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Larose G, Roffey DM, Broekhuyse HM, Guy P, O'Brien P, Lefaivre KA. Trajectory of Recovery following ORIF for Distal Radius Fractures. J Wrist Surg 2024; 13:230-235. [PMID: 38808181 PMCID: PMC11129881 DOI: 10.1055/s-0043-1771045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/15/2023] [Indexed: 05/30/2024]
Abstract
Background Distal radius fractures are commonly seen among the elderly, though studies examining their long-term outcomes are limited. Purpose The aim of this study was to describe the 5-year trajectory of recovery of distal radius fractures treated with open reduction and internal fixation (ORIF). Methods Patients with distal radius fractures (AO/OTA 23.A-C) treated by ORIF were prospectively studied. Patient-Rated Wrist Evaluation (PRWE) score was measured at baseline (preinjury recall) and postoperatively at 6 months, 1 year, and 5 years. Clinically relevant change in PRWE score was assessed using the minimal clinically important difference (MCID). Results A total of 390 patients were included, of which 75% completed 5-year follow-up. Mean baseline PRWE score was 1.25 (standard deviation, SD: 2.9). At 6 months, mean PRWE score was at its highest up to 20.2 (SD: 18.4; p < 0.01). A significant improvement in mean PRWE score was observed at 1 year down to 15.2 (SD: 17.6; p < 0.01); 44% of patients were still one MCID outside of their baseline PRWE score at 1 year. Further significant improvement in mean PRWE score occurred at 5 years down to 9.4 (SD: 13.4; p < 0.01); 29% of patients remained one MCID outside of their baseline PRWE score at 5 years. Conclusion Recovery after ORIF for distal radius fractures showed significant worsening after surgery, followed by significant improvements up to 1 year and between years 1 and 5, albeit to a lesser extent. Statistically and clinically relevant wrist pain and disability persisted at 5 years. Future research should examine different treatment modalities and include a nonoperative treatment arm for comparison. Level of Evidence Prognostic level II.
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Affiliation(s)
- Gabriel Larose
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Darren M. Roffey
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Henry M. Broekhuyse
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Pierre Guy
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter O'Brien
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Kelly A. Lefaivre
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
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Straatman L, Norman E, Knowles N, Walton D, Suh N, Lalone E. Use it or lose it: The relationship between two image-based biomarkers in better understanding osteoarthritis progression in the wrist. J Biomech 2023; 161:111849. [PMID: 37931557 DOI: 10.1016/j.jbiomech.2023.111849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/01/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
Bone tissue is influenced by its mechanical environment and adapts in response to its mechanical load. This is supported by studies analyzing bone adaptation in the knee and hip. Changes to the bone have also been found to precede cartilage degeneration in diseases such as osteoarthritis (OA). Our objective was to demonstrate the relationship between joint contact and bone density in the wrists of healthy adults. Static CT scans with a calibration phantom were taken to obtain measures of bone mineral density (vBMD) in 3 normalized depths; 0 - 2.5, 2.5 - 5, and 5 - 7.5 mm. Participants underwent a four-dimensional CT scan (4DCT) while performing maximum wrist extension to maximum wrist flexion. 3D bone models of the distal radius, scaphoid, and lunate were made, and analyzed vBMD and joint contact area (JCA) in the radiolunate (RL) and radioscaphoid (RS) joints separately. Correlation coefficients were calculated where vBMD was the dependent variable, and kinematic JCA throughout every 10 degrees of motion were the independent variables. Statistically significant independent variables associated with vBMD were assessed using a regression model and were entered in steps; (1) significant correlations, (2) sex, and (3) age.An increase in vBMD was significantly, positively associated with an increase in JCa. Notably, in the deeper regions (5 - 7.5 mm) of the radius that is primarily composed of trabecular bone. Sex contributed to the variance in vBMD, while age did not. Subchondral bone changes are influenced by wrist position, demonstrating that the wrist serves to bear load similar to the knee and hip.
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Affiliation(s)
- Lauren Straatman
- Department of Health and Rehabilitation Science, Western University, Canada; Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada.
