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Bharadwaj RG. Choosing your implant - Volar locking plates - Horses for courses. J Orthop 2024; 50:12-21. [PMID: 38152626 PMCID: PMC10749827 DOI: 10.1016/j.jor.2023.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Ravi G. Bharadwaj
- Dept. of Orthopaedics, Apollo Multispecialty Hospitals, 58 Canal Circular Road, Kolkata, 700054, India
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Abstract
BACKGROUND Communication between health care providers is becoming more intertwined with technology. During the pandemic, telehealth strategies grew exponentially. Remote viewing of imaging on a smartphone may offer efficient communication; however, the reliability of injury assessment when compared with traditional methods is not known. The purpose of this study was to evaluate intraobserver and interobserver reliability of distal radius fracture radiograph review for smartphone versus traditional Picture Archiving and Communication System (PACS). METHODS Eight evaluators (3 attending hand surgeons, 3 hand surgery fellows, 2 orthopedic residents) evaluated 26 distal radius fracture radiographs on 2 different viewers: smartphone or PACS. The reviewers were asked to record: (1) operative or nonoperative preference; (2) fracture classification (based on Fernandez and Jupiter); and (3) treatment strategy (volar plate, dorsal plate, pins, cast, bridge plate, or fragment-specific fixation). The percentage of intraobserver agreement was recorded for each observer. Reliability was calculated using Fleiss' kappa coefficient for intraobserver and interobserver agreement and graded by strength of correlation. RESULTS Intraobserver agreement averaged 97% when deciding between operative and nonoperative treatment, 76% for classification, and 84% for treatment. Kappa scores were graded as "excellent" for operative decision and "substantial" for classification and treatment. Attendings and fellows generally had higher agreement than that of residents. Interobserver agreement was graded as "substantial" for all categories for both PACS and smartphone. CONCLUSIONS Evaluation of radiographs on a smartphone for the purpose of treating distal radius fractures does not appear to be significantly different from an evaluation on traditional PACS.
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Affiliation(s)
| | | | - Emily Tan
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Eon K. Shin
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Rick Tosti
- Thomas Jefferson University, Philadelphia, PA, USA
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3
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Jamnik AA, Chacon J, Xiao AX, Wagner ER, Gottschalk MB. The Effect Immobilization Mechanisms Have on Radiographic Outcomes and Complication Rates in the Conservative Treatment of Distal Radius Fractures: A Systematic Review. Hand (N Y) 2022; 17:118S-128S. [PMID: 35373590 PMCID: PMC9793616 DOI: 10.1177/15589447221081864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Distal radius fractures (DRFs) are among the most common fractures in the United States. Despite their high incidence, there is no consensus on the optimal type of cast or splint to treat these fractures. The purpose of this systematic review is to evaluate the available literature pertaining to the outcomes for different constructs used to conservatively treat DRFs. A literature search of PubMed, Medline, and Embase was conducted to identify research comparing the outcomes of various immobilization mechanisms. In particular, endpoints included complications (eg, loss of reduction, pain), radiographic outcomes, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. A total of 1655 articles were identified during the literature search, and 22 ultimately fulfilled inclusion criteria. These 22 studies included 1826 conservatively treated DRFs. The different immobilization mechanisms were divided into 8 groupings: above-elbow casts, above-elbow splints, below-elbow casts, below-elbow splints, gutter or spica casts, gutter or spica splints, dorsal-volar splints, and dorsal splints. Qualitative review of the studies determined that below-elbow constructs result in equal or better functional and radiologic outcomes when compared with above-elbow constructs. Meta-analysis demonstrated that a statistically significant difference (P = .04) existed in the incidence of loss of reduction between the immobilization constructs, although post hoc analysis did not detect significant differences between 2 particular constructs.
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Affiliation(s)
| | - Jose Chacon
- American University of Integrative
Sciences, Tucker, GA, USA
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4
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Roelofs LJM, Meesters AML, Assink N, Kraeima J, Van der Meulen TD, Doornberg JN, De Vries JPPM, Hoekstra J, ten Duis K, IJpma FFA. A new quantitative 3D gap area measurement of fracture displacement of intra-articular distal radius fractures: Reliability and clinical applicability. PLoS One 2022; 17:e0275206. [PMID: 36166437 PMCID: PMC9514643 DOI: 10.1371/journal.pone.0275206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Gap and step-off measurements are generally used in the surgical decision-making process of distal radius fractures. Unfortunately, there is no consensus on treatment choice as these measurements are prone to inter- and intraobserver variability. In this study, we aim to introduce a new 3D fracture quantification method and compare it to conventional fracture analysis. Methods Forty patients with a minimally displaced intra-articular distal radius fracture that was treated nonoperatively between 2008–2015 were included. 2D-CT images were reassessed by three orthopedic trauma surgeons who performed gap and step-off measurements. Subsequently, 3D models were created and a 3D measurement method for fracture displacement was developed. For each fracture, the ‘3D gap area’ (3D surface between all fracture fragments) was determined by three observers. Interobserver agreements were calculated for all measurements, and the intraobserver agreement was calculated for the new 3D measurement. All patients completed two questionnaires in order to link our measurements to functional outcome. Results The interobserver agreement of the 2D measurements was fair (ICC = 0.54) for the gap and poor (ICC = 0.21) for the step-off. The median gap was 2.8 (IQR: 1.9–3.5) mm and step-off was 0.9 (IQR: 0.0–1.6) mm. Interobserver agreement on 3D gap area measurements was excellent (ICC = 0.81), with a median difference between measurements of 6.0 (IQR: 2.0–19.0) mm2, which indicates reliable assessment of 3D fracture displacement. Intraobserver agreement was also excellent (ICC = 0.98), with a median difference of 4.0 (IQR: 1.5–5.5) mm2. No significant differences in clinical outcome were found between the above and below 2mm displacement groups. The score of the DASH was 3.4 (IQR: 0.4–8.8) versus 4.2 (IQR: 0.0–11.6) respectively. Results from the PRWE questionnaire shows a similar result of 3.5 (IQR: 0.0–12.6) versus 5.0 (IQR: 0.0–25.5). Conclusion 3D gap area is a more objective measurement method compared to the conventional gap and step-off measurements to quantify the level of fracture displacement of distal radius fractures. 3D fracture assessment can be used in addition to the currently used classification systems of distal radius fractures.
