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Pérez-Úbeda MJ, Arribas P, Gimeno García-Andrade MD, Garvín L, Rodríguez A, Ponz V, Ballester S, Fernández S, Fuentes-Ferrer M, Ascaso A, Portolés-Pérez A, Marco F. Adjuvant Arthroscopy Does Not Improve the Functional Outcome of Volar Locking Plate for Distal Radius Fractures: A Randomized Clinical Trial. Arthroscopy 2024; 40:305-317. [PMID: 37394147 DOI: 10.1016/j.arthro.2023.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/24/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To evaluate the outcomes of adding arthroscopy to osteosynthesis of distal radius fractures (DRF) with volar locking plate (VLP), by Patient-Rated Wrist Evaluation (PRWE) 1 year after surgery. METHODS In total, 186 functionally independent adult patients who met the inclusion criteria (DRF and a clinical decision for surgery with a VLP) were randomized to arthroscopic assistance or not. Primary outcome was PRWE questionnaire results 1 year after surgery. For the main variable, PRWE, we obtained the minimal clinically important difference based on a distribution-based method. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand and 12-Item Short Form Health Survey questionnaires, range of motion, strength, radiographic measures, and presence of joint step-offs by computed tomography. Data were collected preoperatively and at +1 and +4 weeks, +3 and +6 months, and +1 year after surgery. Complications were recorded throughout the study. RESULTS In total, 180 patients (mean age: 59.0 ± 14.9 years; 76% women) were analyzed by modified intention to treat. A total of 82% of the fractures were intra-articular (AO type C). No significant difference between arthroscopic (AG) and control (CG) groups in median PRWE was found at +1 year (median AG: 5.0, median CG: 7.5, difference in medians 2.5; 95% confidence interval [CI] -2.0, 7.0, P = .328). The proportion of patients who exceeded the minimal clinically important difference of 12.81 points in the AG and CG was 86.4% vs 85.1%, P = .819, respectively. Percentage of associated injuries and step-offs reduction maneuvers was greater with arthroscopy (mean differences: 17.1 95% CI -0.1, 26.1, P < .001) and 17.4 (95% CI 5.0, 29.7, P = .007). The difference in percentage of residual joint step-offs at the postsurgical computed tomography in radioulnar, radioscaphoid, and radiolunate joints was not significant (P = .990, P = .538, and P = .063). Complications were similar between groups (16.9% vs 20.9%, P = .842). CONCLUSIONS Adjuvant arthroscopy did not significantly improve PRWE score +1 year after surgery for DRF with VLP, although the statistical power of the study is below the initially estimated to detect the expected difference. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- María José Pérez-Úbeda
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
| | - Pedro Arribas
- Rehabilitation Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Lucía Garvín
- Rehabilitation Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto Rodríguez
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Virginia Ponz
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Sandra Ballester
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Jiménez Díaz Foundation, Madrid, Spain
| | - Sergio Fernández
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Manuel Fuentes-Ferrer
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Ana Ascaso
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain; Pharmacology and Toxicology Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Antonio Portolés-Pérez
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain; Pharmacology and Toxicology Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Fernando Marco
- Hand and Wrist Surgery Unit, Orthopedic Surgery and Traumatology Department, Hospital Clínico San Carlos, Madrid, Spain; Surgery Department, Complutense University of Madrid, Madrid, Spain
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Philip S, MacDermid J, Rushton A, Parikh P, Seens H. Patients' and therapists' perspective of integrating home and family work roles into rehabilitation following distal radius fracture. Disabil Rehabil 2024:1-11. [PMID: 38284803 DOI: 10.1080/09638288.2024.2305297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE To explore distal radius fracture (DRF) patients' and hand therapist/occupational therapist/physiotherapists' perceptions of integrating home and family work roles (HFWR) into rehabilitation. METHODS Eighteen patients and eleven therapists completed a semi-structured telephone interview three months after DRF. Reflexive thematic analysis of the interviews and triangulation of patients' and therapists' themes was performed. RESULTS The patient interview yielded five themes: the experience of rehabilitation; predetermined expectations of rehabilitation; incorporating HFWR into therapy sessions; varying patient needs for addressing HFWR; and determination to return to valued activities drives behavioral choices. The therapists' interview yielded five themes: The challenges in integrating HFWR into rehabilitation; HFWR addressed when brought up by a patient; working context and referral sources influence the rehabilitation plan; rehabilitation is not explicitly tailored according to sex and gender; and utilizing HFWR as a rehabilitation strategy is perceived beneficial. CONCLUSIONS Patients have predetermined rehabilitation expectations primarily focused on mobility and strengthening exercises. Therapists and patients agree that adapting home and family work roles is beneficial but was not a major focus for either therapists' or patients' expectations during therapy. An unfavourable environment, patient budget constraints, and limited time were identified as challenges to integrating family roles.
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Affiliation(s)
- Sheena Philip
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Joy MacDermid
- Health and Rehabilitation Sciences, Western University, London, Canada
- School of Physical Therapy, Western University, London, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Canada
| | - Pulak Parikh
- School of Physical Therapy, Western University, London, Canada
| | - Hoda Seens
- Health and Rehabilitation Sciences, Western University, London, Canada
- Windsor University, School of Medicine, Cayon, St Kitts & Nevis
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Grier AJ, Chen KJ, Paul AV, Green CL, Richard MJ, Ruch DS, Pidgeon TS. Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures. Hand (N Y) 2023:15589447231174642. [PMID: 37243339 DOI: 10.1177/15589447231174642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes. METHODS We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication. RESULTS Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%). CONCLUSIONS Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery.
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Affiliation(s)
| | - Kallie J Chen
- University Hospitals Cleveland Medical Center, OH, USA
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Fogel N, Mertz K, Shapiro LM, Roe A, Denduluri S, Kamal RN. Outcome Metrics in the Treatment of Distal Radius Fractures in Patients Aged Above 50 Years: A Systematic Review. Hand (N Y) 2022; 17:43S-49S. [PMID: 34286628 PMCID: PMC9793608 DOI: 10.1177/15589447211028919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The inclusion of patient-reported outcome measures (PROMs) serves to better quantify aspects of patient outcomes missed with objective measures, including radiographic indices and physical examination findings. We hypothesize that PROMs are inconsistently and heterogeneously captured in the treatment of distal radius fractures. METHODS We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of all level I and II randomized controlled trials (RCTs) of distal radius fracture treatment of any modality for those older than 50 years of age from January 2008 to January 2018. A total of 23 studies were included in the final analysis. The metrics used by each study to assess outcomes were collected, compared, and described. RESULTS Physical examination findings and radiographic measures were reported in 70% and 74% of studies, respectively. Patient-reported outcomes measures were used to assess outcomes in 74% of studies. Only the Disabilities of the Arm, Shoulder, and Hand was used in greater than half of the studies (57%). Pain scores were assessed in 39% of studies and complications in only 26%. CONCLUSIONS There is substantial heterogeneity and lack of standardization in the collection of both objective outcome measures and PROMs in level I and II RCTs for the treatment of distal radius fractures. The ability to compare between studies or aggregate data among studies is therefore limited. Radiographic and physical examination findings remain frequently reported despite known limitations of these metrics. The routine collection of PROMs after the treatment of distal radius fractures can ensure care is directed toward improving what is most important to patients.