| | - Elizabeth Norman
- Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada
| | - Nikolas Knowles
- Kinesiology and Health Science, University of Waterloo, Canada
| | - David Walton
- Department of Physical Therapy, Western University, Canada
| | - Nina Suh
- Department of Orthopedics, Emory University, United States
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada
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Yang M, Liang B, Zhao X, Wang Y, Xue M, Wang D. BFR Training Improves Patients' Reported Outcomes, Strength, and Range of Motion After Casting for Colles' Fracture. Med Sci Sports Exerc 2023; 55:1985-1994. [PMID: 37259253 DOI: 10.1249/mss.0000000000003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE This study compared traditional rehabilitation as a treatment modality after plaster cast treatment of Colles' fracture with a combination of individualized blood flow restriction (BFR) and traditional rehabilitation. METHODS Twenty-eight participants were randomized into a BFR group and a non-BFR group after plaster cast treatment of Colles' fracture. The BFR group completed traditional rehabilitation with a medical grade tourniquet applied to the upper arm, and the non-BFR group underwent traditional rehabilitation only. Patients were followed up with radiographic outcomes (palmar tilt and radial inclination) to ensure the stability of the fracture. Clinical assessment of patient-rated wrist evaluation (PRWE) score, grip strength, pinch strength, wrist range of motion (ROM), and muscle stiffness was conducted at cast removal and 6 wk after cast removal. Two-way repeated-measures ANOVA determined significant interactions between time and group in the aforementioned variables. An independent-sample t -test assessed the differences in baseline variables and radiographic outcomes. RESULTS Significant interactions between time and group were noted for PRWE score ( F = 11.796, P = 0.002, η2p = 0.339), grip strength ( F = 5.445, P = 0.029, η2p = 0.191), and wrist ROM (ulnar deviation; F = 7.856, P = 0.010, η2p = 0.255). No significant interactions between time and group were found in measurements of pinch strength or wrist ROM (flexion, extension, radial deviation, pronation, supination). An independent-sample t -test showed no significant difference in baseline variables and radiographic outcomes between the groups before or after intervention. CONCLUSIONS This study found that combining individualized BFR with traditional rehabilitation resulted in greater increases in PRWE score, grip strength, and wrist ROM (ulnar deviation) than traditional rehabilitation alone. Therefore, adding individualized BFR to traditional rehabilitation might be a better option for treatment for similar patients.
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Affiliation(s)
- Mingming Yang
- School of Elite Sport, Shanghai University of Sport, Shanghai, CHINA
| | - Bin Liang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing, CHINA
| | - Xin Zhao
- Department of Orthopaedics, Nanjing First Hospital, Nanjing, CHINA
| | - Yang Wang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing, CHINA
| | | | - Dan Wang
- School of Elite Sport, Shanghai University of Sport, Shanghai, CHINA
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Palola V, Hevonkorpi TP, Ponkilainen VT, Launonen AP, Mattila VM. Sick leave length and the costs of operatively and conservatively treated distal radius fractures in the working age population: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:842. [PMID: 37880683 PMCID: PMC10601330 DOI: 10.1186/s12891-023-06963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Among the working population, a transient loss of working ability due to distal radius fracture (DRF) has a societal impact in terms of sick leave. Non-operative cast immobilization is the most common treatment option for DRF. However, these fractures are increasingly treated operatively. This retrospective cohort study of patients aged 20-64 with DRF compares the effects of different treatment strategies on sick leave length and overall cost of treatment. METHODS Multivariable regression analysis was used with treatment modality as an exposure and sick leave length as an outcome. Sick leave data were obtained from a national register. Costs were evaluated by adding the direct cost of the treatment modality to the mean cost of sick leave per patient in different treatment groups. RESULTS Of 614 working-age patients with a DRF who were treated at a tertiary hospital in Finland between January 2013 and December 2014, 521 were primarily treated non-operatively with cast immobilization and 93 were primarily operated. Of the primarily non-operatively treated patients, 48 were operated during follow-up. The mean follow-up was 5 years. The median time lost from work after DRF was 55 days (7.9 weeks), and the separated medians by treatment modality were 49 (7 weeks) and 70 days (10 weeks) for conservative and operative treatment, respectively. Multivariable linear regression analyses were performed for those patients who had sick leave (n = 292). Regression analysis also showed that operative treatment correlates with longer sick leave. CONCLUSIONS Operative treatment of distal radius fracture led more often to longer time lost from work than conservative treatment. Moreover, due to longer sick leave and the costs of the operation itself, operative treatment is over two times more expensive than conservative treatment. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Vili Palola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland.
| | - Teemu P Hevonkorpi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyvaskyla, Finland
| | - Ville T Ponkilainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyvaskyla, Finland
| | - Antti P Launonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Farzad M, MacDermid J, Hemmati M, Farhoud AR. Occupational Performance 1 Year After a Distal Radius Fracture From the Perspective of the International Classification of Functioning, Disability and Health. Am J Occup Ther 2023; 77:7705205040. [PMID: 37793017 DOI: 10.5014/ajot.2023.050180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
IMPORTANCE Distal radius fractures (DRFs) frequently compromise independent functioning. OBJECTIVE To analyze occupational performance post-DRF using the Canadian Occupational Performance Measure (COPM) and related interviews, guided by the International Classification of Functioning, Disability and Health (ICF). COPM score was compared with standard metrics: Patient-Reported Wrist Evaluation (PRWE) and Participation Behavior Questionnaire (PBQ). METHOD Through a semistructured COPM interview, participants highlighted self-care, productivity, and leisure. They completed the PRWE and PBQ, linking results to ICF sets. DESIGN Prospective cohort. SETTING Outpatient hand surgery clinic at a trauma center. PARTICIPANTS Patients (N = 120), 1 yr post-DRF. OUTCOMES AND MEASURES Incorporated COPM, PRWE, and PBQ, linked to ICF. RESULTS Analysis identified 73 codes, aligning with 30 ICF Hand Conditions codes. Main concerns related to self-care (15.21%), leisure (12.16%), and productivity (16.22%). Major challenges pertained to domestic (67.00%) and civic life (64.53%) within ICF. Occupational performance was positively correlated with participation (r = .62) and inversely with disability (r = -.62). CONCLUSIONS AND RELEVANCE DRFs result in varied occupational challenges that are not always reflected in standard measures. The COPM offers a comprehensive insight into post-DRF patient challenges, emphasizing the value of diverse clinical assessment approaches. What This Article Adds: This study highlights the importance of a holistic approach in occupational therapy for DRF patients, revealing that standard measurements might overlook key challenges that they face. By adopting broader evaluative methods, occupational therapists can better address patient-specific needs and enhance their rehabilitation outcomes.
