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Daoulas T, Bernard M, Dellestable A, Letissier H, Bacle G, Sos C. Consolidation rate in ulnar shortening osteotomy with the APTUS Wrist plate. HAND SURGERY & REHABILITATION 2024; 43:101682. [PMID: 38492803 DOI: 10.1016/j.hansur.2024.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Ulnocarpal impaction syndrome causes pain on the ulnar side of the wrist. Various surgical techniques have been described. Ulnar shortening osteotomy is now a standard treatment. However, it is associated with complications such as non-union of the osteotomy site. The main study objective was to report the rate of radiographic consolidation after ulnar shortening osteotomy with a cutting guide. MATERIAL AND METHODS This multicenter retrospective study of 30 cases reported clinical and radiographic criteria at a minimum 6 month's follow-up. RESULTS The non-union rate was 3.4%. One case presented non-union of the osteotomy site. 87% of patients were satisfied or very satisfied with the procedure. Mean VAS pain rating was 2.7 ± 2.4. Mean QuickDASH and PRWE scores were 24.7 ± 19.2 and 28.6 ± 25. Mean strength on Jamar dynamometer was 27.4 ± 8.9 kg. One patient developed complex regional pain syndrome. Five patients required plate removal for hardware-related discomfort. DISCUSSION Ulna shortening osteotomy with the Aptus Wrist plate provides a standardized approach to the surgical treatment of ulnocarpal impaction syndrome. Compared with other series in the literature, the procedure provided satisfactory consolidation and clinical results.
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Affiliation(s)
- Thomas Daoulas
- Service de Chirurgie Orthopédique, Traumatologique et Urgence Main, Boulevard Tanguy Prigent, CHU de la Cavale Blanche, 29200 Brest, France.
| | - Mathilde Bernard
- Service de Chirurgie de la Main et des Nerfs Périphériques, 2 Boulevard Tonnellé, 37000 Tours, France
| | - Arthur Dellestable
- Service de Chirurgie Orthopédique, Traumatologique et Urgence Main, Boulevard Tanguy Prigent, CHU de la Cavale Blanche, 29200 Brest, France
| | - Hoel Letissier
- Service de Chirurgie Orthopédique, Traumatologique et Urgence Main, Boulevard Tanguy Prigent, CHU de la Cavale Blanche, 29200 Brest, France
| | - Guillaume Bacle
- Service de Chirurgie de la Main et des Nerfs Périphériques, 2 Boulevard Tonnellé, 37000 Tours, France
| | - Clara Sos
- Service de Chirurgie de la Main et des Nerfs Périphériques, 2 Boulevard Tonnellé, 37000 Tours, France
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Soerensen S, Larsen P, Korup LR, Ceccotti AA, Larsen MB, Filtenborg JT, Weighert KP, Elsoe R. Epidemiology of Distal Forearm Fracture: A Population-Based Study of 5426 Fractures. Hand (N Y) 2024; 19:24-29. [PMID: 35856325 PMCID: PMC10786118 DOI: 10.1177/15589447221109967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite intensive research into the epidemiology of adult distal forearm fractures, the literature is limited. This study aimed to provide a full overview of adult distal forearm fracture epidemiology, including incidence, fracture classification, mode of injury, and trauma mechanism in patients sustaining a distal forearm fracture, based on an accurate at-risk population with manually validated data leading to a high quality in data. METHODS This was a population-based cohort study with a manual review of X-rays and charts. The primary outcome measure was the incidence of adult distal forearm fractures. The study was based on an average at-risk population of 522 607 citizens. A total of 5426 adult distal forearm fractures were included during the study period. Females accounted for 4199 (77%) and males accounted for 1227 (23%) of fractures. RESULTS The overall incidence of adult distal forearm fractures was 207.7/100 000/year. Female incidence was 323.4/100 000/year, and male incidence was 93.3/100 000/year. A marked increase in incidence with increasing age was observed for females after 50 years of age. The incidence of distal radius fractures was 203.0/100 000/year, and the incidence of isolated ulna fractures was 3.8/100 000/year. The most common fracture type was an extra-articular AO type 2R3A (69%), and the most common mode of injury was a fall from own height (76%). A small non-trending year-to-year variation was observed during the 5-year study period. CONCLUSION Results show that adult distal forearm fractures are very common in women after the postmenopausal period. The overall incidence of adult distal forearm fractures was 207.8/100 000/year. Female incidence was 323.4/100 000/year.
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Rust A, Samade R, Campbell AB, McManus T, Jain SA. Time to surgery and outcomes following open reduction and internal fixation of both-bone forearm fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:135-142. [PMID: 37368153 DOI: 10.1007/s00590-023-03560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/23/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE To determine the effect of time to surgery on outcomes following open reduction and internal fixation (ORIF) of both-bone forearm fractures (BBFFs). METHODS Ninety-nine patients who underwent ORIF of BBFFs in a single academic medical center over a 16-year time period were retrospectively reviewed. Demographic and clinical data including age, sex, current smoking status, time from injury to surgery (tsurg), presence of open injury, polytrauma status, and complications were obtained. Radiographs of the affected extremity were reviewed for fracture morphology, reduction quality, and time to union (or presence of nonunion). In addition to descriptive statistics, Chi-square and Wilcoxon-Mann-Whitney tests were used to compare categorical and interval, respectively, with a significance level of 0.05. RESULTS A tsurg > 48 h was associated with increased rate of delayed unions (tsurg < 48 h: 25% vs tsurg > 48 h: 59%, p = 0.03), but not complications (tsurg < 48 h: 44% vs tsurg > 48 h: 47%, p = 0.79). Open BBFFs were not associated with increased rates of delayed unions (closed: 16% vs open: 19%, p = 0.77) or complications (closed: 42% vs open: 53%, p = 0.29). A trend toward increased time to union with tsurg > 48 h was also seen, but did not reach significance (tsurg < 48 h: 13.5 weeks vs tsurg > 48 h: 15.7 weeks, p = 0.11). CONCLUSION A tsurg > 48 h is associated with an increased rate of delayed union, but not complications, after ORIF of BBFFs. LEVEL OF EVIDENCE Therapeutic Level III (Retrospective Cohort).
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Affiliation(s)
- Andrew Rust
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Richard Samade
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Andrew B Campbell
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Timothy McManus
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Sonu A Jain
- Departments of Orthopaedics and Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH, 43212, USA.
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Vasara H, Aspinen S, Kosola J, Sartanen J, Naalisvaara T, Myllykoski J, Stenroos A. Adverse Events After Surgical Treatment of Adult Diaphyseal Forearm Fractures: a Retrospective Analysis of 470 Patients. JB JS Open Access 2023; 8:e22.00115. [PMID: 37588248 PMCID: PMC10424891 DOI: 10.2106/jbjs.oa.22.00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Background The incidence of and risk factors for adverse events after internal fixation of diaphyseal forearm fractures have not been well defined in the current literature. The objective of this study was to estimate the incidence of adverse events after diaphyseal forearm fracture surgery in adults and explore potential risk factors for adverse events. Methods We conducted a retrospective, multicenter, cohort study in which we evaluated all diaphyseal forearm fractures between 2009 and 2019 in patients presenting to 4 trauma hospitals in southern Finland. Patients <16 years of age and fracture-dislocations were excluded. There were 470 patients included in this study. Patient records were evaluated to identify and analyze adverse events. Results There were 202 patients with both-bone fractures, 164 patients with isolated ulnar fractures, and 104 patients with isolated radial fractures. In total, 146 patients (31%) experienced an adverse event; 83 (18%) had major adverse events (persistent or requiring surgical intervention). The patients underwent procedures performed by 185 different surgeons. The median number of operations for a single surgeon was 2 (range, 1 to 12). The most common major adverse events were plate and screw-related issues (6%), nonunion (5%), persistent nerve injuries (4%), and refractures (4%). Higher body mass index, Gustilo-Anderson type-II open fractures, both-bone fractures, isolated radial fractures, and operations performed by junior residents were found to be risk factors for adverse events in the multivariable analysis. Conclusions Adverse events after diaphyseal forearm fracture surgery are common. We recommend concentrating these operations in a limited team of surgeons and restricting inexperienced surgeons from operating on these fractures without supervision. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Henri Vasara
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Samuli Aspinen
- Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jussi Kosola
- Department of Orthopedics and Traumatology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Juha Sartanen
- Department of Orthopedics and Traumatology, South Karelia Central Hospital, Lappeenranta, Finland
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tuomo Naalisvaara
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Orthopedics and Traumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jan Myllykoski
- Department of Orthopedics and Traumatology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Antti Stenroos
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Saini R, Sharma A, Baisoya K, Ravalji D. A Comparative Study Between Plate Osteosynthesis and Intramedullary Nailing for Diaphyseal Fracture of Radius and Ulna in Adults. Cureus 2023; 15:e37277. [PMID: 37168172 PMCID: PMC10165502 DOI: 10.7759/cureus.37277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION In this era of active living, industrial growth, increasing automobile accidents, and athletic activities, fractures of the forearm bones are becoming more frequent. The incidence of diaphyseal fractures of both bone forearms is reported to be approximately 10 per 10,000 persons per year, although rates may vary according to age and sex. If not properly treated, a fracture of the forearm bones might cause a serious loss of function. Therefore, to restore function, these fractures require adequate anatomical reduction and internal fixation. The majority of forearm fractures in adults are treated surgically, and various modes of internal fixation are available. In this study, we evaluated and compared the clinical, functional, and radiological outcomes of both bone forearm diaphyseal fractures treated with plate osteosynthesis and intramedullary nailing. MATERIAL AND METHOD This prospective and comparative study was conducted in a tertiary care medical teaching hospital in southern Rajasthan, India. Forty patients with diaphyseal fractures of the radius and ulna bones who presented to the casualty or orthopedic outpatient departments of our institute were included. Patients were divided into two groups, 20 patients in each group and treated by intramedullary nailing (group A) and plate osteosynthesis (group B), and regularly followed up and evaluated for clinical, functional, and radiological outcomes. RESULT Final results were calculated according to the modified Grace-Eversmann scoring system. In group A, out of 20 cases excellent score was seen in six cases (30%), good score in nine cases (45%), fair score in three cases (15%), and at last, two cases (10%) showed poor results. In group B, excellent score was in eight cases (40%), good score was in eight cases (40%), fair score was in three cases (15%), and at last, one case (5%) was poor in our study. CONCLUSION Based on our findings, we conclude that for the treatment of diaphyseal fractures of the radius and ulna, both treatment modalities provide equally satisfactory results.