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Affiliation(s)
| | - Kevin Mertz
- University of Southern California, Los
Angeles, USA
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Fogel N, Shapiro LM, Roe A, Denduluri S, Richard MJ, Kamal RN. Outcomes of Supplementary Spring Wire Fixation With Volar Plating for Volar Lunate Facet Fragments in Distal Radius Fractures. Hand (N Y) 2022; 17:1163-1169. [PMID: 33319593 PMCID: PMC9608301 DOI: 10.1177/1558944720976404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intra-articular distal radius fractures with small volar lunate facet fragments can be challenging to address with volar plate fixation alone. Volar locked plating with supplementary spring wire fixation has been previously described in a small series but has not been further described in the literature. We hypothesized that this technique can provide adequate fixation for volar lunate facet fragments smaller than 15 mm in length, which are at risk of displacement. METHODS We completed a retrospective chart review (2015-2019) of patients who underwent volar locked plating with the addition of supplementary spring wire fixation for intra-articular distal radius fractures with a volar lunate facet fragment (<15 mm). Postoperative radiographs were assessed to evaluate union, evidence of hardware failure, escape of the volar lunate facet fragment, and postoperative volar tilt. Clinical outcome was assessed with wrist flexion/extension, arc of pronosupination, and Quick Disabilities of the Arm, Shoulder, and Hand Score (QuickDASH) scores. RESULTS Fifteen patients were identified, of which all went on to fracture union. There were no hardware failures or escape of the volar lunate facet fragment at final follow-up. One patient underwent hardware removal for symptoms of flexor tendon irritation. The mean wrist flexion was 59°, wrist extension was 70°, pronation was 81°, and supination was 76°. The mean QuickDASH score was 18.5. The mean postoperative volar tilt was 3.6°. CONCLUSIONS Supplementary spring wire fixation with standard volar plating provides stable fixation for lunate facet fragments less than 15 mm. This technique is a safe and reliable alternative to commercially available fragment-specific implants.
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Eraslan U, Usta H, Demirkan AF, Kitis A, Baskoc A. Association between perceived and objective hand-wrist function in distal radius fracture. Hand Surg Rehabil 2022; 41:582-588. [PMID: 35970440 DOI: 10.1016/j.hansur.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/18/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
The relationship between patient-reported outcome measures and objective measures is important for understanding patient expectations. The aim of this study was to investigate the relationship of each section of the Michigan Hand Outcomes Questionnaire (MHQ) to objective measurements in patients with distal radius fracture (DRF). Eighty-four patients who were treated operatively or non-operatively for DRF were included. Injury severity was assessed by the Modified Hand Injury Severity Score. Joint motion was assessed at 6 and 12 weeks and grip strength at 12 weeks after non-operative treatment or surgery. The MHQ was used to assess hand functionality. The relationships between measurements were analyzed by Spearman correlation analysis. Statistical significance was set at p < 0.05. Fifty-one patients (60.7%) were women and 33 (39.3%) men. Mean age was 48.17 ± 12.26 (range, 20-64) years. Fifty-two (61.9%) patients were treated surgically and 32 (38.1%) non-operatively. Forearm pronation-supination and wrist flexion and ulnar deviation at week 6 and forearm pronation-supination, wrist extension and radial deviation at week 12 correlated with MHQ scores, unlike wrist extension and radial deviation at week 6 and flexion and ulnar deviation at week 12. Gross and fine grip strength at week 12 correlated with MHQ, except for the overall hand function, work performance and pain subsections. The MHQ subsections correlated with joint motion and grip strength in the early period after DRF. These findings clarified patient expectations in the early period.
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Affiliation(s)
- U Eraslan
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
| | - H Usta
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
| | - A F Demirkan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
| | - A Kitis
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
| | - A Baskoc
- Institute of Health Sciences, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
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Boel S, Vinther A, Hansen AØ, Juhl CB, Landgren M, Kristensen HK. Factors influencing self-perceived functioning after volar locking plate fixation of distal radius fractures: a scoping review protocol. JBI Evid Synth 2022; 20:2387-2394. [DOI: 10.11124/jbies-21-00459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Boersma E, van de Krol E, Tromp T, van der Sanden MN, Edwards M. Cast OFF-2: 1 week of plaster cast immobilization for non-reduced distal radius fractures-a study protocol for an implementation study. Trials 2021; 22:936. [PMID: 34924017 PMCID: PMC8684679 DOI: 10.1186/s13063-021-05889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The distal radius fracture (DRF) is a common fracture, with the majority of these fractures being stable. Of all diagnosed fractures, 17% is a DRF, of which a large part is extra-articular and one-third is non-displaced. There is a large variation in treatment advisements for non-reduced DRF. Four to 5 weeks of immobilization is often the usual practice. Existing evidence shows that 1 week of immobilization is safe and does not lead to an increase in secondary displacement. Additionally, shorter immobilization periods may lead to less outpatient clinic visits and less home care for elderly people and may lead to earlier return to work and other social activities. Therefore, shorter immobilization periods for non-reduced distal radius fractures may also prove to be cost-effective. In this study, we aim to successfully implement 1 week of plaster cast immobilization for non-reduced distal radius fractures in twelve medical centers and to evaluate the functional outcome and cost-effectiveness. METHODS This study will be performed using a multicenter randomized stepped wedge design in 12 centers. We aim to include in the study 440 patients with an isolated non-reduced DRF between the age of 18 and 85 years old. The patients in the intervention group will be treated with plaster cast immobilization for 1 week. Acceptability of the study protocol, patient-reported outcomes, quality of life, complications, pain catastrophizing score, pain and patient satisfaction, and cost-effectiveness will be measured. The total follow-up will be 12 months. DISCUSSION The strength of this study is the combination of implementing 1 week of plaster cast immobilization for non-reduced DRF and the evaluation of functional outcome, acceptability of the study protocol, and cost-effectiveness in actual practice. TRIAL REGISTRATION Netherlands Trial Register NL9278 . Registered on 17 February 2021.
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Affiliation(s)
- Emily Boersma
- Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, route 618, P.O. Box 9101, NL-6500, HB, Nijmegen, the Netherlands.
| | - Erik van de Krol
- Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, route 618, P.O. Box 9101, NL-6500, HB, Nijmegen, the Netherlands
| | - Tjarda Tromp
- Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, route 618, P.O. Box 9101, NL-6500, HB, Nijmegen, the Netherlands
| | - Maria Nijhuis- van der Sanden
- Department of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Michael Edwards
- Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, route 618, P.O. Box 9101, NL-6500, HB, Nijmegen, the Netherlands
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Kaufman-Cohen Y, Levanon Y, Friedman J, Yaniv Y, Portnoy S. Home exercise in the dart-throwing motion plane after distal radius fractures: A pilot randomized controlled trial. J Hand Ther 2021; 34:531-538. [PMID: 32565105 DOI: 10.1016/j.jht.2020.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION During daily functions, our wrist moves through an oblique plane, named the dart-throwing motion (DTM) plane. This plane is considered a more stable plane because the proximal carpal row remains relatively immobile. However, rehabilitation programs that incorporate exercising in the DTM plane have yet to be explored. PURPOSE OF THE STUDY The purpose of this study was to evaluate the rehabilitation outcomes after treatment in the DTM plane compared with outcomes after treatment in the sagittal plane after distal radius fracture. STUDY DESIGN This is a pilot randomized controlled trial. METHODS Subjects after open reduction internal fixation were assigned into a research group (N = 12; ages 48.7 ± 7.3) and a control group (N = 12; ages 50.8 ± 15). The control group activated the wrist in the sagittal plane, whereas the research group activated the wrist in the DTM plane. Range of motion, pain levels, functional hand motor skills tests, and satisfaction from self-training exercise were measured before and after a 12-session intervention. RESULTS The outcome measures were similar between the treatment groups. The research group reported significantly higher satisfaction rates than the control group on topics such as general satisfaction (research group: 3.4 ± 0.7, control group: 2. 5 ± 1.2, P = .030), motivation to exert oneself (research group: 2.8 ± 1.0, control group: 2.3 ± 1.2, P = .009), progressed function (research group: 3.4 ± 0.7, control group: 2.4 ± 1.1, P = .012), and self-training contribution to the daily function (research group: 3.4 ± 0.7, control group: 2.5 ± 1.2, P = .030). DISCUSSION AND CONCLUSION Pilot results do not favor one treatment method over the other. However, exercising in the DTM plane may contribute to the satisfaction of the client and increase self-training motivation.
