Epidemiology of distal radius fractures and factors predicting risk and prognosis

Osteosynthesis of an extra-articular distal radius fracture using a palmar locking plate with 4 epiphyseal screws (Gold Standard) versus 2 epiphyseal screws: Finite element analysis

Distal radius fractures are common injuries often requiring surgical intervention for effective management. This study compares the biomechanical stability of two osteosynthesis configurations using a palmar locking plate with either four or two epiphyseal screws for extra-articular distal radius fractures. Finite element analysis (FEA) was performed on nine antomical radius models to evaluate displacement, axial stiffness, peri‑implant stresses, and fracture risk using the Mohr-Coulomb criterion. Results demonstrated minimal differences in displacement between the two groups, with both configurations maintaining acceptable levels of stability under a 250 N load. Assemblies with four screws exhibited slightly higher axial stiffness (average 4362 N/mm) compared to two screws (average 3080 N/mm). Peri-implant stresses were generally higher in the two-screw models, yet remained within tolerable ranges. This study is the first to analyze a two-epiphyseal screw configuration, offering insight into the feasibility of reducing screw count without compromising stability. Potential benefits include fewer surgical complications, reduced material use, and lower costs. However, limitations such as the small sample size, simplified loading conditions, and absence of osteodensitometry warrant further experimental validation. The findings suggest that a two-epiphyseal screw assembly could serve as an effective alternative for distal radius fracture management, supporting its potential integration into clinical practice following experimental corroboration.

Is Immobilization Necessary After Open Reduction and Internal Fixation of Distal Radius Fractures? A Meta-Analysis of Randomized Controlled Trials

Distal radius fractures (DRFs) are the most common fractures in adults. With the increased trend in open reduction and internal fixation (ORIF) using a volar locking plate, the postoperative rehabilitation course remains debated and whether or not a postoperative immobilization is necessary is unknown. PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through August 2024. Inclusion criteria consisted of studies that compared patients undergoing immediate mobilization after ORIF for DRF with patients undergoing postoperative immobilization. Adverse events, patient-reported outcomes measures, and range of motion (ROM) were all compared between the 2 groups at various postoperative time points. Four randomized controlled trials were included in this study. No difference was seen in the risk of complications (odds ratio = 1.17, P = .70) and reoperations (odds ratio = 1.35, P = .53) between the 2 groups. The immediate mobilization group had lower pain scores at 6 months (mean difference = -0.46, P = .005) and lower Disabilities of the Arm, Shoulder, and Hand at 3 months (mean difference = -0.45, P = .002), and 6 months (mean difference = -0.46, P = .005). As for ROM, better forearm rotation was seen in the immediate mobilization group at 6 months (mean difference = 3.43, P = .004).

The Consistency of Primary, Secondary and Tertiary Prevention Definitions in the Context of Musculoskeletal Sports Injuries: A Rapid Review and Critical Exploration of Common Terms of Usage

BACKGROUND

Formal statements articulating the meaning of primary, secondary and tertiary prevention concepts are commonly used in the musculoskeletal sports injuries literature, but appear to be employed inconsistently and incorrectly. Standard definitions, appropriate to athletic health and performance practice, are required to systematically develop the state-of-the-art. To accomplish this, we summarized prevention definitions with the aim of improving conceptual clarity across the musculoskeletal sports injuries literature.

MAIN BODY

We used a rapid literature review method, searching Scopus, PubMed/Medline, Cochrane Library reviews/trials, Web of Science, Sports Medicine and Education Index, SPORTDiscus and CINAHL databases for titles/abstracts for available literature, published in English from database-inception to November 2023. Our search terms were: sport/athlete, injury, primary prevention, secondary prevention, and/or tertiary prevention. Definitions were extracted to create categories illustrating overlap and variation. We extracted definitions from 144 included studies (n). Primary prevention appears focused on mitigating injury risk (n = 52) and preventing initial injuries (n = 42). Secondary prevention appears to address five distinct concepts: preventing recurrences (n = 42), preventing sequelae (n = 41), preventing index injury worsening (n = 27), mitigating injury risk (n = 15), and restoring function (n = 12). Tertiary prevention appears focused on preventing sequelae (n = 17) and restoring function (n = 9).

CONCLUSIONS

From a definition viewpoint, the aim of primary prevention is narrowly conceptualized and consistent in the musculoskeletal sports injury research literature. However, secondary prevention definitions vary substantially, with at least three distinct conceptual aims observable. Tertiary prevention definitions appear infrequently in the literature and when observed tend to overlap with secondary prevention. Currently, researchers are likely to struggle with the formulation of clearly-defined and transferrable research questions relating to the aims of secondary prevention.

Manual reduction and splint fixation for distal radius fracture with dislocation: a case report

Introduction

Distal radius fractures (DRF) are one of the most common fractures, accounting for approximately 20% of all fractures. DRF is frequently associated with distal radioulnar joint (DRUJ) dislocation, which may be initially overlooked due to subtle symptoms and imaging findings. This can lead to misdiagnosis and suboptimal treatment.

Patient concerns

An elderly female patient presented with a distal radius fracture. Early clinical and imaging evaluations failed to identify a co-existing DRUJ dislocation.

Diagnosis

The DRUJ dislocation was subsequently diagnosed after careful assessment, highlighting the need for a thorough examination in cases of DRF.

Interventions

The DRUJ dislocation was managed with manual reduction followed by splint fixation. The patient was closely monitored throughout the treatment process.

Outcomes

Following the intervention, the patient demonstrated significant functional recovery, with improvement in wrist mobility and reduction in pain.

Conclusion

This case underscores the importance of early detection of DRUJ dislocation in patients with DRF to avoid misdiagnosis and prevent long-term wrist dysfunction. Timely and appropriate intervention can lead to substantial recovery.

Sleep disturbances in elderly patients with distal radius fractures: a prospective observational study

PURPOSE

No previous studies have reported the presence of sleep disturbances or their association with baseline factors in elderly patients with distal radius fracture (DRF). This study aimed to describe the proportion of patients with sleep disturbances and analyze their association with baseline factors in patients older than 60 years with conservatively treated DRFs.

METHODS

This prospective observational study included 220 patients with extra-articular DRFs who completed the Pittsburgh Sleep Quality Index at two time points: two weeks after cast removal and at the one year follow-up. Sociodemographic, anthropometric, clinical, radiological, and patient-reported outcome measures were analyzed as baseline predictors, with measurements performed two weeks after cast removal.

RESULTS

At two weeks after cast removal, 166 (75.5%) patients had sleep disturbances. Sleep disturbances were associated with the affected dominant hand (β = 1.6; p = 0.04), high-energy injury (β = 3.8; p < 0.001), extra-articular comminuted metaphyseal DRFs (β = 2.3; p < 0.001), higher Tampa Scale of Kinesiophobia scores (β = 2.4; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.4; p < 0.001), higher Pain Anxiety Symptoms Scale-20 scores (β = 2.1; p < 0.001), and higher visual analogue scale scores (β = 4.1; p < 0.001). At the one year follow-up, 85 (38.6%) patients had sleep disturbances, which were associated with higher Tampa Scale of Kinesiophobia scores (β = 2.6; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.5; p < 0.001), and higher Pain Anxiety Symptoms Scale-20 scores (β = 1.8; p = 0.02).

CONCLUSIONS

A high proportion of elderly patients with DRF experienced sleep disturbances. Expanding our understanding of the interplay between sleep disturbances and baseline risk factors may lead to improved care and clinical outcomes for these patients. Future studies should incorporate the clinical management of sleep disturbances in patients with DRFs.

Kinematic analysis of upper limb fractures: Insights for rehabilitation strategies

BACKGROUND

Upper limb fractures significantly alter movement, impacting function and recovery. Three-dimensional motion analysis allows precise assessment of these changes.

METHODS

Sixty patients were divided into four groups: shoulder, elbow, wrist fractures, and controls. Functional assessment was performed using the DASH questionnaire, followed by three-dimensional kinematic analysis with eight Oqus 300 cameras and 14 reflective markers on the thorax, scapula, humerus, forearm, and hand. The Acromion Marker Cluster method was used for accurate scapular tracking. Tasks analyzed included hand on shoulder, hand on back, and hand on neck. All measured variables are expressed in degrees. The analysis focused on the differences in maximum joint angles for each degree of freedom across the tasks. These differences were assessed using MANOVA, followed by ANOVAs and Tukey's post hoc test when applicable.

FINDINGS

Significant kinematic differences were observed between the fracture groups and the control group across all tasks. Shoulder fracture patients exhibited the greatest reductions in humeral flexion and abduction. Elbow fracture patients showed the most restricted elbow flexion. Wrist fracture patients presented significantly reduced radial/ulnar deviation. These movement impairments were observed across all tasks, with the most pronounced limitations seen in the hand-to-shoulder task. Effect sizes (η2) indicated clinically meaningful impacts, particularly for shoulder and wrist movements.

INTERPRETATION

This study reveals distinct kinematic alterations following upper limb osteosynthesis, emphasizing the need for individualized rehabilitation strategies addressing these specific movement impairments to optimize recovery.

Is There a Critical Dorsal Lunate Facet Size in Distal Radius Fractures That Leads to Dorsal Carpal Subluxation? A Biomechanical Study of the Dorsal Critical Corner

PURPOSE

Intra-articular distal radius fractures are common and can be associated with carpal instability. Failure to address articular fragments linked to maintaining carpal stability can lead to radiocarpal subluxation or dislocation. The purpose of this study was to evaluate the size of a dorsal osteotomy in the dorsal/volar plane of the lunate facet that leads to dorsal carpal subluxation.

