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Galán-Olleros M, Mayans-Sanesteban J, Martínez-Álvarez S, Miranda-Gorozarri C, Ramírez-Barragán A, Egea-Gámez RM, Alonso-Hernández J, Martínez-Caballero I. Is reduction necessary in overriding metaphyseal distal radius fractures in children under 11 years: a systematic review and meta-analysis of comparative studies. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03936-4. [PMID: 38594456 DOI: 10.1007/s00590-024-03936-4] [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] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To determine the necessity of reduction in the treatment of overriding metaphyseal distal radius fractures (DRF) in children under 11 years. METHODS In this systematic review and meta-analysis, PubMed, Embase, and Cochrane databases were searched to retrieve studies published from inception to 2023. Two reviewers independently screened for studies with observational or randomized control design comparing two treatments for overriding metaphyseal DRF in patients under 11 years: simple casting without reduction (SC group) versus closed reduction plus casting or pin fixation (CRC/F group); with varying outcomes reported (CRD471761). The risk of bias was assessed using the ROBINS-I tool. RESULTS Out of 3,024 screened studies, three met the inclusion criteria, 180 children (mean age 7.1 ± 0.9 years) with overriding metaphyseal DRF: SC-group (n = 79) versus CRC/F-group (n = 101). Both treatment groups achieved 100% fracture consolidation without requiring further manipulation. The SC-group showed significantly fewer complications (mean difference [MD] 0.08; 95% CI [0.01, 0.53]; I2 = 22%; P < 0.009) and trends towards better sagittal alignment (MD 5.11; 95% CI [11.92, 1.71]; I2 = 94%; P < 0.14), less reinterventions (MD 0.31; 95% CI [0.01, 8.31]; P < 0.48), and fewer patients with motion limitation at the end of follow-up (MD 0.23; 95% CI [0.03, 1.98]; P < 0.18), although these findings were not statistically significant. CONCLUSIONS Despite a limited number of studies comparing SC versus CRC/F in overriding DRF in children under 11 years, this study suggests that anatomical reduction is not necessary. Treating these fractures with SC, even when presenting with an overriding position, leads to reduced complications, shows a trend towards fewer reinterventions, improved sagittal alignment, and less limitation in patient motion. LEVEL OF EVIDENCE Level III, Systematic review of Level-III studies.
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Affiliation(s)
- María Galán-Olleros
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, 28009, Madrid, Spain.
| | - Jorge Mayans-Sanesteban
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario de La Ribera, Alzira, Valencia, Spain
| | - Sergio Martínez-Álvarez
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Carlos Miranda-Gorozarri
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Ana Ramírez-Barragán
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Rosa M Egea-Gámez
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Javier Alonso-Hernández
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Ignacio Martínez-Caballero
- Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, 28009, Madrid, Spain
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Hassankhani A, Amoukhteh M, Jannatdoust P, Valizadeh P, Ghadimi DJ, Vasavada PS, Johnston JH, Gholamrezanezhad A. A meta-analysis on the diagnostic utility of ultrasound in pediatric distal forearm fractures. Emerg Radiol 2024; 31:213-228. [PMID: 38311698 PMCID: PMC10994871 DOI: 10.1007/s10140-024-02208-2] [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] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/24/2024] [Indexed: 02/06/2024]
Abstract
Pediatric distal forearm fractures, comprising 30% of musculoskeletal injuries in children, are conventionally diagnosed using radiography. Ultrasound has emerged as a safer diagnostic tool, eliminating ionizing radiation, enabling bedside examinations with real-time imaging, and proving effective in non-hospital settings. The objective of this study is to evaluate the diagnostic efficacy of ultrasound for detecting distal forearm fractures in the pediatric population. A systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until October 1, 2023, following established guidelines. Eligible studies, reporting diagnostic accuracy measures of ultrasound in pediatric patients with distal forearm fractures, were included. Relevant data elements were extracted, and data analysis was performed. The analysis included 14 studies with 1377 patients, revealing pooled sensitivity and specificity of 94.5 (95% CI 92.7-95.9) and 93.5 (95% CI 89.6-96.0), respectively. Considering pre-test probabilities of 25%, 50%, and 75% for pediatric distal forearm fractures, positive post-test probabilities were 83%, 44%, and 98%, while negative post-test probabilities were 2%, 6%, and 15%, respectively. The bivariate model indicated significantly higher diagnostic accuracy in the subgroup with trained ultrasound performers vs. untrained performers (p = 0.03). Furthermore, diagnostic accuracy was significantly higher in the subgroup examining radius fractures vs. ulna fractures (p < 0.001), while no significant differences were observed between 4-view and 6-view ultrasound subgroups or between radiologist ultrasound interpreters and non-radiologist interpreters. This study highlighted ultrasound's reliability in detecting pediatric distal forearm fractures, emphasizing the crucial role of expertise in precisely confirming fractures through ultrasound examinations.
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Affiliation(s)
- Amir Hassankhani
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Melika Amoukhteh
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Payam Jannatdoust
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Delaram J Ghadimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pauravi S Vasavada
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer H Johnston
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA.
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Crook JL, Pientka W, Zhang AY, Golden A, Koehler D, Sammer D. Risk factors for surgical site infection after surgical treatment of closed distal radial fractures. J Hand Surg Eur Vol 2024; 49:310-315. [PMID: 37666217 DOI: 10.1177/17531934231194672] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
We assessed operatively treated closed distal radial fractures to identify independent risk factors for surgical site infection after treatment. A retrospective review was carried out of 531 operatively treated closed distal radial fractures over a 5-year period. Multiple logistic regression was performed with infection as the dependent variable, using a stepwise regression procedure to select variables to construct the final model. In total, 19 (3.6%) fractures were complicated by postoperative surgical site infection. Uncontrolled diabetes with HbA1c >7, the presence of external fixation or external Kirschner wires, and tobacco use were significant independent predictors of infection. Age and time in the operating room were also statistically significant predictors but deemed to be not clinically meaningful.Level of evidence: IV.
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Affiliation(s)
- Jennifer L Crook
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - William Pientka
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Andrew Y Zhang
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Ann Golden
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Daniel Koehler
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Douglas Sammer
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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Neijhoft J, Sterz J, Rüsseler M, Britz V, Bepler L, Freund V, Horz C, Henrich D, Marzi I, Janko M. Evaluation of a 3D-printed hands-on radius fracture model during teaching courses. Eur J Trauma Emerg Surg 2024; 50:49-57. [PMID: 37524864 PMCID: PMC10923998 DOI: 10.1007/s00068-023-02327-4] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of a 3D-printed hands-on radius fracture model for teaching courses. The model was designed to enhance understanding and knowledge of radius fractures among medical students during their clinical training. METHODS The 3D models of radius fractures were generated using CT scans and computer-aided design software. The models were then 3D printed using Fused-Filament-Fabrication (FFF) technology. A total of 170 undergraduate medical students participated in the study and were divided into three groups. Each group was assigned one of three learning aids: conventional X-ray, CT data, or a 3D-printed model. After learning about the fractures, students completed a questionnaire to assess their understanding of fracture mechanisms, ability to assign fractures to the AO classification, knowledge of surgical procedures, and perception of the teaching method as well as the influence of such courses on their interest in the specialty of trauma surgery. Additionally, students were tested on their ability to allocate postoperative X-ray images to the correct preoperative image or model and to classify them to the AO classification. RESULTS The 3D models were well received by the students, who rated them as at least equal or better than traditional methods such as X-ray and CT scans. Students felt that the 3D models improved their understanding of fracture mechanisms and their ability to explain surgical procedures. The results of the allocation test showed that the combination of the 3D model and X-ray yielded the highest accuracy in classifying fractures according to the AO classification system, although the results were not statistically significant. CONCLUSION The 3D-printed hands-on radius fracture model proved to be an effective teaching tool for enhancing students' understanding of fracture anatomy. The combination of 3D models with the traditional imaging methods improved students' ability to classify fractures and allocate postoperative images correctly.