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Affiliation(s)
- Yael Kaufman-Cohen
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yafi Levanon
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Occupational Therapy Department, Sheba Medical Center, Ramat Gan, Israel
| | - Jason Friedman
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yona Yaniv
- Orthopedic Department, Sheba Medical Center, Ramat Gan, Israel
| | - Sigal Portnoy
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Quadlbauer S, Pezzei C, Jurkowitsch J, Kolmayr B, Simon D, Rosenauer R, Salminger S, Keuchel T, Tichy A, Hausner T, Leixnering M. Immediate mobilization of distal radius fractures stabilized by volar locking plate results in a better short-term outcome than a five week immobilization: A prospective randomized trial. Clin Rehabil 2021; 36:69-86. [PMID: 34852677 DOI: 10.1177/02692155211036674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the impact of immediate (first day after surgery) mobilization compared to standard five weeks cast immobilization on the functional outcome after volar locking plate fixation of distal radius fractures. DESIGN Prospective randomized parallel group comparative trial. SETTING Trauma Hospital, Austria. PARTICIPANTS Patients with isolated unstable distal radius fractures, stabilized with volar angular stable locking plate. INTERVENTIONS The immediate mobilization group received a removable forearm splint for one week and active supervised group physiotherapy and home exercises for the shoulder, elbow, wrist, and fingers from the first postoperative day. The cast immobilization group received a non-removable cast for five weeks. In the first five weeks supervised group physiotherapy and home exercises were performed for shoulder, elbow, and fingers. Thereafter additional supervised and home exercises for the wrist were started. MAIN MEASURES At regular intervals of six and nine weeks, three and six months, and one year post surgery range of motion, grip strength, and x-rays were evaluated. Additionally, the shortened disabilities of the arm, shoulder and hand (QuickDASH) score, Patient-rated Wrist Evaluation, Mayo Wrist score, and pain according to the Visual Analog Scale score were analyzed. RESULTS One hundred and sixteen patients were prospectively randomized into two study groups. At the one-year follow-up, patients in the immediate mobilization group showed a significantly higher range of motion in extension/flexion (mean difference 10.2°, 99% confidence interval 0.6-19.8), grip strength (mean difference 5.1 kg, 99% confidence interval -0.5 to 10.7), and Mayo Wrist score (mean difference 7.9 points, 99% confidence interval 2.3-13.5) than the cast immobilization group. Range of motion in supination/pronation (mean difference 13.4°, 99% confidence interval 1.5-25.3) and in radial/ulnar deviation (mean difference 6.3°, 99% confidence interval 0.9-11.7) differed significantly up to nine weeks favoring the immediate mobilization group. The Patient-rated Wrist Evaluation revealed significantly better scores after three months (mean difference 9.3 points, 99% confidence interval 0.5-18.1) and QuickDASH after six months (mean difference 7.3 points, 99% confidence interval 0.3-14.3) in the immediate mobilization group. All other subsequent follow-up examinations indicated no significant differences in respect of pain, range of motion, and patient-reported outcome measurements between the study groups. There were no significant differences in respect of radiological loss of reduction and complications between the groups. CONCLUSIONS Immediate mobilization in combination with supervised physiotherapy of the wrist after volar locking plate fixation of unstable distal radius fractures results in a significantly improved range of motion and grip strength after one year compared to cast immobilization. No increased risk for loss of reduction and other complications was observed.
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Affiliation(s)
- Stefan Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christoph Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria
| | - Josef Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria
| | - Brigitta Kolmayr
- Department of Physiotherapy, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria
| | - Daniel Simon
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria
| | - Rudolf Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Stefan Salminger
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria
| | - Tina Keuchel
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria
| | - Alexander Tichy
- Platform Bioinformatics and Biostatistics, University of Veterinary Medicine, Vienna, Austria
| | - Thomas Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Martin Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Vienna, Austria
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Blomstrand J, Karlsson J, Fagevik Olsén M, Kjellby Wendt G. The Michigan Hand Outcomes Questionnaire (MHQ-Swe) in patients with distal radius fractures-cross-cultural adaptation to Swedish, validation and reliability. J Orthop Surg Res 2021; 16:442. [PMID: 34233700 PMCID: PMC8262064 DOI: 10.1186/s13018-021-02571-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background The Michigan Hand Outcomes Questionnaire—MHQ—is a well-known self-assessment questionnaire, where patients’ own perception in terms of recovery, pain and the ability to return to activities of daily living is assessed. The purpose of the study was to translate and culturally adapt the Michigan Hand Outcomes Questionnaire to Swedish and to test the validity and reliability in patients with surgically treated distal radius fractures. Methods The cross-cultural adaptation and the translation process were conducted according to predefined guidelines. Seventy-eight patients with surgically treated distal radius fractures completed the translated version of the questionnaire on their six-week follow-up visit. Results The translation and cross-cultural adaptation process revealed no major linguistic or cultural issues. The internal consistency of the MHQ-Swe ranged from 0.77 to 0.94 at test 1 and from 0.81 to 0.96 at test 2 for all subscales, which indicates good internal consistency in the subscales. The hand function subscale revealed the lowest results and work performance the highest. The ICCs showed excellent test-retest reliability, ranging from 0.77 to 0.90 on all MHQ subscales and 0.92 on total score. The highest results for the ICC were seen in the satisfaction subscale (ICC = 0.90), while the lowest were seen in the aesthetic subscale (ICC = 0.77). The correlation analysis between the MHQ-Swe, PRWE and VAS showed a generally moderate to high correlation for all the subscales. Conclusions The Swedish version of the MHQ, the MHQ-Swe, showed good validity and reliability and it is therefore an appropriate and relevant questionnaire for use in patients with surgically treated distal radius fractures. Trial registration FoU i VGR, Projectnumber: 208491, registered December 9, 2015.
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Affiliation(s)
- J Blomstrand
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, SE-431 80, Sweden. .,Institute of Clinical Sciences, Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - J Karlsson
- Institute of Clinical Sciences, Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, SE-431 80, Sweden
| | - M Fagevik Olsén
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, SE-431 80, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation - Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - G Kjellby Wendt
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Göteborgsvägen 31, Mölndal, SE-431 80, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation - Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Abstract
Distal radius fractures (DRFs) are among the most common upper extremity injuries. Multiple medical conditions now are evaluated by standardized outcome sets that enable comparability. Recent international working groups have provided consensus statements for outcomes measurement after DRFs. These statements emphasized the growing importance of patient-reported outcome measures as well as traditional measures, including pain assessment, radiographic alignment, performance, and assessment of complications. A standardized instrument and timeline for measuring outcomes following DRFs offers clinicians, researchers, and health care economists a powerful tool. This article reviews the current evidence and provides recommendations for a DRF standardized outcome set.
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Affiliation(s)
- Matthew J Hall
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA
| | - Peter J Ostergaard
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA
| | - Tamara D Rozental
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115, USA.
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13
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Selles RW, Wouters RM, Poelstra R, van der Oest MJW, Porsius JT, Hovius SER, Moojen TM, van Kooij Y, Pennehouat PY, van Huis R, Vermeulen GM, Feitz R, Slijper HP. Routine Health Outcome Measurement: Development, Design, and Implementation of the Hand and Wrist Cohort. Plast Reconstr Surg 2020; 146:343-354. [PMID: 32740587 DOI: 10.1097/prs.0000000000007008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five "measurement tracks," including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.