METHODS

Dorsal lunate facet fractures were simulated twice in each of nine fresh-frozen cadavers. After completing a partial dorsal osteotomy in the radial/ulnar plane between the scaphoid and lunate facets, an osteotomy in the dorsal/volar plane was completed. Using a cutting jig, first an estimated 5-mm osteotomy, and then a 10-mm osteotomy (from the dorsal rim of the distal radius) were completed. The wrist was mounted in a custom jig and loaded with 100 N. Displacement of the lunate in the dorsal/volar plane compared with displacement in an intact specimen was evaluated and used to assess carpal subluxation.

RESULTS

Lunate translation was 0 mm ± 0 mm in the intact state. The 5-mm osteotomy averaged 29% of the distal radius dorsal lunate facet in the dorsal/volar plane, and lunate translation was 0.7 mm ± 1.7 mm. The 10-mm osteotomy averaged 54% of the dorsal lunate facet in the dorsal/volar plane, and lunate translation was 2.8 mm ± 2.6 mm. Assuming a linear relationship from the osteotomies created, an osteotomy of an estimated ≥40% of the distal radius in the dorsal to volar plane resulted in substantial dorsal subluxation, although this specific osteotomy was not assessed in our study.

CONCLUSIONS

Sequentially increased dorsal osteotomies of the dorsal lunate facet result in increased dorsal carpal subluxation.

CLINICAL RELEVANCE

Distal radius fractures that include >40% of the "dorsal critical corner" are at risk for dorsal carpal subluxation and may require supplementary fixation.

Gender-Specific Patterns of Injury in Older Adults After a Fall from a Four-Wheeled Walker (Rollator): Retrospective Study from a Swiss Level 1 Trauma Centre

AIM

As the population is aging, falls by older people, in particular falls from four-wheeled walkers ("rollators"), are a growing problem. These falls must be examined by targeted research and interventions that incorporate gender differences. Therefore, this study examined the injury patterns of elderly patients admitted to a tertiary trauma centre in Switzerland after falls from rollators and focussed on gender differences.

METHODS

This was a retrospective single-centre study for the period from May 2012 to December 2019 which included elderly patients (≥65 years) who had suffered a fall from a rollator. Injury history, patient data, demographic information, and patient outcomes were compared between males and females, with the data sourced from the Ecare patient database, which contains all information related to patient visits and treatment procedures.

RESULTS

A total of 152 eligible patients were included in the analysis, with 56.6% hospitalised at our facility and 14.5% transferred to another hospital. The cohort comprised 50 (32.9%) males and 102 (67.1%) females. Males were more prevalent in the 75-84 age group, while females predominated in the 85 and older group, and this difference was statistically significant (p = 0.043). Osteoporosis was significantly more common in females (37.3% vs. 10%, p ≤ 0.001). Consequently, treatment with vitamin D and/or calcium was also significantly more prevalent among women (29.4% vs. 8%, p = 0.003). Most falls occurred at home (22.4%) or in nursing care facilities and rehabilitation centres (22.4%), without gender-based differences (p = 0.570). Men were six times more likely than women to sustain injuries when under the influence of alcohol (p = 0.002). Fractures to the lower extremities were the most common injuries, accounting for 34.2% of all injuries, with no statistically significant differences between groups (p = 0.063). Head injuries occurred in 34.9% of patients, with a trend towards more injuries in males (44% vs. 30.4%, p = 0.098). The cumulative rates of fractures to the pelvis, upper extremities, and lower extremities were significantly higher in females (59.8%) than in males (38%), p = 0.011. In-hospital mortality was significantly higher in men than in women (12.9% vs. 2.9%, p = 0.026). Operative procedures were significantly more common in women (33% vs. 16.3%; p < 0.001).

CONCLUSION

Women were more frequently affected by falls related to rollators than men. Most falls occurred at home, in nursing care facilities, or rehabilitation centres, with no significant gender-based differences. There was a trend toward more head injuries in males, while the cumulative fracture rate of the pelvis, upper extremities, and lower extremities was significantly higher in females. In-hospital mortality was more than four times higher in men. These findings may guide the development of gender-specific interventions to reduce rollator-related injuries in the vulnerable elderly population.

Development of decision-aid of goal-setting for patients with distal radius fracture: Aid for decision-making in occupation choice for distal radius fracture

BACKGROUND

Patients with distal radius fractures (DRFs) encounter significant difficulties and challenges in their daily lives due to their medical condition and a lack of strategies for modifying activities. Occupation-based interventions have emerged as promising strategies to improve occupational performance and participation outcomes, addressing these challenges.

PURPOSE

This study aims to develop the aid for decision-making in occupation choice for distal radius fracture (ADOC-DRF), a novel decision-aid tool designed to facilitate patient-centered and occupation-based goal-setting by offering illustrations tailored to the postsurgical recovery period and prescribed activity loads.

STUDY DESIGN

We utilized consensus development methods, including the nominal group technique and a web-based Delphi survey.

METHODS

Through the nominal group technique with three experts, we established the development concept, items, and illustrations for the ADOC-DRF prototype. Subsequently, a Delphi web survey was conducted to gather expert opinions using a five-point Likert scale (1 = disagree and 5 = agree) and achieve consensus among 22 experts, aiming for a consensus point of 3.75 (75%) or higher.

RESULTS

Three rounds of Delphi web surveys were conducted, involving a variety of items and comments, ultimately achieving the required consensus rate. This process identified 52 items, which were categorized into four distinct post-DRF progression phases: phase 1: immobilization, phase 2 early: immobilization removal (start of active motion), phase 2 late: immobilization removal (callus formation), and phase 3: resistance period (bone healing).

CONCLUSIONS

The ADOC-DRF shows promise as an innovative tool for facilitating occupation-based intervention in hand therapy for DRF patients. However, its generalizability is currently limited to Japan. To ensure broader applicability and utility, it is essential to validate the tool in diverse cultural contexts through international multicenter studies, thereby enhancing its global relevance.

Clinical effect of rehabilitation after distal radius fracture surgery using a wearable device: A comparative prospective cohort study

BACKGROUND

Appropriate postoperative rehabilitation of distal radius fractures is essential for early recovery and pain management, but may be limited by medical staff and equipment availability and costs. Home-based training or wearable devices provide an alternative.

OBJECTIVES

To assess use of a wearable device and home-based training for rehabilitation after distal radius fracture surgery.

DESIGN

Prospective comparative cohort study.

METHOD

Between April and November 2021, patients aged > 20 years with distal radius fracture who could understand and use wearable devices and their application were recruited. Patients with polytrauma, neurological disorder or musculoskeletal disorder were excluded. The control group underwent a regimen of passive and active finger and wrist exercises after surgery, while the experimental group performed equivalent rehabilitation using a wearable device (smart glove). Outcomes comprised pain on visual analog scale, wrist range of motion, Quick Disabilities of the Arm, Shoulder, and Hand score, Modified Mayo Wrist Score, and radiographic parameters (radial inclination, radial height, ulnar variance and volar tilt) at 6 and 12 weeks after surgery.

RESULTS

Fracture type, age and gender did not differ between the control (n = 7) and experimental (n = 7) groups. All participants achieved bone union and exhibited equivalent radiographic parameters at follow-up. The experimental group showed significantly improved Mayo scores (65.7 vs. 56.4, p = 0.044), wrist range of motion (259.3 vs. 179.3, p = 0.021), and pain (1.43 vs. 3.29, p = 0.011) at 6 but not 12 weeks' follow-up.

CONCLUSIONS

Rehabilitation using a smart glove showed better short-term clinical outcomes after surgery than conventional rehabilitation. Rehabilitation using a wearable device may be beneficial for early recovery after distal radius fracture surgery.

Surgical vs. Conservative Treatment of Distal Radius Fractures in the Elderly: A Systematic Review and Meta-Analysis

Elderly patients with distal radius fractures (DRFs) pose a significant medical challenge due to their high incidence and related healthcare costs. Both surgical methods like volar plate fixation and conservative approaches such as casting are common, yet their relative effectiveness remains unclear. This review and meta-analysis compare surgical and conservative treatments, focusing on wrist functionality, upper extremity performance, grip strength, and pain after one year. A literature search was conducted in PubMed, Cochrane Library, Scopus, and Web of Science up to November 6, 2024, to find randomized controlled trials (RCTs) for DRFs in patients aged 65 and older. Thirteen RCTs with 2400 participants were included. After one year, there was no significant difference in wrist function between groups (mean difference (MD)=-1.24; 95% confidence interval (CI) -2.61 to 0.13; p=0.78; I²=78%), but upper limb function favored surgery as measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) score (MD=-2.32; 95% CI -3.66 to -0.98; p=0.0007; I²=83%). Surgical treatment significantly improved grip strength (MD=3.82; 95% CI 1.55 to 6.09; p=0.001) but resulted in higher pain levels (MD=2.73; 95% CI 1.16 to 4.31; p=0.0007). Results showed substantial heterogeneity and publication bias. Surgical treatment offers slight functional advantages in grip strength and DASH scores but is associated with higher pain; conservative treatment remains viable with minimal differences in long-term wrist function. Further high-quality studies are necessary to address heterogeneity and publication bias.

Influence of palmar tilt on wrist palmar flexion range-of-motion limitation after conservative treatment of distal radial fractures

BACKGROUND

Distal radial fractures are common forearm injuries. A key rehabilitation objective is achieving adequate wrist palmar and dorsal flexion range-of-motion (ROM). However, few studies have explored this relationship, with even lesser number of studies investigating the impact of distal radius alignment on wrist ROM limitation due to fractures. We aimed to determine the effect of radial alignment on wrist palmar and dorsal flexion ROM after conservative treatment for distal radial fractures.

