clear advantage (i.e. evidence for or against) for one procedure based on fracture pattern (e.g. volar plate for volar shearing fracture).
9. The surgery, when indicated, will be performed in a timely fashion to allow ideal treatment of the fracture.
10. The surgeon will perform the surgery in the most appropriate location (i.e., ASC, outpatient, inpatient) based on the health of the patient and other injuries rather the nature of the fracture. Open fractures and associated injuries may dictate that surgery should be inpatient.
11. The surgeon will choose a cost effective treatment based on the nature of the fracture and expectations after surgery.
12. The facility has each type of implant/equipment available and capable support personnel.
13. In the event that the patient has an open wound, it is assumed that the clinician has cleaned the wound before considering treatment.
14. It is assumed that a low-energy open fracture is a Grade I or II open fracture.
Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment. Practitioners are advised to consider management options in the context of their own training and background and institutional capabilities when selecting recommended treatment options.
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