- Design
- Cost and quality-of-life analysis within a multicentre cluster-randomised trial (CAST)
- Population
- 693 adults with displaced distal radius fractures
- Primary outcome
- Societal cost per patient and EQ-5D-5L at 1 year
- Effect
- €2,212 non-operative vs €4,339 immediate plating vs €4,393 delayed plating
An analysis of the Dutch CAST trial (European Journal of Trauma and Emergency Surgery, 7 October) followed 693 adults with displaced distal radius fractures for a year and costed their care from a societal perspective, including healthcare, patient and productivity costs.
Mean total cost per patient was about €2,212 with non-operative treatment, €4,339 with immediate plate fixation and €4,393 with delayed plating after redisplacement. Quality of life improved between 3 and 12 months in every group but did not return to pre-injury levels in any.
The practical point is that trying a cast first and plating only if the fracture redisplaces costs barely more than plating immediately, while saving surgery in those who stay aligned. This is a descriptive cost study, not a formal cost-effectiveness analysis, and the groups were not randomised by treatment.
- Consider initial non-operative treatment for displaced distal radius fractures with acceptable reduction.
- Arrange radiographic follow-up to detect redisplacement early.
- Counsel patients that delayed plating, if needed, is not more costly than immediate plating.
- Warn patients that wrist function may not return fully to pre-injury level by one year.
Why it matters
It removes the cost argument for plating everyone early to avoid a second episode of care.
Don't overread it
Treatment groups were not randomised, so the cost differences partly reflect which patients were selected for surgery.
The statistics, in plain English
These are mean costs per patient in a descriptive analysis. The €58 difference between immediate and delayed plating is negligible.
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