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Affiliation(s)
- Lisanne J. M. Roelofs
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M. L. Meesters
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nick Assink
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab/Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim D. Van der Meulen
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Job N. Doornberg
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Surgery, Subdivision of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean-Paul P. M. De Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost Hoekstra
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kaj ten Duis
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank F. A. IJpma
- Department of Surgery, Subdivision of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
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5
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Carula BC, Giostri GS, Bebber F, Batista MFDS, Silva FBD, Novak EM. Evaluation of Intra- and Interobserver Reproducibility of the New AO/OTA Classification for Distal Radius Fractures Compared with the Fernandez Classification. Rev Bras Ortop 2022; 57:917-923. [PMID: 36540737 PMCID: PMC9757955 DOI: 10.1055/s-0041-1740471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/13/2021] [Indexed: 10/14/2022] Open
Abstract
Objective To evaluate the inter- and intraobserver reliability and reproducibility of the new AO/OTA 2018 classification for distal radius fractures and to compare it with the Fernandez classification system. Method A questionnaire was applied in the Qualtrics software on 10 specialists in hand surgery who classified 50 radiographs of distal radius fractures according to the Fernandez and AO/OTA 2018 classifications and, subsequently, indicated their treatment. The questionnaire was applied in time T0 and repeated after 4 weeks (t1) . The mean agreement between the answers, and the reliability and inter- and intraobserver reproducibility were analyzed using kappa indexes. Results The mean interobserver agreement in the Fernandez classification was 76.4, and it was 59.2% in the AO/OTA 2018 classification. The intraobserver agreements were 77.3 and 56.6%, respectively. The inter- and intraobserver kappa indexes for the Fernandez classification were 0.57 and 0.55, respectively, and, in the AO/OTA 2018 classification, they were 0.34 and 0.31, respectively. Conclusion The AO/OTA 2018 classification showed a low intra- and interobserver reproducibility when compared with the Fernandez classification. However, both classifications have low intra- and interobserver indexes. Although the Fernandez classification did not obtain excellent results, it remains with better agreement for routine use.
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Affiliation(s)
- Beatriz Canhoto Carula
- Hospital Universitário Cajuru, Curitiba, PR, Brasil,Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brasil,Endereço para correspondência Beatriz Canhoto Carula, MD Rua Desembargador Mota1648, Curitiba, PRBrasil
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6
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Calotta NA, Shores JT, Coon D. Upper-Extremity Venous Thromboembolism Following Operative Treatment of Distal Radius Fractures: An Uncommon but Dangerous Complication. J Hand Surg Am 2021; 46:1123.e1-1123.e7. [PMID: 34001409 DOI: 10.1016/j.jhsa.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius fractures are the most common long bone fracture in the United States, with an estimated incidence of 640,000 cases per year. Operative fixation presents a theoretical risk factor for the development of upper-extremity venous thromboembolism (UE-VTE). Additionally, patients presenting with distal radius fracture commonly have preexisting comorbidities that further increase the risk of UE-VTE. Finally, UE-VTE is considered the highest risk for eventual development of pulmonary embolism. Despite this, scant attention has been paid to studying UE-VTE in this population. The purpose of this study was to measure the incidence of this complication and to identify possible medical factors that increased the risk of developing UE-VTE. METHODS We queried the Truven MarketScan Commercial Claims and Encounters Database for all patients who experienced a distal radius fracture and were subsequently treated with open reduction and internal fixation between 2012 and 2016. Patients were identified using relevant Common Procedural Terminology codes. Demographic and medical variables were tabulated. Our primary outcome was the development of ipsilateral UE-VTE or pulmonary embolism in the first 60 days after surgery. RESULTS The study included 24,494 patients. The mean age was 50.7 years (range, 18-91), and 58% were women. There were 79 cases (0.3%) of UE-VTE and 19 cases of pulmonary embolism in the study population (24.1% of all UE-VTE cases; 0.08% of total sample). Multivariable logistic regression showed that coexisting heart failure and estrogen use were associated with increased risk of UE-VTE. CONCLUSIONS Although uncommon, the development of UE-VTE after open reduction and internal fixation for distal radius fractures is a concerning complication. Coexisting heart failure and estrogen use are associated with increased risk of UE-VTE. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Nicholas A Calotta
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Devin Coon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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7