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Affiliation(s)
- Maryam Farzad
- Maryam Farzad, PhD, MSc, BSc, is Postdoctoral Associate, School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada, and Assistant Professor, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;
| | - Joy MacDermid
- Joy MacDermid, PhD, MSc, BSc, is Professor, Department of Physical Therapy and Surgery, Western University, London, Ontario, Canada; Codirector, Clinical Research Laboratory, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; and Professor, Department of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Motahar Hemmati
- Motahar Hemmati, BSc OT, is Master's Student, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amir Reza Farhoud
- Amir Reza Farhoud, MD, is Assistant Professor, Department of Orthopedic Surgery, Imam Hospital Complex, Tehran University of Medical Sciences, Joint Reconstruction Research Center, Tehran, Iran
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Luk MLM, Chan ACM, Cho JSY, Ng DMT, Lam ICY, Yau ELK, Miller T, Pang MYC. Predictors of chronic pain and disability in patients treated conservatively after distal radius fracture: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1535-1543. [PMID: 36973426 DOI: 10.1007/s00264-023-05785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To determine predictors of chronic pain and disability among patients with distal radius fractures (DRF) treated conservatively with closed reduction and cast immobilization. METHODS This was a prospective cohort study. Information on patient characteristics, post-reduction radiographic parameters, finger and wrist range of motion, psychological status (Hospital Anxiety and Depression Scale or HADS), pain (Numeric Rating Scale or NRS), and self-perceived disability (Disabilities of the Arm, Should, and Hand or DASH) were taken at baseline, cast removal, and 24 weeks. Differences in outcomes between time points were determined using analysis of variance. Multiple linear regressions were used to determine predictors of pain and disability at 24 weeks. RESULTS One hundred forty patients with DRF (70% women, age: 67.0 ± 17.9) completed 24 weeks of follow-up and were included in the analysis. NRS (off-cast), range of ulnar deviation (off-cast), and greater occupational demands were significant predictors of pain at week 24 (adjusted R2 = 0.331, p < 0.001). Significant predictors of perceived disability at week 24 were HADS (off cast), sex (female), dominant-hand injury, and range of ulnar deviation (off cast) (adjusted R2 = 0.265, p < 0.001). CONCLUSIONS Off-cast NRS and HADS scores are important modifiable predictors of patient-reported pain and disability at 24 weeks in patients with DRF. These factors should be targeted in the prevention of chronic pain and disability post-DRF.
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Straatman L, Knowles N, Suh N, Walton D, Lalone E. The Utility of Quantitative CT (QCT) to Detect Differences in Subchondral Bone Mineral Density Between Healthy People and People with Pain Following Wrist Trauma. J Biomech Eng 2022; 144:1131490. [PMID: 35044448 DOI: 10.1115/1.4053594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Indexed: 11/08/2022]
Abstract
The mechanisms underlying chronic pain development following musculoskeletal trauma are complex and multifactorial. In their search, some researchers are turning to the subchondral bone as a potential contributor to pain due to its vascularity, using a depth-specific imaging technique. However, this technique has been mainly used in the knee. We propose the use of a quantitative computed tomography (QCT) depth-specific analysis to measure subchondral bone following wrist trauma. Ten participants (n=5 post-trauma; n=5 healthy) underwent bilateral CT scans of their wrist accompanied by a calibration phantom with known densities. Average subchondral vBMD was studied at three depths from the subchondral surface (0 to 2.5, 2.5 to 5, 5 to 7.5mm) according to radial articular surface contact in both wrists of each participant. Percentage differences and Cohen's d effect sizes were calculated to analyze bilateral vBMD and vBMD differences between groups. This image-based tool demonstrated subject-specific, depth-specific, and joint-specific measures of vBMD within the wrist. This methodology highlighted the differences between depth-specific vBMD in healthy people and people who have experienced wrist trauma. Overall, the healthy cohort demonstrated higher vBMD across all three depths and both articular surfaces. This imaging technique further distinguished between subchondral cortical and trabecular bone, wherein clinical implications can be drawn from these distinctions in future work. Our study therefore supports the utility of a QCT imaging technique in detecting differences in depth-specific vBMD in the wrist.