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Affiliation(s)
- Ramavtar Saini
- Orthopedics, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Anshu Sharma
- Orthopedics, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Kuldeep Baisoya
- Orthopedics, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Divyaraj Ravalji
- Orthopedics, Geetanjali Medical College and Hospital, Udaipur, IND
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Zhang JY, Samineni AV, Sing DC, Rothman A, Stein AB. Higher-Than-Expected Rates of Distal Radioulnar Joint Fixation in Radial Shaft Fractures: Location of Fracture Matters. Hand (N Y) 2023; 18:328-334. [PMID: 33858223 PMCID: PMC10035106 DOI: 10.1177/15589447211006836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate rates of distal radioulnar joint (DRUJ) fixation based on location of the radial shaft fracture and risk factors associated with postoperative complications following radial shaft open reduction internal fixation (ORIF). METHODS Adult patients who underwent isolated radial shaft ORIF from 2014 to 2018 were identified from American College of Surgeons National Surgical Quality Improvement Program database and stratified by fracture location and by the presence or absence of DRUJ fixation. Preoperative patient characteristics and postoperative complications were compared to determine risk factors associated with DRUJ fixation. RESULTS We identified 1517 patients who underwent isolated radial shaft ORIF, of which 396 (26.1%) underwent DRUJ fixation. Preoperative patient characteristics and postoperative complications were similar between cohorts. Distal radioulnar joint fixation was performed in 50 (30.7%) of 163 distal radial shaft fractures, 191 (21.8%) of 875 midshaft fractures, and 3 (13.0%) of 23 proximal shaft fractures (P = .025). Risk factors for patients readmitted include male sex (odds ratio [OR] = 12.76, P = .009) and older age (OR = 4.99, P = .035). Risk factors for patients with any postoperative complication include dependent functional status (OR = 6.78, P = .02), older age (50-69 vs <50) (OR = 2.73, P = .05), and American Society of Anesthesiologists (ASA) ≥3 (OR = 2.45, P = .047). CONCLUSIONS The rate of DRUJ fixation in radial shaft ORIF exceeded previously reported rates of concomitant DRUJ injury, especially among distal radial shaft fractures. More distally located radial shaft fractures are significantly associated with higher rates of DRUJ fixation. Male sex is a risk factor for readmission, whereas dependent functional status, older age, and ASA ≥3 are risk factors for postoperative complications.
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Descriptive Epidemiology of Isolated Distal Radius Fractures in Children: Results From a Prospective Multicenter Registry. J Pediatr Orthop 2023; 43:e1-e8. [PMID: 36299238 DOI: 10.1097/bpo.0000000000002288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION More than 1 in 4 pediatric fractures involves the distal radius. Most prior epidemiologic studies are limited to retrospective, single center investigations, and often include adults. This study aims to describe the contemporary epidemiology of pediatric distal radius fractures using prospectively collected data from a multicenter Pediatric Distal Radius Fracture Registry. METHODS Patients aged 4 to 18 years diagnosed with a distal radius fracture from June 2018 through December 2019 at 4 tertiary care pediatric centers were screened and enrolled in this prospective longitudinal cohort study. Patients were excluded if they presented with bilateral distal radius fractures, polytrauma, or re-fracture. Demographic information, mechanism of injury, fracture characteristics, associated injuries, and procedural information were recorded. All radiographs were reviewed and measured. Descriptive statistics and bivariate analyses were performed. RESULTS A total of 1951 patients were included. The mean age was 9.9±3.3 years, and 61.3% of patients were male ( P <0.001). Most injuries occurred during a high-energy fall (33.5%) or sports participation (28.4%). The greatest proportion of fractures occurred during the spring months (38.5%). Torus fractures (44.0%) were more common than bicortical (31.3%) or physeal (21.0%) fractures. Of the physeal fractures, 84.3% were Salter-Harris type II. Associated ulnar fractures were observed in 51.2% of patients. The mean age at injury was higher for patients with physeal fractures (11.6±2.9 y) than patients with torus or bicortical fractures (9.4±3.1 and 9.6±3.1 y, respectively; P <0.001). Thirty-six percent of distal radius fractures underwent closed reduction and 3.3% underwent surgical fixation. Patients treated with closed reduction were more likely to be male (68.7% vs. 57.2%; P <0.001), obese (25.3% vs. 17.2%; P <0.001), and have bicortical fractures (62.2% vs. 14.5%; P <0.001). CONCLUSIONS Distal radius fractures in children have a male preponderance and are most likely to occur in the spring months and during high-energy falls and sports. Physeal fractures tend to occur in older children while torus and bicortical fractures tend to occur in younger children. LEVEL OF EVIDENCE Level I-prognostic.
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Clark P, Montiel-Ojeda D, Rascón-Pacheco RA, Guagnelli MA, Lopez-Gonzalez D, Bremer A, Borja-Aburto VH. Fracture incidence in children and adolescents 0-19 years old in Mexico: a 12-year cross-sectional analysis. Arch Osteoporos 2022; 17:127. [PMID: 36129580 DOI: 10.1007/s11657-022-01162-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/05/2022] [Indexed: 02/03/2023]
Abstract
The objective was to know the behavior of fractures in Mexican children and adolescents. According to our study, fractures in Mexican male children and adolescents seem to be decreasing; however, we still need more national studies to know the possible causes of these fractures. PURPOSE To describe the trends of fractures in Mexican children and adolescents across a 12-year period (2007 to 2019), and to analyze if these trends have changed over time between sexes and age groups. METHODS We identified all fracture cases registered in children and adolescents (0 to 19 years) at the emergency rooms and surgical departments of the Mexican Institute of Social Security between January 2007 and December 2019. We used ICD-10 to classify the fractures. The population was divided into two age groups: children (0 to 9 years) and adolescents (10 to 19 years). Additional information regarding sex and age was gathered up as well. We calculated annual incidence; incidence rates are presented per 10,000 population at risk. Changes in fracture trends were calculated using the average annual percentage change (AAPC). RESULTS Over 12 years, 1,400,443 fractures were registered. The most frequent site of fracture was forearm in 37.1% followed by shoulder (18.1%). The overall rates of fractures have remained similar over 12 years (86.5, IQR 81.0-94.2); however, a significant decrease in fractures was observed the last 3 years (2017-2019). According to the AAPC, only in men, in both age groups, a significant decrease in fractures was observed. CONCLUSION This is the first study in Mexico to follow the behavior of fractures in the pediatric population over 12 years. Fractures seem to be decreasing in children and adolescents. An epidemiological follow-up of childhood fractures is necessary to understand the causes of fractures to generate better prevention and treatment strategies.
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Affiliation(s)
- Patricia Clark
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Diana Montiel-Ojeda
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
| | | | - Miguel A Guagnelli
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Desirée Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Children's Hospital of Mexico Federico Gomez - Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Alhelí Bremer
- Faculty of Medicine and Psychology, Autonomous University of Baja California (UABC), Tijuana, Baja California, Mexico
| | - Víctor Hugo Borja-Aburto
- Teaching and Research Unit, Directorate of Medical Benefits, Mexican Institute of Social Security, IMSS, Mexico City, Mexico
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Jacobs RC, Schmitz MW, Swiontkowski MF. Intramedullary Nail and Plate Combination Technique for Peri-Implant Both-Bone Forearm Fractures. Cureus 2022; 14:e28828. [PMID: 36225435 PMCID: PMC9535688 DOI: 10.7759/cureus.28828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
A 35-year-old female patient with cerebellar ataxia presented with a right periprosthetic both-bone forearm fracture after a ground-level fall. Her surgical history was significant for multiple both-bone forearm fractures treated by open reduction and internal fixation. Subsequent treatment with a combination of intramedullary nailing and plate fixation for each bone provided successful fracture union while allowing immediate return to weight-bearing and range of motion. This case report demonstrates that intramedullary nailing and plate fixation of both-bone forearm fractures provides complete protection of the radius and ulna in recurrent, peri-implant both-bone forearm fractures. This technique is a valuable treatment option in the setting of a patient at risk for recurrent injury of the forearm.