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Esworthy GP, Johnson NA, Divall P, Dias JJ. Origins of the threshold for surgical intervention in intra-articular distal radius fractures. Bone Joint J 2021; 103-B:1457-1461. [PMID: 34465150 DOI: 10.1302/0301-620x.103b9.bjj-2021-0313.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement. METHODS A systematic review of three databases was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. This search identified papers investigating functional outcome, including presence of arthritis, following injury. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. RESULTS Knirk and Jupiter (1986) were the first to quantify a threshold, with all their patients developing arthritis with > 2 mm displacement. Some papers have discussed using 1 mm, although 2 mm is most widely reported. Current guidance from the British Society for Surgery of the Hand and a Delphi panel support 2 mm as an appropriate value. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, radiological arthritis does not correlate with the clinical presentation. Function following injury has been shown to be equivalent to an uninjured population, with arthritis progressing slowly or not at all. Joint space narrowing has also been shown to often be benign. CONCLUSION Knirk and Jupiter originated the threshold value of 2 mm. The lack of correlation between the radiological and clinical presentations warrants further modern investigation. Measurement often varies between observers, calling a threshold concept into question and showing the need for further development in this area. The principle of treatment remains restoration of normal anatomical position. Cite this article: Bone Joint J 2021;103-B(9):1457-1461.
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Affiliation(s)
| | - Nick A Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.,Pulvertaft Hand Centre, Derby, UK
| | - Pip Divall
- Education Centre Library, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joseph J Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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8
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De Jonge MC, Assink J, Vanhoenacker FM. Acute Bony Injuries of Hand and Wrist. Semin Musculoskelet Radiol 2021; 25:277-293. [PMID: 34374063 DOI: 10.1055/s-0041-1729151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. At the carpal level, scaphoid fractures are the most common followed by fractures of the dorsal side of the triquetrum. The metacarpals often fracture, most commonly the base of the thumb and the subcapital region of the fifth metacarpal. In the fingers, we encounter many different types of fractures, often avulsions reflecting underlying soft tissue pathology (e.g., mallet finger). Dislocations are common in the fingers, predominantly in the distal interphalangeal joints. From an imaging standpoint, conventional radiography is always the initial examination. Complex (intra-articular) fractures, fracture-dislocation injuries, and a strong clinical suspicion of radiographically occult fractures need to be further evaluated for decision making regarding treatment. Computed tomography is the primary imaging modality of choice for the first two. In the latter, magnetic resonance imaging can be preferable, depending on clinical suspicion and the local situation in the associated hospital.
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Affiliation(s)
- Milko C De Jonge
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Joeri Assink
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium.,Department of Radiology, Ghent University Hospital, Ghent, Belgium
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9
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Boersma EZ, Nijhuis-van der Sanden MWG, Edwards MJR, Ring D, Teunis T. Satisfaction with Alignment After Reduction of a Displaced Distal Radial Fracture. J Bone Joint Surg Am 2021; 103:483-488. [PMID: 33475312 DOI: 10.2106/jbjs.20.00482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alignment adequate to offer nonoperative treatment after reduction of a distal radial fracture is a matter of opinion. This study addressed factors associated with interobserver reliability of satisfaction with alignment after the reduction of a distal radial fracture. METHODS A survey sent to members of the Science of Variation Group divided the participants into 4 groups that each rated 24 sets of radiographs of adult patients with a distal radial fracture before and after manipulative reduction and cast or splint immobilization. This resulted in a total of 96 fractures rated by 111 participants. Observers indicated whether they were satisfied with the reduction, meaning that nonoperative treatment was an option, or not, meaning that they recommend surgery. The Fleiss kappa was used to measure reliability. RESULTS There was fair reliability of satisfaction with reduction of a distal radial fracture (kappa, 0.34 [95% confidence interval (CI), 0.28 to 0.41]). No surgeon factors were associated with variations in reliability. Multivariable linear regression analysis indicated that every degree decrease in dorsal angulation of the distal part of the radius on the lateral radiograph increased satisfaction by a mean of 1% (beta, -0.01 [95% CI, -0.02 to -0.006]; p = 0.001); each millimeter decrease in the anterior-to-posterior distance between the dorsal and volar articular margins on the lateral radiograph increased satisfaction by 3% (beta, -0.03 [95% CI, -0.04 to -0.005]; p = 0.014), and each millimeter decrease in ulnar positive variance increased satisfaction by 6% (beta, -0.06 [95% CI, -0.08 to -0.03]; p < 0.001), accounting for 44% of the observed variation. CONCLUSIONS Surgeons are influenced by radiographic deformity, but do not agree on adequate alignment after reduction of a distal radial fracture. CLINICAL RELEVANCE Greater involvement of patients in decisions with regard to acceptable deformity has the potential to decrease treatment variation.