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Affiliation(s)
- Lauren Straatman
- Department of Health and Rehabilitation Sciences, Western University; Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre, Western University, Rm. EC1458, 1201 Western Rd.London, Ontario N6G 1H1
| | | | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre; Schulich School of Medicine and Dentistry, Western University
| | - David Walton
- Department of Health and Rehabilitation Sciences, Western University; School of Physical Therapy, Western University
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre
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Hevonkorpi TP, Raittio L, Vähä-Tuisku S, Launonen AP, Mattila VM. Long-term subjective results and radiologic prognosis of a distal radius fracture in working-aged patients - a prognostic cohort study of 201 patients. J Int Med Res 2021; 49:3000605211060985. [PMID: 34929107 PMCID: PMC8733368 DOI: 10.1177/03000605211060985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate long-term outcomes associated with distal radius fracture (DRF) in working-aged patients. The authors hypothesized that the majority of patients experience no permanent loss of function when measured with patient-rated wrist evaluation (PRWE). METHODS This was a retrospective cohort study of patients with a DRF aged between 18 and 65 years. The primary outcome measure was PRWE score at a minimum of 4 years after DRF. Secondary outcome measures were pain catastrophizing scale (PCS) and radiographic measurements. RESULTS Of 201 patients included, 179 were primarily treated non-operatively with a 5-week cast treatment and 22 were primarily operated. The mean follow-up duration was 5 years. The mean PRWE score was 10.9 (95% confidence interval 8.4, 13.4) and median PRWE was 3.5 (interquartile range, 0.0-13.0). There was minor correlation between PCS and PRWE score (correlation coefficient [CC] 0.3), and between PRWE score and dorsal angulation of the fracture measured after closed reduction (CC 0.2) and in one-week follow-up radiographs (CC 0.2). CONCLUSIONS Working-aged patients seem to gain nearly normal wrist function after DRF in longer follow-up. Pain catastrophizing appears to correlate with long-term treatment outcome.
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Affiliation(s)
- Teemu P Hevonkorpi
- Department of Surgery, 236131Central Finland Central Hospital, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland
| | - Lauri Raittio
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland.,Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
| | - Susanna Vähä-Tuisku
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland.,Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
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Zeidan M, Stephens AR, Zhang C, Presson AP, Kazmers NH. Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:235-239. [PMID: 34632351 PMCID: PMC8496877 DOI: 10.1016/j.jhsg.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Although baseline biopsychosocial factors are associated with short-term patient-reported outcomes following distal radius fracture open reduction internal fixation (ORIF), their effect on mid-term outcomes is unclear. We aimed to evaluate the effect of social deprivation, previously established as a surrogate for depression, pain interference, and anxiety, on quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores >1 year following distal radius ORIF. Methods Adult patients (≥18 years) with an isolated distal radius fracture treated with ORIF by orthopedic trauma and hand surgeons at a single tertiary academic center over a 3-year period were included. Outcomes at ≥1 year postoperatively were evaluated using QuickDASH. Age, follow-up duration, area deprivation index (ADI; a measure of social deprivation), subspecialty (hand vs trauma), and postoperative alignment were assessed using linear regression with 95% confidence intervals after bootstrapping and a permutation test for P values to test for their association with the final QuickDASH score. Results Follow-up data were obtained for 98 of 220 (44.5%) patients at a mean of 3.1 ± 1.0 years after surgery. Mean age and ADI were 53.2 ± 15.4 years and 26.8 ± 18.7, respectively. Most fractures were intra-articular (67.3%), and 72.4% had acceptable postoperative alignment parameters, as defined by the American Academy of Orthopaedic Surgeons clinical practice guidelines. The mean QuickDASH score was 13.0 ± 16.5. There were no significant associations between the final QuickDASH score and any studied factor, including ADI, as determined using univariable analysis. Multivariable analysis showed no association between ADI and the final QuickDASH score, independent of age, sex, treating service, follow-up duration, and fracture alignment or pattern. Conclusions At mid-term follow up after distal radius ORIF, ADI did not correlate with QuickDASH scores, and the QuickDASH scores of the patients did not differ from those of the general population. However, our cohort mostly comprised patients with levels of deprivation below the national median. Although studies have shown that the short-term outcomes of distal radius ORIF are influenced by biopsychosocial factors, outcomes at the time of final recovery may not be associated with social deprivation. Type of study/level of evidence Prognostic IV.
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Affiliation(s)
- Michelle Zeidan
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | | | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT
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Kasapinova K, Kamiloski V. Outcomes of surgically treated distal radius fractures associated with triangular fibrocartilage complex injury. J Hand Ther 2021; 33:339-345. [PMID: 32151501 DOI: 10.1016/j.jht.2017.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort. INTRODUCTION Clinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radius fractures expressed with the patient-rated disability are missing. The purpose of this study was to evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC. METHODS Patients undergoing operative treatment for distal radius fracture were prospectively enrolled (n = 70). TFCC was examined by wrist arthroscopy and injuries classified according to Palmer. Comparative analyses were performed on 45 patients with TFCC injury (injured group) and 25 patients with intact TFCC (intact group). The outcome measures included the Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury. RESULTS TFCC was injured in 45 patients (64%). In patients with intact TFCC, mean total PRWE score was 27 (3 months) and 16 (12 months), compared to patients with TFCC injury with 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 at 3 and 12 months for the intact group and 39 and 27 for the injured group. PRWE and DASH results showed significant difference at 3 and 12 months when compared with Mann-Whitney test. DISCUSSION PRWE and DASH scores evaluation showed that patients with associated TFCC injury had greater pain and disability at 3 and 12 months after injury. CONCLUSIONS Disability outcomes were worse in patients with distal radius fracture, where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radius fractures.