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Affiliation(s)
- Ruud W Selles
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Robbert M Wouters
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Ralph Poelstra
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Mark J W van der Oest
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Jarry T Porsius
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Steven E R Hovius
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Thybout M Moojen
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Yara van Kooij
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Pierre-Yves Pennehouat
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Rob van Huis
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Guus M Vermeulen
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Reinier Feitz
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Harm P Slijper
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
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Lameijer CM, Ten Duis HJ, Haag CMSC, El Moumni M, van der Sluis CK. The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant? Disabil Rehabil 2020; 43:3777-3788. [PMID: 32356451 DOI: 10.1080/09638288.2020.1753247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Following distal radius fractures in young non-osteoporotic patients, clinical relevancy of outcome has been scarcely reported. Outcome can be put in perspective by using measurement errors of radiological measurements and Minimal Important Change when reporting on clinician and patient reported outcome. Aim of this study was to assess the clinical relevance of radiological measurements, clinician and patient reported outcomes following distal radius fractures in young non-osteoporotic patients.Methods: Retrospective cohort study. Non-osteoporotic patients following a distal radius fracture were selected. Radiographs of both wrists were obtained at baseline, 6 weeks and at follow-up. Active range of motion and grip strength measurements were obtained at the follow-up visit and 4 questionnaires were answered to assess pain, upper extremity functioning, and health status.Results: Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years at the time of injury were included. Median follow up was 62 months (IQR 53.0-84.5). Several radiological measurements evolved statistically significantly over time, however none exceeded measurement errors. Flexion/extension difference of injured compared to uninjured wrist (mean difference 11.2°, t = -7.5, df = 72, p < 0.001), exceeded Minimal Important Change, while grip strength differences did not. When comparing patients with DRFs to healthy controls, only the differences on Patient Reported Wrist Evaluation subscales "pain", "function" and total scores exceeded minimal important change (8, 10 and 13 points, respectively). Multivariable regression analysis revealed statistically significant relationships between residual step-off and respectively diminished flexion/extension (B = -36.8, 95% CI -62; -11.1, p = 0.006), diminished radial/ulnar deviation (B = -17.9, 95% CI -32.0; -3.9, p = 0.013) and worse ShortForm-36 "mental component score" (B = -15.4, 95% CI -26.6; -4.2, p < 0.001).Conclusion: Radiological measurements following distal radius fractures seem to evolve over time, but differences were small and were probably not clinically relevant. Range of motion, in particular flexion/extension, was impaired to such extend that it was noticeable for a patient, whereas grip strength was not impaired. The Patient Reported Wrist Evaluation was clinically relevantly diminished. Residual articular incongruency seems to influence range of motion.Implications for rehabilitationReporting Minimal Important Change regarding clinician and patient reported outcome following distal radius fractures is of more clinical value than reporting on statistical significance.Following distal radius fractures, the changes in radiological measurements do not seem to reflect a clinical relevant change.Range of motion, in particular flexion/extension, should be measured following distal radius fractures, as this might be impaired in a clinically relevant way.Measuring grip strength is of less importance following distal radius fractures, because grip strength does not seem to be affected.Residual articular incongruency seems to influence range of motion and therefore should be reduced to a minimum when treating non-osteoporotic patients.
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Affiliation(s)
- Charlotte M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Jan Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Charlotte M S C Haag
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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Liu Y, Bai YM. Efficacy of non-bridging external fixation in treating distal radius fractures. Orthop Surg 2020; 12:776-783. [PMID: 32343053 PMCID: PMC7307264 DOI: 10.1111/os.12677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the efficacy of non‐bridging external fixation in treating distal radius fractures (DRF) and its effect on wrist joint function. Methods The medical records of 207 patients who were treated for DRF between May 2008 and April 2017 in our hospital (age, 18.0–70.0 years; 99 males and 108 females) were retrospectively analyzed. All patients had evident wrist trauma and the diagnosis of DRF was confirmed by imaging tests. A total of 101 patients received bridging external fixation (control group), whereas another 106 received non‐bridging external fixation (study group). At 12 weeks after the procedure, the treatment effect was measured using the Dienst scoring system (rating scale: ≤3 points, excellent; 4–7 points, good; 8–11 points, fair; >12 points, poor), and the wrist joint function was evaluated by Gartland and Werley classification (rating scale: 0–2 points, excellent; 3–8 points, good; 9–20 points, fair; >21 points, poor); meanwhile, the radial length, radial inclination, and palmar tilt were examined by X‐ray. Follow‐up visits were conducted once every 2 weeks for 6 months, and the incidences of complications in the two groups within 6 months after operation were recorded, including incision infection, Kirschner wire loosening, delayed fracture healing, and arthritis. Results There were no differences in the sex ratio, mean age, mean injury period, Arbeitsgemeinschaft fur osteosynthesefragen classification, and cause of fracture between the two groups (all P > 0.05). In terms of the treatment effects, the study group had a higher percentage of excellent results (P < 0.001) and lower percentages of fair and poor results (P = 0.002, P = 0.001) than the control group 12 weeks after treatment, while both groups had similar percentages of good results (P = 0.109). In terms of the score of the wrist joint function, the study group had a higher proportion of excellent result than the control group 12 weeks after treatment (P = 0.029), whereas no intergroup differences in the proportion of good, fair, and poor results were observed (all P > 0.05). After follow‐up for 6 months, the incidences of incision infection, Kirschner wire loosening, delayed fracture healing, and arthritis, as well as the total complication rate were found to be similar between the two groups (all P > 0.05). Conclusions Using non‐bridging external fixation for treating DRF allows some level of wrist movement during the early stage of fixation, effectively maintains the radial length, radial inclination, and palmar tilt, and achieves better outcomes than bridging external fixation.
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Affiliation(s)
- Ying Liu
- Operating Room, Cangzhou People's Hospital, Cangzhou, China
| | - Yu-Ming Bai
- The Second Department of Orthopaedics, Cangzhou Central Hospital, Cangzhou, China
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16
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Lameijer CM, van Bruggen SGJ, Haan EJA, Van Deurzen DFP, Van der Elst K, Stouten V, Kaat AJ, Roorda LD, Terwee CB. Graded response model fit, measurement invariance and (comparative) precision of the Dutch-Flemish PROMIS® Upper Extremity V2.0 item bank in patients with upper extremity disorders. BMC Musculoskelet Disord 2020; 21:170. [PMID: 32178644 PMCID: PMC7077019 DOI: 10.1186/s12891-020-3178-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/28/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The Dutch-Flemish PROMIS® Upper Extremity (DF-PROMIS-UE) V2.0 item bank was recently developed using Item Response Theory (IRT). Unknown for this bank are: (1) if it is legitimate to calculate IRT-based scores for short forms and Computerized Adaptive Tests (CATs), which requires that the items meet the assumptions of and fit the IRT-model (Graded Response Model [GRM]);(2) if it is legitimate to compare (sub) groups of patients using this measure, which requires measurement invariance; and (3) the precision of the estimated patients' scores for patients with different levels of functioning and compared to legacy measures. Aims were to evaluate (1) the assumptions of and fit to the GRM, (2) measurement invariance and (3) (comparative) precision of the DF-PROMIS-UE v2.0. METHODS Cross-sectional data were collected in Dutch patients with upper extremity disorders. Assessed were IRT-assumptions (unidimensionality [bi-factor analysis], local independence [residual correlations], monotonicity [coefficient H]), GRM item fit, measurement invariance (absence of Differential Item Functioning [DIF] due to age, gender, center, duration, and location of complaints) and precision (standard error of IRT-based scores across levels of functioning). To study measurement invariance for language [Dutch vs. English], additional US data were used. Legacy instruments were the Disability of the Arm, Shoulder and Hand (DASH), the QuickDASH and the Michigan Hand Questionnaire (MHQ). RESULTS In total 521 Dutch (mean age ± SD = 51 ± 17 years, 49% female) and 246 US patients (mean age ± SD = 48 ± 14 years, 69% female) participated. The DF-PROMIS-UE v2.0 item bank was sufficiently unidimensional (Omega-H = 0.80, Explained Common Variance = 0.68), had negligible local dependence (four out of 1035 correlations > 0.20), good monotonicity (H = 0.63), good GRM fit (no misfitting items) and demonstrated sufficient measurement invariance. Precise estimates (Standard Error < 3.2) were obtained for most patients (7-item short form, 88.5%; standard CAT, 91.3%; and, fixed 7-item CAT, 87.6%). The DASH displayed better reliability than the DF-PROMIS-UE short form and standard CAT, the QuickDASH displayed comparable reliability. The MHQ-ADL displayed better reliability than the DF-PROMIS-UE short form and standard CAT for T-scores between 28 and 50. For patients with low function, the DF-PROMIS-UE measures performed better. CONCLUSIONS The DF-PROMIS-UE v2.0 item bank showed sufficient psychometric properties in Dutch patients with UE disorders.