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Affiliation(s)
- Emily Z Boersma
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Michael J R Edwards
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Teun Teunis
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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10
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van Leeuwen RJH, van de Wall BJM, van Veleen NM, Hodel S, Link BC, Knobe M, Babst R, Beeres FJP. Temporary external fixation versus direct ORIF in complete displaced intra-articular radius fractures: a prospective comparative study. Eur J Trauma Emerg Surg 2021; 48:4349-4356. [PMID: 33630119 DOI: 10.1007/s00068-021-01611-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In complex distal radius fractures (DRF), both direct osteosynthesis (one-stage approach) and temporary external fixation as a bridge to definitive osteosynthesis (two-stage approach) are used. Studies directly comparing these two management options are lacking. This study aims to compare the two procedures with regard to complications, and radiological and functional outcomes. MATERIAL This prospective observational study included all patients presenting with AO OTA C2 or C3 DRF (1) between January 2011 and January 2018. All patients were categorised into two groups according to received treatment: patients who underwent direct definitive osteosynthesis (Group One Stage) and patients who received an external fixator followed by definitive fixation (Group Two Stage). Primary outcome was the Patient-Rated Wrist Evaluation score (PRWE) measured at 1 year follow-up. Secondary outcomes included complications, range of motion (ROM), and radiologic parameters (ulnar variance, radial inclination and volar tilt). RESULTS A total of 187 patients were included in Group One Stage with a mean age of 55.6 years (SD 17.2), of which 67 had a C2 and 120 a C3 fracture. Group Two Stage consisted of 66 patients with a mean age of 53.7 years (SD 20.4 years), of which 6 patients having a C2 and 60 a C3 fracture. There was no significant difference in complications and median PRWE between Group One Stage (12.0, IQR 2.0-20.0) and Group Two Stage (12.2, IQR 5.5-23.4) (p = 0.189), even after correction for differences in baseline characteristics. The ROM and radiologic parameters did not show any significant differences as well. CONCLUSION No differences were found in clinical, functional, and radiological outcome between one- and two-staged surgical techniques. It may be concluded that a two-stage approach is a viable and safe alternative.
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Affiliation(s)
| | | | - Nicole M van Veleen
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Sandro Hodel
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Matthias Knobe
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
| | - Reto Babst
- Clinic of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital (LUKS), 6000, Lucerne, Switzerland
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11
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Rosado EG, Olivella G, Natal-Albelo EJ, Echegaray GJ, Rivera LL, Guevara CA, Alejandro LM, Martínez-Rivera A, Ramírez N, Foy CA. Practice Variation Among Hispanic American Orthopedic Surgeons in the Management of Geriatric Distal Radius Fracture. Geriatr Orthop Surg Rehabil 2020; 11:2151459320969378. [PMID: 33282446 PMCID: PMC7683847 DOI: 10.1177/2151459320969378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction There is a controversy in the management of distal radius fractures (DRF) and its criteria for surgical intervention on geriatric patients. The American Academy of Orthopedic Surgeons (AAOS) developed evidence-based guidelines for treatment of DRF. The aim of this study was to evaluate the current practice of Hispanic orthopedic surgeons in the management of geriatric DRF and examine their adherence to AAOS guidelines based on years of surgical experience. Material & Methods A survey was emailed to all orthopedic surgeons who live in Puerto Rico and treated DRF in their daily practice. Responses concerning demographic, management and clinical scenarios were evaluated. For each clinical scenario, treatment of choice was selected with the same fracture in a geriatric and young adult patient. Comparison between years of surgical experience and adherence to the AAOS guidelines was performed. Results A total of 65 surgeons responded the survey with 65% having >15 years in practice. A high consensus with AAOS guidelines for DRF was found. Use of preoperative radiographs was reported in all respondents, with an additional 12% routine use of preoperative computed tomography scans. Seventy-seven percent of respondents did not allow any range of motion (ROM) at immediate postoperative period, while 23% allowed active or passive ROM. Use of postoperative therapy was reported in 72.3%. Correlation between years of surgical experience showed a higher use of Vitamin C postoperatively for prophylaxis of Complex Regional Pain Syndrome among surgeons <15 years (P = 0.01). A general consensus trend toward operative fixation was noted among geriatric and young adult patients with the same fracture type in all clinical scenarios. Discussion and Conclusions This survey demonstrates a practice variation toward surgical management of geriatric DRF among Hispanic orthopedic surgeons; despite their compliance with the AAOS AUC guidelines. The geriatric DRF management does not vary significantly among years of surgical experience.