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Affiliation(s)
- Jonas Neijhoft
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Jasmina Sterz
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Miriam Rüsseler
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Vanessa Britz
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Lena Bepler
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Verena Freund
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Christian Horz
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Dirk Henrich
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Maren Janko
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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de Bruijn MAN, van Ginkel LA, Boersma EZ, van Silfhout L, Tromp TN, van de Krol E, van der Heijden BEPA, Hermans E, Stirler VMA, Edwards MJR. The past, present and future of the conservative treatment of distal radius fractures. Injury 2023; 54 Suppl 5:110930. [PMID: 37923503 DOI: 10.1016/j.injury.2023.110930] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023]
Abstract
The distal radius fracture is a common fracture with a prevalence of 17% on the emergency departments. The conservative treatment of distal radius fractures usually consists of three to six weeks of plaster immobilization. Several studies show that one week of plaster immobilization is safe for non- or minimally displaced distal radius fractures that do not need reduction. A shorter period of immobilization may lead to a better functional outcome, faster reintegration and participation in daily activities. Due to upcoming innovations such as three-dimensional printed splints for distal radius fractures, a patient specific splint can be produced which may offer more comfort. Furthermore, these three-dimensional printed splints are expected to be more environmental friendly in comparison with traditional plaster casts.
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Affiliation(s)
- Marcel A N de Bruijn
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Laura A van Ginkel
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Faculty of Science and Technology - Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Emily Z Boersma
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lysanne van Silfhout
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tjarda N Tromp
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik van de Krol
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Military Health Organisation, Ministry of Defence, Kromhout Kazerne, Utrecht, The Netherlands
| | - Brigitte E P A van der Heijden
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Erik Hermans
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent M A Stirler
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Military Health Organisation, Ministry of Defence, Kromhout Kazerne, Utrecht, The Netherlands
| | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Sharma M, Choudhury SR, Prakash M, Sinha A, Sheth R, Sandhu MS. MDCT evaluation of distal radius fractures and their association with carpal and distal ulnar fractures. Emerg Radiol 2023; 30:629-635. [PMID: 37656265 DOI: 10.1007/s10140-023-02169-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the characteristics of distal radius fractures (DRFs) in patients undergoing multi-detector computed tomography (MDCT) and their association with carpal and distal ulnar fractures. METHODS This retrospective study analyzed 120 patients, who underwent MDCT for evaluation of DRFs. Two radiologists independently evaluated the data for various fracture characteristics and for associated carpal and distal ulnar fractures. RESULTS Out of 120 DRFs, 74 were complete articular, 40 were partial articular and only 6 were extra-articular. Displacement was present in 99 fractures and intra-articular step off was present in 73 fractures. A total of 81 carpal bone fractures were identified in 46 (38.3%) patients, with more than one carpal bone fracture in 21 patients. Distal ulnar fractures were detected in 79 patients (65.8%), out of which 67 involved the ulnar styloid. DRFs with intra-articular step off were more frequently associated with carpal bone fracture (p value: 0.021), while displaced DRFs were more frequently associated with distal ulnar fracture (p value <0.001). Interobserver agreement for detection of carpal bone fractures (κ = 0.807) and distal ulnar fractures (κ = 0.923) was excellent. CONCLUSION Majority of DRFs in patients referred for MDCT were complete articular with high incidence of displacement and intra-articular step off. Associated carpal bone and distal ulna fractures were not uncommon.
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Affiliation(s)
- Madhurima Sharma
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Shayeri Roy Choudhury
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anindita Sinha
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rishabh Sheth
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bry K, Kortesniemi M, Koivikko M, Kerttula L. Comparison of cone beam computed tomography and plane radiographs of radial fractures as a basis for radiographical measurements. BMC Med Imaging 2023; 23:125. [PMID: 37710172 PMCID: PMC10500865 DOI: 10.1186/s12880-023-01093-4] [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] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine whether radiological measurements of radial fracture position made in cone beam computed tomography (CBCT) projection images are comparable to those made on traditional radiographs and could potentially substitute them. METHODS Sixteen patients with fractures of the distal radius referred for radiographs were recruited for an additional CBCT scan which was performed immediately afterwards. Projection images and volumetric data were saved from the CBCT scans. Measurements of ulnar variance, radial inclination and volar tilt were made from all three sets of images. RESULTS Agreement of projection image based measurements with radiographs was nearly as good as as the agreement of cross sectional image measurements with radiographs. The average difference between the results for projection images and radiographs were -1.2 mm (SD 1.9 mm), for radial inclination 0.7° (SD 2.9°) and for volar tilt 1.9° (SD 5.6°). CONCLUSION Differences between radiological measurements between the modalities studied are small and projection images could be used for the assessment of distal radial fractures.
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Affiliation(s)
- Kristian Bry
- Bridge Hospital, HUS, Haartmaninkatu 4, 00029 Helsinki, Finland
- Department of Radiology, Helsinki Medical Imaging Center, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
| | - Mika Kortesniemi
- Department of Radiology, Medical Imaging Center, University of Helsinki and Helsinki University Hospital, P.O.Box 263, HUS, 00029 Helsinki, Finland
| | - Mika Koivikko
- Bridge Hospital, HUS, Haartmaninkatu 4, 00029 Helsinki, Finland
- Department of Radiology, Helsinki Medical Imaging Center, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
| | - Liisa Kerttula
- Bridge Hospital, HUS, Haartmaninkatu 4, 00029 Helsinki, Finland
- Department of Radiology, Helsinki Medical Imaging Center, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
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Román-Veas J, Gutiérrez-Monclus R, López-Gil JF, Valenzuela-Fuenzalida J, Araya-Quintanilla F, Gutiérrez-Espinoza H, Hagert E. Baseline predictors related to functional outcomes in patients older than sixty years with complex regional pain syndrome type 1 after distal radius fracture treated conservatively: a prospective observational study. Int Orthop 2023; 47:2275-2284. [PMID: 37438487 DOI: 10.1007/s00264-023-05880-0] [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: 06/10/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE This study aimed to analyze baseline predictors of functional outcomes six weeks and at one year follow-up in patients older than 60 years with complex regional pain syndrome type 1 (CRPS I) after distal radius fracture (DRF). METHODS A total of 120 patients with CRPS I after DRF were prospectively recruited. Presumptive relevant factors were collected and analyzed as potential baseline predictors. Additionally, functional outcomes were assessed at the beginning of physiotherapy treatment, at six weeks after finishing physiotherapy treatment, and at one year follow-up. Patient-Rated Wrist Evaluation; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; Jamar dynamometer; and visual analog scale (VAS) were assessed. RESULTS All participants completed the study. At 6 weeks, the main results showed an association of lower values of grip strength with female sex (p = 0.010), intra-articular DRFs (p = 0.030), longer immobilization time (p = 0.040), lower levels of physical activity (p < 0.001), higher levels of kinesiophobia (p = 0.010), and anxiety (p = 0.020). At 1-year follow-up, the results showed an association of lower values of DASH with higher BMI (p < 0.001) and longer immobilization time (p < 0.001); and higher values of VAS showed an association with older age (p = 0.010), higher BMI (p = 0.010), and lower levels of physical activity (p = 0.040). CONCLUSION At six weeks, factors such as BMI, immobilization time, physical activity, and kinesiophobia are associated with lower functional outcomes. Additionally, at one year follow-up, BMI, immobilization time, and physical activity continue to be associated with lower functional outcomes in patients with CRPS I after DRF treated conservatively.
