Resident Participation in Operative Fixation of Distal Radius Fractures: A Comparison of Outcomes

Purpose: Our purpose was to compare open reduction internal fixation (ORIF) of distal radius fracture (DRF) cases performed either entirely or in part by supervised hand surgery residents against those performed entirely by the attending surgeon. Methods: All patients undergoing isolated ORIF DRF by four attending surgeons within a three year period were analyzed. Cases were categorized according to degree of resident involvement: ORIF performed by attending with either no resident or a resident as assistant (group 1), resident performing a portion of the procedure (group 2), or resident performing the entire procedure (group 3). Early postoperative complications, operative times, fluoroscopic use, and radiographic reduction quality were outcomes of interest. We used a noninferiority design, hypothesizing that resident involvement would not be associated with inferior outcomes compared to cases without resident involvement. Multiple logistic regression models, adjusted for patient demographic and surgical characteristics, were fit to assess the relationship between resident involvement and surgical outcomes. Results: A total of 390 cases were included. The mean age was 60 years, and 74% of cases involved women. DRF surgeries with resident involvement (groups 2 + 3) were noninferior to surgeries in group 1 in terms of the ulnar variance, radial inclination, radiation exposure events, exposure time, total radiation dose, and operative time. Soong grade, complications, and reoperations were not noninferior, with lower rates of complications/reoperations noted in the cases with resident involvement. Conclusions: Resident participation in DRF fixation cases under appropriate supervision yields outcomes that are largely noninferior to attending-only procedures across most outcomes, including reduction quality, radiation exposure, and operative time. The lower rates of short-term complications and more optimal plate positioning in resident-involved cases are likely attributable to selection bias with more complex cases performed by attendings only. These data can be used during perioperative discussions, particularly in academic centers, where patients may express concerns regarding the role of trainees in their surgical care. Type of study/level of evidence: Therapeutic II.