PATIENTS AND METHODS

This retrospective, cohort study, included 82 patients with distal radial fractures (11 men, 71 women, mean age: 65.9 ± 16.6 years) who underwent examination at an orthopedic clinic. Wrist ROM limitation was defined as ˂60° of dorsal flexion and ˂55° of palmar flexion. The palmar tilt (PT), radial length (RL), and radial inclination (RI) were radiographically measured. The patient's age, residual symptoms, and rehabilitation period were extracted from medical records. Univariate and multivariate analyses were conducted with the presence/absence of wrist ROM limitation as the objective variable, with the PT, RL, and RI as explanatory variables. A comparison of age, and rehabilitation period between the groups with and without wrist ROM limitation was performed using the Mann-Whitney U test. The presence/absence of residual symptoms were compared between two groups using the chi-squared test.

RESULTS

Univariate analysis revealed that PT, RL and RI were associated with palmar flexion ROM limitation. Multivariate analysis showed that PT was the only factor associated with palmar flexion ROM limitation (odds ratio: 0.85, 95% confidence interval: 0.78-0.91, p < 0.001), while dorsal flexion ROM limitation was not associated with any of the three measurements. The group with palmar flexion ROM limitation presented older age (73.1 vs. 59.6 years), higher residual symptom frequency (23 vs. 12 patients), and longer rehabilitation period (159.2 vs. 73.9 days) compared to the group without the limitation (p < 0.01).

CONCLUSION

Dorsal displacement of the distal radius induces alterations in the wrist joint motion axis, potentially affecting limitation in palmar flexion ROM. Patients with palmar flexion ROM limitation had more residual symptoms and longer rehabilitation period than those without. These findings may contribute to the development of evidence-based joint ROM exercises, risk management, goal setting, and rehabilitation programs for patients with distal radial fractures.

Impact of surgeon volume on the risk of complications following volar locking plating of unstable distal radius fracture

Complications following volar locking plating (VLP) of distal radius fracture (DRF) are frequent. Increasing evidence has shown an inverse relationship between increased surgeon experience and fewer complications in a variety of surgeries, and this study aimed to verify whether this relationship existed when specified in the DRF surgically treated with VLP. Patients with an unstable DRF surgically treated by VLP in our institution between January 2016 and December 2021 were included. Data on complication were obtained by inquiring the medical charts and the follow-up register, also the covariables for adjustment. Surgeon volume was defined by the number of VLP procedures within 12 months preceding index surgery, and its optimal cutoff was determined by constructing the receiver operator characteristic, in which high- or low-volume was dichotomized. The relationship between surgeon volume and risk of complications was investigated using a univariate and multivariate logistic regression model. Five hundred sixty-one patients were enrolled and operated on by 21 surgeons, with a median of 14 for each surgeon. The 1-year complication rate was 13.5%, with tenosynovitis (4.1%), carpal tunnel syndrome (2.7%), and complex regional pain syndrome type 1 (2.3%) being the most common. The optimal cutoff was 8, and 69.2% of patients were operated by high-volume surgeons, with a 7.5% incidence; 30.8% of the patients were operated by low-volume surgeons, with a 27.2% incidence. Low-volume was associated with an increase in the risk of general complications by 4.8 times (95% confidential interval, 2.9-8.2). Subgroup analyses showed that this trend was intensified for AO type C fracture (odds ratio, 5.9), slightly mitigated for type B (odds ratio, 3.7), but not significant for type A. The finding highlighted the need to maintain 8 cases/year to improve the complications of DRFs, and for severe cases, centralized treatment is recommended.

A meta-analysis comparing volar locking plates and cast immobilization for distal radius fractures in the elderly

BACKGROUND

The long-term outcomes (≥ 2 years of follow-up) of volar locked plate (VLP) fixation versus closed reduction and casting (CRC) for the treatment of displaced distal radial fractures (DRFs) remain unclear. This study aimed to conduct a meta-analysis comparing the long-term clinical outcomes of VLP and CRC in elderly patients (aged ≥ 60 years).

METHODS

A comprehensive search of PubMed, Web of Science, and Cochrane Library was performed to identify studies comparing the long-term outcomes of VLP and CRC for DRFs. Only randomized controlled trials (RCTs) with a mean follow-up duration of at least 2 years and participants aged 60 years or older were included. The risk of bias in the included studies was assessed. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, EuroQol 5 Dimension 5-level score (EQ-5D-5 L), grip strength, and incidence of reoperation.

RESULTS

Four RCTs, comprising 423 patients, were included. The meta-analysis revealed that VLP fixation was associated with significantly improved outcomes compared to CRC in terms of PRWE score (pooled mean difference: -6.21; 95% CI: -10.28 to -2.15; p = 0.003), DASH score (pooled mean difference: -8.18; 95% CI: -13.35 to -3.01; p = 0.002), and grip strength (pooled mean difference: -6.63; 95% CI: 0.25 to 13.01; p = 0.04). There were no significant differences in EQ-5D-5 L score (95% CI: -0.08 to 0.05; p = 0.74) or incidence of reoperation (RR = 0.56; 95% CI: 0.22 to 1.42; p = 0.22).

CONCLUSIONS

A two-year follow-up of displaced DRFs in elderly patients showed no significant long-term clinical advantage of VLP fixation over CRC.

Comminuted, displaced, and angulated distal radial and ulnar metaphyseal fractures after a trampoline park accident

The authors present the case of a six-year-old boy with a fractured right distal radius and ulna, causing mildly comminuted displaced angulated fractures of the right distal radial and ulnar metaphyses. Pediatric wrist fractures are amongst the most common fractures seen in children, making up 25% of all pediatric fractures. These fractures disrupt growth patterns and can lead to long-term adverse effects.

Abnormally low serum albumin levels are associated with abnormal bone mineral density and osteoporotic fractures: a retrospective studies

BACKGROUND

Many studies have indicated that abnormal bone mineral density (BMD) is related to abnormal liver and kidney function, but the effect of serum albumin level on abnormal BMD and osteoporotic fracture is still controversial. The aim of this retrospective study was to investigate the effects of serum albumin levels on abnormal BMD and osteoporotic fractures.

METHODS

The study included 538 patients through the electronic medical records of inpatients and outpatients stored at Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology. A multivariate logistic regression model was employed to test the relationship between serum albumin levels and abnormal BMD, and the effect of serum albumin levels on osteoporotic fractures was verified through the U test. Correlation between age, sex, kidney stones, coronary heart disease, hypertension, diabetes, fatty liver disease, haemoglobin (HB), mean corpuscular haemoglobin concentration (MCHC), platelets (PLT), platelet distribution width (PDW), lymphocytes (LYMP), alanine aminotransferase (ALT), total protein (TP), albumin (ALB), uric acid (UA), total bilirubin (TBIL), total cholesterol (TC), high-density lipoprotein (HDL) and abnormal BMD were analysed by logistic regression modelling after excluding confounding factors.

RESULTS

The ALB level in osteoporotic patients was 41.70 (36.40-45.00) g/L, which was significantly lower than those in the normal BMD and reduced BMD groups. The odds ratio (OR) (95% confidence interval [CI]) between the osteoporosis and normal BMD groups was 0.445 (0.394-0.502); the OR (95% CI) between the osteoporosis and reduced BMD groups was 0.395 (0.341-0.459). In the subgroup analysis by whether or not a fracture was present, the OR (95% CI) was 0.073 (0.045-0.119).

CONCLUSIONS

ALB is a protective factor against osteoporosis and osteoporotic fractures, suggesting that it may have the potential to predict osteoporosis onset and fractures.

Can Machine Learning Identify Patients Who are Appropriate for Outpatient Open Reduction and Internal Fixation of Distal Radius Fractures?

Purpose

This study aimed to identify which patients were "unsafe" for outpatient surgery patients and determine the most predictive demographic and clinical factors contributing to postoperative risk following open reduction internal fixation for distal radius fractures.

Methods

Adult patients (aged ≥18 years) who presented with distal radius fracture and underwent open reduction internal fixation were identified using the American College of Surgeons National Surgical Quality Improvement Program database for years 2016 to 2021. Patients who were deemed "unsafe" therefore contraindicated for outpatient open reduction internal fixation of distal radius fracture if they required admission (length of stay of one or more days) or experienced any complication or required readmission within 7 days of the index operation. The model with optimal performance was determined according to area under the curve on the receiver operating characteristic curve and overall accuracy. Additional model metrics were also evaluated, and predictive factors (ie, features) that were most important to model derivation were identified.

Results

A total of 2,020 eligible patients underwent open reduction and internal fixation for distal radius fractures. The majority (78.6%) were women, with a mean age of 57.5 ± 16.0 years. Of these patients, 21.5% experienced short-term adverse events. Gradient boosting was the optimal model for predicting patients who were "unsafe" for outpatient surgery, with key features including International Classification of Diseases, 10th Revision code, preoperative white blood cell count, age, body mass index, and Hispanic ethnicity.

Conclusions

Using machine learning techniques, a predictive model was developed, which demonstrated good discrimination and excellent performance in predicting which patients were "unsafe" for outpatient operative fixation of distal radius fracture. Findings of this study highlight the predictive value of artificial intelligence and machine learning for the purposes of preoperative risk stratification as well as its potential to better inform shared decision making and guide personalized fracture care.

Level of evidence/type of study

Prognostic IV.

Impact of Possible Sarcopenia and Nutritional Status on Postoperative Quick Disabilities of the Arm, Shoulder, and Hand Score in Geriatric Women With Distal Radius Fracture

PURPOSE

Distal radius fracture (DRF), sarcopenia, and malnutrition have been reported to be interrelated. However, there are few reports on the effects of sarcopenia and malnutrition on DRF patients' postoperative outcomes. This study examined the healthy-side grip strength and preoperative blood tests to determine the presence of possible sarcopenia (PS) and malnutrition in geriatric women with DRF and their impact on postoperative functional outcomes.