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Affiliation(s)
| | | | - José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- Department of Environmental Health, T.H Chan School of Public Health, Harvard University, Boston, USA
| | | | - Felipe Araya-Quintanilla
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | | | - Elizabet Hagert
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- Dept of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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9
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Ayache A, Unglaub F, Spies CK, Langer MF. [Radiocarpal dislocations and fracture dislocations]. Unfallchirurgie (Heidelb) 2023:10.1007/s00113-023-01349-2. [PMID: 37474778 DOI: 10.1007/s00113-023-01349-2] [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] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/22/2023]
Abstract
Radiocarpal dislocations and fracture dislocations are rare but always severe and complex injuries. They occur frequently in young and active patients as a result of high energy accidents. A detailed clinical and imaging examination and an accurate classification leads to a suitable and mostly surgical treatment strategy. The strategy should consider the most important components of the injury, the bony, the ligamentous and the intracarpal lesions. Delayed sequelae, residual pain and functional impairment are frequent after these severe injuries, but with adequate treatment, good, even long-term functional results are possible.
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Affiliation(s)
- Ali Ayache
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.
| | - Frank Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
- Medizinsche Fakultät Mannheim, Ruprecht-Karls Universität Heidelberg, Mannheim, Deutschland
| | - Christian K Spies
- Handchirurgie, Spital Langenthal, Spital Region Oberaargau SRO AG, Langenthal, Schweiz
| | - Martin F Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
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10
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Oakley B, Busby C, Kulkarni S, Arnold SJ, Kulkarni SS, Ollivere BJ. Manipulation of distal radius fractures: a comparison of Bier's block vs haematoma block. Ann R Coll Surg Engl 2023; 105:434-440. [PMID: 36239973 PMCID: PMC10149229 DOI: 10.1308/rcsann.2022.0116] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Displaced distal radius fractures often require manipulation under anaesthesia. Many anaesthetic techniques are described, with the two most commonly used being Bier's block (BB) and haematoma block (HB). Despite national guidance preferring a BB, an HB is often performed instead. This study aims to compare the analgesic properties of a BB with those of an HB when manipulating distal radius fractures. METHODS This is an observational cohort study comparing the management of displaced distal radius fractures requiring reduction across two National Health Service trusts. Patients aged over 18 with isolated, displaced distal radius fractures were recruited. Patient demographics, AO fracture classification and grade of clinician performing the procedure were recorded. A numeric rating scale (NRS) pain score was obtained for each patient after manipulation. The quality of reduction was judged against standardised anatomical parameters. RESULTS Some 200 patients were recruited (100 HB, 100 BB). There were no differences in age (BB: median 66.5 years, interquartile range [IQR] 55-74; HB: median 67 years, IQR 55-74; p = 0.79) or fracture characteristics (p = 0.29) between cohorts. Patients undergoing BB had significantly lower pain scores with a lower IQR than those undergoing HB (p < 0.005). Patients undergoing BB manipulation were more likely to have the fracture reduced and normal anatomy restored (p < 0.005). BBs were performed mainly by Foundation Year 2 junior doctors, whereas HB manipulations were performed by a range of clinicians from emergency nurse practitioners to consultants. CONCLUSIONS BB provides better analgesia than an HB. This can be performed successfully and reliably by Senior House Officer-level junior doctors.
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Affiliation(s)
- B Oakley
- Nottingham University Hospitals NHS Trust, UK
| | - C Busby
- Sherwood Forest Hospitals NHS Foundation Trust, UK
| | - S Kulkarni
- Sherwood Forest Hospitals NHS Foundation Trust, UK
| | - S J Arnold
- Nottingham University Hospitals NHS Trust, UK
| | - S S Kulkarni
- Sherwood Forest Hospitals NHS Foundation Trust, UK
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Anttila TT, Karjalainen TV, Mäkelä TO, Waris EM, Lindfors NC, Leminen MM, Ryhänen JO. Detecting Distal Radius Fractures Using a Segmentation-Based Deep Learning Model. J Digit Imaging 2023; 36:679-687. [PMID: 36542269 PMCID: PMC10039188 DOI: 10.1007/s10278-022-00741-5] [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: 09/07/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
Deep learning algorithms can be used to classify medical images. In distal radius fracture treatment, fracture detection and radiographic assessment of fracture displacement are critical steps. The aim of this study was to use pixel-level annotations of fractures to develop a deep learning model for precise distal radius fracture detection. We randomly divided 3785 consecutive emergency wrist radiograph examinations from six hospitals to a training set (3399 examinations) and test set (386 examinations). The training set was used to develop the deep learning model and the test set to assess its validity. The consensus of three hand surgeons was used as the gold standard for the test set. The area under the ROC curve was 0.97 (CI 0.95-0.98) and 0.95 (CI 0.92-0.98) for examinations without a cast. Fractures were identified with higher accuracy in the postero-anterior radiographs than in the lateral radiographs. Our deep learning model performed well in our multi-hospital and multi-radiograph system manufacturer settings. Thus, segmentation-based deep learning models may provide additional benefit. Further research is needed with algorithm comparison and external validation.
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Affiliation(s)
- Turkka T Anttila
- Musculoskeletal and Plastic Surgery, Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5B, Helsinki, 00260, Finland.
| | - Teemu V Karjalainen
- Department of Orthopedics, Traumatology and Hand Surgery, Central Finland Hospital, Jyvaskyla, Finland
| | - Teemu O Mäkelä
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Eero M Waris
- Musculoskeletal and Plastic Surgery, Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5B, Helsinki, 00260, Finland
| | - Nina C Lindfors
- Musculoskeletal and Plastic Surgery, Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5B, Helsinki, 00260, Finland
| | - Miika M Leminen
- Analytics and AI Development Services, IT Department, Helsinki University Hospital, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma O Ryhänen
- Musculoskeletal and Plastic Surgery, Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5B, Helsinki, 00260, Finland
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12
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Tauber M. [Winter sports injuries to the elbow joint]. Orthopadie (Heidelb) 2022; 51:903-909. [PMID: 36227359 DOI: 10.1007/s00132-022-04315-9] [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] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Elbow injuries occur quite often when practicing winter sports. Due to the high sports dynamics and risk of fall the elbow joint is prone to injuries. Hereby, the most common injury is the dislocation of the elbow. TREATMENT Isolated ligamentous instabilities can usually be treated non-operatively when the joint is centered on post-reduction imaging. In the case of persistent symptomatic instability, secondary ligament reconstruction surgery is associated with reliable and good results. Most fractures of the elbow involve the radial head in terms of postero-lateral rotation instability, whereas distal humerus and olecranon fractures are more likely to occur in high-energy or direct trauma. Indication for surgical treatment is given according to common guidelines, including involvement of the joint line, fragment dislocation and instability with risk of secondary fracture dislocation. Minimally invasive techniques for the radial head as well as anatomic preformed locking plate systems seem to have reached a wide acceptance.