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Affiliation(s)
- Edwin G Rosado
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gerardo Olivella
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Eduardo J Natal-Albelo
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gabriel J Echegaray
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Lenny L Rivera
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Carlos A Guevara
- Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Larry M Alejandro
- Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Arnaldo Martínez-Rivera
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramírez
- Pediatric Orthopaedic Surgery Department, Mayagüez Medical Center, Mayagüez, Puerto Rico
| | - Christian A Foy
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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12
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Nagai T, Nagaoka M, Tanimoto K, Tomizuka Y, Uei H, Nakanishi K. Relationship between potentially inappropriate medications and functional prognosis in elderly patients with distal radius fracture: a retrospective cohort study. J Orthop Surg Res 2020; 15:321. [PMID: 32787973 PMCID: PMC7425136 DOI: 10.1186/s13018-020-01861-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background Potentially inappropriate medications (PIMs) are a major concern in geriatric care. PIMs increase the risk of falls in elderly patients. However, the relationship between PIMs, subsequent falls, and functional prognosis for distal radius fracture (DRF) remains unclear. The aim of this study was to examine the relationship between PIMs, activities of daily living, and subsequent falls in elderly DRF patients. Methods The study included 253 patients aged ≥ 65 years who required surgical treatment for DRF. Clinical characteristics of patients obtained included age, sex, body mass index, number of medicines used at admission, number and type of PIMs used at admission, bone mineral density, use of drugs for osteoporosis, severity of comorbidities, nutritional status, Barthel Index (BI), length of hospital stay, subsequent falls, fracture type, and Mayo wrist score. Subjects were divided into two groups according to PIMs use and no use. Propensity score matching was used to assess patient characteristics and confirm factors affecting BI and subsequent falls. Results One hundred seven patients (42.3%) were prescribed PIMs upon hospital admission. The mean BI gain was significantly lower in patients prescribed PIMs than in those who were not (p = 0.006), as was the rate of falls post-surgery (p = 0.009). Multivariate analysis of BI gain showed that PIMs affected BI gain (95% confidence interval [CI], − 1.589 to − 0.196, p = 0.012), and logistic regression analysis revealed that PIMs influenced subsequent falls (odds ratio, 0.108, 95% CI, 1.246 to 2.357, p < 0.001). Conclusions PIM use hindered the improvement in activities of daily living and increased the incidence of subsequent falls in patients assessed. These results demonstrate the importance of appropriate drug control for patients with DRF.
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Affiliation(s)
- Takako Nagai
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan. .,Department of Orthopedic Surgery, Osumi Hospital, Tokyo, Japan. .,Department of Rehabilitation Medicine, Nihon University Hospital, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 1018309, Japan.
| | - Masahiro Nagaoka
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Koji Tanimoto
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Yoshiaki Tomizuka
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo, Japan
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Malik H, Appelboam A, Taylor G. Colles’ type distal radial fractures undergoing manipulation in the ED: a multicentre observational cohort study. Emerg Med J 2020; 37:498-501. [DOI: 10.1136/emermed-2020-209478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 11/04/2022]
Abstract
BackgroundColles’ type fractures of the distal radius are one of the most commonly manipulated fractures in the ED. Local audit data suggest that a high proportion of these injuries undergo subsequent surgical fixation. If widespread, this could represent a potential burden on patients and the NHS worthy of further research. The aims of this study were to estimate the rate of surgical fixation of Colles’ type distal radial fractures after ED fracture manipulation and explore variations in their management in UK EDs.MethodsWe conducted a multicentre observational study in 16 EDs in the UK from 4 February 2019 to 31 March 2019. All adult patients with a Colles’ fracture who underwent fracture manipulation in the ED were included. Patients who could not be followed up and those with volar displaced fractures were excluded. We measured the rate of wrist fracture surgery at 6 weeks, patient demographics and variations in anaesthetic technique used.ResultsDuring the study period, 328 adult patients attended the participating EDs with a distal radial fracture. Of these, 83 patients underwent fracture manipulation in the ED and were eligible for the study. Their mean age (SD) was 65.3 (17.0) years, 84.3% were female and the most common method of anaesthesia used was haematoma block (38.6%). 34 (41.0%, 95 % CI 30.3 to 52.3) patients had subsequent surgical fixation of their fracture. Younger age was associated with higher rates of surgical fixation but ED anaesthetic technique did not affect the subsequent need for surgery in this sample.ConclusionSubsequent surgical fixation was carried out in 41% of patients who underwent manipulation of Colles’ type wrist fractures in this cohort. This merits further research and represents a potential target to rationalise repeat procedures.
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Vaghela KR, Velazquez-Pimentel D, Ahluwalia AK, Choraria A, Hunter A. Distal radius fractures: an evidence-based approach to assessment and management. Br J Hosp Med (Lond) 2020; 81:1-8. [PMID: 32589543 DOI: 10.12968/hmed.2020.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Distal radius fractures account for one in five bony injuries in both primary and secondary care. These are commonly the result of a fall on outstretched hands or high-energy trauma. On assessment, clinicians should determine the mechanism of injury, associated bony or soft tissue injuries, and neurovascular symptoms. Investigations should always include radiographs to evaluate for intra-articular involvement and fracture displacement. Owing to the heterogeneous injury patterns and patient profiles, the preferred management should consider the severity of the fracture, desired functional outcome and patient comorbidities. Non-operative management in select patients can give good results, especially in older adults. Immobilisation with or without reduction forms the mainstay of non-operative treatment. Surgical management options include closed reduction and application of a cast, percutaneous K-wires, open reduction and internal fixation with plates, or external fixation. Patients should be encouraged to mobilise as soon as it is safe to do so, to prevent stiffness. Median nerve compression is the most common complication followed by tendon rupture, arthrosis and malunion. This article outlines the British Orthopaedic Association Standards for Trauma and Orthopaedics for the management of distal radius fractures.