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Affiliation(s)
- Katerina Kasapinova
- Medical Faculty, University "St.Cyril and Metodius", Department of Traumatology, University Surgery Clinic "St.Naum Ohridski", Skopje, Republic of Macedonia.
| | - Viktor Kamiloski
- Medical Faculty, University "St.Cyril and Metodius", Department of Traumatology, University Surgery Clinic "St.Naum Ohridski", Skopje, Republic of Macedonia
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Early Mobilization After Volar Locking Plate Osteosynthesis of Distal Radial Fractures in Older Patients-A Randomized Controlled Trial. J Hand Surg Am 2020; 45:1047-1054.e1. [PMID: 32636043 DOI: 10.1016/j.jhsa.2020.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 03/26/2020] [Accepted: 05/01/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate if early mobilization after open reduction internal fixation of distal radius fractures improved the functional outcome. We hypothesized that early mobilization would lead to improved patient-reported outcome. Second, we aimed to assess whether early mobilization increased the risk of postoperative implant loosening or breakage. METHODS All included patients were treated with a volar locking plate. After surgery, patients were randomized to either early mobilization (E-MOB) with a removable orthosis (wrist lacer) and daily wrist exercises or to late mobilization (L-MOB) with a standard dorsal plaster cast for 2 weeks and, after that, a removable orthosis and exercises. We measured all patients at 4 weeks and at 3, 6, and 12 months after surgery. At each postoperative visit, we measured range of motion and grip strength and patients filled out the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiographic implant loosening or breakage was assessed 14 days after surgery. RESULTS A total of 47 patients were allocated to E-MOB and 48 to L-MOB. The DASH score improved substantially throughout the follow-up period with no significant differences between the 2 groups at any time point. Implant loosening and fracture redisplacement was observed in 1 patient in the E-MOB group. Range of motion and grip strength were similar between the 2 groups at all time points. CONCLUSIONS Early mobilization after surgical treatment of distal radius fractures does not lead to improved patient-reported outcome. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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12
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Sgromolo NM, Cancio JM, Rhee PC. Safety and Efficacy of Blood Flow Restriction Therapy after Operative Management of Distal Radius Fractures: A Randomized Controlled Study. J Wrist Surg 2020; 9:345-352. [PMID: 32760614 PMCID: PMC7395840 DOI: 10.1055/s-0040-1712504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Background Blood flow restriction (BFR) therapy is an emerging addition to rehabilitative programs that allows patients to increase strength at lower loads over shorter time periods. Therefore, we conducted a study to evaluate the safety and efficacy of a rehabilitation program using BFR to a traditional rehabilitation protocol following operative fixation of distal radius fractures. Methods A randomized controlled study was conducted comparing a standardized rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients treated with volar plate fixation following a displaced distal radius fracture. The same exercises done in the control group were performed by the BFR group with a restrictive tourniquet in place. Patients were followed with serial radiographs to ensure fracture stability. Outcome measures included wrist range of motion, grip strength, pinch strength, visual analog scale (VAS) pain scores at rest and during activity, patient rated wrist evaluation scores (PRWE), and disabilities of the arm, shoulder, and hand scores. Results Nine patients were randomized and enrolled within the BFR group ( n = 5) and control ( n = 4) groups. Patients within the BFR group had a significantly greater reduction in pain with activity over the course of the rehabilitation program. Additionally, the BFR group had a significant improvement in PRWE scores during the 8-week rehabilitation program. There was no difference in radiographic measures after initiation of BFR, and all patients tolerated therapy without noted complications. Conclusion BFR therapy is safe and well tolerated after operatively treated distal radius fractures. The addition of BFR therapy can result in quicker reduction in pain with activity and improvement in patient disability when used early following operative management of a distal radius fracture. Level of Evidence This is a Level 1, prognostic study.
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Affiliation(s)
- Nicole M. Sgromolo
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Jill M. Cancio
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio Military Medical Center, JBSA Ft. Sam Houston, San Antonio, Texas
- Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, San Antonio, Texas
| | - Peter C. Rhee
- Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Clinical Investigation Facility, Travis Air Force Base, California
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13
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Outcomes of surgically treated distal radial fractures with associated triangular fibrocartilage complex injury. J Hand Ther 2020; 32:57-63. [PMID: 29054543 DOI: 10.1016/j.jht.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort. INTRODUCTION Clinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radial fractures expressed with the patient-rated disability are missing. PURPOSE OF THE STUDY To evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC. METHODS Patients undergoing operative treatment for distal radial fracture were prospectively enrolled (n = 70). The TFCC was examined by wrist arthroscopy, and injuries were classified according to Palmer. Comparative analyses were performed on data from 45 patients with TFCC injury (the injured group) and 25 patients with an intact TFCC (the intact group). The outcome measures included The Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury. RESULTS The TFCC was injured in 45 patients (64%). In patients with an intact TFCC, the mean total PRWE score was 27 (at 3 months) and 16 (at 12 months), whereas in patients with TFCC injury, it was 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 for the intact group and 39 and 27 for the injured group at 3 and 12 months, respectively. PRWE and DASH results showed significant difference at 3 and 12 months when compared using the Mann-Whitney test. CONCLUSIONS Disability outcomes were worse in patients with distal radial fracture where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radial fractures.