METHODS

Fifty-five woman older than 60 years treated with volar-locking plate fixation for low-energy DRF from standing-level falls were retrospectively studied. Based on the criteria of The Asian Working Group for Sarcopenia 2019, patients with a healthy-side grip strength <18 kg were defined as PS. Nutritional assessment was performed using Onodera's Prognostic Nutritional Index (PNI) before surgery, with a value <50 defined as malnutrition. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) was used for functional assessment at 1 year after surgery. Patients were divided into two groups according to PS, and patient demographic data and postoperative outcomes were compared. Multiple regression analysis was performed to estimate the regression coefficient and 95% confidence intervals for 1-year QuickDASH after surgery with adjustment for age, PS, and malnutrition.

RESULTS

Possible sarcopenia was present in 10 patients (18.2%), and malnutrition in 24 patients (43.6%). Possible sarcopenia patients were older, had lower PNI, serum albumin, and both sides grip strength, and worse QuickDASH compared with non-PS patients. In multiple regression analysis, age, PS, and malnutrition were significant predictors of QuickDASH (standardized coefficient β, 0.35, 0.34, and 0.24; 95% confidence interval, 0.22-1.02, 3.52-16.49, and 0.50-10.78).

CONCLUSIONS

Possible sarcopenia with a healthy-side grip strength <18 kg and malnutrition with a PNI <50 were associated with worse 1-year QuickDASH after surgery in women DRF patients over 60 years.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic Ⅳ.

Design and analysis of exoskeleton devices for rehabilitation of distal radius fracture

In this work, the mechanical principles of external fixation and resistance training for the wrist affected by a distal radius fracture (DRF) are revealed. Based on the biomechanical analysis, two wearable exoskeleton devices are proposed to facilitate the DRF rehabilitation progress. Chronologically, the adjustable fixation device (AFD) provides fixed protection and limited mobilization of the fractured wrist in the early stage, while the functional recovery of relevant muscles is achieved by the resistance training device (RTD) in the later stage. According to the designed mechatronic systems of AFD and RTD, the experimental prototypes for these two apparatuses are established. By experiments, the actual motion ranges of AFD are investigated, and the feasibility in monitoring joint angles are validated. Meanwhile, the resistant influences of RTD are analyzed based on the surface electromyography (sEMG) signal features, the results demonstrate that the training-induced muscle strength enhancement is generally increased with the increment in external resistance. The exoskeleton devices presented in this work would be beneficial for the active rehabilitation of patients with DRF.

Action observation intervention using three-dimensional movies improves the usability of hands with distal radius fractures in daily life-A nonrandomized controlled trial in women

OBJECTIVE

Prolonged immobilization of joints after distal radius fracture (DRF) causes cerebral disuse-dependent plasticity (DDP) and deterioration of upper extremity function. Action observation therapy (AOT) can improve DDP.

TRIAL DESIGN

This nonrandomized controlled trial (UMIN 000039973) tested the hypothesis that AOT improves hand-use difficulties during activities of daily living in patients with DRF.

METHOD

Right-handed women with volar locking plate fixation for DRF were divided into AOT and Non-AOT groups for a 12-week intervention. The primary outcome was difficulty in using the fractured hand, assessed with the Japanese version of the Patient-related Wrist Evaluation (PRWE). The secondary outcomes were range of motion (ROM) of the injured side and gap between measured ROM and patient-estimated ROM. The survey was administered immediately post operation and at postoperative weeks 4, 8, and 12. The AOT group used a head-mounted display and three-dimensional video during ROM exercises. The Non-AOT group used active ROM exercises alone. A generalized linear model (GLM) was used to confirm interactions and main effects by group and time period, and multiple comparisons were performed.

RESULTS

Thirty-five patients were assigned to the AOT group (n = 18, median age, 74 years) or the Non-AOT group (n = 17, median age, 70 years). In the GLM, PRWE Total, PRWE Specific, and PRWE Usual scores revealed interactions between groups and periods. The post-hoc test revealed that the PRWE Specific scores (z = 3.43, p = 0.02) and PRWE Usual scores (z = 7.53, p<0.01) were significantly lower in the AOT group than in the Non-AOT group at 4 weeks postoperatively, whereas PRWE Total scores (z = 3.29, p = 0.04) were lower at 8 weeks postoperatively.

CONCLUSIONS

These results suggested that AOT can improve hand-use difficulties in right-handed women after DRF surgery. AOT positively affects the motor imagery of patients with DRF and can reverse the patient's perceived difficulty in using the fractured hand during rehabilitation.

Artificial intelligence in traumatology

Aims

The aim of this study was to create artificial intelligence (AI) software with the purpose of providing a second opinion to physicians to support distal radius fracture (DRF) detection, and to compare the accuracy of fracture detection of physicians with and without software support.

Methods

The dataset consisted of 26,121 anonymized anterior-posterior (AP) and lateral standard view radiographs of the wrist, with and without DRF. The convolutional neural network (CNN) model was trained to detect the presence of a DRF by comparing the radiographs containing a fracture to the inconspicuous ones. A total of 11 physicians (six surgeons in training and five hand surgeons) assessed 200 pairs of randomly selected digital radiographs of the wrist (AP and lateral) for the presence of a DRF. The same images were first evaluated without, and then with, the support of the CNN model, and the diagnostic accuracy of the two methods was compared.

Results

At the time of the study, the CNN model showed an area under the receiver operating curve of 0.97. AI assistance improved the physician's sensitivity (correct fracture detection) from 80% to 87%, and the specificity (correct fracture exclusion) from 91% to 95%. The overall error rate (combined false positive and false negative) was reduced from 14% without AI to 9% with AI.

Conclusion

The use of a CNN model as a second opinion can improve the diagnostic accuracy of DRF detection in the study setting.

An Analysis of the Clinical and Radiological Outcomes of Fragment-Specific Fixation of Intra-articular Distal End Radius Fractures

Background and objective Distal radius fractures (DRFs) present unique challenges for fixation, as they often involve small, periarticular fragments that require advanced techniques to achieve proper anatomical alignment and functional recovery. This study aimed to investigate the efficacy of fragment-specific fixation in managing these fractures. Methods We conducted a longitudinal study involving 57 patients with fresh intra-articular DRFs. The participants, aged 18-80 years, were evaluated through comprehensive radiological assessments, including X-rays and CT scans, alongside clinical examinations. Ethical approval and informed consent were obtained for all procedures. Results The sample included 57 patients; 57.89% were male and 42.11% were female. The most common occupations were housewives (33.33%) and business professionals (19.30%). Injuries were nearly equally distributed between the left (47.37%) and right (52.63%) sides, with road traffic accidents accounting for 52.63% of cases. Radiological evaluations indicated significant improvements in volar tilt, from 10.38 ± 1.46 degrees postoperatively to 9.57 ± 1.67 degrees after three months, and in radial inclination, from 21.09 ± 1.72 degrees to 20.28 ± 2.04 degrees. Clinical outcomes, as measured by Green and O'Brien and Gartland and Werley scores, showed a substantial recovery, with 75.44% of patients achieving an excellent rating with no poor outcomes. Conclusions Based on our findings, fragment-specific fixation for DRFs is highly effective, leading to significant improvements in both radiological and functional outcomes. The technique helped maintain anatomical alignment and facilitated bone healing and we recommend its adoption as a standard treatment for complex DRFs. We also recommend future studies investigating its long-term outcomes and comparing this approach with other fixation methods to optimize patient care further.

Risks of Chronic Preoperative Opioid Use on Distal Radius Surgery Outcomes

BACKGROUND

The purpose of this study was to determine the influence of chronic preoperative opioid use on complications, reoperation rates, and postoperative opioid use among patients undergoing open reduction and internal fixation (ORIF) of distal radius fractures.

METHODS

A retrospective review of 111 patients who underwent ORIF of a distal radius fracture from 2019 to 2021 at an academic medical center by the same fellowship-trained orthopedic hand surgeon was conducted. Patient demographics, medical comorbidities, perioperative details, surgical complications, and patient-reported outcome measures were analyzed. The SCRIPTS database was used to obtain opioid prescription data.

RESULTS

A total of 10 patients (9.01%) were identified as preoperative chronic opioid users. This group was not associated with risk of increased complication. However, they were more likely to continue using narcotics at 90 and 180 days postoperatively. Patients with a history of substance use were at an increased risk of hardware complications and prolonged postoperative pain. In addition, these patients were more likely to receive narcotics at 90 and 180 days, and to have more refills postoperatively.

CONCLUSION

Patients with preoperative opioid use are not at an increased risk of surgical complication following ORIF of distal radius fractures. However, they are at an increased risk of prolonged postoperative opioid use. Patients with a known history of substance use were at an increased risk of hardware complications, prolonged pain, and increased postoperative opioid use. Surgeons should consider these associations to better manage individual patients in the postoperative period.

Considering occupational performance during recovery of distal radius fracture: A scoping review

INTRODUCTION

Distal radius fracture (DRF) is one of the most common upper extremity fractures treated by hand therapists and can lead to chronic physical impairment and reduced occupational performance. This scoping review aimed to reveal what is currently known about occupational performance following DRF and to explore if and how occupational performance is defined and considered in the research.

METHODS

This review was guided by the PRISMA-Scoping review and the Joanna Briggs Institute (JBI) guidelines. Relevant databases were searched, and studies that addressed occupation performance in adult participants following DRF were included. The findings were summarised according to the components of occupational performance (person, occupation, and environment), and quality was measured using the Mixed Methods Appraisal Tool.

RESULTS

Forty-three articles met the eligibility criteria for inclusion. All of the studies discussed at least two components of occupational performance, while 25 recognised all three. The consideration of occupational performance was dominated by biomechanical issues associated with the person component (i.e. range of motion, strength). There was some acknowledgement of the psychosocial aspects of the person and, to a lesser extent, the environment, as well as the impact of both on return to occupational performance.

CONCLUSION

Despite occupational performance being at the core of occupational therapy theory, its consideration within the context of research on DRF appears to be focussed on the person component of occupational performance and on biomechanical issues. Further research is recommended to determine how much this reflects current clinical practice and if a more comprehensive consideration of occupational performance will improve rates of recovery following DRF.

