National Surgical Trends for Distal Radius Fractures in Korea

  • Jo, Young-Hoon (Department of Orthopaedic Surgery, Hanyang University College of Medicine) ;
  • Lee, Bong-Gun (Department of Orthopaedic Surgery, Hanyang University College of Medicine) ;
  • Kim, Joo-Hak (Department of Orthopaedic Surgery, Myongji Hospital) ;
  • Lee, Chang-Hun (Department of Orthopaedic Surgery, Eulji University College of Medicine) ;
  • Kim, Sung-Jae (Department of Orthopaedic Surgery, Hallym University College of Medicine) ;
  • Choi, Wan-Sun (Department of Orthopaedic Surgery, Ajou University School of Medicine) ;
  • Koo, Ja-Wook (Department of Orthopaedic Surgery, Hanyang University College of Medicine) ;
  • Lee, Kwang-Hyun (Department of Orthopaedic Surgery, Hanyang University College of Medicine)
  • Received : 2017.01.14
  • Accepted : 2017.04.10
  • Published : 2017.07.10


The objective of this study was to investigate national surgical trends for distal radius fractures (DRFs) in Korea and analyze healthcare institution type-specific surgical trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2011 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes and procedure codes were used to identify patients aged ${\geq}20years$ with newly diagnosed DRFs. A total of 459,388 DRFs occurred from 2011 to 2015. The proportion of DRF cases treated by surgery tended to increase over time, from 32.6% in 2011 to 38.3% in 2015 (P < 0.001). Open reduction with internal fixation (ORIF) using a plate steadily gained in popularity each year, increasing from 39.2% of overall surgeries in 2011 to 60.9% in 2015. The type of surgery for DRFs differed depending on the type of healthcare institution. ORIF (91%) was the most popular procedure in tertiary hospitals, whereas percutaneous pinning (58%) was most popular in clinics. In addition, general hospitals and hospitals with 30-100 beds used external fixation more frequently than tertiary hospitals and clinics did. Overall, our findings indicate that surgical treatment of DRF, particularly ORIF, continues to increase, and that the component ratio of operation codes differed according to the healthcare institution type.


  1. Mattila VM, Huttunen TT, Sillanpaa P, Niemi S, Pihlajamaki H, Kannus P. Significant change in the surgical treatment of distal radius fractures: a nationwide study between 1998 and 2008 in Finland. J Trauma 2011; 71: 939-42.
  2. Oinuma T, Sakuma M, Endo N. Secular change of the incidence of four fracture types associated with senile osteoporosis in Sado, Japan: the results of a 3-year survey. J Bone Miner Metab 2010; 28: 55-9.
  3. Kwon GD, Jang S, Lee A, Park CM, Lee YK, Kim TY, Kim HY, Park EJ, Ha YC. Incidence and mortality after distal radius fractures in adults aged 50 years and older in Korea. J Korean Med Sci 2016; 31: 630-4.
  4. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37: 691-7.
  5. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26: 908-15.
  6. Kodama N, Imai S, Matsusue Y. A simple method for choosing treatment of distal radius fractures. J Hand Surg Am 2013; 38: 1896-905.
  7. Walenkamp MM, Mulders MA, Goslings JC, Westert GP, Schep NW. Analysis of variation in the surgical treatment of patients with distal radial fractures in the Netherlands. J Hand Surg Eur Vol Forthcoming 2016.
  8. Ng CY, McQueen MM. What are the radiological predictors of functional outcome following fractures of the distal radius? J Bone Joint Surg Br 2011; 93: 145-50.
  9. Arora R, Gabl M, Erhart S, Schmidle G, Dallapozza C, Lutz M. Aspects of current management of distal radius fractures in the elderly individuals. Geriatr Orthop Surg Rehabil 2011; 2: 187-94.
  10. de Putter CE, Selles RW, Polinder S, Hartholt KA, Looman CW, Panneman MJ, Verhaar JA, Hovius SE, van Beeck EF. Epidemiology and health-care utilisation of wrist fractures in older adults in the Netherlands, 1997-2009. Injury 2013; 44: 421-6.
  11. Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004-2010. Acta Orthop 2013; 84: 292-6.
  12. Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am 2009; 91: 1868-73.
  13. Waljee JF, Zhong L, Shauver MJ, Chung KC. The influence of surgeon age on distal radius fracture treatment in the United States: a population-based study. J Hand Surg Am 2014; 39: 844-51.
  14. Sebastin SJ, Chung KC. An Asian perspective on the management of distal radius fractures. Hand Clin 2012; 28: 151-6.
  15. Mellstrand Navarro C, Ahrengart L, Tornqvist H, Ponzer S. Volar locking plate or external fixation with optional addition of K-wires for dorsally displaced distal radius fractures: a randomized controlled study. J Orthop Trauma 2016; 30: 217-24.
  16. Abramo A, Kopylov P, Geijer M, Tagil M. Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: a randomized study of 50 patients. Acta Orthop 2009; 80: 478-85.
  17. Leung F, Tu YK, Chew WY, Chow SP. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study. J Bone Joint Surg Am 2008; 90: 16-22.
  18. Xie X, Xie X, Qin H, Shen L, Zhang C. Comparison of internal and external fixation of distal radius fractures. Acta Orthop 2013; 84: 286-91.
  19. Walenkamp MM, Bentohami A, Beerekamp MS, Peters RW, van der Heiden R, Goslings JC, Schep NW. Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis. Strateg Trauma Limb Reconstr 2013; 8: 67-75.
  20. Dicpinigaitis P, Wolinsky P, Hiebert R, Egol K, Koval K, Tejwani N. Can external fixation maintain reduction after distal radius fractures? J Trauma 2004; 57: 845-50.
  21. Jeudy J, Steiger V, Boyer P, Cronier P, Bizot P, Massin P. Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation 'versus' locked volar plating. Injury 2012; 43: 174-9.
  22. Grewal R, MacDermid JC, King GJ, Faber KJ. Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial. J Hand Surg Am 2011; 36: 1899-906.
  23. Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PR. External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury 2013; 44: 409-16.
  24. Kandemir U, Matityahu A, Desai R, Puttlitz C. Does a volar locking plate provide equivalent stability as a dorsal nonlocking plate in a dorsally comminuted distal radius fracture?: a biomechanical study. J Orthop Trauma 2008; 22: 605-10.
  25. Fernandez DL, Jakob RP, Buchler U. External fixation of the wrist. Current indications and technique. Ann Chir Gynaecol 1983; 72: 298-302.