Recovery of strength after reduced pediatric fractures of the forearm, wrist or hand; A prospective study

Biceps Transfer to FDP-FPL Tendon Augmented with Fascia Lata to Restore Hand Function in Neglected Fracture Treated by Traditional Bone-setters

Neglected bone fractures owing to the traditional bone-setter practices could lead to devastating complications. We aimed to describe the procedure and outcome of fascia lata augmentation for a forearm massive soft tissue loss case. Here, we report a case of a 14-year-old boy who presented to our hospital with a history of neglected right forearm fracture 4 years prior. He had been treated by a traditional bone-setter instead of seeking professional medical help, which resulted in wide-spread infection requiring debridement and, eventually, massive soft tissue loss, wrist radial deviation deformity due to epiphyseal growth arrest, and loss of all right-hand function. Intervention performed was biceps transfer to flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendon augmented with fascia lata with anterior capsulectomy, bilobed flap, and transfixing wire of wrist joint, followed by ulnar centralization with wrist arthrodesis. The patient reported satisfaction postreconstruction, owing to the enhancement of hand function and appearance. He also showed significant improvement in activities of daily living and penmanship, and was even able to continue his old hobby as a traditional puppeteer. Autologous fascia lata tendon transfer connecting biceps to FDP and FPL tendon alongside ulnar centralization with wrist arthrodesis is a novel technique that has promising results to improve hand function and appearance.

Functional recovery after reduced pediatric fractures of the forearm with respect to perceived limitations, common post-traumatic symptoms, range of motion, and dexterity: a prospective study

PURPOSE

Studies on functional recovery after pediatric forearm fractures are scarce. Outcome measures are usually (retrospectively) incorporated to compare treatments. How these parameters recover has only rarely fallen within the scope. Aim was to provide insight into "normal recovery" by evaluating how limitations, post-traumatic symptoms, range of motion (ROM) and dexterity recuperate.

MATERIALS AND METHODS

Prospective observational study regarding children 4 and 18 years with a reduced forearm fracture. Limitations, post-traumatic symptoms, ROM, and dexterity were evaluated 6 weeks, 3 and 6 months post-trauma. ROM of the unaffected side was used as a baseline.

RESULTS

Of 54 participants 25.9% and 5.9% perceived limitations after 3 respectively 6 months. Pain, swelling and hypertrichosis were common symptoms. Movements distal from the elbow were restrained 6 weeks post-trauma. Supination and palmar flexion were most affected, followed by dorsal flexion and pronation. Palmar flexion and pronation were still affected after 3 months and associated with treatment invasiveness. Dexterity was diminished at 6 weeks only.

CONCLUSIONS

Mild limitations are common. Further investigation of the association between pain, reduced sensitivity and hypertrichosis with treatment invasiveness is warranted. Regarding ROM supination, pronation, palmar and dorsal flexion should be incorporated in future studies. Dexterity is an unsuitable outcome measure.IMPLICATIONS FOR REHABILITATIONThis study relates to monitoring recovery from pediatric forearm fractures.Physicians ought to realize that one in four children experience limitations preceding 3 months post-trauma, in which case involvement of a hand therapist should be considered.Pain, swelling and especially hypertrichosis are common post-traumatic symptoms in children and should on itself not immediately raise concerns for complex regional pain syndrome (CRPS).To assess recovery of range of motion measuring pronation, supination, dorsal, and palmar flexion is sufficient.

Telerehabilitation Technology Used for Remote Wrist/Finger Range of Motion Evaluation: A Scoping Review

Background

Monitoring finger/wrist range of motion (ROM) is an important component of routine hand therapy after surgery. Telerehabilitation is a field that may potentially address various barriers of in-person hand therapy appointments. Therefore, the purpose of this scoping review is to identify telerehabilitation technologies that can be feasibly used in a patient's home to objectively measure finger/wrist ROM.

Methods

Following PRISMA-ScR guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases using alternative word spellings for the following core concepts: "wrist/hand," "rehabilitation," and "telemedicine." Studies were imported into Covidence, and systematic two-level screening was done by two independent reviewers. Patient demographics and telerehabilitation information were extracted from the selected articles, and a narrative synthesis of the findings was done.

Results

There were 28 studies included in this review, of which the telerehabilitation strategies included smartphone angle measurement applications, smartphone photography, videoconference, and wearable or external sensors. Most studies measured wrist ROM with the most accurate technologies being wearable and external sensors. For finger ROM, the smartphone angle application and photography had higher accuracy than sensor systems. The telerehabilitation strategies that had the highest level of usability in a remote setting were smartphone photographs and estimation during virtual appointments.

Conclusions

Telerehabilitation can be used as a reliable substitute to in-person goniometer measurements, particularly the smartphone photography and motion sensor ROM measurement technologies. Future research should investigate how to improve the accuracy of motion sensor applications that are available on easy-to-access devices.

The patterns and management of fracture patients under COVID-19 outbreak in China

Background

Currently, the perioperative care of fracture patients is compromised due to the outbreak of COVID-19 in China and the world. This study aims to assess the clinical features of fracture patients at our hospital during the COVID-19 outbreak and formulate the medical steps to ensure the effective treatment of fracture patients with minimal risk of infection to healthcare workers.

Methods

One hundred twelve patients with different fractures that were admitted to the orthopedics department of our hospital from January 24 to March 9 in 2020 were reviewed. Data including age, gender, injury location, admission time, operation time, discharge time were compared with fracture patients from the same period in 2019

Results

Compared to the same period in 2019, there is a 42% decrease in the number of fracture patients in 2020. Specifically, the incidences of forearm, thigh, hand, and foot fractures have increased during the COVID-19 outbreak, while other parts are less affected. The time from injury to hospitalization, the surgery wait time and time of discharge after surgery for patients with hip fractures were 2.9±7.1, 2.0±1.7 and 7.7±4.0 days respectively in 2019, which changed to 2.0±5.0, 4.5±4.0 and 10.6±4.2 days in 2020. Following the orthopedic treatment regimen followed at our hospital, all patients had non-life-threatening limb fractures. Six patients were operated in a negative pressure room, and emergency screening was completed for six patients. No patients were positive for COVID-19, and all were discharged safely without infection or other serious complications.

Conclusions

Hip fractures are highly prevalent during this epidemic. However, mandatory screening delays surgery by more than 48 hours. The orthopedic department should prioritize screening of emergency patients to minimize the risk of infection among other patients and medical personnel.