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Korup LR, Larsen P, Nanthan KR, Arildsen M, Warming N, Sørensen S, Rahbek O, Elsoe R. Children’s distal forearm fractures: a population-based epidemiology study of 4,316 fractures. Bone Jt Open 2022; 3:448-454. [PMID: 35658607 PMCID: PMC9233428 DOI: 10.1302/2633-1462.36.bjo-2022-0040.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims The aim of this study was to report a complete overview of both incidence, fracture distribution, mode of injury, and patient baseline demographics of paediatric distal forearm fractures to identify age of risk and types of activities leading to injury. Methods Population-based cohort study with manual review of radiographs and charts. The primary outcome measure was incidence of paediatric distal forearm fractures. The study was based on an average at-risk population of 116,950. A total number of 4,316 patients sustained a distal forearm fracture in the study period. Females accounted for 1,910 of the fractures (44%) and males accounted for 2,406 (56%). Results The overall incidence of paediatric distal forearm fractures was 738.1/100,000 persons/year (95% confidence interval (CI) 706/100,000 to 770/100,000). Female incidences peaked with an incidence of 1,578.3/100,000 persons/year at age ten years. Male incidence peaked at age 13 years, with an incidence of 1,704.3/100,000 persons/year. The most common fracture type was a greenstick fracture to the radius (48%), and the most common modes of injury were sports and falls from ≤ 1 m. A small year-to-year variation was reported during the five-year study period, but without any trends. Conclusion Results show that paediatric distal forearm fractures are very common throughout childhood in both sexes, with almost 2% of males aged 13 years sustaining a forearm fracture each year. Cite this article: Bone Jt Open 2022;3(6):448–454.
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Affiliation(s)
- Lærke R. Korup
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Larsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Kumanan R. Nanthan
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Marie Arildsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Nikolaj Warming
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Sørensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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Immediate Weight Bearing of Plated Both-Bone Forearm Fractures Using Eight Cortices Proximal and Distal to the Fracture in the Polytrauma Patient Is Safe. J Am Acad Orthop Surg 2021; 29:666-672. [PMID: 34030171 DOI: 10.5435/jaaos-d-20-01252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/25/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Rehabilitation of trauma patients is facilitated by surgical stabilization permitting weight bearing (WB) of the fractured extremity. Both-bone forearm fracture (BBFx) plate osteosynthesis is an accepted technique with high union and low complication rates; yet, postoperative WB protocols have not been adequately investigated. There exists concern for increased complications in plated BBFx fractures for patients prescribed immediate WB. We hypothesized that immediate WB of surgically treated BBFxs results in acceptable rates of complications. METHODS Patients presenting to a Level-1 trauma center from 2007 to 2016 with a BBFx were identified retrospectively. Patients were skeletally mature, surgically treated with prescribed immediate WB protocol, and followed for 6 months or to fracture union. Collected data included demographics, fracture characteristics, associated injuries, and WB protocols for all extremities. Complications recorded included nonunion, hardware failure, and infection. Standard statistical comparisons were used to evaluate the risk of complication in polytrauma patients with modified lower extremity WB protocols (polytrauma group) and patients with no lower extremity WB restrictions (isolated group). RESULTS Two hundred thirteen patients were included with 75 (35%) females and 138 (65%) males. Mean age was 40 years and mean follow-up was 46 weeks. There were 142 (67%) patients in the poly-trauma and 71 (33%) patients in the isolated groups. In the poly-trauma group 21 (10%) patients had bilateral lower extremity WB restrictions. There were 11 (6%) complications noted: 2 non-unions, 4 hardware failures, and 5 infections. Demographics did not vary between the two groups. There was no difference in complications in the isolated (5.7%) versus poly-trauma groups (5.0%) (P = 0.75). CONCLUSION Immediate WB rehabilitation after BBFx plate osteosynthesis seems to be safe and associated with low nonunion and complication rates. Our results demonstrate that polytrauma patients using ambulatory aids for lower extremity injuries can immediately WB without increased risk compared with isolated BBFx patients.
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Tsou PY, Ma YK, Wang YH, Gillon JT, Rafael J, Deanehan JK. Diagnostic accuracy of ultrasound for upper extremity fractures in children: A systematic review and meta-analysis. Am J Emerg Med 2020; 44:383-394. [PMID: 32507477 DOI: 10.1016/j.ajem.2020.04.071] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Ultrasound has an excellent diagnostic accuracy for fractures that is reportedly comparable to plain radiographs. We aim to summarize the diagnostic accuracy of ultrasound for upper extremity fractures in children. METHODS Databases were searched from inception through November 2019 using pre-defined index terms, including "ultrasound," "fractures of upper extremities" and "children". The study is reported using Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). Meta-analysis of the diagnostic accuracy of ultrasound for fractures was conducted using the random-effects bivariate model. Subgroup analysis of fracture site (elbow vs non-elbow fractures) was also performed. Meta-regression was performed to determine if the site of fracture affected the diagnostic accuracy. RESULTS Thirty-two studies were identified in the meta-analysis. Ultrasound for fractures of the upper extremities has a sensitivity: 0.95 (95% CI: 0.93-0.97), specificity: 0.95 (95% CI: 0.91-0.98), positive likelihood ratio: 21.1 (95% CI: 10.8-41.5) and negative likelihood ratio: 0.05 (95% CI: 0.03-0.07), with an area under ROC (AUROC) curve of 0.98 (95% CI: 0.97-0.99). Subgroup analysis for elbow fracture showed ultrasound has a sensitivity: 0.95 (95% CI: 0.86-0.98), specificity: 0.87 (95% CI: 0.76-0.94), positive likelihood ratio: 7.3 (95% CI: 3.7-14.4) and negative likelihood ratio: 0.06 (95% CI: 0.02-0.16), with an AUROC of 0.96 (95% CI: 0.94-0.97). Meta-regression suggested the fracture sites would affect diagnostic accuracy of ultrasound (elbow vs non-elbow, p < 0.01). CONCLUSIONS Current evidence suggests ultrasound has excellent diagnostic accuracy for non-elbow upper extremity fractures in children, serving as an alternative diagnostic modality to plain radiographs.
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Affiliation(s)
- Po-Yang Tsou
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yu-Kun Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Hsun Wang
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason T Gillon
- Department of Pediatric Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - John Rafael
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Julia K Deanehan
- Department of Pediatric Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Jerrhag D, Englund M, Karlsson MK, Rosengren BE. Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord 2017; 18:240. [PMID: 28576135 PMCID: PMC5457562 DOI: 10.1186/s12891-017-1596-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022] Open
Abstract
Background A distal forearm fracture is a very common injury causing both suffering and substantial health care costs. The incidence of this fracture type seemed to increase worldwide until the middle 1980’s, but thereafter most reports have shown stable or decreasing rates. As few large studies have been presented lately we aimed to describe recent epidemiology and time trends of distal forearm fractures in adults. We paid special attention to fractures in working ages as they present challenges in terms of treatment and costs for sick-leave, and have not previously been thoroughly investigated. Methods By use of population data from Statistics Sweden and official in- and out-patient register data of men and women (≥17 years) in Sweden (Skåne region), we ascertained distal forearm fractures and estimated age- and sex-specific rates and time-trends from year 1999 to 2010 (11.2 million person-years (py)). Results The total incidence rate was 278 per 100,000 py (31,233 fractures) with 23% higher annual numbers 2010 compared with 1999. An increase in the annual age standardized incidence was found in men, +0.7% per annum (95% confidence interval (CI) 0.1, 1.4), and women, +0.9% (95% CI 0.5, 1.3), driven mainly by an increasing incidence in working ages (17–64 years). Also, expected demographic changes including a 25% population increase may result in 38% more fractures until 2050, compared to 2017. Conclusions The incidence of distal forearm fractures in adults in southern Sweden is increasing, mainly driven by an increase in working ages. In combination with expected demographic changes these findings may present substantial challenges for the future.
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Affiliation(s)
- Daniel Jerrhag
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University, SE 20502, Malmo, Sweden.