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Affiliation(s)
- C M Lameijer
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, the Netherlands.
| | - S G J van Bruggen
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, the Netherlands
| | - E J A Haan
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - K Van der Elst
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - V Stouten
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven - University of Leuven, Leuven, Belgium
| | - A J Kaat
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - L D Roorda
- Amsterdam Rehabilitation Research Center | Reade, Dr. Jan van Breemenstraat 2, Amsterdam, 1056 AB, the Netherlands
| | - C B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Chung KC, Cho HE, Kim Y, Kim HM, Shauver MJ. Assessment of Anatomic Restoration of Distal Radius Fractures Among Older Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e1919433. [PMID: 31951273 PMCID: PMC6991267 DOI: 10.1001/jamanetworkopen.2019.19433] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE The value of precise anatomic restoration for distal radius fractures (DRFs) in older adults has been debated for many decades, with conflicting results in the literature. In light of the growing population of adults aged 60 years and older, both fracture incidence and associated treatment costs are expected to increase. OBJECTIVE To determine the association between radiographic measures of reduction and patient outcomes after DRF in older patients. DESIGN, SETTING, AND PARTICIPANTS Data were collected from the Wrist and Radius Injury Surgical Trial (WRIST), a multicenter randomized clinical trial of DRF treatments for adults aged 60 years and older (enrollment from April 10, 2012, to December 31, 2016, with a 2-year follow-up). Data analysis was performed from January 3, 2019, to August 19, 2019. WRIST participants who completed 12-month assessments were included in the study. According to the biomechanical principle of alignment, 2-phase multivariable regression models were adopted to assess the association between radiographic measures of reduction and functional and patient-reported outcomes 12 months following treatment. INTERVENTIONS Participants were randomized to receive volar locking plate, percutaneous pinning, or external fixation. Those who opted for nonoperative treatment received casts. MAIN OUTCOMES AND MEASURES Hand grip strength, wrist arc of motion, radial deviation, ulnar deviation, the Michigan Hand Outcomes Questionnaire (MHQ) total score, MHQ function score, and MHQ activities of daily living score were measured at 12 months following treatment. RESULTS Data from 166 WRIST participants (144 [86.7%] women; mean [SD] age, 70.9 [8.9] years) found that only 2 of the 84 correlation coefficients calculated were statistically significant. For patients aged 70 years or older, every degree increase in radial inclination away from normal (22°) grip strength in the injured hand was 1.1 kg weaker than the uninjured hand (95% CI, 0.38-1.76; P = .004) and each millimeter increase toward normal (0 mm) in ulnar variance was associated with a 10.4-point improvement in MHQ ADL score (95% CI, -16.84 to -3.86; P = .003). However, neither of these radiographic parameters appeared to be associated with MHQ total or function scores. CONCLUSIONS AND RELEVANCE The study results suggest that precise restoration of wrist anatomy is not associated with better patient outcomes for older adults with DRF 12 months following treatment. Surgeons can consider this evidence to improve quality of care by prioritizing patient preferences and efficient use of resources over achieving exact realignment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01589692.
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Affiliation(s)
- Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor
| | - Hoyune E. Cho
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Yeonil Kim
- Early Development Statistics, Merck & Co Inc, Rahway, New Jersey
| | - H. Myra Kim
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Melissa J. Shauver
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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Giladi AM, Giberson-Chen CC, Parker AM, Desale S, Rozental TD. Adhering to Radiographic Clinical Practice Guidelines for Distal Radial Fracture Management Is Associated with Improved Outcomes and Lower Costs. J Bone Joint Surg Am 2019; 101:1829-1837. [PMID: 31626007 DOI: 10.2106/jbjs.18.01245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Treatment of Distal Radius Fractures has not been evaluated in clinical practice. We hypothesized that adhering to the distal radial fracture radiographic clinical practice guideline (CPG) improves outcomes and reduces costs. METHODS We reviewed 266 patients with distal radial fractures treated at 1 institution. Based on CPG radiographic parameters (Recommendation 3), care was rated as "appropriate" or "inappropriate." QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) scores were collected. The direct costs of distal radial fracture care were determined. Descriptive statistics and nonparametric tests were used to evaluate demographic characteristics and outcomes across groups. QuickDASH scores, grouped by postoperative time interval, were analyzed using linear mixed effect models to predict outcome trends. RESULTS In this study, 145 patients in the operative treatment group and 121 patients in the nonoperative treatment group were included. Of the 145 patients in the operative treatment group, 6 underwent an inappropriate surgical procedure, limiting any analyses of that group. Of the 121 patients in the nonoperative treatment group, 68 were treated inappropriately. For the patients in the nonoperative treatment group, appropriate care provided a significant outcome benefit by 1 year; the median QuickDASH score was 10.1 points for the appropriate treatment group and 19.5 points for the inappropriate treatment group (p = 0.05). The total direct costs for inappropriate nonoperative treatment were, on average, 60% higher than appropriate nonoperative treatment. In predictive models, patients with appropriate care in the operative treatment group and the nonoperative treatment group had better outcomes than patients with inappropriate nonoperative treatment at all time points after 29 days. CONCLUSIONS When nonoperative distal radial fracture management was aligned with radiographic CPG criteria, patients in our cohort had improved patient-reported outcomes with lower costs. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Carew C Giberson-Chen
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amber M Parker
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sameer Desale
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland
| | - Tamara D Rozental
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Heyer FL, de Jong JJA, Willems PC, Arts JJ, Bours SGP, van Kuijk SMJ, Poeze M, Geusens PP, van Rietbergen B, van den Bergh JP. Long-term functional outcome of distal radius fractures is associated with early post-fracture bone stiffness of the fracture region: An HR-pQCT exploratory study. Bone 2019; 127:510-516. [PMID: 31226529 DOI: 10.1016/j.bone.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
Identifying determinants of long-term functional outcome after a distal radius fracture is challenging. Previously, we reported on the association between early HR-pQCT measurements and clinical outcome 12 weeks after a conservatively treated distal radius fracture. We extended the follow-up and assessed functional outcome after two years in relation to early HR-pQCT derived bone parameters. HR-pQCT scans of the fracture region were performed in 15 postmenopausal women with a distal radius fracture at 1-2 (baseline), 3-4 weeks and 26 months post-fracture. Additionally, the contralateral distal radius was scanned at baseline. Bone density, micro-architecture parameters and bone stiffness using micro-finite element analysis (μFEA) were evaluated. During all visits, wrist pain and function were assessed using the patient-rated wrist evaluation questionnaire (PRWE), quantifying functional outcome with a score between 0 and 100. Two-year PRWE was associated with torsional and bending stiffness 3-4 weeks post-fracture (R2: 0.49, p = 0.006 and R2: 0.54, p = 0.003, respectively). In contrast, early micro-architecture parameters of the fracture region or contralateral bone parameters did not show any association with long-term outcome. This exploratory study indicates that HR-pQCT with μFEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice.