CONSUMER AND COMMUNITY INVOLVEMENT

As part of the protocol development for this review, consumers and stakeholders were consulted. They provided feedback on clarity and importance of the research questions.

PLAIN LANGUAGE SUMMARY

A distal radius fracture happens when you break the bone on the thumb side of your wrist. This type of injury often occurs when you fall and land on an outstretched hand. It is one of the more common injuries that hand therapists see in their practice. For some people, recovering from this fracture can take a long time and come with a lot of pain, difficulty moving, and emotional stress. These problems can make it hard to do everyday things like driving, cooking, or getting dressed. It can also affect both paid and unpaid work as well as leisure and social activities, making life more difficult for everyone involved. The findings from this review suggest that the current research usually focuses on how the body physically heals from this type of injury, but it does not pay as much attention to the emotional and social impact on healing. Also, it does not always discuss the activities that are important to the person, or the environment where they live, work, and socialise. This may show a gap in the research regarding our full comprehension of recovery from distal radius fractures. Taking a broader view and approach to recovery, considering a person's emotions, social life, environment, and daily activities, could help people recover fully and get back to their previous life routines and roles after this type of injury.

Assessment of stabilizing feedback control of walking: A tutorial

Walking without falling requires stabilization of the trajectory of the body center of mass relative to the base of support. Model studies suggest that this requires active, feedback control, i.e., the nervous system must process sensory information on the state of the body to generate descending motor commands to the muscles to stabilize walking, especially in the mediolateral direction. Stabilization of bipedal gait is challenging and can be impaired in older and diseased individuals. In this tutorial, we illustrate how gait analysis can be used to assess the stabilizing feedback control of gait. We present methods ranging from those that require limited input data (e.g. position data of markers placed on the feet and pelvis only) to those that require full-body kinematics and electromyography. Analyses range from simple kinematics analyses to inverse dynamics. These methods assess stabilizing feedback control of human walking at three levels: 1) the level of center of mass movement and horizontal ground reaction forces, 2) the level of center of mass movement and foot placement and 3) the level of center of mass movement and the joint moments or muscle activity. We show how these can be calculated and provide a GitHub repository (https://github.com/VU-HMS/Tutorial-stabilizing-walking) which contains open access Matlab and Python code to calculate these. Finally, we discuss what information on feedback control can be learned from each of these.

Pain Sensitization and Association With Baseline Factors in Elderly Patients With Distal Radius Fracture: A Cross-Sectional Study

BACKGROUND

The aim of this study was to describe the presence of pain sensitization (PS) and its association with baseline factors after cast removal in patients older than 60 years with distal radius fracture (DRF) treated conservatively.

METHODS

This cross-sectional study included 220 patients older than 60 years with extra-articular DRF who completed the Pain Sensitivity Questionnaire (PSQ). Patients with PSQ score > 7 points were considered positive for PS. In addition, sociodemographic, anthropometrics, clinical, radiological, lifestyle behaviors, pain-related psychological factors, and functional outcomes were analyzed as baseline predictors, all measured were performed 2 weeks after cast removal.

RESULTS

A total of 159 patients (72.3%) showed PS. The results showed an association between higher values of PSQ-total with the affected dominant hand (β = 1.1; P = 0.04), high energy of injury (β = 3.5; P < .001), extra-articular comminuted metaphyseal DRFs (β = 1.8; P < .001), lower values of Rapid Assessment of Physical Activity questionnaire (β = 3.1; P < .001), higher values of Pittsburgh Sleep Quality Index (β = 2.5; P < .001), higher values of Tampa Scale of Kinesiophobia (β = 1.9; P < .001), higher values of Pain Catastrophizing Scale (β = 1.8; P < .001), higher values of Disabilities of the Arm, Shoulder and Hand questionnaire (β = 1.6; P < .001), lower values of grip strength (β = 1.4; P < .001) and higher values of Visual analog scale (β = 4.2; P < .001).

CONCLUSIONS

A high percentage of patients older than 60 years with extra-articular DRFs present PS at 2 weeks after cast removal. Our results may help physicians and physiotherapists identify risk and/or prognostic baseline factors for the occurrence of PS after DRF, and the need for a therapeutic approach that incorporates the clinical management of this condition in these patients.

Long-Term Association Between Patient-Reported Outcomes and Psychological Factors in Patients With a Distal Radius Fracture

Purpose

The outcome after a distal radius fracture (DRF) is often evaluated with radiography, clinical examination, and patient-reported outcome measures. However, research has identified associations between psychological factors and outcomes after a DRF. A knowledge gap exists about psychological factors and their potential implications for long-term outcomes after a DRF. The aim of this study was to examine the long-term association between psychological factors and patient-reported outcomes.

Methods

This multicenter investigation included patients aged 15-75 years with closed physes presenting with an acute DRF. Patients who completed a long-term follow-up (after 11-13 years) with patient-reported outcome measures were invited to participate in the study, and surveys measuring psychological factors were sent to the patients.

Results

Two hundred and four patients (70%) completed the follow-up (mean [range] age at injury, 56 [18-75] years; 154 were females [75%]). Multivariable analysis showed that higher age, injury to the dominant hand, and greater pain catastrophizing were associated with an increase in scores on the Disabilities of the Arm, Shoulder, and Hand questionnaire.

Conclusions

A decade after sustaining a DRF, patients with higher scores on the Pain Catastrophizing Scale reported inferior outcomes as measured by the Disabilities of the Arm, Shoulder, and Hand. The Pain Catastrophizing Scale accounts for 13% of the observed variance in Disabilities of the Arm, Shoulder, and Hand.

Type of study/level of evidence

Therapeutic level IIb.

The Association Between Social Determinants of Health and Distal Radius Fracture Outcomes

PURPOSE

The purpose of this study was to determine if adverse social determinants of health (SDOH) are associated with differential complication rates following surgical fixation of distal radius fractures and assess which SDOH domain (economic, educational, social, health care, or environmental) is most associated with postoperative complications.

METHODS

Using a national administrative claims database, we conducted a retrospective cohort analysis of patients undergoing open treatment for an isolated distal radius fracture between 2010 and 2020. Patients were stratified based on the presence/absence of at least one SDOH code and propensity score matched to create two cohorts balanced by age, sex (male or female), insurance type, and comorbidities. Social determinants of health examined included economic, educational, social, health care, and environmental factors. Multivariable logistic regression analyses were performed to assess the isolated effect of SDOH on 90-day and 1-year complication rates.

RESULTS

After propensity matching, 57,025 patients in the adverse SDOH cohort and 57,025 patients in the control cohort were included. Patients facing an adverse SDOH were significantly more likely to experience 90-day complications, including emergency department visits (Odds ratio (OR): 3.18 [95% confidence interval (CI): 3.07-3.29]), infection (OR: 2.37 [95% CI: 2.12-2.66]), wound dehiscence (OR: 2.06 [95% CI: 1.72-2.49]), and 1-year complications, including complex regional pain syndrome (OR: 1.35 [95% CI: 1.15-1.58]), malunion/nonunion (OR: 1.18 [95% CI: 1.08-1.29]), and hardware removal (OR: 1.13 [95% CI: 1.07-1.20]). Additionally, patients facing an adverse SDOH had a significantly increased risk of 90-day complications, regardless of fracture severity, and patients with economic and social challenges had the highest odds of both 90-day and 1-year postoperative complications.

CONCLUSIONS

Social determinants of health are associated with increased complications following distal radius fracture fixation, even when controlling for demographic and clinical factors. We recommend routine screening for adverse SDOH and inclusion of SDOH data into health records to not only inform quality improvement initiatives and risk adjustment for outcome-based quality measurements but also to allow providers to begin to discuss and address such barriers during the perioperative period.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognosis II.

Effect of ultrasound-guided nerve blocks on anesthesia and pulmonary function in patients undergoing distal radius fracture surgery

This study aimed to assess the impact of ultrasound (US)-guided nerve blocks (NBs) on anesthesia and their protective effect on pulmonary function (PF) in patients undergoing distal radius fracture (DRF) surgery. A total of 122 patients undergoing DRF surgery between April 2020 and June 2023 were included. According to the type of peripheral NB technique, these patients were randomized into a control group (CG; n = 60) receiving brachial plexus block (BPB) using blinded techniques, and an observation group (OG; n = 62) receiving US-guided supraclavicular BPB. Anesthetic effects, BPB-related indexes, adverse events, PF parameters (forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow), and serum biochemical indexes (interleukin [IL]-6/10) were compared. The OG showed a relatively higher proportion of good anesthetic effects, shorter onset and completion times of block, and longer block duration compared to the CG, with a lower AE rate. Despite reductions in PF parameters and IL-10 levels after intervention, the OG maintained higher values than the CG. IL-6 levels increased significantly in the OG but remained lower than in the CG. In conclusion, US-guided NBs demonstrated significant anesthetic efficacy and apparently reduced anesthesia adverse events while also exerting a protective effect on PF in DRF surgery patients.

Monitoring Everyday Upper Extremity Function in Patients with Complex Regional Pain Syndrome: A Secondary, Retrospective Analysis from ncRNAPain

Objective

Complex regional pain syndrome (CRPS) represents a rare complication following injury to a limb. The DASH questionnaire (disability of arm, shoulder, and hand) evaluates everyday arm function. We assessed the DASH and its subitems in comparison to patients with brachial plexus lesions or fracture controls, analysed it over time, and in relation to active range of motion (ROM), to determine patients' impairment and trajectory.

Methods

The dataset included 193 patients with upper extremity CRPS from the noncoding RNA (ncRNA) Pain cohort, 36 fracture controls, and 12 patients with traumatic brachial plexus lesions. For the clinical and psychological characterisation, questionnaires and a goniometer for the measurement of ROM were utilized. Thirty-three patients were followed up after approximately 2.5 years of guideline treatment.