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Affiliation(s)
- Mark Tauber
- Deutsches Schulterzentrum in der ATOS Klinik München, Effnerstr. 38, 81925, München, Deutschland.
- Universitätsklinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Universität Salzburg, Salzburg, Österreich.
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Ariga A, Suzuki H, Fukushima K, Fujita K. Evaluation of Ulnar Setting of Volar Locking Plates for Distal Radius Fractures Using Modified Skyline View. J Hand Surg Glob Online 2022; 5:17-20. [PMID: 36704379 PMCID: PMC9870808 DOI: 10.1016/j.jhsg.2022.09.002] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/06/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose Volar lunate facet fragments in distal radius fractures are located at the center of the load in the wrist joint and, therefore, should be properly supported by the distal ulnar setting of volar locking plates to obtain better postoperative outcomes. This study evaluated the usefulness of the modified skyline view (MSV) in intraoperative fluoroscopy for the ulnar setting of volar locking plates by comparing it with that of the anteroposterior view (APV). Methods Sixty-five patients with distal radius fractures who underwent open reduction and plate fixation as well as follow-up intraoperative fluoroscopy and postoperative computed tomography (CT) at our institution between April 2019 and March 2022 were included. The distance between the ulnar edge of the plate and the distal radius (d-value) was measured retrospectively using intraoperative fluoroscopy (distance measured from MSV and distance measured from APV) or postoperative CT (distance measured using postoperative CT). The distance measured from MSV and that measured from APV were compared with those measured using CT as the true values. Each measurement was performed twice by 2 examiners at an interval of 1 month. The comparison scores were evaluated using the intraclass correlation coefficient. Results The distance measured from MSV showed a difference of 0.6 ± 0.5 mm from that measured using CT, which was significantly smaller than that measured from APV (1.2 ± 0.9 mm; P < .001). Neither postoperative volar subluxation nor dislocation of bone fragments was found during the study period. Both intraclass correlation coefficient (1,1) and intraclass correlation coefficient (2,1) reliabilities were substantial to almost perfect. Conclusions Modified skyline view is an effective and versatile imaging method for estimating the ulnar setting of volar locking plates; it provides measurements more similar to those provided by postoperative CT compared with APV. The use of MSV may reduce postoperative complications, such as volar subluxation and dislocation of bone fragments, especially in cases with volar lunate facet fragments in which the ulnar setting of the plate is significant. Type of study/level of evidence Diagnostic III.
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Affiliation(s)
- Akane Ariga
- Department of Orthopedic Surgery, Saku Central Hospital Advanced Care Center, Saku-City, Nagano, Japan
| | - Hidetsugu Suzuki
- Department of Orthopedic Surgery, Saku Central Hospital Advanced Care Center, Saku-City, Nagano, Japan,Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan,Corresponding author: Hidetsugu Suzuki, MD, PhD, Department of Orthopedic Surgery, Saku Central Hospital Advanced Care Center, 28-3400 Nakagomi, Saku-City, Nagano, 385-0051, Japan.
| | - Kazuyuki Fukushima
- Department of Orthopedic Surgery, Saku Central Hospital Advanced Care Center, Saku-City, Nagano, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Chen GF, Liang JB, Zhang CY, Wang B, Cai GP, Yao C. [Kirschner wire retractor-assisted reduction and inverted insertion of elastic nail in the treatment of children's irreducible subradial 1/3 fractures]. Zhongguo Gu Shang 2022; 35:752-756. [PMID: 35979769 DOI: 10.12200/j.issn.1003-0034.2022.08.010] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the clinical effect of Kirschner wire retractor-assisted reduction and inverted insertion of elastic nail in the treatment of children's irreducible subradial 1/3 fractures. METHODS A total of 34 children with irreducible subradial 1/3 fractures treated by surgery from August 2016 to December 2020 were retrospective analyzed. Among them, 16 cases underwent Kirschner wire retractor-assisted closed reduction and percutaneous elastic intramedullary nailing with inverted insertion(observation group), 10 males and 6 females, aged from 4 to 10 years old with an average of(6.0±0.4)years;18 cases underwent open reduction and plate internal fixation (control group), 11 males and 7 females, the age from 3 to 10 years with an average of(7.0±0.5) years. The operation time, intraoperative blood loss, hospital stay, incision length, fracture healing time and complications of the two groups were observed and the wrist function was evaluated by Cooney wrist joint score. RESULTS All patients were followed up for 3-12 years old with an average of (11.40±0.48) months in the observation group and 4-13 months with an average of (11.50±0.39) months in the control group. Bone healing was achieved in all patients, and there was no incision infection in both groups. The operation time, intraoperative blood loss, hospital stay and incision length in observation groups were lower than those of control group (P<0.05). There was no significant difference in the fracture healing time between two groups(P>0.05). There was no significant difference in postoperative healing and recovery of wrist function between groups(P>0.05). CONCLUSION Compared with open reduction and plate internal fixation, Kirschner wire retractor-assisted reduction and percutaneous elastic intramedullary nail fixation for irreducible subradial radial 1/3 fractures has the advantages of less trauma, shorter operation time, less blood loss, and satisfactory short-term clinical results.
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Affiliation(s)
- Guo-Fu Chen
- Department of Orthopaedics, Taizhou Hospital, Linhai 317000, Zhejiang, China
| | - Jun-Bo Liang
- Department of Orthopaedics, Taizhou Hospital, Linhai 317000, Zhejiang, China
| | - Chuan-Yi Zhang
- Department of Orthopaedics, Taizhou Hospital, Linhai 317000, Zhejiang, China
| | - Bin Wang
- Department of Orthopaedics, Taizhou Hospital, Linhai 317000, Zhejiang, China
| | - Guo-Ping Cai
- Department of Orthopaedics, Taizhou Hospital, Linhai 317000, Zhejiang, China
| | - Can Yao
- Department of Orthopaedics, Taizhou Hospital, Linhai 317000, Zhejiang, China
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Cheng YB, Yang S. [Wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous internal fixation for the treatment of distal radius Fernandez type Ⅳ fractures]. Zhongguo Gu Shang 2022; 35:566-571. [PMID: 35730228 DOI: 10.12200/j.issn.1003-0034.2022.06.012] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore clinical effect of treatment for distal radius Fernandez type Ⅳ fractures by wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation. METHODS From January 2018 to December 2019, 11 patients distal radius Fernandez type Ⅳ fractures treated with wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation, including 8 males and 3 females, aged from 23 to 42 years old. The fracture were all calssified to type Ⅳ according to Fernandez classification. Postoperative fracture healing, activity of wrist joint and recovery of wrist joint were observed, postoperative visual analogue scale(VAS) at 12 months was used to evaluate pain of wrist joint, and Cooney wrist score scale was used to evaluate clinical effects. RESULTS All the 11 patients were followed up from 12 to 13 months, and fractures were healed well for 4 to 6 months. Postoperative VAS at 12 months ranged from 0 to 3, palm tilt angle ranged from 0° to 15 °, ulnar drift angle ranged from 15° to 21°, wrist flexion and extension motion ranged from 110° to 162°, forearm rotation motion ranged from 165° to 178°. Cooney wrist joint comprehensive score ranged from 70 to 95 points, and 8 patients got excellent result, 2 good, and 1 fair. No osteoarthritis and complications occurred. CONCLUSION Wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation for the treatment of Fernandez Ⅳ distal radius fractures could recevie effective fixation, and could receive satisfied clinical effect with system function exercise postoperative.