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14
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Gray RJ, Thom M, Riddle M, Suh N, Burkhart T, Lalone E. Image-Based Comparison Between the Bilateral Symmetry of the Distal Radii Through Established Measures. J Hand Surg Am 2019; 44:966-972. [PMID: 31311681 DOI: 10.1016/j.jhsa.2019.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 02/20/2019] [Accepted: 05/31/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Anthropometric assessment of bony structures in the body is important for preoperative computer-aided surgery, implant design, finite element modeling, and biomechanical studies investigating joint structure and function. The use of the contralateral limb in surgery and clinical practice relies on the assumption that the right and left limbs of an individual are symmetric. Therefore, the purpose of this study was to quantify the bilateral symmetry of the bony structures of the distal radius using 3-dimensional (3D) computed tomography. METHODS We collected computed tomography images of 37 paired, fresh-frozen, healthy cadaveric male upper limbs (aged 75.4 ± 8.3 years). Three-dimensional reconstructed models were created using semiautomatic segmentation. Using the 3D models, we measured 3D radial inclination, 3D volar tilt, 3D radial height, medial volar cortical angle, middle volar cortical angle, and lateral volar cortical angle and compared them between sides. RESULTS There were no statistically significant differences measured between right and left distal radius in 37 paired wrists. Mean radial height was 12.81 mm (SD, 1.74 mm) on the left and 12.88 mm (SD, 1.72 mm) on the right. Mean volar tilt was 10.74° (SD, 3.74°) and 10.77° (SD, 3.19°) and radial inclination was 24.05° (SD, 2.63°) and 24.18° (SD, 3.41°) on the left and right, respectively. Mean volar cortical angle across the radius was 140.9° (SD, 7.9°) on the left and 140.1° (SD, 7.9°) on the right. CONCLUSIONS Direct bilateral comparison of the distal radius and wrist joints is useful to predict normal anatomy of the injured radius, because bilateral similarities exist. CLINICAL RELEVANCE This article provides a comprehensive list of measurements of the distal radius compared bilaterally using a 3D model. From this study, we found that the contralateral radius can be used as a benchmark with which to compare fracture reduction and to manage malunions during the preoperative planning of corrective osteotomies. It can also be used to define normal anatomy.
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Affiliation(s)
- Robert J Gray
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Mitchell Thom
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Michael Riddle
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Nina Suh
- Roth-McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, University of Western Ontario, Ontario, Canada
| | - Timothy Burkhart
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada.
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15
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Hiraga Y, Hisano S, Mizunoe A, Nomiyama K. The mediating effect of psychological factors on the relationship between pain intensity and wrist joint function: a longitudinal study with mediation analysis. Disabil Rehabil 2019; 43:1814-1818. [PMID: 31599170 DOI: 10.1080/09638288.2019.1676318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Psychological factors and pain intensity are associated with wrist function. However, the mediating role of psychological factors in the relationship between pain intensity and wrist function in distal radius fractures remains unclear. We performed mediation analysis to investigate how psychological factors mediate the relationship between pain intensity and wrist function. METHODS Twenty-one patients with distal radius fractures were included in this longitudinal study. Patient-rated wrist evaluation, one pain intensity-related outcome measure (numerical rating scale), and three psychological outcome measures (pain catastrophizing scale, hospital anxiety and depression scale, and pain self-efficacy questionnaire) were assessed. The mediation analysis with a bootstrap sampling procedure was used to assess indirect effects. The level of significance was set at 5%. RESULTS Mediation analysis showed that the pain intensity, as measured by patient-rated wrist evaluation, had significant indirect effects on the hospital anxiety and depression scale-anxiety (95% bootstrapped confidence interval: 0.96-9.62) and pain self-efficacy questionnaire (95% bootstrapped confidence interval: 0.43-8.11) scores. CONCLUSIONS The relationship between pain intensity and wrist function was mediated by anxiety and self-efficacy. Our findings suggest that interventions focused on psychological factors, particularly anxiety and self-efficacy, may be important in distal radius fractures rehabilitation.IMPLICATIONS FOR REHABILITATIONIn patients with distal radius fractures, early post-operative pain mediates psychological factors and affects wrist function.Anxiety and self-efficacy are psychological factors that should be noted, and rehabilitation, including self-management, should be considered.Rehabilitative interventions for distal radius fractures should focus on psychological factors and management of post-operative pain.