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Faculty of Medicine, Lund, Sweden.,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University, SE 20502, Malmo, Sweden
| | - Bjorn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University, SE 20502, Malmo, Sweden
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Tsukutani Y, Hagino H, Ito Y, Nagashima H. Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis. Osteoporos Int 2015; 26:2249-55. [PMID: 25986382 DOI: 10.1007/s00198-015-3124-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/31/2015] [Indexed: 01/19/2023]
Abstract
UNLABELLED We investigated the incidence of fragility fractures from 2010 to 2012 in Sakaiminato, Japan. The incidence rates of limb fractures in Sakaiminato were lower than in Caucasian populations but had increased relative to data obtained in Japan in the 1990s. Clinical vertebral fractures occurred at higher rates in Sakaiminato than in Caucasian populations. INTRODUCTION To elucidate the incidence and prognosis of fragility fractures in Sakaiminato, Japan. METHODS A survey of all hip, distal radius, proximal humerus, and clinical vertebral fractures was performed from 2010 to 2012 in patients aged 50 or older in Sakaiminato city, Tottori prefecture, Japan. The age- and gender-specific incidence rates (per 100,000 person-years) were calculated based on the population of Sakaiminato city each year. The incidence rates of hip, distal radius, and proximal humerus fractures were compared with previous reports. We conducted a follow-up study assessing patients within 1 year following their initial treatment at two Sakaiminato hospitals. RESULTS The age-adjusted incidence rates in population aged 50 years or older (per 100,000 person-years) of hip, distal radius, proximal humerus, and clinical vertebral fractures were, respectively, 217, 82, 26, and 412 in males and 567, 432, 96, and 1229 in females. Age-specific incidence rates of hip, distal radius, and proximal humerus fractures all increased since the 1990s. Our study also revealed that anti-osteoporotic pharmacotherapy was prescribed 1 year post-fracture at rates of 29, 20, 30, and 50 % for patients with hip, distal radius, proximal humerus, and clinical vertebral fractures, respectively. CONCLUSIONS The incidence rates of limb fractures in Sakaiminato were substantially lower than Caucasian populations in northern Europe but had increased relative to data obtained in Japan in the 1990s. Unlike upper and lower limb fractures, clinical vertebral fractures occurred at higher rates in our study population than in other Asian and North European countries.
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Affiliation(s)
- Y Tsukutani
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori, 683-8504, Japan,
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15
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Is high weight status associated with pediatric forearm fractures requiring anatomic reduction? J Investig Med 2015; 63:649-52. [PMID: 25738647 DOI: 10.1097/jim.0000000000000185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High weight status is associated with increased forearm fracture risk but its relationship to severity of fracture has not been evaluated. We compared the epidemiology of children's forearm fractures treated with fracture reduction to those not treated with reduction, hypothesizing that high weight status would be significantly associated with need for reduction. METHODS This is a case-control study including Washington, DC children, ages 2 to 17 years, treated for isolated forearm fractures in an urban, tertiary care pediatric emergency department from 2003 to 2006. Descriptive statistics and logistic regression were conducted to compare patients with forearm fracture reductions to nonintervention controls. RESULTS Of 888 forearm fractures, 330 (37.2%) required reduction (cases) whereas 558 (64.8%) did not (controls). Cases were more likely than controls to be male [adjusted odds ratio, 1.67 (95% confidence interval, 1.11-2.50)] and to have experienced a more severe mechanism of trauma [adjusted odds ratio, 2.11 (95% confidence interval, 1.14-3.90)]. The groups did not differ in weight status, age, or race/ethnicity. CONCLUSIONS The need for reduction among children with forearm fractures is significantly associated with male sex and major mechanisms of trauma but not with high weight status. Strategies to reduce severe forearm fractures should focus on preventing major mechanisms of trauma.
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Abrahamsen B, Jørgensen NR, Schwarz P. Epidemiology of forearm fractures in adults in Denmark: national age- and gender-specific incidence rates, ratio of forearm to hip fractures, and extent of surgical fracture repair in inpatients and outpatients. Osteoporos Int 2015; 26:67-76. [PMID: 25138260 DOI: 10.1007/s00198-014-2831-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/28/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED National epidemiological studies of forearm fractures are scarce. We examined in- and outpatient rates in Denmark, including anatomical location, surgery, hospitalization ratio, recurrent fractures, and ratio of forearm to hip fractures. This may be useful for triangulation in countries with less detailed information. Rates were higher than previously estimated. INTRODUCTION Despite a significant contribution to the overall burden of osteoporotic, nonvertebral fractures, relatively little information is available about age- and gender-specific incidence rates for many countries including Denmark. METHODS We used national individual patient data on inpatient and outpatient treatment to calculate rates of forearm fractures, taking readmissions into account, with subtables for distal and proximal fractures. We also calculated ratios of forearm to hip fractures that may be useful when imputing forearm fracture rates from other administrative sources. In addition, we report the rates of hospital admission and the rates of surgical treatment, allowing readers to extrapolate from the number of admissions or surgical procedures to incidence rates, should their data sources be less comprehensive. RESULTS Forearm fracture rates were 278 per 100,000 patient years in men aged 50+ and 1,110 per 100,000 in women aged 50+. The female to male incidence rate ratio was 4.0 for the age group 50+ but close to unity in persons aged 40 or under. Two thirds of patients were treated on an outpatient basis with little difference across age and gender strata. Four out of five fractures were treated conservatively. The rate of forearm fractures in Denmark was somewhat higher in both genders than recently imputed from hip fracture rates and were close to the rates previously reported in studies from Norway and Sweden. CONCLUSION The rates of forearm fracture in Denmark are higher than previously estimated and very similar to the high risk reported from studies in Norway and Sweden.
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Affiliation(s)
- B Abrahamsen
- Odense Patient Data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark,
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17
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Dimai HP, Svedbom A, Fahrleitner-Pammer A, Resch H, Muschitz C, Thaler H, Szivak M, Amrein K, Borgström F. Epidemiology of distal forearm fractures in Austria between 1989 and 2010. Osteoporos Int 2014; 25:2297-306. [PMID: 24935164 DOI: 10.1007/s00198-014-2766-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Only few studies have been published hitherto on country-specific incidence of distal forearm fracture. In the prevailing study, incidences were estimated, and trend analyses were performed for the entire Austrian population aged ≥50á. Incidence decreased significantly in women, but not in men, over the past 12 years of observation. INTRODUCTION To estimate incidence of distal forearm fracture and assess incidence trends in the entire Austrian population aged ≥50á from 1989-2010 for inpatient fractures and from 1999 to 2010 for all fractures. METHODS The number of inpatient forearm fractures was obtained from the Austrian Hospital Discharge Register (AHDR) for the entire population aged ≥50á from 1989 to 2010. Total number of distal forearm fractures was modeled using patient-level data on 36,327 patients with distal forearm fractures. Crude and age-standardized incidence rates (cases per 100,000) were estimated in 5-year age intervals. To analyze the change in incidence over time, average annual changes expressed as incidence rate ratios (IRR) were calculated. RESULTS For all distal forearm fractures, age-standardized incidence in women in 1999 and 2009 were estimated at 709 (95 % CI 675-743) and 607 (578-637), respectively. The age-standardized incidences in men the same years were estimated at 171 (156-185) and 162 (151-174), respectively. IRR analyses showed a significant decrease in women (-1.1 %, p < 0.01) but not in men (-0.8 %, p > 0.05) over the last 12 years (1999-2010). CONCLUSION Incidence of distal forearm fracture in the entire Austrian population is comparable to hip fracture incidence which is known to be among the highest worldwide. However, trend analyses reveal a significant decrease for all distal forearm fractures in women, but not in men, over the last 12 years.
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Affiliation(s)
- H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerpl. 2, A-8036, Graz, Austria,
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Nagy L, Jungwirth-Weinberger A, Campbell D, Pino JGD. The AO Ulnar Shortening Osteotomy System Indications and Surgical Technique. J Wrist Surg 2014; 3:91-97. [PMID: 25077046 PMCID: PMC4078186 DOI: 10.1055/s-0034-1375965] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ulnar shortening osteotomy is an established and frequently performed surgical procedure in wrist surgery. The technical aspects of the procedure have continued to develop in recent years, with instruments and implants being developed specifically for this purpose. Ulnar shortening osteotomy is required for different clinical indications and situations. These varying indications demand different amounts of shortening, but all must be precise and accurate. Controversy exists as to how this can best be achieved in terms of the location for osteotomy, the surgical approach and geometry of the osteotomy, as well as which implant to use to provide optimal stability. The goal of all techniques (besides successfully resolving the underlying problem) is to achieve reliable and rapid bone union without compromising early functional rehabilitation and also to avoid hardware complications. The AO Hand Expert Group has developed a specialized instrumentation system with dedicated and specifically designed implants to ensure exact and accurate cutting with precise and rigid stabilization of the ulna. The matched drill guides and double-blade saws allow accurate completion of the planned amount of shortening together with precise coaptation of the osteotomy fragments. The specific ulnar osteotomy LCP (locking compression plate) combines maximum stability with minimum bulk and soft tissue irritation. The features of the implant, its surgical technique, and early results are described.