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Affiliation(s)
- F L Heyer
- Research School NUTRIM, Maastricht University, the Netherlands; Department of Surgery, Maastricht University Medical Center, the Netherlands; Department of Internal Medicine, VieCuri Medical Center Venlo, the Netherlands.
| | - J J A de Jong
- Department of Radiology, Maastricht University Medical Center, the Netherlands
| | - P C Willems
- Research school CAPHRI, Maastricht University, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, the Netherlands
| | - J J Arts
- Research school CAPHRI, Maastricht University, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, the Netherlands
| | - S G P Bours
- Department of Rheumatology, Maastricht University Medical Center, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology & Medical Technology Assessment, Maastricht University Medical Center, the Netherlands
| | - M Poeze
- Research School NUTRIM, Maastricht University, the Netherlands; Department of Surgery, Maastricht University Medical Center, the Netherlands
| | - P P Geusens
- Research school CAPHRI, Maastricht University, the Netherlands; Department of Rheumatology, Maastricht University Medical Center, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - B van Rietbergen
- Faculty of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - J P van den Bergh
- Research School NUTRIM, Maastricht University, the Netherlands; Department of Internal Medicine, VieCuri Medical Center Venlo, the Netherlands; Department of Rheumatology, Maastricht University Medical Center, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium
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Wollstein R, Allon R, Zvi Y, Katz A, Werech S, Palmon O. Association between Functional Outcomes and Radiographic Reduction Following Surgery for Distal Radius Fractures. J Hand Surg Asian Pac Vol 2019; 24:258-263. [DOI: 10.1142/s2424835519500310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Quality of reduction in distal radius fractures (DRF) is assessed using radiographic parameters, however few studies examine the association between radiographic measurements and functional outcomes. Our purpose was to evaluate the relationship between radiographic measurements and clinical outcome measures following surgery for DRF using detailed testing to demonstrate further associations between post-surgical radiographic measurements and function. Methods: Measurements were performed on postoperative radiographs of 38 patients following ORIF of DRF. Measurements included: radial inclination, radial height, ulnar variance, volar tilt, radiocarpal interval (d2/w2), and the intra-articular step-off. Clinical outcome measures included motion, grip strength, functional dexterity testing, Moberg pick-up test, specific activities of daily living, DASH score, pain scale, manual-assessment questionnaire. Results: Different radiographic parameters correlated with different specific tasks. The parameter correlated with most functional tasks was ulnar-variance. Radial inclination, radial-styloid scaphoid distance, and fracture classification correlated with some functions. Intraarticular step-off, and radial height were not associated with functional testing. Conclusions: Surgical radiographic results may affect post-operative function. Detailed task specific testing may enable a better evaluation of surgical outcomes. Further study and refinement of functional assessment may change our surgical goals in DRF.
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Affiliation(s)
- Ronit Wollstein
- Department of Orthopaedic Surgery, New York University, School of Medicine, New York, NY, USA
- Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Raviv Allon
- Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Yoav Zvi
- Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Alan Katz
- Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Sharon Werech
- Lin Medical Center, Kupat Holim Clalit, Haifa, Israel
| | - Orit Palmon
- Lin Medical Center, Kupat Holim Clalit, Haifa, Israel
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Zhang C, Xue S, Wang Y, Yu D, Hua L, Guo C, Wang D, Lei M. Oral administration of Lactobacillus casei Shirota improves recovery of hand functions after distal radius fracture among elder patients: a placebo-controlled, double-blind, and randomized trial. J Orthop Surg Res 2019; 14:257. [PMID: 31412879 PMCID: PMC6694534 DOI: 10.1186/s13018-019-1310-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023] Open
Abstract
Background To evaluate the effect of oral Lactobacillus casei Shirota (LcS) administration on recovery of hand functions in senior patients diagnosed with an acute distal radius fracture. Methods This clinical trial is double-blind and placebo-controlled, in which 293 senior patients with distal radius fracture were initially enrolled. After exclusion, 264 eligible patients were randomly assigned to receive oral placebo or LcS daily for a period of 3 months after the fracture. Treatment outcomes were Michigan Hand Questionnaire (MHQ) score, radial deviation and inclination, and ulnar deviation and variance, all of which were monitored and measured every month. Results Throughout the length of this study, MHQ score, radial deviation and inclination, and ulnar deviation and variance of patients on oral LcS displayed a significantly faster improvement in comparison to those receiving placebo, over the 3-month intervention period. Conclusion Oral administration of LcS dramatically accelerated hand function recovery in senior patients with distal radius fracture.
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Affiliation(s)
- Chunhua Zhang
- Department of Emergency Medicine, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Sujuan Xue
- Department of Nutrition and Diet, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yong Wang
- Department of Orthopedics, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Dan Yu
- Department of Nutrition and Diet, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Limei Hua
- Department of Nutrition, Bethune International Heping Hospital, No. 398 Zhong Shan West Road, Shijiazhuang, 050082, Hebei, China
| | - Chunhua Guo
- Department of Oral and Maxillofacial Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Dawei Wang
- Department of Oral and Maxillofacial Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Min Lei
- Department of Nutrition and Diet, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Nowak LL, Davis AM, Mamdani M, Beaton D, Kennedy C, Schemitsch EH. A Systematic Review and Standardized Comparison of Available Evidence for Outcome Measures Used to Evaluate Proximal Humerus Fracture Patients. J Orthop Trauma 2019; 33:e256-62. [PMID: 31135514 DOI: 10.1097/BOT.0000000000001462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To summarize and appraise any patient-reported or clinician-measured outcome measures based on their measurement properties in proximal humerus fracture patients. DATA SOURCES AND STUDY SELECTION MEDLINE, EMBASE, and CINAHL were searched from January 2000 to August 2018 to identify all studies of proximal humerus fracture patients that reported a measurement property evaluation of an outcome measure. DATA EXTRACTION AND SYNTHESIS Quality appraisal of each measure was completed using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool. The EMPRO takes into account all studies of each measure, and the overall score is transformed linearly to a range of 0 (lowest) to 100 (best). RESULTS Eleven instruments were identified. Intended concepts of the instruments included clinician-measured shoulder function, patient-reported function or disability, and patient-reported general health state. Only the Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score, Constant Score, University of California, Los Angeles Shoulder Score, and EuroQol 5 Dimension (EQ5D) were evaluated in more than 1 study. The Shoulder Function Index (SFINX), DASH, and EQ5D had the highest EMPRO scores (80, 66, and 58, respectively). The SFINX and DASH consistently scored among the top 3 instruments for each attribute. CONCLUSIONS Evidence on the measurement properties of outcome measures for proximal humerus fracture patients is limited. With the available evidence, the SFINX is recommended as a clinician-measured functional outcome measure, the DASH as a patient-reported functional outcome measure, and the EQ5D as a general health status measure.
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Robinson M, Johnson AM, Walton DM, MacDermid JC. A comparison of the polytomous Rasch analysis output of RUMM2030 and R (ltm/eRm/TAM/lordif). BMC Med Res Methodol 2019; 19:36. [PMID: 30786868 PMCID: PMC6381688 DOI: 10.1186/s12874-019-0680-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 02/14/2019] [Indexed: 11/11/2022] Open
Abstract
Background Patient-reported outcome measures developed using Classical Test Theory are commonly comprised of ordinal level items on a Likert response scale are problematic as they do not permit the results to be compared between patients. Rasch analysis provides a solution to overcome this by evaluating the measurement characteristics of the rating scales using probability estimates. This is typically achieved using commercial software dedicated to Rasch analysis however, it is possible to conduct this analysis using non-specific open source software such a R. Methods Rasch analysis was conducted using the most commonly used commercial software package, RUMM 2030, and R, using four open-source packages, with a common data set (6-month post-injury PRWE Questionnaire responses) to evaluate the statistical results for consistency. The analysis plan followed recommendations used in a similar study supported by the software package’s instructions in order to obtain category thresholds, item and person fit statistics, measures of reliability and evaluate the data for construct validity, differential item functioning, local dependency and unidimensionality of the items. Results There was substantial agreement between RUMM2030 and R with regards for most of the results, however there are some small discrepancies between the output of the two programs. Conclusions While the differences in output between RUMM2030 and R can easily be explained by comparing the underlying statistical approaches taken by each program, there is disagreement on critical statistical decisions made by each program. This disagreement however should not be an issue as Rasch analysis requires users to apply their own subjective analysis. While researchers might expect that Rasch performed on a large sample would be a stable, two authors who complete Rasch analysis of the PRWE found somewhat dissimilar findings. So, while some variations in results may be due to samples, this paper adds that some variation in findings may be software dependent.