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Affiliation(s)
- Yuki Hiraga
- Fukuoka Rehabilitation Hospital, Fukuoka, Japan.,Department of Health Care Administration and Management, Graduate School of Kyushu University, Fukuoka, Japan
| | - Shinya Hisano
- Department of Occupational Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Aya Mizunoe
- Fukuoka Rehabilitation Hospital, Fukuoka, Japan
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16
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Modarresi S, Suh N, Walton DM, MacDermid JC. Depression affects the recovery trajectories of patients with distal radius fractures: A latent growth curve analysis. Musculoskelet Sci Pract 2019; 43:96-102. [PMID: 31374477 DOI: 10.1016/j.msksp.2019.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distal radius fractures (DRFs) are common and can lead to substantial pain and disability. Most people recover in six months, but some experience persistent pain and disability for one year or longer after injury. Therefore, it is important to understand the factors that can help predict poor recovery. OBJECTIVE To identify recovery trajectories in DRF patients and to determine the factors that can help predict poor recovery. METHODS Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected in addition to the Self-Administered Comorbidity Questionnaire, from which data regarding depression were extracted. Latent growth curve analysis (LGCA) was used to identify the recovery trajectories. Comparisons of proportion between the emergent classes were then conducted using chi-square and Kruskal-Wallis tests. RESULTS The LGCA revealed three distinct trajectories (rapid-recovery: (69%), slow-recovery: (23%), and non-recovery: (8%) as the best fit to the data. The proportion of people with depression was significantly greater in the non-recovery class (24%) compared to the slow (16%, p = 0.04) and rapid-recovery (8%, p = 0.03) classes. Additionally, the proportion of females were significantly lower in the non-recovery (64%, p = 0.03) compared to the slow (85%, p = 0.03) and the rapid-recovery classes (81%, p = 0.048). CONCLUSION Recovery from DRF was best described using three different trajectories. Greater self-reported depression and a lower proportion of females in the non-recovery class were distinguishing factors between the classes. Patients who appear to be in slow-recovery or non-recovery classes may be followed more closely.
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Affiliation(s)
- Shirin Modarresi
- Health & Rehabilitation Science, Western University, London, ON, Canada.
| | - Nina Suh
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Joy C MacDermid
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada; School of Physical Therapy, Western University, London, ON, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
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17
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Cancio JM, Sgromolo NM, Rhee PC. Blood Flow Restriction Therapy after Closed Treatment of Distal Radius Fractures. J Wrist Surg 2019; 8:288-294. [PMID: 31404177 PMCID: PMC6685733 DOI: 10.1055/s-0039-1685455] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Background Blood flow restriction (BFR) therapy is an innovative rehabilitative program that enables patients to increase strength at a fraction of the weight typically necessary in endurance exercises. Therefore, we conducted a pilot study evaluating patient outcomes with a BFR therapy program for closed management after a distal radius fracture compared to a traditional rehabilitation protocol. Literature review A randomized-controlled study was conducted comparing a standardized hand therapy rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients who were initially treated with closed reduction and short arm cast immobilization for a displaced distal radius fracture between May 1, 2015 and August 1, 2016. BFR therapy was performed with a restrictive tourniquet applied to the upper brachium, performing the same strengthening exercises as the control group but with the restrictive tourniquet in place. Clinical assessment was conducted at 6, 10, and 14 weeks from the date of initial cast immobilization. Outcome measures collected included wrist range of motion; grip strength; pinch strength; visual analogue scale for pain with activity and at rest; patient-rated wrist evaluation (PRWE) scores; and disabilities of the arm, shoulder, and hand scores. Results Thirteen patients were enrolled and randomized between the BFR ( n = 6) and control ( n = 7) groups. The BFR group noted significantly greater reduction in pain with activity compared to the control group after 8 weeks of therapy (Δ -4.0 vs. -2.3, p = 0.03). Similarly, patients in the BFR group displayed greater reduction in PRWE scores compared to the control group after 8 weeks of BFR therapy (Δ -57.9 vs. 30.8, p = 0.01). The two groups did not demonstrate any significant difference in radiographic outcomes at any time point or throughout the course of the study. All patients tolerated the BFR therapy program and there were no complications. Clinical relevance The addition of BFR therapy to the rehabilitative program after closed management of a distal radius fracture is safe, well tolerated by patients, without any deleterious effects on radiographic outcomes. This pilot study noted that BFR therapy in patients with nonoperative distal radius fractures may result in a larger reduction in pain with activity and greater improvement in overall self-perceived function.
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Affiliation(s)
- Jill M. Cancio
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio Military Medical Center, JBSA Ft. Sam Houston, Texas; Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, Texas
| | - Nicole M. Sgromolo
- San Antonio Military Medical Center, Fort Sam Houston, Texas; Department of Orthopaedic Surgery
| | - Peter C. Rhee
- Mayo Clinic, Orthopedic Surgery, Rochester, Minnesota
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18
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van Leerdam RH, Huizing F, Termaat F, Kleinveld S, Rhemrev SJ, Krijnen P, Schipper IB. Patient-reported outcomes after a distal radius fracture in adults: a 3-4 years follow-up. Acta Orthop 2019; 90:129-134. [PMID: 30669949 PMCID: PMC6461106 DOI: 10.1080/17453674.2019.1568098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There are few reports on the outcome of distal radius fractures after 1 year. Therefore we investigated the long-term patient-reported functional outcome and health-related quality of life after a distal radius fracture in adults. Patients and methods - We reviewed 823 patients, treated either nonoperatively or operatively in 2012. After a mean follow-up of 3.8 years 285 patients (35%) completed the Patient-Rated Wrist Evaluation (PRWE) and EuroQol-5D. Results - The mean PRWE score was 11. The mean EQ-5D index value was 0.88 and the mean EQ VAS for self-rated health status was 80. Nonoperatively treated type A and type B fractures had lower PRWE scores compared with operatively treated patients, whereas the EQ-5D was similar between groups. The EQ VAS for patients aged 65 and older was statistically significantly lower than that of younger patients. Interpretation - Patients had a good overall long-term functional outcome after a distal radius fracture. Patients with fractures that were possible to treat nonoperatively had less pain and better wrist function after long-term follow-up than patients who needed surgical fixation.