Results

CRPS patients had a similar mean DASH of 54.7 (standard deviation (S.D.) ±21) as brachial plexus lesion patients (M = 51.4, S.D. ± 16.1) but different significantly from fracture controls (M = 21.2, S.D. ± 21.1). Pain and older age were predictors of the DASH. Activities requiring force or impact on the arm, shoulder, or hand were mostly affected in patients with CRPS. After 2.5 years of standard treatment, the mean DASH score fell to 41.3 (S.D. ± 25.2), weakness in leisure activities was recuperated, pain feelings were lessened, and ROM, e.g., wrist flexion, recovered by 36°. Two-thirds of patients improved in both the DASH and the ROM.

Conclusions

CRPS is as disabling as a complete loss of arm function in brachial plexus lesions and exhibits only partial recovery. Developing QuickDASH versions for CRPS patients could reduce the load of questions in clinical studies. It would be prudent to consider the unexpected age dependency of the DASH in future studies. This trial is registered with DRKS00008964.

The Impact of Neighborhood and Socioeconomic Disparities on Distal Radius Fracture Follow-Up Adherence

BACKGROUND

The aims of this retrospective cohort study were (1) to assess whether the Area Deprivation Index (ADI), a novel neighborhood-level socioeconomic disparities metric, is associated with follow-up nonadherence, and (2) to determine the individual-level socioeconomic factors associated with follow-up nonadherence after treatment of distal radius fractures (DRFs).

METHODS

The authors included all patients who underwent nonoperative or operative management of DRFs at an academic level I trauma center between 2019 and 2021. A manual chart review was performed to collect data on ADI, sociodemographic factors, injury characteristics, conservative and surgical interventions, and health care utilization.

RESULTS

There was a significant weak negative Spearman-ranked correlation between ADI state deciles and clinic attendance rates ( rs [220] = -0.144 [95% CI, -0.274 to -0.009]; P = 0.032). Socioeconomic factors associated with significant differences in clinic attendance rates were having a spouse or partner (protective) ( P = 0.007), Medicaid insurance ( P = 0.013), male sex ( P = 0.023), and current smoking ( P = 0.026). Factors associated with differences in no-show rates were having a spouse or partner (odds ratio [OR], 0.326 [95% CI, 0.123 to 0.867]; P = 0.025), Medicaid insurance (OR, 7.78 [95% CI, 2.15 to 28.2]; P = 0.002), male sex (OR, 4.09 [95% CI, 1.72 to 9.74]; P = 0.001), and cigarette use (OR, 5.07 [95% CI, 1.65 to 15.6]; P = 0.005).

CONCLUSIONS

ADI has a weak, negative correlation with clinic attendance rates after DRF treatment. Significant disparities in clinic follow-up adherence exist between patients on the basis of marital status, insurance, sex, and cigarette use.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.

A Systematic Review of the Optimal Management of Pediatric Distal Radius Displacement Fractures: Open Reduction and Internal Fixation Versus Cast Placement

Distal radius fractures are among the most common pediatric injuries, affecting thousands of children each year. These fractures often require clinical intervention to reduce displacement and ensure the proper healing of the growth plate and wrist bone. The primary objective of this comprehensive analysis is to compare the effectiveness of open reduction and internal fixation (ORIF) versus cast placement in the treatment of pediatric distal radius fractures, with the aim of identifying the optimal treatment approach. Therefore, a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on pediatric distal radius displacement fractures using extensive database searches from 2000 to 2024 for specific keywords, ensuring transparency and reproducibility. Our findings indicate that higher displacement necessitates ORIF to minimize long-term complications and ensure better functional outcomes for pediatric patients. Rare studies comparing ORIF and cast placement are analyzed, emphasizing the advantages and limitations of each approach. The document concludes that the choice between ORIF and casting depends on factors such as fracture severity, patient's age, and specific characteristics of the injury to ensure optimal outcomes in pediatric distal radius fracture management. In conclusion, our data suggests that ORIF and cast placement each have pros and cons for pediatric distal radius fractures, with the best treatment depending on fracture specifics and patient factors, but neither method is clearly superior for long-term outcomes.

A prospective randomized control trial comparing outcomes of casting, pinning, and plating for distal end of radius fractures (AO type A2, A3, C1, or C2) in the elderly population

PURPOSE

With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly.

METHODS

A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score.

RESULTS

Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group.

CONCLUSION

The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients.

Pediatric Hand Surgery Training: A Spectrum of Educational Resources

Treatment of children with upper-extremity trauma, congenital hand differences, cerebral palsy, and brachial plexus birth injuries requires specialized training, given the spectrum of pathology and complexities of treating an individual who is still developing. Although a limited number of dedicated pediatric hand surgery fellowships are available, mastering the large breadth of the field should ideally begin early in training and may take several different pathways. The authors seek to provide a comprehensive list of resources for trainees interested in pediatric hand surgery, including training opportunities, educational tools, and networking organizations. By shining a light on these pediatric hand surgery resources, we hope to encourage future trainees to plan ahead, so that they are well-prepared for the care of children with complex upper limb reconstructive needs.

Effect of Kinesio taping on edema and wrist functions in patients with distal radius fracture followed conservatively with a cast: A randomized controlled single-blinded study

BACKGROUND

Data in the literature on the results of Kinesio taping (KT) application after cast removal in patients with distal radius fracture (DRF) are quite limited.

PURPOSE

It was aimed to evaluate the effectiveness of KT applied immediately after cast removal in addition to the exercise program on edema, functionality, range of motion, and muscle strength in patients with conservatively followed DRF.

STUDY DESIGN

Randomized controlled single-blinded clinical study.

METHODS

This study was conducted with 64 patients with a diagnosis of DRF. The patients were randomized as Kinesio taping group (KTG) and control group. Both groups received a conventional home exercise program. KT was applied to patients in KTG for 10 days. Circumference and volume measurements were taken at baseline and day 10. Arm, Shoulder, and Hand Questionnaire for Disability, Visual Analog Scale, grip strength, and wrist joint range of motion measurements were taken at baseline, day 5, and day 10.

RESULTS

The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the fifth day at the wrist level (<0.001) and 6 cm proximal to the wrist (p = 0.001). The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the 10th day at the wrist level (p < 0.05) and 6 cm proximal to the wrist (p = 0.01). Wrist extension angle (<0.001), wrist flexion angle (p = 0.001), and supination angle (p = 0.001) were higher in KTG on the 10th day. On the 10th day, the grip strength (p < 0.05) was higher in the KTG, while the Visual Analog Scale value (p < 0.01), Arm, Shoulder, and Hand Questionnaire for Disability score (p < 0.01), and the percentage of strength loss in the healthy arm (p < 0.01) were lower in the KTG.

CONCLUSIONS

In patients with DRF who were treated conservatively with a cast, the inclusion of Kinesio taping (KT) in the rehabilitation program was found to be effective in reducing edema and pain, as well as improving functionality, strength, and range of motion.

Association of distal radial fracture with comorbidities: model development and validation

BACKGROUND

To better assess the risk of distal radial fracture in the general population, we need models that take into account a wide range of risk factors other than osteoporosis. The objective was to develop and validate a model for association of patients' characteristics with distal radial fracture that effectively incorporates multifactorial aspects and includes comorbidities.

METHOD

We analyzed data from a large Longitudinal Health Insurance Database between 2000 and 2013. The outcome of the study was the occurrence of distal radial fracture and the predictors were demographic and comorbidity data. Two machine learning models were developed and validated for patients ≥50 (N = 2745) and <50 (N = 1587) years of age.

RESULTS

For patients aged ≥50 years, selected characteristics included sex, age, urbanization level, osteoarthritis, carpal tunnel syndrome, obesity, hyperlipidemia, trigger finger, hypertension, hypothyroidism, diabetes, hyperthyroidism, and rheumatoid arthritis. For patients <50 years old, selected characteristics included age, sex, diabetes mellitus, urbanization level, carpal tunnel syndrome, hyperlipidemia, osteoarthritis, obesity, and hypertension. Accuracy, sensitivity, specificity, area under the curve, and likelihood ratio were 0.77, 0.83, 0.72, 0.77, and 2.92 for age ≥50 years and 0.73, 0.79, 0.67, 0.73, and 2.41 for age <50 years.

CONCLUSION

The study models can serve as reliable screening tools to assess the risk of distal radial fracture in the general population before bone mineral density testing. In addition, they can be integrated into decision support systems to help healthcare providers identify high-risk patients for additional evaluation and education, ultimately improving the quality of care.

Sports and Recreation-Related Wrist Fractures: An Epidemiological Study

Background Wrist fractures have increased over the past several decades. The objective of this study was to identify all-cause and sports-related incidence rates of wrist fractures presenting to emergency departments (EDs) in the United States (U.S.) from 2013 to 2022. A secondary aim of the study was to identify if wrist fractures significantly decreased during 2020. Methodology The National Electronic Injury Surveillance System database was queried to identify the number of wrist fractures presenting to U.S. EDs from 2013 to 2022. Incidence rates in 100,000 person-years were calculated by sport, age, sex, and year. Results From 2013 to 2022, there were 2,027,131 wrist fractures evaluated at U.S. EDs. Injuries peaked in the 10-14-year-old age group, followed by the 5-9 and 85+-year-old age groups. In total, 1,096,598 were sustained during sports and recreation. Cycling, playgrounds, and skateboarding were the leading sports and recreation-related activities. Sports-related wrist fractures followed a unimodal distribution peaking in the 10-14-year-old age group. Females sustained 52% of wrist fractures overall but only 39% of sports-related wrist fractures. All-terrain vehicle and skateboarding-related wrist fractures significantly increased over the study period. Playground and soccer-related wrist fractures significantly decreased in 2020. Conclusions All-cause wrist fractures presenting to U.S. EDs significantly increased from 2013 to 2022 though sports-related wrist fractures did not. Pediatric males and elderly females are most at risk for wrist fractures overall while sports-related wrist fractures predominate in the pediatric population. Youth sports and recreation officials should be aware of the risks to mitigate the incidence of sports-related wrist fractures.