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Affiliation(s)
- Kalpesh R Vaghela
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Anika Choraria
- Department of Radiology, University College Hospital, London, UK
| | - Alistair Hunter
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
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Armstrong KA, von Schroeder HP, Baxter NN, Zhong T, Huang A, McCabe SJ. Stable rates of operative treatment of distal radius fractures in Ontario, Canada: a population-based retrospective cohort study (2004–2013). Can J Surg 2020; 62:386-392. [PMID: 31782295 DOI: 10.1503/cjs.016218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Rates of surgical management of distal radius fractures are increasing internationally despite the higher cost and limited outcome evidence to support this shift. This study examines the epidemiology of distal radius fractures and asks if the same shift has occurred in Ontario, Canada (population 13.9 million). Methods This population-based, retrospective cohort study examined distal radius fractures in people aged 18 years and older over a 10-year period (2004–2013). The incidence analyses were based on the first occurrence of a fracture within a 2-year time period. The number of fractures, age-adjusted incidence rates and frequency of fracture treatment type by year were assessed. We used a Poisson regression with robust standard errors to determine if there was a statistically significant change in the frequency of fracture treatment type over time. Results There were 25 355 distal radius fractures among Ontarians 18 years of age and older in 2013. Between 2004 and 2013, the age-adjusted incidence rate for people 35 years of age and older was stable, between 2.32 and 2.70 per 1000 population. Rates of cast immobilization remained stable between 82% and 84%. Of those patients treated surgically, the rate of open reduction and internal fixation rose from 7% in 2004 to 13% in 2013 at the expense of other types of surgical management. Conclusion In Ontario, rates of cast immobilization are stable and there has been a movement toward open reduction and internal fixation among patients treated surgically.
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Affiliation(s)
- Kathleen A. Armstrong
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Armstrong, von Schroeder, Baxter, Zhong, McCabe); and ICES, Toronto, Ont. (Huang)
| | - Herbert P. von Schroeder
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Armstrong, von Schroeder, Baxter, Zhong, McCabe); and ICES, Toronto, Ont. (Huang)
| | - Nancy N. Baxter
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Armstrong, von Schroeder, Baxter, Zhong, McCabe); and ICES, Toronto, Ont. (Huang)
| | - Toni Zhong
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Armstrong, von Schroeder, Baxter, Zhong, McCabe); and ICES, Toronto, Ont. (Huang)
| | - Anjie Huang
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Armstrong, von Schroeder, Baxter, Zhong, McCabe); and ICES, Toronto, Ont. (Huang)
| | - Steven J. McCabe
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Armstrong, von Schroeder, Baxter, Zhong, McCabe); and ICES, Toronto, Ont. (Huang)
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Li D, Liu Y, Li D, Tang W, Yin Q. Identification of a novel three-column classification for double-column die-punch fractures of the distal radius. Exp Ther Med 2020; 19:1871-1877. [PMID: 32104243 PMCID: PMC7026990 DOI: 10.3892/etm.2020.8434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/12/2019] [Indexed: 12/03/2022] Open
Abstract
The present study aimed to classify double-column die-punch fractures of the distal radius according to imaging data, and to evaluate their clinical features. A retrospective analysis of imaging data derived from 498 patients diagnosed with a double-column die-punch fracture of the distal radius was performed. The fractures were divided into those with middle-column avulsion with fracture of the radial-column articular surface (type I), those with middle-column collapse with fracture of the radial-column articular surface (type II), those with middle-column collapse with fracture of epiphysis of the radial column (type III) or mixed-type fractures (type IV). The intra- and inter-observer consistency between assessors was analyzed with kappa statistics. The patients with double-column die-punch fractures of the distal radius were followed up. There were 21 cases of type I fracture, 135 cases of type II fracture, 130 cases of type III fracture and 212 cases of type IV fracture. The intra-observer kappa coefficient ranged from 0.810–0.861, whereas the inter-observer kappa coefficient range was 0.830–0.876, with high consistency. Following 13 months of follow-up, the patients were assessed for functional recovery of the wrist and hand using the Gartland-Werley scoring system. The analysis indicated that in 95.78% of the patients, wrist function was rated as excellent or good (n=477), while in 4.22% of patients it was rated as fair (n=21), mainly due to the development of post-traumatic arthritis of the wrist following inappropriate therapy. All of the cases were type IV and type III fractures. These data demonstrated the application of a novel classification system named the Three-Column Classification, used to classify double-column die-punch fractures of the distal radius. This method reflected the mechanisms and severity of the fractures, conforming to the principle of AO fracture classification. Furthermore, it exhibited high consistency and may provide reference values for clinical diagnosis, treatment and prognostic evaluation.