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Affiliation(s)
- Ya-Bo Cheng
- Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichuan, China
| | - Shun Yang
- Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichuan, China
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Klifto KM, Ruch DS, Mithani SK, Pidgeon TS, Richard MJ, Klifto CS. Outcomes associated with proton pump inhibitors and distal radius fractures: A post-hoc comparative analysis. J Plast Reconstr Aesthet Surg 2022; 75:2650-2657. [PMID: 35599218 DOI: 10.1016/j.bjps.2022.04.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 03/09/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022]
Abstract
Long-term, high-dose, daily proton pump inhibitors (PPI) may impact outcomes associated with distal radius fractures (DRF). The hypothesis was that differences existed in patient demographics, but there existed no differences in injury patterns, interventions, post-operative complications, and patient-reported outcomes between patients not on a PPI and patients on a PPI with a DRF. METHODS: An IRB-approved, post-hoc analysis of patients with DRF from 2012 through 2018 was performed. Patients included were age ≥18 years, sustained a DRF, had completed medical and medication records, Quick Disabilities of the Arm, Shoulder and Hand (DASH) scores, Global Assessment of Functioning (GAF) scores, visual analogue scale (VAS) pain scores, and a minimum of 1-year follow-up. Patients were stratified into two cohorts. Cohort one patients had no prescription or over-the-counter PPI use (no PPI cohort). Cohort two patients had adherence to a long-term, high-dose, daily PPI (PPI cohort). RESULTS: Two hundred and eighty-one DRF patients were included. Of these 281 patients, 240 were in the no PPI cohort and 41 were in the PPI cohort. Patients in the PPI cohort had more median nerve injuries (12% versus 3%, p = 0.025) and radial shaft fractures (5% versus 0%, p = 0.020), less contralateral upper extremity injuries (0% versus 4%, p = 0.001), and more post-operative nonunions (7% versus 1%, p = 0.029) compared to patients in the no PPI cohort. The results obtained suggest that a CONCLUSIONS: Long-term, high-dose, daily PPI's may be associated with more median nerve injuries and radial shaft fractures, less contralateral upper extremity injuries, and more post-operative nonunions compared to DRF patients not on a PPI.
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Affiliation(s)
- Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, University of Missouri School of Medicine, Columbia, MO, United States; Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, United States.
| | - David S Ruch
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, United States.
| | - Suhail K Mithani
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, United States.
| | - Tyler S Pidgeon
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, United States.
| | - Marc J Richard
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, United States.
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, United States.
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Wirtz R, Pianigiani S, Innocenti B, Schuind F. Three-dimensional analysis of the gap space under forearm casts. Chin J Traumatol 2022; 25:77-82. [PMID: 34154866 DOI: 10.1016/j.cjtee.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/26/2020] [Accepted: 03/01/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Secondary displacement represents a frequent complication of conservative treatment of fractures, particularly of the distal radius. The gap space between skin and cast may lead to a certain degree movements and this increased mobility might favor redisplacement. The aim of this study was to develop a new 3D method, to measure the gap space in all 3 geometrical planes, and to validate this new technique in a clinical setting of distal radius fractures. METHODS This study applies 3D imaging to measure the space between plaster and skin as a potential factor of secondary displacement and therefore the failure of conservative treatment. We developed and validated a new methodology to analyze and compare different forearm casts made of plaster of Paris and fiberglass. An unpaired t-test was performed to document differences between the investigated parameters between plaster of Paris and fiberglass casts. The significance level was set at p < 0.05. RESULTS In a series of 15 cases, we found the width of the gap space to average 4 mm, being slightly inferior on the radial side. Comparing the two different casting materials, plaster of Paris and fiberglass, we found a significantly larger variance of space under casts made of the first material (p=0.39). A roughness analysis showed also a markedly significantly higher irregularity of the undersurface of plaster of Paris as compared with fiberglass. CONCLUSION This study allows for a better understanding of the nature of the "gap space" between cast and skin and will contribute to develop and improve new immobilization techniques and materials.
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18
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Saka N, Hoshika S, Inoue M, Watanabe J, Banno M. Below- or above-elbow immobilization in conservative treatment of distal radius fractures: a systematic review and meta-analysis. Injury 2022; 53:250-258. [PMID: 34961625 DOI: 10.1016/j.injury.2021.12.021] [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] [Received: 09/20/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is no consensus regarding the range of immobilization in the conservative treatment of distal radius fractures (DRFs). Therefore, this systematic review and meta-analysis aimed to compare the clinical outcome of patients with DRFs treated conservatively with below- or above-elbow immobilization. MATERIALS AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, two independent reviewers searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and World Health Organization International Clinical Trials Registry Platform in April 2020; a subsequent update search was conducted in April 2021. We identified all randomised controlled trials comparing two immobilization methods in DRFs. The primary outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) or QuickDASH questionnaire scores in the short- and long-term (≤ and >six weeks, respectively) follow-up as well as the treatment failure rate. The secondary outcome measures were radiographic outcome, patient-rated wrist evaluation (PRWE) score, pain score and adverse events. Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2. We used the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence. RESULTS The initial search revealed 1,775 records, and ten studies with 909 participants in total were included. There was no significant difference in DASH score in the short-term follow-up (4.99 lower, 95% confidence interval (CI): 10.45 lower to 0.46 higher; very low certainty) and treatment failure (risk ratio: 0.91, 95% CI: 0.59 to 1.40; low certainty). A clinically irrelevant but significant mean difference (0.83 lower, 95%CI: 1.64 lower to 0.03 lower; low certainty) was found in the DASH score in favour of below-elbow immobilization in the long-term follow-up. The overall risk of bias in DASH scores was high based on the measurement bias. Furthermore, there was no significant difference in secondary outcome measures. CONCLUSION This meta-analysis did not demonstrate clinically meaningful difference between below- and above-elbow immobilization in terms of DASH score both in the short- and long-term follow-ups. However, overall certainty of evidence was considered very low, based on the very serious risk of bias, inconsistency and imprecision. Hence, there is a need for further higher quality research. TRIAL REGISTRATION NUMBER UMIN000040134 (4/14/2020).