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Affiliation(s)
- Michael Robinson
- Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada.
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, London, ON, Canada
| | - David M Walton
- School of Physical Therapy, The University of Western Ontario, London, ON, Canada
| | - Joy C MacDermid
- The University of Western Ontario, London, ON, Canada.,Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.,Science McMaster University, Hamilton, ON, Canada
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Heidgerd R, Morgan J, Schentrup D. Evaluation of Functional Outcomes for Adult Patients After Distal Radius Fracture Treated With Volar Plate Fixation Versus Nonsurgical Care. J Trauma Nurs 2019; 26:59-64. [PMID: 30624384 DOI: 10.1097/JTN.0000000000000416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Distal radius fractures are one of the most common fractures patients experience. Although there are a variety of treatments, there is a lack of standardization as it relates to treatment of such fractures. The purpose of this study was to compare treatment outcomes between surgical and nonsurgical care of distal radius fractures to inform evidence-based guidelines for the management of distal radius fractures. A retrospective chart analysis was performed in the public university hospital setting on a sample of 60 patient health records divided equally into those treated surgically and nonsurgically. Data were analyzed related to specific variables in those patients who met specific inclusion/exclusion criteria. Analysis identified that patients treated surgically experienced improved healing and return of range of motion. There was no statistical significance comparing pain in both the surgical and nonsurgical groups. Diabetes and smoking were found to have a negative impact on healing and clinical outcomes. Despite limitations, this pilot project serves as a baseline for future research regarding best practices in the treatment of distal radius fractures. It also demonstrates the negative impact that diabetes and smoking can have on clinical outcomes.
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25
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Rancy SK, Malliaris SD, Bogner EA, Wolfe SW. Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant. J Wrist Surg 2018; 7:358-365. [PMID: 30349747 PMCID: PMC6196090 DOI: 10.1055/s-0038-1669438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3-20), VAS pain scores averaged 0.6 (range, 0-8) and PRWE averaged 12.1 (range, 0-53.5). Grip strength of the operated hand averaged 58 lbs (range, 20-130). ROM included: wrist flexion 73° (50-95), wrist extension 78° (60-110), pronation 77° (60-90), supination 79° (60-90), ulnar deviation 31° (5-45), and radial deviation 17° (10-30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.
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Affiliation(s)
| | - Stephanie D. Malliaris
- Division of Hand and Upper Extremity Surgery, Denver Health Medical Center, University of Colorado School of Medicine, University of Colorado Denver, Denver, Colorado
| | - Eric A. Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Abstract
BACKGROUND The purpose of the present study was to systematically evaluate the completeness of trial registration and the extent of outcome-reporting bias in modern randomized controlled trials (RCTs) relating to the treatment of distal radial fracture. METHODS With use of 4 databases (PubMed, Cochrane CENTRAL, Embase, and PEDro), this systematic review identified all RCTs of distal radial fracture treatment published from January 1, 2010, to December 31, 2015. We independently determined the registration status of these trials in a public trial registry and compared the characteristics of registered and non-registered trials. We assessed the quality and consistency of primary outcome measure (POM) reporting between the registration data and the final published studies. RESULTS Ninety studies met the inclusion criteria. Of those, only 28 (31%) were registered, and only 3 (3%) were "appropriately registered" (i.e., prospectively registered and identifying and fully describing the POM). Registered trials had larger sample sizes and were more likely to be multicenter, to report funding sources, and to be published in higher-impact-factor journals. Sixteen (18%) of the 90 registered RCTs named a POM in the registry; 7 (44%) of those 16 registered RCTs stated a different POM, an additional POM, or no POM at all in the final publication than was stated in the registry data. Additionally, 13 (81%) of those 16 registered RCTs had discrepancies in the time point reported for the POM. CONCLUSIONS In an attempt to address publication and outcome-reporting bias, prospective trial registration in a public registry has been deemed a condition for publication by the International Committee of Medical Journal Editors (ICMJE) since 2005. This study shows poor registration rates as well as inconsistencies in the reporting of POMs of recent trials relating to the treatment of distal radial fracture, one of the most common and most investigated injuries in orthopaedic practice. CLINICAL RELEVANCE The problems of registration and outcome-reporting bias in RCTs are important to highlight and address, and to find a solution will require the cooperation of researchers, reviewers, and journal editors. Increasing the transparency and consistency of reporting will help to increase the quality of research, which can impact patient care through evidence-based guidelines.
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Affiliation(s)
- Shiela Lee
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Tanvir Khan
- Department of Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Douglas Grindlay
- Department of Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Alexia Karantana
- Department of Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, United Kingdom
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Watson NJ, Martin SA, Keating JL. The impact of wrist fracture, surgical repair and immobilization on patients: a qualitative study. Clin Rehabil 2018; 32:841-851. [DOI: 10.1177/0269215518754614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Narelle J Watson
- Faculty Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Western Centre for Health Research & Education, Sunshine Hospital, St. Albans, VIC, Australia
| | - Sally A Martin
- Western Centre for Health Research & Education, Sunshine Hospital, St. Albans, VIC, Australia
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Nazari G, Bobos P, Macdermid JC, Lalone EA, Grewal R. Physical impairments predict hand dexterity function after distal radius fractures: A 2-year prospective cohort study. Hand Therapy 2018; 23:64-9. [DOI: 10.1177/1758998317751238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The overall aim of this study was to determine whether physical impairments – loss of range of motion and grip strength – could be used to predict hand dexterity functions in patients at 1 and 2 years after distal radius fracture. Methods This was a prospective cohort study. Hand dexterity was assessed at three different levels using the NK hand dexterity test. We used a manual goniometer to measure the active range of motion in the affected hand for wrist flexion and extension movements, and a J-Tech grip strength device to measure patients’ hand grip strength levels. Assessments were performed at 1- and 2-year follow-ups. Separate multivariable regression analyses were performed to determine if range of motion predicts hand dexterity functions at 1 and 2 years after distal radius fracture. Results A total of 160 patients with distal radius fracture were included in this study. Range of motion (flexion and extension) and grip strength were both statistically significant (p < 0.05) independent variables in predicting hand dexterity functions at all three levels among patients after distal radius fracture at 1-year follow-up. Range of motion and strength levels accounted for 31%, 33% and 22% of the variance in patients’ large, medium and small hand dexterity functions, respectively. At 2 years, grip strength remained the only statistically significant (p < 0.001) independent variable in predicting hand dexterity functions at all three levels. Conclusions Physical impairments (loss of range of motion and grip strength) have higher predictive values for large and medium hand dexterity functions, than small hand dexterity functions, in patients after distal radius fracture, at both 1- and 2-year follow-up periods.