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Affiliation(s)
- Dong Li
- Department of Radiology, Liyang People's Hospital, Liyang, Jiangsu 213000, P.R. China
| | - Yu Liu
- Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China
| | - Dongcheng Li
- Department of Radiology, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China
| | - Wen Tang
- Department of Radiology, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214062, P.R. China
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International Survey: Factors Associated With Operative Treatment of Distal Radius Fractures and Implications for the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria. J Orthop Trauma 2019; 33:e394-e402. [PMID: 31188260 DOI: 10.1097/bot.0000000000001517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Through an international survey, we assessed whether deciding to operatively treat an intra-articular distal radius fracture (DRF) is guided by identifiable patient and surgeon factors. In addition, we compared surgeons' treatment decisions with the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria (AUC) treatment recommendations. METHODS This cross-sectional survey asked 224 surgeons to operatively or nonoperatively treat 28 hypothetical patients with radiographs of an intra-articular DRF. We randomized patient age (50/70 years), gender, mechanism of injury, activity level, and OTA/AO fracture type. We classified 6 fractures as "nonclinically significant displacement" and 22 as "potentially clinically significant displacement." Multilevel logistic regression analysis was performed. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Statistical significance was P < 0.05. RESULTS Patient factors independently associated with surgery included younger age (OR 6.7, P = 0.003), clinically significant fracture displacement (type B: OR 122, CI, 20-739, P < 0.001; type C: OR 59, CI, 12-300, P < 0.001), normal activity level (OR 5.0, P < 0.001), and high-energy mechanisms (OR 1.3, P = 0.002). Surgeon factors associated with recommending surgery included practicing outside the United States (Europe: OR 2.6, P < 0.001; "other": OR 4.8, P < 0.001). Hand surgeons most often selected surgery, as compared to orthopaedic trauma surgeons (OR 2.3, P = 0.001) and "other orthopaedists" (OR 2.2, P = 0.022). Thirty-seven percent of treatment decisions for patients with normal activity levels were rated by AUC recommendations as "rarely appropriate," which included 91% disagreement for 70-year-olds with nonclinically significant displacement. CONCLUSIONS Surgeons use patient age and fracture displacement to make treatment recommendations for intra-articular DRF. We recommend that the AUC be updated to include these clinical factors as essential components in its algorithm. LEVEL OF EVIDENCE Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Meek R, Sundaralingam A, Shen M, Sundaralingam A, Sorace L. Functional outcome and management pathways for adult patients presenting to an Australian health service with distal radius fracture. Emerg Med Australas 2019; 32:105-111. [PMID: 31418525 DOI: 10.1111/1742-6723.13375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Primarily to determine mid-term functional outcome for patients with distal radius fracture (DRF) and to compare this between operative and conservatively managed patients. Secondarily to examine for differences in age, gender and number of instability factors between management groups. METHODS Eligible patients (age 18 years or more, closed DRF managed to completion of care within Monash Health), presenting between 1 January and 31 December 2016. Completion of the patient-rated wrist evaluation (PRWE) questionnaire was sought at 6-12 months post-injury. Management was noted (operative or conservative). Age, sex and number of defined instability factors present (dorsal angulation >20°, intra-articular fracture, associated ulna fracture, dorsal comminution, radial shortening >2 mm) are reported and compared between management groups. RESULTS Of 369 eligible patients, 199 (54%) completed a PRWE. Median age was 60 years (interquartile range [IQR] 45-71), 150 (75%) were women, median number of instability factors present was 2 (IQR 1-4) and 45 (23%) underwent operative management. Difference in PRWE scores between operative and conservatively managed patients was not significant (20 [IQR 7-36] vs 16 [IQR 5-35]). Differences in age and gender between management groups were not significant. Significantly more in the operative group had presence of four or more instability factors (44% [95% confidence interval 30-60] vs 20% [14-27]). CONCLUSION The mid-term median PRWE score was 18 (IQR 5-36). This was not significantly different between operative and conservatively managed patients. Operation was more likely when four or more instability factors were present.
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Affiliation(s)
- Robert Meek
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Ananth Sundaralingam
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Matthew Shen
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Aravinthan Sundaralingam
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Monash Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Laurence Sorace
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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Xie L, Chen C, Yu X, Hu W, Chen H, Sun L. Management of distal radius fracture: A comparison of actual and theoretical treatments. Int J Surg 2018; 60:137-140. [PMID: 30415090 DOI: 10.1016/j.ijsu.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE The objective of this study was to explore whether there were any differences between the theoretical operative treatment of distal radius fractures according to AAOS guideline on basis of measurement of radiographs and the treatment they actually received in our institution. METHODS From April 2015 to February 2018, a total of 693 patients with 697 fresh close adult distal radius fractures were evaluated retrospectively. Fractures were respectively grouped into categories by AAOS criterion and actually treatment. After gleaning demographic information and measuring radiographic items, all results were put into a database. Single factors analysis, Chi-square test and further logistic regression analysis were performed to determine correlations between actual and theoretical treatments. RESULTS In all 240 fractures fulfilled at least one AAOS criterion for surgery, only 61 fractures actually received operation. And in the conservative group recommended by AAOS, 52 of 457 fractures actually were proceeded with surgery. There were slight correlation between AAOS guideline and actually operation (Phi = 0.181). From multivariable logistic regression analysis, Only one of three AAOS criterion was proved probable indicator of clinic treatment. Three factors, namely age, intra-articular step-off as well as with other fractures, were proved probable actually surgery indications (P < 0.05). CONCLUSIONS AAOS surgery criteria of distal radius fractures were partially instructive, but not so precise predictors for actually operation. In the clinic, the choice of operative treatment correlated with multiple factors.