Frykman Type 7-8 Distal Radius Fractures in Elderly Patients: Conservative Treatment vs Volar Plating

INTRODUCTION

The aim of this study was to determine the clinical outcomes of conservative and surgical treatments in elderly patients with displaced Frykman type 7-8 distal radius fractures.

METHODS

The clinical outcomes of 50 patients aged 60 and older with displaced Frykman type 7-8 fractures who underwent surgical and conservative treatments between January 2019 and January 2022 were determined. The joint range of motion, pain scores, functional scores, radiological parameters, and any complications that occurred posttreatment were evaluated for each patient who underwent both treatments.

RESULTS

Descriptive characteristics, excluding sex, were evaluated in 18 patients treated with casting and 32 patients treated with volar plating, and no statistically significant differences were detected between the groups. The functional and radiological assessments of the groups showed no significant differences (p>0.05). The volar tilt of patients who underwent surgical treatment was significantly greater than that of patients who were treated with a cast (p=0.02). The Mayo wrist scores of patients with step-offs greater than 2 mm were significantly lower (p=0.007; p<0.01). The visual analog scale (VAS) scores of patients who met the step-off criterion were significantly greater (p=0.025; p<0.05). The Mayo wrist scores of patients whose radiological parameters were within acceptable limits were significantly greater (p=0.007; p<0.01). The Quick-Quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores of patients whose radiological parameters were within acceptable limits were significantly lower (p=0.007; p<0.01).

CONCLUSION

In elderly patients with identified Frykman type 7-8 fractures, casting and volar plating treatments produced similar results. Especially in patients with low expectations and multiple comorbidities, satisfactory results can be achieved with plaster treatment.

Ligament-Sparing Volar Radiocarpal Arthrotomy During Distal Radius Fracture Repair: Biomechanical Implications on Wrist Stability in a Cadaveric Model

PURPOSE

Distal radius (DR) fracture fixation with volar locked plating typically uses indirect fracture reduction without direct visualization of the articular surface in an attempt to preserve the volar radiocarpal ligaments and prevent iatrogenic radiocarpal instability. This study assessed the biomechanical stability after a volar radiocarpal arthrotomy for direct articular visualization for DR fracture repair compared to a standard trans-flexor carpi radialis approach without arthrotomy in a cadaver model.

METHODS

Ten fresh-frozen upper extremity matched-pair cadaveric specimens were tested. For each pair, one limb underwent trans-FCR approach with a volar arthrotomy that partially sectioned the long and short radiolunate ligaments to visualize the DR articular surface (Group 1). The contralateral limb underwent standard trans-FCR approach without arthrotomy (Group 2). Following capsular repair (Group 1), all specimens (Groups 1 and 2) underwent biomechanical testing, including axial loading (22.2 N, 44.5 N, 89.0 N, 177.9 N), volar translational, and dorsal translation loading (22.2 N, 44.5 N, 89.0 N) to assess carpal stability using both fluoroscopy and motion capture. Ulnar carpal translation was assessed using the Gilula method, measuring radiographic lunate overhang from the ulnar edge of the lunate fossa relative to the full width of the lunate. Dorsal and volar translation were assessed by measuring lunate overhang with respect to the dorsal or volar radial cortex. To simulate fractures with dorsal radiocarpal ligament disruption, the dorsal capsule was sectioned, and the biomechanical comparisons were repeated.

RESULTS

Ulnar translation of the lunate remained below 2 mm for both groups in all testing scenarios. No significant differences were identified in ulnar, volar, or dorsal translation with increasing loads between the groups.

CONCLUSIONS

This volar ligament-sparing radiocarpal arthrotomy did not cause biomechanical radiocarpal instability.

CLINICAL RELEVANCE

This arthrotomy may provide enhanced visualization of the DR articular surface during fracture fixation without causing iatrogenic wrist instability.

Impact of body mass index on fracture severity, clinical, radiological and functional outcome in distal radius fractures: a retrospective observational study after surgical treatment

INTRODUCTION

Distal radius fracture (DRF) is one of the three most common fractures of the human body with increasing incidences in all groups of age. Known causes of increasing incidence, such as ageing of the population or increased obesity, have been described and discussed. So far, literature reports ambivalent effects of body mass index (BMI) on bone physiology. It is worthwhile to examine the influence of BMI on the outcome of fractures more detailed. This study aims to investigate the influence of an abnormal BMI on fracture severity and treatment, as well as clinical, radiological, and functional outcome to improve clinical decision making.

MATERIALS AND METHODS

A retrospective observational study was conducted on data obtained from patients, who underwent open reduction and internal fixation (ORIF) of a DRF at a local Level 1 Trauma Center between May 2018 and October 2021. Follow-up examinations were performed approximately 1 year after surgical fracture treatment, during which various questionnaires and functional measurements (CMS, DASH, NRS, ROM) were applied. In addition, postoperative complications were recorded and radiological examinations of the affected hand were performed. After excluding incomplete data sets and applying set exclusion criteria, the complete data of 105 patients were analyzed.

RESULTS

74 patients were female and 31 male with significant difference in mean BMI [p = 0.002; female: 23.8 (SD ± 3.3), men: 26.2 (SD ± 3.9)]. Patients with higher BMI had significantly more severe fractures (p = 0.042). However, there was no significant difference in surgery time for fracture management. At follow-up, patients with lower BMI showed a smaller difference in hand strength between the fractured and the other hand (p = 0.017). The BMI had no significant effect on the clinical and radiological outcome.

CONCLUSION

Despite the ambivalent effects of BMI on the skeletal system, our findings indicate that a higher BMI is associated with more severe DRF. Thereby BMI does not correlate with surgery time for fracture treatment. Furthermore, no evidence of an influence on the clinical and radiological outcome could be detected.

Risk Factors for 30-Day Complications and Unplanned Reoperation Following Surgical Treatment of Distal Radius Fractures

BACKGROUND

The purpose of this study was to identify demographic data, medical comorbidities, and perioperative factors that are associated with increased risk of overall surgical complications, wound complications, and reoperation within 30 days of open reduction and internal fixation (ORIF) of distal radius fractures.

METHODS

All adult patients undergoing ORIF of distal radius fractures in the National Surgical Quality Improvement Program database between 2005 and 2020 were identified. Patients were excluded for secondary procedures, open/infected injuries, or inpatient surgical setting. Demographic data, medical comorbidities, and perioperative data were examined for each patient, and patients were grouped by the presence or absence of any surgical complication. Univariate analysis and multivariate logistic regression were used to identify risk factors.

RESULTS

A total of 20 301 patients from between 2005 and 2020 met the inclusion criteria, of which 219 complications (1.1% of cases) were identified. Following multivariate analysis, independent risk factors found to be associated with surgical complications included male sex, smoking, heart failure, longer operative time, and American Society of Anesthesiologists (ASA) classification of 3 or higher.

CONCLUSION

Male sex, smoking, heart failure, prolonged operative time, and ASA status of 3 or higher are associated with an increased risk of surgical complications following ORIF of distal radius fractures. These complications, with the exception of heart failure, were also associated with an increased risk of wound complications. Finally, male sex, nonwhite race, smoking, dialysis, prolonged operative time, and 3 or higher ASA class were associated with reoperations. Understanding these risk factors allows surgeons to better predict and prevent complications in high-risk populations.

Analysis of factors influencing hospitalization cost of patients with distal radius fractures: an empirical study based on public traditional Chinese medicine hospitals in two cities, China

BACKGROUND

Distal radius fractures (DRFs) have become a public health problem for all countries, bringing a heavier economic burden of disease globally, with China's disease economic burden being even more acute due to the trend of an aging population. This study aimed to explore the influencing factors of hospitalization cost of patients with DRFs in traditional Chinese medicine (TCMa) hospitals to provide a scientific basis for controlling hospitalization cost.

METHODS

With 1306 cases of DRFs patients hospitalized in 15 public TCMa hospitals in two cities of Gansu Province in China from January 2017 to 2022 as the study object, the influencing factors of hospitalization cost were studied in depth gradually through univariate analysis, multiple linear regression, and path model.

RESULTS

Hospitalization cost of patients with DRFs is mainly affected by the length of stay, surgery and operation, hospital levels, payment methods of medical insurance, use of TCMa preparations, complications and comorbidities, and clinical pathways. The length of stay is the most critical factor influencing the hospitalization cost, and the longer the length of stay, the higher the hospitalization cost.

CONCLUSIONS

TCMa hospitals should actively take advantage of TCMb diagnostic modalities and therapeutic methods to ensure the efficacy of treatment and effectively reduce the length of stay at the same time, to lower hospitalization cost. It is also necessary to further deepen the reform of the medical insurance payment methods and strengthen the construction of the hierarchical diagnosis and treatment system, to make the patients receive reasonable reimbursement for medical expenses, thus effectively alleviating the economic burden of the disease in the patients with DRFs.

Impact of Socioeconomic Factors on Time to Surgery for Distal Radius Fractures

Background

Delay in care secondary to socioeconomic status (SES) and demographic factors represents an area for potential improvement. Reducing time to surgery in distal radius fracture (DRF) fixation may improve outcomes while reducing cost. The purpose of this study is to investigate the effect of SES on time to surgery in our study population.

Methods

Patients undergoing outpatient DRF surgery within an academic healthcare system during a 4-year period were reviewed. Time to surgery and demographic factors were analyzed. The US Census Bureau was used to determine median household income (MHI) for a patient's ZIP code; patients were stratified into three groups based on MHI.