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Affiliation(s)
- Natsumi Saka
- Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan; Department of Health Research Methods, Evidence & Impact, McMaster University. 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan.
| | - Shota Hoshika
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Funabashi Orthopaedic Hospital, 1 Chome-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Madoka Inoue
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan
| | - Jun Watanabe
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke-City, Tochigi, Japan; Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Masahiro Banno
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan; Department of Psychiatry, Seichiryo Hospital, Tsurumai 4-16-27, Showa-ku, Nagoya, 466-0064, Japan; Department of Psychiatry, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8560, Japan
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PAULA EMYGDIOJOSÉLEOMILDE, BISNETO EDGARDDENOVAESFRANÇA, PAULOS RENATAGREGÓRIO, JUNIOR RAMESMATTAR. RADIOCARPAL FRACTURE DISLOCATIONS: A NEW CLASSIFICATION AND TREATMENT PROPOSAL. Acta Ortop Bras 2022; 30:e248404. [PMID: 35431626 PMCID: PMC8982567 DOI: 10.1590/1413-785220223001e248404] [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] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022]
Abstract
Introduction The radiographic and surgical findings, and treatment of radiocarpal fracture dislocations, were analyzed retrospectively in 40 patients. Materials and Methods All patients were classified according to Dumontier´s radiological classification and compared with the surgical findings. Based on this analysis, a new classification and treatment are proposed. Results From 1995 to 2018, 40 patients with radiocarpal fracture dislocation underwent surgery. Thirty-six were males and four were females. The mean age was twenty-four years (range: 18-45). Three dislocations were volar dislocations and 37 were displaced dorsally. Initially, 8 (20%) patients were classified as group I, 29 (72.5%) as group II, and 3 (7.5%) remained unclassified. The main variations occurred in group II. Seven fractures were stable after radial styloid fixation and 6 remained unstable. Sixteen fractures presented articular fragments or an interposed capsule, which prevented anatomical reduction using conservative maneuvers. Conclusion Based in our intraoperative observations and surgical results, we believe that a more detailed classification should be adopted. Level of Evidence IV; Therapeutic Studies; Case Series.
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Rouhani A, Chavoshi M, Sadeghpour A, Aslani H, Mardani-Kivi M. Outcome of open reduction and Kirschner wire fixation in pediatric radial neck fracture. Clin Shoulder Elb 2021; 24:239-244. [PMID: 34875730 PMCID: PMC8651599 DOI: 10.5397/cise.2021.00402] [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] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Radial neck fracture in children is rare. This study attempted to evaluate the outcome of surgically treated patients and any associated complications. METHODS This study evaluated 23 children under 15 years of age with radial neck fracture who were treated with open reduction between 2006 and 2016 to determine their range of motion, postoperative complications, and radiographic outcomes. The results were assessed clinically using the Mayo clinic elbow performance score. RESULTS The mean follow-up duration for patients was 34.6 months. The average postoperative angulation was 3.6°. Hypoesthesia was reported in only 9% of patients, and none of the patients complained of postoperative pain. The postoperative X-ray results were excellent in 60% and good in 40%. No radiographic complications were identified. The elbow score was excellent in 87% and good in 13% (mean score, 96.74). There was a statistical relationship between range of motion limitations and age, degree of fracture, initial displacement, and surgical pin removal time. CONCLUSIONS Although most patients accept the closed reduction method as a primary treatment, the present study suggests that an open-reduction approach has been associated with optimal therapeutic outcomes for patients in whom closed reduction was not satisfactory or indicated.
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Affiliation(s)
- Alireza Rouhani
- Department of Orthopedics, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Alireza Sadeghpour
- Department of Orthopedic Surgery, School of Medicine and Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Aslani
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Mardani-Kivi
- Orthopedic Research Center, Department of Orthopedics, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Zago NN, Sande de Souza LAP, Kimura BG, Bertoncello D, Grecco MAS, Fernandes LFRM. Serious games therapy associated with conventional physical therapy intervention accelerated hand muscles strengthening and hand functioning after complex fracture of the wrist: A case report. J Hand Ther 2021; 33:580-586. [PMID: 30853255 DOI: 10.1016/j.jht.2018.11.003] [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: 05/24/2018] [Revised: 10/26/2018] [Accepted: 11/14/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case report. INTRODUCTION A severe wrist fracture can cause permanent physical disabilities and deformities, leading to limit patients in their occupation and social environment. PURPOSE OF THE STUDY We aim at presenting a treatment protocol and the functional outcome of a patient with severe clinical state after a rare wrist fracture. METHODS We provided physical therapy intervention associated with serious games for muscle strengthening. RESULTS AND DISCUSSION There was an increase in strengthening and a decrease in Disability of the Arm, Shoulder and Hand score and Patient Rated Wrist Evaluation scores. The International Classification of Functioning scores have changed from severe to light or to absent in many of the domains. CONCLUSION The use of serious games combined with a conventional physical therapy intervention played a fundamental role in recovery and return to work activities, and there was also an important recovery of general health condition.
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Affiliation(s)
- Najara Nader Zago
- Control Motor and Biomechanical Laboratory, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | | | - Bruno Goto Kimura
- Control Motor and Biomechanical Laboratory, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Dernival Bertoncello
- Control Motor and Biomechanical Laboratory, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
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Meng H, Yan JZ, Wang B, Ma ZB, Kang WB, Liu BG. Influence of volar margin of the lunate fossa fragment fixation on distal radius fracture outcomes: A retrospective series. World J Clin Cases 2021; 9:7022-7031. [PMID: 34540957 PMCID: PMC8409212 DOI: 10.12998/wjcc.v9.i24.7022] [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: 03/11/2021] [Revised: 05/13/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Distal radius fractures accompanied by the volar margin of the lunate fossa (VMLF) lesions are often overlooked or inadequately reduced in clinical practice.
AIM To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint.
METHODS This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017. The patients were divided into two groups according to whether the VMLF fragments were fixed or not. X-rays and computed tomography were performed before surgery, immediately postoperatively, and at 1, 3, and 6 mo to measure the scapholunate angle, radiolunate angle, capitolunate angle, and effective radiolunate flexion (ERLF). The Mayo wrist score and disabilities of the arm, shoulder, and hand (DASH) score were determined at 1 year.
RESULTS Thirty-five patients were included. There were 15 males and 20 females. Their mean age was 52.5 ± 14.3 (range: 19-70) years. There were 38 wrists (17 on the left side, 15 on the right, and three bilateral; 16 in the fixed group, and 22 in the unfixed group). The interval between trauma and surgery was from 1 h to 1 mo. The incidence of postoperative wrist instability in the unfixed group (86.4%) was higher than in the fixed group (25.0%) (P ≤ 0.001). Ten patients had ERLF > 25° in the unfixed group and none in the fixed group (P = 0.019). The Mayo wrist score was 94 ± 5.7 in the fixed group and 68 ± 15.1 in the unfixed group (P < 0.001). The DASH score was 4.6 ± 2.5 in the fixed group and 28.5 ± 19.5 in the unfixed group (P < 0.001).
CONCLUSION Injuries of VMLF, even small fractures, might damage the radial-lunar ligament, leading to postoperative wrist instability, sagittal force line imbalance, and poor recovery of wrist joint function.