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Lameijer CM, ten Duis HJ, Vroling D, Hartlief MT, El Moumni M, van der Sluis CK. Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 2018; 138:1699-1712. [PMID: 30317380 PMCID: PMC6224009 DOI: 10.1007/s00402-018-3046-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Outcomes of non-osteoporotic patients who sustained a distal radius fracture (DRF) have not gained much attention in recent literature. The aims of this study were to determine the prevalence of posttraumatic arthritis (PA), to analyze associations of radiological measurements, clinician-reported and patient-reported outcomes (CROs and PROs) with PA and gain insight into employment changes after DRF in non-osteoporotic patients. METHODS Non-osteoporotic patients following a DRF were selected. Radiographs of both wrists were obtained at follow-up and the degree of PA was determined. Radiological measurements consisted of grading of PA, ulnar variance, radial length, radial inclination, dorsal tilt, distal radio-ulnar joint width, scapholunate dissociation, step-off and gap. Active range of motion and grip strength measurements were performed and all patients filled in four questionnaires to assess pain, upper extremity functioning, and health status (Disability of Arm, Shoulder and Hand; Patient Reported Wrist Evaluation; Michigan Hand Questionnaire; Short Form-36). RESULTS Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years were included. Prevalence of PA was 32% at a median follow-up of 62.0 months. Patients with PA had statistically significant longer radial length (1.1 mm, 95% CI - 2.1; - 0.0, p = 0.045). Patients with PA had a statistically significant diminished flexion/extension arc of motion (12.0°, p = 0.008) and ulnar/radial deviation arc of motion (6.3°, p = 0.018). When corrected for dominance, all grip strength measurements were not statistically significantly different between patients with and without PA. Statistically significant poorer PROs in patients with PA were the MHQ subscales general functioning (65 versus 75, p = 0.018), esthetics (94 versus 100, p = 0.037), satisfaction (75 versus 92, p = 0.042) and total score of the MHQ (83 versus 91, p = 0.044), as well as the SF-36 subscale physical functioning (95 versus 100, p = 0.028). In regression analyses the DASH, PRWE function and PRWE total were statistically significantly associated with flexion/extension arc of motion. Seven patients (10%) changed or left their occupation because of the DRF. CONCLUSION Non-osteoporotic patients had a considerably high prevalence of PA following DRFs, despite a relatively short follow-up time. Patients with longer radial length more often had PA. Irrespective of AO/OTA fracture type, patients with PA had diminished range of motion, but no altered grip strength measurements. Non-osteoporotic patients following DRFs perceived diminished general functioning and dissatisfaction, which was impacted by the diminished active range of motion. Pain or impaired general health status was not reported. The PRO MHQ might be a valuable evaluation tool in this patient group. Change of occupation following DRFs should receive attention in further research.
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Affiliation(s)
- C. M. Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - H. J. ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - D. Vroling
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. T. Hartlief
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - C. K. van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Alfie V, Gallucci G, Boretto J, Donndorff A, Dubois JP, Benitez S, Giunta D, de Carli P. Patient-Rated Wrist Evaluation: Spanish Version and Evaluation of Its Psychometric Properties in Patients with Acute Distal Radius Fracture. J Wrist Surg 2017; 6:216-219. [PMID: 28725503 PMCID: PMC5515606 DOI: 10.1055/s-0037-1599127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Purpose The purpose of this paper is to validate a Spanish version of patient-rated wrist evaluation (PRWE) and evaluate its psychometric attributes in a population of patients with distal radius fracture. Material and Methods A translation and cross-cultural adaptation of the PRWE to Spanish (PRWE-S) was performed according to standardized guidelines. A total of 50 patients with a distal radius fracture were included during the different steps of the study. The reliability of the new instrument was assessed in terms of construct validity with the Quick DASH (Disability of the Arm, Shoulder, and Hand). Internal consistency and test-retest stability were also examined. Results The Spearman's correlation test for analysis of the criterion validity (0.75) indicates a strong positive correlation between the PRWE-S and the Quick DASH. The internal consistency according to Cronbach's α was 0.96, and the intraclass correlation coefficient was moderate (0.46). Conclusion A Spanish version of the PRWE indicated good validity and reliability in distal radius fracture patients. This valuable tool can be used in Spanish-speaking countries to evaluate various aspects as pain and function in patients with injuries of the wrist.
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Affiliation(s)
- Veronica Alfie
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gerardo Gallucci
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Boretto
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Agustin Donndorff
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juieta Puig Dubois
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sonia Benitez
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo de Carli
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Bemgård M, Archenholtz B. Developing an instrument for the measurement of grip ability after distal radius fracture. Scand J Occup Ther 2017; 25:466-474. [PMID: 28475403 DOI: 10.1080/11038128.2017.1323950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Distal radius fracture (DRF) often causes reduced ability to perform activities of daily living (ADLs). There is a need for recurrent evaluation of the ability to perform ADL in the early stage of rehabilitation as a complement to traditional functional measures. AIM Develop a short and simple performance test for use in clinical practice through modification of the Sollerman Grip Function Test (GFT). METHOD DRF patients and controls performed the GFT. The tasks that discriminated patients from controls were calculated for sensitivity to change and correlated to the QuickDASH questionnaire at three subsequent occasions. Interrater reliability was tested. RESULTS Twelve GFT tasks discriminated DRF patients from healthy controls. One task was excluded due to heavy load. Remaining 11 tasks were all sensitive to change. Four tasks with correlation to the QuickDASH and representing the grip types most frequently used in ADL came to constitute the Wrist Performance Test (WPT). A test-retest showed satisfactory interrater reliability (rs = 0.87). CONCLUSION A short performance test was developed through modification of the GFT. It is easy to use in clinical practice to evaluate the rehabilitation process after DRF.
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Affiliation(s)
- Marianne Bemgård
- a Department of Occupational Therapy , Sahlgrenska University Hospital Mölndal , Mölndal , Sweden
| | - Birgitha Archenholtz
- b Strategic Department of Quality Development , Sahlgrenska University Hospital , Göteborg , Sweden
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Affiliation(s)
- Sanjeev Kakar
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Lei M, Hua LM, Wang DW. The effect of probiotic treatment on elderly patients with distal radius fracture: a prospective double-blind, placebo-controlled randomised clinical trial. Benef Microbes 2016; 7:631-637. [PMID: 27633174 DOI: 10.3920/bm2016.0067] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Probiotic treatment has been shown to improve bone formation, increase bone mass density and prevent bone loss. We aimed to assess the effect of probiotic treatment on functional recovery in elderly patients with a distal radius fracture. A total of 417 elderly patients with an acute distal radius fracture were enrolled in this double-blind placebo-controlled clinical trial. They were randomised to receive skimmed milk containing either a commercial probiotic (Lactobacillus casei Shirota) or placebo daily for a period of 6 months after the fracture. Treatment outcomes were the DASH (disabilities of the arm, shoulder and hand) score, pain, complex regional pain syndrome (CRPS) score, active range of motion and grip strength, all of which were measured on a monthly basis. Throughout the duration of the study, DASH score, pain, CRPS score, wrist flexion and grip strength of patients receiving probiotics exhibited a significantly faster pace of improvement than those on placebo, with treatment outcomes of patients receiving Lactobacillus casei Shirota at month 4 at comparable levels with those of patients receiving placebo at month 6. In elderly patients with a fracture of the distal radius, administration of the probiotic could greatly accelerating the healing process.
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Affiliation(s)
- M. Lei
- Department of Nutrition and Diet, the Third Hospital of Hebei Medical University, No. 139 Zi Qiang Road, Shijiazhuang 050051, Hebei Province, China P.R
| | - L-M. Hua
- Department of Nutrition, Bethune International Heping Hospital, No. 398, Zhong Shan West Road, Shijiazhuang 050082, Hebei Province, China P.R
| | - D-W. Wang
- Department of Oral and Maxillofacial surgery, the Third Hospital of Hebei Medical University, No. 139 Zi Qiang Road, Shijiazhuang 050051, Hebei Province, China P.R
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Teunis T, Ring D. Comprehensive Outcome Assessment After Distal Radius Fracture. J Hand Surg Am 2016; 41:e257. [PMID: 27296325 DOI: 10.1016/j.jhsa.2016.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/13/2016] [Accepted: 05/18/2016] [Indexed: 02/02/2023]
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