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Affiliation(s)
- Linzhen Xie
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
| | - Chunhui Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
| | - Xianbin Yu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
| | - Wei Hu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
| | - Hua Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
| | - Liaojun Sun
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
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20
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Mulders MAM, Detering R, Rikli DA, Rosenwasser MP, Goslings JC, Schep NWL. Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis. J Hand Surg Am 2018; 43:710-719.e5. [PMID: 29908929 DOI: 10.1016/j.jhsa.2018.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the association between alignment, as determined by plain radiographs, and patient-reported outcome in adults with a displaced distal radius fracture. We also determined which specific radiological parameters are associated with patient-reported outcomes. METHODS We performed a systematic literature search to identify studies that evaluated the association between radiological and patient-reported outcome in adults with a displaced distal radius fracture and who had an average follow-up of at least 12 months. Radiological outcome was determined as acceptable or unacceptable reduction, defined by radiological parameters. Patient-reported outcome was assessed with the Disability of the Arm, Shoulder, and Hand, the Quick-Disability of the Arm, Shoulder, and Hand, and the Patient-Rated Wrist Evaluation questionnaires. RESULTS Sixteen articles were included, comprising 1,961 patients with a distal radius fracture. A significant mean difference of 4.15 points in patient-reported outcomes (95% confidence interval [CI], 0.26-8.04) was found in favor of an acceptable radiological reduction. Moreover, a significant mean difference of 5.38 points in patient-reported outcomes (95% CI, 1.69-9.07) was found in favor of an acceptable dorsal angulation, and 6.72 points (95% CI, 2.16-11.29) in favor of an acceptable ulnar variance. CONCLUSIONS An unacceptable radiological reduction is significantly associated with worse patient-reported outcomes in adults with a displaced distal radius fracture. Dorsal angulation and ulnar variance are the most important radiological parameters. Despite the statistical significance, the mean difference of each association did not meet the threshold of the minimally clinically important difference and therefore were unlikely to be clinically important. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
| | - Robin Detering
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam
| | - Daniel A Rikli
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Melvin P Rosenwasser
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Jamka K, Szczechowicz J, Pieniążek M, Kubasiak K. Comparing the effectiveness of mobilization techniques with movement and myofascial techniques in patients following distal radius fractures treated conservatively. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0012.0895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Fractures of the distal radius are one of the most common types in the upper limb area. They lead to significant reduction in range of mobility, muscle weakness and the occurrence of serious pain.
Material and methods: The research involved 20 patients from the Specialist Hand Rehabilitation Centre in Krakow, who were rehabilitated after fractures to the distal radial bone. They were randomly divided into two groups. In group A (n = 10), there were patients who underwent mobilization techniques with movement according to the Mulligan concept as part of their manual work. Group B (n = 10) consisted of patients subjected to myofascial techniques. Functional examination of the hand was carried out twice before and after beginning rehabilitation. The range of active mobility, muscle strength and superficial feeling were examined. Based on the obtained results, functional loss was calculated according to Swanson’s method, Total Active Motion and the sensory index. The obtained results were subjected to statistical analysis using the Excel 10 programme.
Results: Significant improvement in hand and muscle strength was noted in both groups. In the group of patients treated with myofascial techniques, better rates of improvement for the tested parameters were obtained than in the group treated with the use of joint mobilization techniques.
Conclusions: 1. The applied programme of rehabilitating patients following fracture of the distal radial bone is characterized by statistically significant improvement in hand function. 2. The use of soft-tissue techniques is a more effective method of hand function restitution than the method of mobilization with movement.
myofascial techniques, forearm fractures, physiotherapy
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Affiliation(s)
- Krzysztof Jamka
- Studia doktoranckie, AWF im. B. Czecha w Krakowie / Ph.D. student, University of Physical Education, Krakow, Poland
| | - Jakub Szczechowicz
- Katedra Fizjoterapii, AWF im. B. Czecha w Krakowie / Department of Physiotherapy, University of Physical Education, Krakow, Poland
| | - Marek Pieniążek
- Katedra Fizjoterapii, AWF im. B. Czecha w Krakowie / Department of Physiotherapy, University of Physical Education, Krakow, Poland
| | - Katarzyna Kubasiak
- Specjalistyczny Ośrodek Rehabilitacji Ręki w Krakowie / Specialized Hand Therapy Centre in Krakow, Poland
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