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Affiliation(s)
- Hua Meng
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Jia-Zhi Yan
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Bing Wang
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Zong-Bo Ma
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Wei-Bo Kang
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Bao-Ge Liu
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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Gutiérrez-Espinoza H, Olguín-Huerta C, Cuyul-Vásquez I, Ríos-Riquelme M, Valenzuela-Fuenzalida J, Araya-Quintanilla F. Association Between Body Mass Index and Functional Outcomes in Elderly Patients with Extra-articular Distal Radius Fracture: A Prospective Observational Study. Indian J Orthop 2021; 55:1009-1014. [PMID: 34194659 PMCID: PMC8192664 DOI: 10.1007/s43465-021-00358-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/12/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The association between body mass index (BMI) and functional outcomes is unknown in elderly individuals with distal radius fracture (DRF). OBJECTIVE The aim of this study is to evaluate if there is association between BMI and functional outcomes in patients older than 60 years with DRF treated conservatively. MATERIALS AND METHODS A prospective observational study was performed. A total of 228 patients with extra-articular DRF were prospectively recruited. All patients were categorized by their BMI as normal, overweight, or obese. Functional outcomes were assessed after cast removal and at 1-year follow-up. The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH), and Patient-Rated Wrist Evaluation (PRWE) questionnaires were used to assess upper limb and wrist/hand function, respectively, while the Jamar Dynamometer was used to assess grip strength. RESULTS Of the total number of patients, 184 were female (80.7%), 87 were overweight (38.2%), and 111 were obese (48.7%). After cast removal, the correlations between BMI and functional outcomes were DASH 0.06 (p = 0.578), PRWE 0.04 (p = 0.692), and grip strength - 0.02 (p = 0.763). At 1-year follow-up, the correlations were DASH 0.55 (p = 0.036), PRWE 0.32 (p = 0.041), and grip strength - 0.21 (p = 0.043). CONCLUSION This study suggests that at 1-year follow-up, there was a low-to-moderate association between BMI and poor functional outcomes in elderly patients with extra-articular DRF treated conservatively. LEVEL OF EVIDENCE Level IV, observational prospective study.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Rehabilitation in Health Research Center, CIRES, University of the Americas, Echaurren Street 140, 3rd floor, Santiago, Chile
- School of Health Sciences, Physiotherapy Department, Universidad Gabriela Mistral, Santiago, Chile
| | - Cristian Olguín-Huerta
- Rehabilitation in Health Research Center, CIRES, University of the Americas, Echaurren Street 140, 3rd floor, Santiago, Chile
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de La Salud, Universidad Católica de Temuco, Temuco, Chile
| | - Mario Ríos-Riquelme
- Sciences in Physical Activity Department, Universidad de Santiago, Libertador Bernardo O´Higgins Avenue 3363, Santiago, Chile
| | - Juan Valenzuela-Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Republica Avenue 259, Santiago, Chile
| | - Felipe Araya-Quintanilla
- Rehabilitation in Health Research Center, CIRES, University of the Americas, Echaurren Street 140, 3rd floor, Santiago, Chile
- Departamento de Ciencias Químicas y Biológicas, Facultad de Salud, Universidad Bernardo O’Higgins, Santiago, Chile
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Ogliari G, Ong T, Marshall L, Sahota O. Seasonality of adult fragility fractures and association with weather: 12-year experience of a UK Fracture Liaison Service. Bone 2021; 147:115916. [PMID: 33737194 DOI: 10.1016/j.bone.2021.115916] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the monthly and seasonal variation in adult osteoporotic fragility fractures and the association with weather. METHODS 12-year observational study of a UK Fracture Liaison Service (outpatient secondary care setting). Database analyses of the records of adult outpatients aged 50 years and older with fragility fractures. Weather data were obtained from the UK's national Meteorological Office. In the seasonality analyses, we tested for the association between months and seasons (determinants), respectively, and outpatient attendances, by analysis of variance (ANOVA) and Tukey's test. In the meteorological analyses, the determinants were mean temperature, mean daily maximum and minimum temperature, number of days of rain, total rainfall and number of days of frost, per month, respectively. We explored the association of each meteorological variable with outpatient attendances, by regression models. RESULTS The Fracture Liaison Service recorded 25,454 fragility fractures. We found significant monthly and seasonal variation in attendances for fractures of the: radius or ulna; humerus; ankle, foot, tibia or fibula (ANOVA, all p-values <0.05). Fractures of the radius or ulna and humerus peaked in December and winter. Fractures of the ankle, foot, tibia or fibula peaked in July, August and summer. U-shaped associations were showed between each temperature parameter and fractures. Days of frost were directly associated with fractures of the radius or ulna (p-value <0.001) and humerus (p-value 0.002). CONCLUSION Different types of fragility fractures present different seasonal patterns. Weather may modulate their seasonality and consequent healthcare utilisation.
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Affiliation(s)
- Giulia Ogliari
- Department of Health Care for Older People, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom.
| | - Terence Ong
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Lindsey Marshall
- Department of Trauma & Orthopaedics, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom.
| | - Opinder Sahota
- Department of Health Care for Older People, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, United Kingdom; Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Derby Road, Nottingham NG7 2UH, United Kingdom; National Institute for Health Research (NIHR, Nottingham Biomedical Research Centre (BRC), Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, United Kingdom.
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25
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Lee J, Kim JK, Oh M, Shin YH. The Characteristics of Women with Subsequent Distal Radius Fracture after Initial Distal Radius Fracture. J Bone Metab 2021; 28:123-129. [PMID: 34130364 PMCID: PMC8206611 DOI: 10.11005/jbm.2021.28.2.123] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the characteristics of women with subsequent distal radius fracture (DRF) and to compare bone fragility variables in women with initial and subsequent DRF. METHODS We enrolled 227 women who experienced DRF (203 women with initial DRF and 24 women with subsequent DRF) between September 2016 and April 2019. We compared demographic characteristics and bone fragility variables, including bone mineral density, trabecular bone score, hip geometry, bicortical thickness of the distal radius, and fracture risk assessment tool (FRAX) scores between the 2 groups. To reduce bias, patients with subsequent DRF were propensity score-matched in a 1:2 manner with patients affected by initial DRF, and additional comparisons were performed. RESULTS Patients in the subsequent DRF group were older than those in the initial DRF group, but this difference was not significant (P=0.091). The proportion of patients receiving treatment with osteoporosis medication was significantly higher in the subsequent DRF group (41.7% vs. 19.2%, P=0.011). Bone fragility variables did not differ significantly between the 2 groups. However, the ten-year probability of major osteoporotic fractures based on FRAX scores was significantly higher in patients with subsequent DRF (7.5% vs. 10.8%, P<0.001). Similar results were observed when comparing the propensity score-matched initial and subsequent DRF groups. CONCLUSIONS These findings suggest that the occurrence of subsequent DRF after initial DRF can be attributed to multiple factors rather than bone fragility alone. Systematic and multidisciplinary management would be helpful in preventing the occurrence of subsequent DRF after the initial DRF.