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Affiliation(s)
- Ladislav Nagy
- AO Hand Expert Group (HAEG), Davos, Switzerland
- Department of Orthopedics, University of Zürich, Balgrist, Zürich, Switzerland
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Ryan LM, Guagliardo M, Teach SJ, Wang J, Marsh JE, Singer SA, Wright JL, Chamberlain JM. The association between fracture rates and neighborhood characteristics in Washington, DC, children. J Investig Med 2014; 61:558-63. [PMID: 23360838 DOI: 10.2310/jim.0b013e318280a835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Effects of neighborhood contextual features have been found for many diseases, including bone fractures in adults. Our study objective was to evaluate the association between neighborhood characteristics and pediatric bone fracture rates. We hypothesized that neighborhood indices of deprivation would be associated with higher fracture rates. MATERIALS AND METHODS Pediatric bone fracture cases treated at a tertiary, academic, urban pediatric emergency department between 2003 and 2006 were mapped to census block groups using geographical information systems software. Fracture rates were calculated as fractures per 1000 children in each census block. Exploratory factor analysis of socioeconomic indicators was performed using 2000 census block data. Factor scores were used to predict odds of bone fracture at the individual level while adjusting for mean age, sex composition, and race/ethnicity composition at census block level using our sample data. RESULTS We analyzed 3764 fracture visits in 3557 patients representing 349 distinct census blocks groups. Fracture rates among census blocks ranged from 0 to 207 per 1000 children/study period. Logistic regression modeling identified 2 factors (race/education and large families) associated with increased fracture risk. Census variables reflecting African American race, laborer/service industry employment, long-term block group residence, and lower education levels strongly loaded on the race/education factor. The large families factor indicated the children-to-families ratio within the block group. The poverty factor was not independently associated with fracture risk. CONCLUSIONS Thus, neighborhood characteristics are associated with risk for fractures in children. These results can help inform translational efforts to develop targeted strategies for bone fracture prevention in children.
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Affiliation(s)
- Leticia Manning Ryan
- Division of Emergency Medicine, Children's National Medical Center, Children's National Medical Center, Washington, DC 20010, USA.
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Ireland A, Maden-Wilkinson T, Ganse B, Degens H, Rittweger J. Effects of age and starting age upon side asymmetry in the arms of veteran tennis players: a cross-sectional study. Osteoporos Int 2014; 25:1389-400. [PMID: 24531424 DOI: 10.1007/s00198-014-2617-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 01/07/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED While tennis playing results in large bone strength benefits in the racquet arm of young players, the effects of tennis playing in old players have not been investigated. Large side asymmetries in bone strength were found in veteran players, which were more pronounced in men, younger players and childhood starters. INTRODUCTION Regular tennis results in large racquet arm bone and muscle strength advantages; however, these effects have not been studied in old players. The non-racquet arm can act as an internal control for the exercising racquet arm without confounding factors, e.g. genotype. Therefore, veteran tennis player side asymmetries were examined to investigate age, sex and starting age effects on bone exercise benefits. METHODS Peripheral quantitative computed tomography (pQCT) scans were taken at the radius, ulna and humerus mid-shaft and distal radius in both arms of 88 tennis players (51 males, 37 females; mean age 63.8 ± 11.8 years). Thirty-two players began playing in adulthood, thereby termed 'old starters'; players were otherwise termed 'young starters'. RESULTS Muscle size and bone strength were greater in the racquet arm; notably, distal radius bone mineral content (BMC) was 13 ± 10% higher and humeral bone area 23 ± 12% larger (both P < 0.001). Epiphyseal BMC asymmetry was not affected by age (P = 0.863) or sex (P = 0.954), but diaphyseal asymmetries were less pronounced in older players and women, particularly in the humerus where BMC, area and moment of resistance asymmetries were 28-34 % less in women (P < 0.01). Bone area and periosteal circumference asymmetries were smaller in old starters (all P < 0.01); most notably, no distal radius asymmetry was found in this group (0.4 ± 3.4%). CONCLUSIONS Tennis participation is associated with large side asymmetries in muscle and bone strength in old age. Larger relative side asymmetries in men, younger players and young starters suggest a greater potential for exercise benefits to bone in these groups.
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Affiliation(s)
- A Ireland
- Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK,
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Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ. Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res 2014; 29:581-9. [PMID: 23959594 PMCID: PMC3929546 DOI: 10.1002/jbmr.2072] [Citation(s) in RCA: 229] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/30/2013] [Accepted: 08/05/2013] [Indexed: 11/07/2022]
Abstract
To assess recent trends in fracture incidence from all causes at all skeletal sites, we used the comprehensive (inpatient and outpatient) data resources of the Rochester Epidemiology Project to estimate rates for Olmsted County, MN, USA, residents in 2009 to 2011 compared with similar data from 1989 to 1991. During the 3-year study period, 2009 to 2011, 3549 residents ≥50 years of age experienced 5244 separate fractures. The age- and sex-adjusted (to the 2010 US white population) incidence of any fracture was 2704 per 100,000 person-years (95% confidence interval [CI] 2614 to 2793) and that for all fractures was 4017 per 100,000 (95% CI 3908 to 4127). Fracture incidence increased with age in both sexes, but age-adjusted rates were 49% greater among the women. Overall, comparably adjusted fracture incidence rates increased by 11% (from 3627 to 4017 per 100,000 person-years; p = 0.008) between 1989 to 1991 and 2009 to 2011. This was mainly attributable to a substantial increase in vertebral fractures (+47% for both sexes combined), which was partially offset by a decline in hip fractures (-25%) among the women. There was also a 26% reduction in distal forearm fractures among the women; an increase in distal forearm fractures among men aged 50 years and over was not statistically significant. The dramatic increase in vertebral fractures, seen in both sexes and especially after age 75 years, was attributable in part to incidentally diagnosed vertebral fractures. However, the fall in hip fracture incidence, observed in most age groups, continues the steady decline observed among women in this community since 1950. More generally, these data indicate that the dramatic increases in the incidence of fractures at many skeletal sites that were observed decades ago have now stabilized.
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Affiliation(s)
- Shreyasee Amin
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
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Abstract
Osteoporotic fractures are associated with excess mortality and decreased functional capacity and quality of life. Age-standardized incidence rates of fragility fractures, particularly of the hip and forearm, have been noted to be decreasing in the last decade across many countries with the notable exception of Asia. The causes for the observed changes in fracture risk have not been fully identified but are likely the result of multiple factors, including birth cohort and period effects, increasing obesity, and greater use of anti-osteoporosis medications. Changing rates of fragility fractures would be expected to have an important impact on the burden of osteoporosis.
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Sinikumpu JJ, Pokka T, Sirniö K, Ruuhela R, Serlo W. Population-based research on the relationship between summer weather and paediatric forearm shaft fractures. Injury 2013; 44:1569-73. [PMID: 23701940 DOI: 10.1016/j.injury.2013.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/03/2013] [Accepted: 04/22/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Paediatric forearm shaft fractures show an increasing incidence. The predictive factors of these fractures are not fully understood. Summer weather is suggested to have an effect on the risk of children's fractures. We studied the effect of rainfall, temperature and wind on paediatric forearm shaft fractures in summer. METHODS All 148 children's forearm shaft fractures in the geographic catchment district during the summer months in 1997-2009 were included. There were 1989 days in the study period. Daily meteorological readings captured the maximum daytime temperature, precipitation and wind speed. The direct daily association between fractures (yes/no) and different weather conditions was analysed in this population-based study. RESULTS The risk of forearm shaft fracture was 50% higher on dry days compared to rainy days (P=0.038). Temperature and wind speed had no statistically significant effect on fractures. CONCLUSIONS The results give support for the presumption by the general public and professionals that summer weather affects children's fractures. A 1.5-fold increase in the risk is especially significant as the forearm shaft fractures are challenging to manage and prone to complications. Paediatric trauma units should prepare themselves for these severe injuries on dry summer days.
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Affiliation(s)
- Juha-Jaakko Sinikumpu
- Oulu University Hospital, Department of Children and Adolescents, Division of Paediatric Surgery and Orthopaedics, Oulu, Finland.
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Wilcke MKT, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop 2013; 84:292-6. [PMID: 23594225 PMCID: PMC3715813 DOI: 10.3109/17453674.2013.792035] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The incidence of fractures of the distal radius may have changed over the last decade, and operative treatment has been commoner during that time. We investigated the incidence of fractures of the distal radius and changing trends in surgical treatment during the period 2004-2010. PATIENTS AND METHODS Registry data on 42,583 patients with a fracture of the distal radius from 2004 to 2010 were evaluated regarding diagnosis, age, sex, and surgical treatment. RESULTS The crude incidence rate was 31 per 10(4) person-years with a bimodal distribution. After the age of 45 years, the incidence rate in women increased rapidly and leveled off first at a very high age. The incidence rate in postmenopausal women was lower than previously reported. In men, the incidence was low and it increased slowly until the age of 80 years, when it amounted to 31 per 10(4) person-years. The number of surgical procedures increased by more than 40% despite the fact that there was reduced incidence during the study period. In patients ≥ 18 years of age, the proportion of fractures treated with plating increased from 16% to 70% while the use of external fixation decreased by about the same amount. INTERPRETATION The incidence rate of distal radius fractures in postmenopausal women appears to have decreased over the last few decades. There has been a shift in surgical treatment from external fixation to open reduction and plating.