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Affiliation(s)
- Roderick H van Leerdam
- Department of Surgery, Leiden University Medical Center (LUMC), The Netherlands; ,Correspondence:
| | - Floortje Huizing
- Department of Surgery, Leiden University Medical Center (LUMC), The Netherlands;
| | - Frank Termaat
- Department of Surgery, Leiden University Medical Center (LUMC), The Netherlands;
| | | | - Steven J Rhemrev
- Department of Surgery, The Hague Medical Center (HMC), The Netherlands
| | - Pieta Krijnen
- Department of Surgery, Leiden University Medical Center (LUMC), The Netherlands;
| | - Inger B Schipper
- Department of Surgery, Leiden University Medical Center (LUMC), The Netherlands;
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19
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van der Oest MJW, Porsius JT, MacDermid JC, Slijper HP, Selles RW. Item reduction of the patient-rated wrist evaluation using decision tree modelling. Disabil Rehabil 2019; 42:2758-2765. [PMID: 30739531 DOI: 10.1080/09638288.2019.1566407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: The aim of this study is to assess the viability of a decision tree version of an often used questionnaire to measure wrist pain and disability, the Patient Rated Wrist Evaluation.Methods: Patient Rated Wrist Evaluation scores were collected from a cohort of 10394 patients who are part of a routine outcome measurement system. A decision tree version of the Patient Rated Wrist Evaluation (PRWE) was created. The intraclass correlation was used to evaluate the inter-version reliability between the original PRWE and the decision tree version.Results: The decision tree reduced the number of questions from 5 to 3 for the pain subscale, and from 10 to 3 for the disability subscale. The intraclass correlation between the original PRWE and the decision tree version was 0.97. The mean difference between the Patient Rated Wrist Evaluation and the decision tree Patient Rated Wrist Evaluation total sumscore was 0.35 (95% CI -9.92-10.62).Conclusions: We found that the decision tree was successful at reducing the items of the Patient Rated Wrist Evaluation from fifteen to only six questions with very high similarity to the scores of the full questionnaire.Implications for rehabilitationThe Patient Rated Wrist Evaluation can reliably be used with 6 instead of 15 questions.Decision trees are useful statistical tools to shorten lengthy questionnaires, especially when large amounts of data are available.Having a shortened Patient Rated Wrist Evaluation saves patients and clinicians time in answering this specific questionnaire.
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Affiliation(s)
- Mark J W van der Oest
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands.,Department of Rehabilitation, Erasmus MC, Rotterdam, the Netherland.,Hand and Wrist Center, Xpert Clinic, Eindhoven, the Netherlands
| | - Jarry T Porsius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands.,Department of Rehabilitation, Erasmus MC, Rotterdam, the Netherland.,Hand and Wrist Center, Xpert Clinic, Eindhoven, the Netherlands
| | - Joy C MacDermid
- School of Rehabilitation Science and School of Physical Therapy, Western University, Ontario, Canada
| | - Harm P Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands.,Hand and Wrist Center, Xpert Clinic, Eindhoven, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands.,Department of Rehabilitation, Erasmus MC, Rotterdam, the Netherland
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20
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Alkner BA, Halvardsson C, Bråkenhielm G, Eskilsson T, Andersson E, Fritzell P. Effect of postoperative pneumatic compression after volar plate fixation of distal radial fractures: a randomized controlled trial. J Hand Surg Eur Vol 2018; 43:825-831. [PMID: 29504445 DOI: 10.1177/1753193418760493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We investigated the difference between postoperative rehabilitation with or without adjunctive intermittent pneumatic compression therapy following distal radial fracture treated with volar plating. A total of 115 patients were randomized to a control or to an experimental group. After 4 weeks of immobilization the experimental group received intermittent pneumatic compression therapy in addition to conventional postoperative rehabilitation. Primary outcome up to 1 year postoperatively was assessed using the Canadian Occupational Performance Measure. No significant differences between groups were found. There were no clinically relevant differences regarding the secondary outcome measures swelling, strength, pain and flexibility. We conclude that postoperative intermittent pneumatic compression treatment had no major benefits. The results of the present study do not support general use of intermittent pneumatic compression initiated 4 weeks following volar plating surgery for distal radial fracture. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Björn A Alkner
- 1 Department of Orthopaedics, Eksjö, Region Jönköping County and Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | | | - Gustaf Bråkenhielm
- 1 Department of Orthopaedics, Eksjö, Region Jönköping County and Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | | | - Erika Andersson
- 2 Department of Occupational Therapy, Falun Hospital, Falun, Sweden
| | - Peter Fritzell
- 3 Center for Clinical Research, Falun and Futurum - Academy for Health and Care, Region Jönköping County, Sweden
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