Results

A total of 413 patients met inclusion criteria. SES (14.7 d in the low-SES group, 14.0 d in the mid-SES group, and 11.1 d in the high-SES group, P = 0.00063), insurance (11.7 d for insured versus 16.3 d for Medicaid/uninsured, P < 0.0001), race (non-White group: 15.2 d versus White group: 10.9 d, P < 0.0001), and treatment facility (16.2 d at county hospital versus 10.9 d at university hospital, P < 0.0001) were associated with time to surgery in univariate analysis. Multivariate analysis found that only treatment facility was associated with time to surgery.

Conclusions

Non-White, uninsured/Medicaid individuals residing in low-SES areas may be more likely to receive care at a safety-net facility and are at greatest risk for delay in time to surgery. Measures aimed to reduce barriers to care, increase healthcare coverage, and improve patient education should be initiated to mitigate these disparities.

Complications After Open Reduction and Internal Fixation for Distal Radius Fractures in Patients With and Without Rheumatoid Arthritis

PURPOSE

Rheumatoid arthritis (RA) can have severe impact on patients' functional abilities and increase the risk of fragility fractures. Little is known about how patients with RA fare after operative management of distal radius fractures. The purpose of this study was to compare postoperative complications after surgical fixation in patients with RA and controls, hypothesizing that patients with RA would have higher levels of postoperative complications.

METHODS

Patients were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Revision, codes for open treatment of distal radius fractures and RA at 3 level 1 trauma centers over a 5-year period (2015-2019). Chart abstraction provided details regarding injuries and treatment. Age- and sex-matched controls were identified in a 2:1 ratio. Postoperative complications were classified according to the Clavien-Dindo-Sink classification system and divided into early (less than 90 days) and late groups.

RESULTS

Sixty-four patients (21 with RA and 43 controls) were included. The patients were predominantly women, with a mean age of 62 years and a mean Charlson comorbidity index of 2.1. The RA medications at the time of injury included conventional synthetic disease-modifying antirheumatic drugs (5/21), biologic disease-modifying antirheumatic drugs (5/21), or chronic oral prednisone (6/21). Rheumatoid medications, except hydroxychloroquine, were withheld for 2-3 weeks after surgery. Rheumatoid patients were significantly more likely to sustain a complication compared with the control group, although this was no longer significant on adjusted analysis. Class I complications were the most common. The incidence of early versus late complications was similar between the groups. A high rate of early return to surgery for fixation failure occurred in the RA group compared with none in the control group.

CONCLUSIONS

Patients with RA undergoing operative management of distal radius fractures are at risk of postoperative complications, particularly fracture fixation failure, necessitating return to the operative room. High levels of pain, stiffness, and mechanical symptoms were noted in the RA group.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Are There Racial and Ethnic Disparities in Management and Outcomes of Surgically Treated Distal Radius Fractures?

BACKGROUND

Racial/ethnic disparities have been demonstrated across multiple orthopedic sub-specialties. There is a paucity of literature examining disparities in distal radius fracture (DRF) management.

METHODS

Using the National Surgical Quality Improvement Program database, we analyzed 15 559 non-Hispanic (NH) White, NH Black, NH Asian, and Hispanic adults who underwent open reduction and internal fixation for DRF from 2013 to 2019. We evaluated time from hospital admission to surgery and length of stay using Poisson regression. Deep venous thrombosis, pulmonary embolism (PE), and wound complications were reported using descriptive statistics. Thirty-day reoperation and readmission were analyzed using binary logistic regression.

RESULTS

Wait time to surgery was longer for Hispanic patients than NH White patients (incidence rate ratio [IRR]: 2.54, P < .001); this narrowed over time (IRR: 0.944, P = .047). Length of stay was longer for NH Black (IRR: 1.78, P < .001) and Hispanic patients (IRR: 1.83, P < .001), but shorter for NH Asian (IRR: 0.715, P = .019) than NH White patients; this temporally narrowed for NH Black patients (IRR: 0.908, P = .001). Deep venous thrombosis, PE, and wound complications occurred at a rate less than 0.30% across all groups. Hispanic patients were less likely to undergo reoperation than NH White patients (odds ratio [OR]: 0.254, P = .003). While there was no difference in readmission between groups in the aggregated study period, NH Black patients experienced a temporal increase in readmissions relative to NH White patients (OR: 1.40, P = .038).

CONCLUSIONS

Racial and ethnic disparities exist in DRF management. Further investigation on causes for and solutions to combat these disparities in DRF care may help improve the inequities observed.

Ligament-Sparing Volar Radiocarpal Arthrotomy During Distal Radius Fracture Repair: Anatomical Description and Quantification of Articular Surface Area Visualized in a Cadaveric Model

PURPOSE

Distal radius (DR) fracture repair using the volar locked plating technique typically involves indirect fracture reduction, assessed using fluoroscopy, without direct visualization of the articular surface. This method of fracture repair may be guided by the rationale that volar radiocarpal ligament disruption may cause radiocarpal instability, although direct articular visualization may facilitate improved fracture reduction. This study investigated anatomical feasibility and articular surface visualization using volar ligament-sparing radiocarpal arthrotomy pertinent to DR fracture repair.

METHODS

Ten fresh-frozen cadaveric specimens of the upper extremity underwent volar arthrotomy via the standard flexor carpi radialis approach with partial longitudinal sectioning of the long radiolunate and partial transverse sectioning of the short radiolunate ligaments to visualize the articular surface of the DR. Following arthrotomy, the visible surface of the DR was analyzed using digital photography. The wrist was disarticulated, and the fully exposed articular surface was photographed. The visible area of the articular surface was quantified using digital imaging software by calculating the ratio of the surface area visualized using the arthrotomy to the total articular surface area.

RESULTS

The percentage of the articular surface area of the DR visualized using the volar arthrotomy was 76% ± 7.6% (range, 69%-90%), including both the scaphoid facet, lunate facet, and scapholunate ridge.

CONCLUSIONS

Volar radiocarpal arthrotomy allows clinically relevant visualization of the articular surface of the DR, including the scaphoid and lunate facets.

CLINICAL RELEVANCE

Radiocarpal arthrotomy may facilitate improved articular reduction during DR fracture repair via the volar approach.

Footwear and Falls in Long-Term Residential Aged Care Facilities: An Analysis of Video Capture Data

INTRODUCTION

Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate.

METHODS

Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and fall characteristics (proposed mechanism and fall direction).

RESULTS

There were 300 falls experienced by 118 older adults aged 58 years-98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%), and wearing shoes (7/99 falls, 7%).

CONCLUSION

Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.

Decrease in incidence of distal radius fractures in Oslo, Norway

This study reported the incidence of validated adult distal radius fractures in Oslo, Norway, in 2019. The incidence has been reduced over the last 20 years. However, it is still high compared to other regions in Norway and some of the other Nordic countries.

PURPOSE

We aimed to report the incidence of distal radius fractures in Oslo in 2019 and compare it to the incidence rates in 1998/1999.

METHODS

Patients aged ≥ 20 years resident in Oslo sustaining a distal radius fracture in 2019 were identified by electronic diagnosis registers, patient protocols, and/or radiology registers. The diagnosis was verified using medical records and/or radiology descriptions. We used the same method as the previous study from Oslo, making the comparison over time more accurate. The age-adjusted incidence rates and the age-standardized incidence rate ratio (IRR) were calculated.

RESULTS

The absolute number of fractures decreased from 1490 in 1998/1999 to 1395 in 2019. The IRR for women and men in the age group ≥ 20 years in 2019 compared to 1998/1999 was 0.77 (95% CI 0.71-0.84) and 0.77 (95% CI 0.66-0.90), respectively. The IRR for women and men in the age group ≥ 50 years in 2019 compared to 1998/1999 was 0.78 (95% CI 0.71-0.86) and 0.78 (95% CI 0.63-0.97), respectively. For the population in Oslo with Asian background compared to Norwegian background in the age group ≥ 50 years, the IRR in 2019 was 0.57 (95% CI 0.40-0.80) for women and 0.77 (95% CI 0.44-1.37) for men.

CONCLUSIONS

The incidence of distal radius fractures in Oslo has decreased over the last 20 years. It is still, however, higher than in other areas of Norway and in some of the other Nordic countries.

Current clinical practice patterns and perspectives of Australian hand therapists during the treatment of adults with distal radius fracture: A national survey

INTRODUCTION

Successful return to pre-injury occupational performance following distal radius fracture (DRF) may be influenced by person and environment factors such as pain, age, social support, and socioeconomic status. The primary aim of this study was to explore Australian hand therapists' current clinical practice and determine whether they consider these factors during the management of DRF.

METHODS

A mixed methods online survey was distributed to members of the Australian Hand Therapy Association. Descriptive statistics were used to examine the quantitative data, and the qualitative data were analysed by content analysis.

RESULTS

Of the 120 members who completed the survey, 68% were occupational therapists and 32% were physiotherapists with 74% in the private and 26% in the public health-care setting. Most factors perceived to influence recovery were consistent with person factors and a biomechanical approach. Other factors related to occupational performance, such as social and leisure skills, environment and culture were reported less often. When asked about defining occupational performance, the key categories identified through qualitative open responses were 'performing meaningful activities/occupations', 'performing work/employment', and 'completing activities/function'.

CONCLUSION

The data suggest that hand therapists in Australia primarily identify person factors as key to recovery after DRF. Context and environmental factors that influence occupational performance did not appear to be considered as often during treatment or when defining occupational performance. Further research is needed to explore the contextual and environmental factors that influence hand therapy intervention and determine whether they play a role in the successful return to pre-injury occupational performance following DRF.

CONSUMER AND COMMUNITY INVOLVEMENT

The survey was conceptualised by the research team, which included two experienced hand therapists and piloted with 10 consumers. Hand therapists (consumers) of various years of experience and discipline (i.e., occupational therapy and physiotherapy) provided feedback to improve the survey in terms of content, comprehensibility, and length. No clients/patients of hand therapists were involved in the development of the survey or the study, and the consumers of the study were considered hand therapists.