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Affiliation(s)
- Maria K T Wilcke
- Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital
| | - Henrik Hammarberg
- Section of Hand Surgery, Department of Clinical Sciences and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
| | - Per Y Adolphson
- Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital
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Ryan LM, Teach SJ, Singer SA, Wood R, Freishtat R, Wright JL, McCarter R, Tosi L, Chamberlain JM. Bone mineral density and vitamin D status among African American children with forearm fractures. Pediatrics 2012; 130:e553-60. [PMID: 22926174 PMCID: PMC3428759 DOI: 10.1542/peds.2012-0134] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level ≤ 20 ng/mL) compared with fracture-free control patients. METHODS This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. RESULTS The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio 0.38 [0.20-0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09-10.94]). CONCLUSIONS These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits.
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Affiliation(s)
- Leticia Manning Ryan
- Children's National Medical Center, Division of Emergency Medicine, 111 Michigan Ave NW, Washington, DC 20010, USA.
| | - Stephen J. Teach
- Division of Emergency Medicine,,Center for Clinical and Community Research,,Pediatrics, and,Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Steven A. Singer
- Department of Emergency Medicine, George Washington University Medical Center, Washington, DC; and
| | | | - Robert Freishtat
- Division of Emergency Medicine,,Departments of Integrative Systems Biology,,Pediatrics, and,Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Joseph L. Wright
- Division of Emergency Medicine,,Center for Clinical and Community Research,,Child Health Advocacy Institute, and,Pediatrics, and,Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Laura Tosi
- Division of Orthopaedics and Sports Medicine, Children's National Medical Center, Washington, DC
| | - James M. Chamberlain
- Division of Emergency Medicine,,Center for Clinical and Community Research,,Pediatrics, and,Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
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Sinikumpu JJ, Lautamo A, Pokka T, Serlo W. The increasing incidence of paediatric diaphyseal both-bone forearm fractures and their internal fixation during the last decade. Injury 2012; 43:362-6. [PMID: 22154046 DOI: 10.1016/j.injury.2011.11.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/07/2011] [Accepted: 11/08/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of children's forearm fractures is increasing worldwide. This is different from the declining trend observed in the overall injury rate, and the reason for the increase is not known. Diaphyseal forearm fractures comprise 3-6% of all paediatric fractures, and they offer a challenge to their treatment. The purpose of this study was to evaluate the incidence of diaphyseal both-bone forearm fractures in children during the last decade in Northern Finland. Another objective was to study the background factors, treatment, and re-displacement of these fractures. MATERIALS AND METHODS All 168 children (<16 years) admitted to our paediatric trauma centre due to diaphyseal both-bone forearm fractures during 2000-2009 were included. The type of injury, background factors, radiographics, treatments and re-dislocations were reviewed. The age-related incidence rates were evaluated. RESULTS The incidence of diaphyseal both-bone forearm fractures increased 4.4-fold (95% CI 2.0-10.8; P<0.001) between 2000 (8.2/100000) and 2009 (35.9/100000). The increase in the incidence was accelerating (P<0.001) and the overall increase was 338%. The incidence of surgical treatment for diaphyseal fractures increased 4.2-fold (95% CI 1.9-10.4, P=0.001), which is in relation to increasing number of fractures. However, internal fixation increased from 13.3% in 2000-2001 to 52.7% in 2008-2009 (P=0.015), as an alternative to conservative treatment. The re-displacement rate was high (29.9%) amongst the patients with conservative treatment compared to those who were invasively operated (1.4%) (P<0.001). The mean age of the patients increased by 2.4 years in the study period (P=0.019). Trampoline was the most important and still increasing reason for the fractures. At the beginning of the study, there were no trampoline-related fracture, but towards the end of the study 30-41% of the fractures were caused by a trampoline injury (P=0.004). CONCLUSIONS There was an accelerating increase in the incidence of paediatric diaphyseal both-bone forearm fractures during the last decade. Trampoline was the most important and still increasing reason for these fractures. The mean age of the patients was increasing. Increasing proportion of diaphyseal both-bone forearm fractures was treated operatively. Re-displacement was unusual amongst operated cases.
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Affiliation(s)
- Juha-Jaakko Sinikumpu
- Division of Paediatric Surgery and Orthopaedics, Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
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de Putter CE, van Beeck EF, Looman CWN, Toet H, Hovius SER, Selles RW. Trends in wrist fractures in children and adolescents, 1997-2009. J Hand Surg Am 2011; 36:1810-1815.e2. [PMID: 22036281 DOI: 10.1016/j.jhsa.2011.08.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 08/02/2011] [Accepted: 08/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius and carpal fractures in children and adolescents represent approximately 25% of all pediatric fractures. Incidence rates and causes of these fractures change over time owing to changes in activities and risk factors. The purpose of this study was to examine recent population-based trends in incidence and causes of wrist fractures in children and adolescents. METHODS We obtained data from the Dutch Injury Surveillance System of emergency department visits of 15 geographically distributed hospitals, and from the National Hospital Discharge Registry. This included a representative sample of outpatients and inpatients, respectively. We calculated incidence rates of wrist fractures per 100,000 person-years for each year between 1997 and 2009. Using Poisson's regression, we analyzed trends for children and adolescents 5 to 9, 10 to 14, and 15 to 19 years of age separately for boys and girls. RESULTS During the study period, incidence rates increased significantly in boys and girls 5 to 9 and 10 to 14 years of age, with the strongest increase in the age group 10 to 14 years. The observed increases were mainly due to increased incidence rates during soccer and gymnastics at school. CONCLUSIONS This population-based study revealed a substantial sports-related increase in the incidence rate of wrist fractures in boys and girls aged 5 to 9 and 10 to 14 years in the period 1997 to 2009. CLINICAL RELEVANCE With knowledge of the epidemiology of wrist fractures, prevention programs can be improved. From this study, we know that the incidence rate of wrist fractures in childhood is increasing, mainly as a result of soccer and gymnastics at school. Future sport injury research and surveillance data are necessary to develop new prevention programs based on identifying and addressing specific risk factors, especially in young athletes.
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Affiliation(s)
- C E de Putter
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC Rotterdam, Rotterdam.
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Tsai CH, Muo CH, Fong YC, Lo WY, Chen YJ, Hsu HC, Sung FC. A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000-2007. Osteoporos Int 2011; 22:2809-15. [PMID: 21107533 DOI: 10.1007/s00198-010-1489-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED This population-based study was conducted using claims data obtained from the National Health Insurance to investigate the trend in incidence of distal radial fractures in adults in Taiwan from 2000 to 2007. Our results revealed an increasing trend, particularly among women >50 years of age. INTRODUCTION This population-based study used insurance claims data from 2000 to 2007 obtained from the National Health Research Institute to investigate the longitudinal trend in distal radial fractures in adults ≥20 years old in Taiwan. METHODS We estimated the age- and gender-specific annual incidence rates of distal radial fracture and compared the differences in distribution by sociodemographic status between patients with and those without distal radial fracture and the differences in incidence rates between 2000 and 2007. RESULTS The incidence of fracture was higher in women than in men. The overall female-to-male rate ratios were 1.52 in 2000 (12.3 vs 8.06 per 10,000 persons) and 1.89 in 2007 (18.9 vs 10.0 per 10,000 persons). There was marked increase in age-specific incidence beginning in the 50-54-year age group, particularly among women. CONCLUSION These results imply the need for more effective intervention for the prevention of subsequent fracture and disability, particularly for perimenopausal women.
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Affiliation(s)
- C-H Tsai
- Department of Orthopedics, China Medical University and Hospital, Taichung, Taiwan
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Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P, Hyvönen P, Leppilahti J. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int 2011; 22:2307-12. [PMID: 20972668 DOI: 10.1007/s00198-010-1463-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/24/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED The purpose of this study was to assess changes in epidemiology and reasons for wintertime excess of distal radius fractures in Oulu, Finland. Our results showed that age-specific incidence of distal radius fractures in elderly women in Finland has increased compared with a previous study. Slippery pavement surfaces assessed by a new meteorological model partly explained wintertime excess of fractures, but factors beyond weather are contributing to seasonality. INTRODUCTION In this report, we describe the epidemiology and seasonal variation of distal radius fractures in Oulu, Finland, with a focus on the effect of weather and slippery pavement conditions. METHODS Records of patients aged ≥16 years living in Oulu with a distal radius fracture during the year 2008 were reviewed. Demographic data and details of the injury were assessed from medical records, and fractures were classified according to AO classification. Population data for Oulu during the year 2008 were used to calculate crude incidence as well as sex- and age-specific incidence rates. The number of wintertime fractures was compared with those related to pavement surface slipperiness using a unique weather and pavement condition model of the Finnish Meteorological Institute. RESULTS The crude incidence was 258/100,000 person-years. Sex- and age-specific incidence rates rose to 1,107/100,000 person-years for females and 466/100,000 person-years for males aged ≥80 years. Poisson regression analysis showed that the number of fractures was 2.5 (95% confidence interval (CI), 1.6 to 4.0; P < 0.001) times greater on slippery winter days compared with non-winter days whereas on normal winter days fractures were 1.4 (95% CI, 1.1 to 1.9; P = 0.01) times greater. Both low- and high-energy injuries resulted in similar fracture patterns by AO classification. CONCLUSIONS Our results suggest that the epidemiology of distal radius fractures in elderly women in Finland has changed compared with a previous study. Weather analysis showed that the slipperiness of the pavement could partly explain the wintertime excess of distal radius fractures.
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Affiliation(s)
- T Flinkkilä
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, 90029 OYS, Oulu, Finland.
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Leslie WD, Sadatsafavi M, Lix LM, Azimaee M, Morin S, Metge CJ, Caetano P. Secular decreases in fracture rates 1986-2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int 2011; 22:2137-43. [PMID: 21069292 DOI: 10.1007/s00198-010-1470-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 09/14/2010] [Indexed: 10/18/2022]
Abstract
SUMMARY We examined trends in fracture rates over 20 years in the Province of Manitoba, Canada. Hip fractures, major low-trauma fractures, and high-trauma fractures declined significantly from 1986 to 2006. INTRODUCTION Secular decreases in hip fracture rates have been reported in some countries. Whether this phenomenon applies to other fracture sites is not well described. METHODS We used 20 years of data from the Population Health Research Data Repository for the Province of Manitoba, Canada. Age-adjusted fracture rates were calculated for men and women age 50 years and older 1986-2006 according to fracture site and mechanism (presence/absence of external injury codes). Generalized linear models with generalized estimating equations were used to derive adjusted annual rates and test for linear change in men and women. RESULTS Major low-trauma fractures (hip, forearm, spine, and humerus) showed a significant annual linear decline in women (-1.2% [95% CI, -0.7% to -1.8%]) and in men (-0.4% [95% CI, -0.7% to -0.2%]). Hip fracture showed a significant annual decline for both sexes, while forearm and humerus fractures showed a significant decline only in women. The only fracture category that did not show a significant annual decline in either sex was the spine. The observed annual reduction in high-trauma fractures was even larger and did not show a sex difference (-1.8% [95% CI, -2.8% to -0.7%]). CONCLUSION We observed a decrease in both low-trauma and high-trauma fracture rates over the study period. This decline was apparent in years prior to widespread osteoporosis testing or availability of modern pharmacotherapy.
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Affiliation(s)
- W D Leslie
- University of Manitoba, Winnipeg, Canada.
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Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 2011; 22:1277-88. [PMID: 21461721 PMCID: PMC3546313 DOI: 10.1007/s00198-011-1601-6] [Citation(s) in RCA: 609] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 02/23/2011] [Indexed: 12/18/2022]
Abstract
Osteoporosis constitutes a major public health problem through its association with age-related fractures, most notably those of the proximal femur. Substantial geographic variation has been noted in the incidence of hip fracture throughout the world, and estimates of recent incidence trends have varied widely. Studies in the published literature have reported an increase, plateau, and decrease in age-adjusted incidence rates for hip fracture among both men and women. Accurate characterisation of these temporal trends is important in predicting the health care burden attributable to hip fracture in future decades. We therefore conducted a review of studies worldwide, addressing secular trends in the incidence of hip and other fractures. Studies in western populations, whether in North America, Europe or Oceania, have generally reported increases in hip fracture incidence through the second half of the last century, but those continuing to follow trends over the last two decades have found that rates stabilise with age-adjusted decreases being observed in certain centres. In contrast, some studies suggest that the rate is rising in Asia. This synthesis of temporal trends in the published literature will provide an important resource for preventing fractures. Understanding the reasons for the recent declines in rates of hip fracture may help understand ways to reduce rates of hip fracture worldwide.
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Affiliation(s)
- C Cooper
- The MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK.
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Abstract
BACKGROUND Pediatric forearm fractures result in substantial morbidity and costs. Despite the success of public health efforts in the prevention of other injuries, the incidence of pediatric forearm fractures is increasing. Our objective is to characterize the epidemiology of forearm fractures in Washington, DC, children evaluated in an urban pediatric emergency department (ED). METHODS This retrospective study includes Washington, DC, children, aged 0 years to 17 years, treated for an isolated forearm fracture in the Children's National Medical Center ED from 2003 to 2006. Patients with bone mineralization disorders and repeat ED visits for the same fracture event were excluded. Chart review was done to obtain demographic and clinical data. Descriptive epidemiologic and bivariate analyses were conducted. RESULTS This preliminary analysis included 929 patients. The majority of patients are male (64%) and African American (80%). The mean age (± standard deviation) is 8.4 years (±3.9). Weight-for-age percentile was ≥95% in 24.1% of cases. Most forearm fractures occurred during the spring season. The most common mechanism of injury was fall-related (83%) whereas direct trauma caused 10% of fractures. "Fall from monkey bars" was the specific mechanism of injury in 17% of all cases. The majority of forearm fractures (58%) resulted from minor trauma. CONCLUSIONS Falls from monkey bars and minor trauma are implicated in the majority of childhood forearm fractures. The prevention strategies should target playground safety. Further research is needed to evaluate factors, including obesity and bone health, which may contribute to forearm fracture risk associated with minor trauma.
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Abstract
PURPOSE OF REVIEW Summary highlighting the evidence that bone health may affect forearm fracture risk in children. RECENT FINDINGS Although the incidence of other fractures and injuries are decreasing, the incidence of forearm fractures is increasing in otherwise healthy children. There is a growing volume of research that forearm fracture risk in children may be related to deficiencies in parameters of bone health. Available evidence of this relationship was summarized and included direct links to bone health (measurement of bone properties), indirect links to bone health (diet, vitamin D status, BMI), and genetic analyses. SUMMARY There is consistent and convincing evidence of an association between bone mineral density and forearm fracture risk in children. Studies of calcium intake and supplementation are less extensive in scope but suggest that effects of calcium deficiency on the radius may contribute to childhood forearm fracture risk. Forearm fracture risk in obese children is likely to reflect a combination of suboptimal bone health status and behavioral characteristics. Published data on the role of vitamin D status and genetic factors are limited but merit further consideration. Further investigation is needed to better understand the factors contributing to forearm fracture risk in children and translate this knowledge into effective clinical prevention and practice.
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Affiliation(s)
- Leticia M Ryan
- Children's National Medical Center, Division of Emergency Medicine, Center for Clinical and Community Research, Washington, District of Columbia, USA.
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Abstract
Despite public health measures to prevent childhood injuries, the incidence of pediatric fractures is increasing. This fracture incidence is dependent on many demographic factors, the various contributors to bone health, and an individual's risk-taking behavior. Although traditional play activities continue to be the prevalent causes for fractures, there is an evolving array of new sport and recreation activities that carry significant fracture risk. The following review article outlines the developing epidemiology of pediatric fractures by analyzing some of the individual risk factors that influence fracture incidence as well as the variety of activities that are associated with these fractures.
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Abstract
OBJECTIVES Forearm fractures account for a significant proportion of childhood injuries and seem to be increasing in incidence. Poor vitamin D status increases overall fracture risk in infants with rickets and adults with osteoporosis. Children with vitamin D insufficiency (serum 25-hydroxy vitamin D level <20 ng/mL) have decreased bone mineral density (BMD) compared with children having normal vitamin D status. The relationship between vitamin D status and childhood forearm fracture has not been investigated. METHODS This prospective study enrolled African American children, aged 5 to 9 years, with a forearm fracture. Bone health evaluation included measurement of serum 25-hydroxy vitamin D level and BMD by dual energy x-ray absorptiometry scan. Univariable analyses were used to test the associations between fracture status and the independent variables, serum vitamin D level and BMD. RESULTS Vitamin D levels were available for 17 cases. The mean (+/-SD) 25-hydroxy vitamin D level was 20.1 (+/-7.3) ng/mL with a range of 10 to 38 ng/mL. The mean of this group was at the cut point for vitamin D insufficiency. Ten cases (59%) were vitamin D insufficient. Dual energy x-ray absorptiometry scan results for these patients were consistent with normal bony mineralization for age. CONCLUSIONS A significant proportion of African American children with fractures in our study have vitamin D insufficiency. Analysis of serum 25-hydroxy vitamin D levels and BMD in additional cases and controls will determine the significance of these findings. CLINICAL RELEVANCE Vitamin D insufficiency may play a previously unrecognized role in childhood fractures. Strong consideration should be given to routine vitamin D testing in African American children with forearm fractures.
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Lofthus CM, Frihagen F, Meyer HE, Nordsletten L, Melhuus K, Falch JA. Epidemiology of distal forearm fractures in Oslo, Norway. Osteoporos Int 2008; 19:781-6. [PMID: 17985071 DOI: 10.1007/s00198-007-0499-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 10/11/2007] [Indexed: 11/25/2022]
Abstract
UNLABELLED The population of Oslo has the highest incidence of hip fracture reported. The present study shows that the overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. INTRODUCTION The population of Oslo has the highest incidence of hip fracture reported. The present study reports the incidence of distal forearm fracture in Oslo and the fracture rates of immigrants. METHODS Patients aged > or = 20 years resident in Oslo sustaining a distal forearm fracture in a one-year period in 1998/99 were identified using electronic diagnosis registers, patient protocols, and/or X-ray registers of the clinics in Oslo. Medical records were obtained and the diagnosis verified. The age- and sex-specific incidence rates were calculated and compared with those for 1979. Data on immigrant category and country of origin of the patients were obtained. RESULTS The age-adjusted fracture rates per 10,000 for the age group > or = 50 years were 109.8 and 25.4 in 1998/99 compared with 108.3 and 23.5 in 1979 for women and men, respectively (n.s.). The relative risk of fracture in Asians was 0.72 (95% CI 0.53-1.00) compared with ethnic Norwegians. CONCLUSIONS The overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. Furthermore, the present data suggest that Asian immigrants in Oslo have a slightly lower fracture risk than ethnic Norwegians.
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Affiliation(s)
- C M Lofthus
- Centre of Endocrinology, The Hormone Laboratory, Aker University Hospital, 0514 Oslo, Norway.
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Abstract
Fractures in childhood have long been considered an unavoidable consequence of growth. Studies in recent years have documented the epidemiology of these very common fractures and have also documented considerable variation by fracture type and from country to country. There have also been a number of studies aimed at identifying risk factors particularly for the most common distal forearm fracture. These studies have consistently associated bone mineral density with these fractures. Other possible risk factors include obesity, physical inactivity, sports, cola beverages, calcium intake, risk taking, and coordination. While prospective studies are required to confirm these risk factors, accumulating evidence now suggests that a substantial proportion of fractures in children are preventable.
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Affiliation(s)
- Graeme Jones
- Menzies Research Institute, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
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Wigg AER, Hearn TC, McCaul KA, Anderton SM, Wells VM, Krishnan J. Number, incidence, and projections of distal forearm fractures admitted to hospital in Australia. THE JOURNAL OF TRAUMA 2003; 55:87-93. [PMID: 12855886 DOI: 10.1097/01.ta.0000038544.45839.3d] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study documents the number, incidence, and relative risk (RR) of distal forearm fractures requiring admission to hospital in Australia in 1997 and estimates of the projected numbers for 2021. METHODS Distal forearm fracture numbers from 1993 to 1998 were obtained. The incidence and RR were calculated by gender and 5-year age groups for 1997. Projected numbers for 2021 were estimated using population projection data. RESULTS In 1997, fracture numbers were 12357 for male patients and 19319 for female patients. The incidence was 152 per 100000 for male patients and 157 per 100000 for female patients. The highest incidence and RR was in the 10- to 14-year age group for male patients and in the 85 years and over age group for female patients. If fracture incidence remains constant (on the basis of predicted population changes in Australia), by 2021, it is estimated that fracture numbers for people 50 years of age and over will increase by 81%, compared with 11% for people under 50. In the older age group, the number for women will be 4.7 times higher than for men. CONCLUSION This study quantifies the potential disproportionate increase in distal forearm fractures requiring admission in Australia, particularly for female patients, because of an aging population.
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Affiliation(s)
- Alison E R Wigg
- Department of Surgery, Flinders Medical Center and Repatriation General Hospital, Flinders University of South Australia, South Australia, Australia
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Wareham K, Johansen A, Stone MD, Saunders J, Jones S, Lyons RA. Seasonal variation in the incidence of wrist and forearm fractures, and its consequences. Injury 2003; 34:219-22. [PMID: 12623254 DOI: 10.1016/s0020-1383(02)00212-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of wrist and forearm fractures. We examined seasonal variation in the incidence of these injuries, and looked at resulting pressures on outpatient and inpatient trauma services. AWISS collected data from eight Accident and Emergency (A&E) departments which between them serve a total of 1.2 million people in South Wales. During a single year, we identified all 5013 people who presented with a wrist or forearm fracture. Seasonal variation in wrist/forearm fracture incidence was apparent, but showed a different pattern in different age groups. Overall incidence figures were dominated by an increase in children's fractures in spring and summer. Children under the age of 15 suffered a total of 360 wrist and forearm fractures during the three winter months; an incidence of 5.9/1000 per year that was only about half that observed during the remainder of the year (10.7/1000 per year). In contrast, older people showed a higher incidence in the winter. During the winter months people aged over 75 sustained a total of 160 wrist/forearm fractures; an incidence of 8.2/1000 per year, significantly higher than the incidence observed in other months (5.8/1000 per year). Seasonality of incidence was not apparent in other age groups. Children presenting during the spring and summer months were significantly more likely to need admission to hospital; 22.8% were admitted compared with just 10.3% of those presenting during the winter months (P<0.001, chi(2)-test). Other age groups showed no significant seasonal variation in the likelihood of hospital admission.
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Affiliation(s)
- Karen Wareham
- Bone Research Unit, Academic Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, UK
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Islam SS, Biswas RS, Nambiar AM, Syamlal G, Velilla AM, Ducatman AM, Doyle EJ. Incidence and risk of work-related fracture injuries: experience of a state-managed workers' compensation system. J Occup Environ Med 2001; 43:140-6. [PMID: 11227632 DOI: 10.1097/00043764-200102000-00013] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Incidence rates of occupational fractures at various anatomic sites and associated risk factors have not been well documented. We identified 3490 work-related fractures from a West Virginia Workers Compensation database that occurred between July 1, 1994, and June 30, 1995. The annual incidence rate was 55 per 10,000 workers, which is substantially higher than the work-related fracture rates reported previously. The incidence rate of fracture was highest in the agricultural sector, followed by the mining, construction, and manufacturing sectors (202.0, 165.2, 116.7, and 88.0 per 10,000 workers, respectively). The age-specific gender distribution comparing fracture and non-fracture injuries showed a bimodal distribution, with greater proportions of female employees at the younger and older age groups. Fracture of the phalanges was the most common, followed by fractures of the foot bone and carpal bone (15.8, 9.5, and 7.9 per 10,000 workers, respectively). In a multiple logistic regression analysis, age, gender, occupation, caught in-between objects, fall, struck by or against object, and vehicle collision were significant independent predictors of fracture (all sites combined). We believe work-related fractures to be a bigger problem than previously reported. The association among gender, age, occupation, and causes of fractures identified in this study will be useful in developing gender- and occupation-specific prevention intervention.
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Affiliation(s)
- S S Islam
- Institute of Occupational and Environmental Health, PO Box 9190, West Virginia University School of Medicine, Morgantown, WV 26506, USA
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Xie X, Bärenholdt O. Bone density and geometric properties of the distal radius in displaced and undisplaced Colles' fractures: quantitative CT in 70 women. ACTA ORTHOPAEDICA SCANDINAVICA 2001; 72:62-6. [PMID: 11327416 DOI: 10.1080/000164701753606716] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We examined cortical and trabecular bone density and geometric properties of the unfractured distal radius in 70 women with recent Colles' fractures, using multilayer peripheral quantitative computed tomography (pQCT). We found that cortical volumetric density, cortical area and mean cortical thickness were lower in the displaced than in the undisplaced fractures, suggesting that the cross-sectional volumetric density and geometric properties of cortical bone may be essential in determining the severity of a Colles' fracture. We also compared lumbar spine and femoral neck bone mineral density (BMD) and the occurrence of osteoporosis in the displaced and undisplaced fracture groups and found no significant difference, which suggests that displacement of a Colles' fracture is not associated with general osteoporosis.
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Affiliation(s)
- X Xie
- Department of Clinical Physiology, Hilleroed Hospital, Denmark.
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Kaufman JM, Johnell O, Abadie E, Adami S, Audran M, Avouac B, Sedrine WB, Calvo G, Devogelaer JP, Fuchs V, Kreutz G, Nilsson P, Pols H, Ringe J, Van Haelst L, Reginster JY. Background for studies on the treatment of male osteoporosis: state of the art. Ann Rheum Dis 2000; 59:765-72. [PMID: 11005775 PMCID: PMC1753010 DOI: 10.1136/ard.59.10.765] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Male osteoporosis represents an important, although long underestimated, public health problem. Both in men and in women aging is accompanied by continuous bone loss and by an exponential increase in the incidence of osteoporotic fracture, with a female to male incidence ratio of about 2 to 3 to 1 in the elderly for hip and vertebral fractures. Morbidity after osteoporotic fractures appears to be more serious and mortality more common in men than in women. To date, no single treatment has been proved to be effective and safe in published prospective studies. The present report, based on a systematic search of the literature on male osteoporosis, summarises the state of the art on the clinical consequences of male osteoporosis and its risk factors, in relation to the present state of knowledge about female osteoporosis. This constitutes the background for the design of rational clinical development strategies for therapeutic interventions in male osteoporosis. From this review of the literature it is apparent that notwithstanding the existing sex differences in pathophysiology of osteoporosis and the difference in age-specific incidence of osteoporotic fractures, there are also important similarities between osteoporosis in women and men. The higher incidence of fracture in women than in men results from quantitative differences in risk factors rather than from different risk factors. Even though there are sex differences in bone geometry, incidence of fracture seems to be similar in men and women for a same absolute areal bone mineral density. However, the lack of data on the changes in fracture rates in men resulting from pharmacological intervention, leading to changes in bone mineral density or bone turnover, remains the main limitation for extrapolation of established treatment outcomes from women to men.
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Affiliation(s)
- J M Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Belgium
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