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Affiliation(s)
- Jongjin Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minyoung Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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26
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Yuan SP, Zhang XP, Sun Y, Wei X. [Meta-analysis of external fixator and open reduction and internal fixation for the treatment of distal radius fracture]. Zhongguo Gu Shang 2021; 34:429-37. [PMID: 34032044 DOI: 10.12200/j.issn.1003-0034.2021.05.007] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare clinical efficacy and safety of plate internal fixation (ORIF) and external fixator (EF) in treating distal radius fractures by Meta-analysis. METHODS From establishment of database to August, 2019, randomized controlled trial (RCT) about open reduction and internal fixation (ORIF) and external fixation (EF) in treating distal radius fractures was conducted by using computer-based databases, including CNKI, VIP, Wanfang Data, Medline, Cochrane library databases. Data extraction and quality evaluation of included study according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform Meta-analysis. Palm angle, ulnar deflection angle, radius height, grip strength, ulnar variation, disabilities of arm, shoulder and hand (DASH) score, total complication rate, infection rate and tendon rupture between two groups were compared. RESULTS Totally 19 RCT were included with 1 730 patients, 873 patients in ORIF group and 857 patients in EF group. Meta analysis result showed that after operation at 12 months, there were no significant difference in radial height [MD=0.04, 95%CI (-0.90, 0.99), P=0.93], tendon rupture [RR=1.82, 95%CI (0.71, 4.67), P=0.21], carpal tunnel syndrome [RR=2.15, 95%CI(0.98, 4.70), P=0.06], complex regional pain syndrom [RR=0.63, 95%CI(0.31, 1.27)P=0.78] between two groups. While there were significant difference in palm inclination angle [MD=1.38, 95%CI (0.83, 1.93), P< 0.000 01], ulnar deflection angle[MD=0.99, 95%CI(0.54, 1.45), P<0.000 1], ulna variability[MD=0.66, 95%CI(0.21, 1.12), P=0.005], DASH score[MD=2.42, 95%CI(0.37, 4.46), P=0.02], incidence of complications[RR=0.83, 95%CI(0.71, 0.96), P=0.01], infection rate[RR=0.20, 95%CI(0.11, 0.36), P<0.000 1]between two groups. There was statistical difference in tendinitis incidence between two groups [MD=3.88, 95%CI (1.56, 9.64), P<0.003]. CONCLUSION Compared with EF in treating distal radius fracture, ORIF has better clinical effects in postoperative complications, palm angle, ulnar deviation angle, ulnar variation rate and infection rate. While there were no significant difference between in DASH score, radial height, tendon rupture and carpal tunnel syndrome better EF and ORIF. For the patient pursue rapid recovery of function, ORIF is better choice.
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Affiliation(s)
- Shu-Peng Yuan
- Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China
| | - Xing-Ping Zhang
- Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China
| | - Yan Sun
- Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China
| | - Xu Wei
- Wangjing Hospital of China Academy of Chinese Medical Science, Beijing 100102, China
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27
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Qiao B, Jiang DM. [Treatment status and thoughts of distal radius fracture]. Zhongguo Gu Shang 2021; 34:97-100. [PMID: 33665993 DOI: 10.12200/j.issn.1003-0034.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bo Qiao
- The Third Affiliated Hospital of Chongqing Medical Unversity, Jieer Hospital, Chongqing 401120, China
| | - Dian-Ming Jiang
- The Third Affiliated Hospital of Chongqing Medical Unversity, Jieer Hospital, Chongqing 401120, China
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28
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Tobler P, Cyriac J, Kovacs BK, Hofmann V, Sexauer R, Paciolla F, Stieltjes B, Amsler F, Hirschmann A. AI-based detection and classification of distal radius fractures using low-effort data labeling: evaluation of applicability and effect of training set size. Eur Radiol 2021; 31:6816-6824. [PMID: 33742228 PMCID: PMC8379111 DOI: 10.1007/s00330-021-07811-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
Objectives To evaluate the performance of a deep convolutional neural network (DCNN) in detecting and classifying distal radius fractures, metal, and cast on radiographs using labels based on radiology reports. The secondary aim was to evaluate the effect of the training set size on the algorithm’s performance. Methods A total of 15,775 frontal and lateral radiographs, corresponding radiology reports, and a ResNet18 DCNN were used. Fracture detection and classification models were developed per view and merged. Incrementally sized subsets served to evaluate effects of the training set size. Two musculoskeletal radiologists set the standard of reference on radiographs (test set A). A subset (B) was rated by three radiology residents. For a per-study-based comparison with the radiology residents, the results of the best models were merged. Statistics used were ROC and AUC, Youden’s J statistic (J), and Spearman’s correlation coefficient (ρ). Results The models’ AUC/J on (A) for metal and cast were 0.99/0.98 and 1.0/1.0. The models’ and residents’ AUC/J on (B) were similar on fracture (0.98/0.91; 0.98/0.92) and multiple fragments (0.85/0.58; 0.91/0.70). Training set size and AUC correlated on metal (ρ = 0.740), cast (ρ = 0.722), fracture (frontal ρ = 0.947, lateral ρ = 0.946), multiple fragments (frontal ρ = 0.856), and fragment displacement (frontal ρ = 0.595). Conclusions The models trained on a DCNN with report-based labels to detect distal radius fractures on radiographs are suitable to aid as a secondary reading tool; models for fracture classification are not ready for clinical use. Bigger training sets lead to better models in all categories except joint affection. Key Points • Detection of metal and cast on radiographs is excellent using AI and labels extracted from radiology reports. • Automatic detection of distal radius fractures on radiographs is feasible and the performance approximates radiology residents. • Automatic classification of the type of distal radius fracture varies in accuracy and is inferior for joint involvement and fragment displacement.
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Affiliation(s)
- Patrick Tobler
- University Hospital Basel, University of Basel, Clinic of Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Joshy Cyriac
- University Hospital Basel, University of Basel, Clinic of Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Balazs K Kovacs
- University Hospital Basel, University of Basel, Clinic of Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Verena Hofmann
- University Hospital Basel, University of Basel, Clinic of Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Raphael Sexauer
- University Hospital Basel, University of Basel, Clinic of Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Fabiano Paciolla
- University Hospital Basel, University of Basel, Clinic of Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Bram Stieltjes
- University Hospital Basel, University of Basel, Clinic of Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Felix Amsler
- Amsler Consulting Basel, Gundeldingerrain 111, 4059, Basel, Switzerland
| | - Anna Hirschmann
- University Hospital Basel, University of Basel, Clinic of Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
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Hong HB. [Clinical observation on pulley suspension traction reduction combined with self-made splint fixation for the treatment of extended distal radius fracture]. Zhongguo Gu Shang 2021; 34:108-13. [PMID: 33665995 DOI: 10.12200/j.issn.1003-0034.2021.02.003] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore clinical effects of pulley suspension traction reduction combined with self-made splint fixation in treating extended distal radius fracture. METHODS From December 2017 to December 2019, 60 patients with extended distal radius fractures were divided into observation group and control group, 30 patients in each group. In observation group, there were 12 males and 18 females, aged from 50 to 75 years old with an average of (59.63±8.08) years old;according to AO classification, 25 patients were type A2 and 5 patients with type A3;fractures were fixed by pulley suspension traction and self-made splint. In control group, there were 11 males and 19 females, aged from 52 to 76 years old with an average of (59.77±8.03) years old;according to AO classification, 24 patients were with type A2 and 6 patients were type A3;fractures were treated by conventional manipulation with self-made splint fixation. The radius height, ulnar angle and palmar angle between two groups were compared before and after treatment, and clinical effects were evaluated by advanced Green and O'Brien wrist joint scoring after treatment. RESULTS All patients were followed up from 11 to 13 months with an average of (11.90± 0.80) months. The splint was removed for 42 to 60 days with an average of (50.20±4.94) days. After removal of splint, X-rays indicated that all patients obtained bone healing with smooth of joint surface. In observation group, radius height was (4.57± 1.16) mm, ulnar angle was (12.83±3.25) °, palmar angle were (-21.17±3.36) ° respectively before treatment, (10.10± 1.75) mm, (24.30±3.16) °, (9.40±2.13) ° respectively at 8 weeks after treatment;in control group, radius height, ulnar angle, palm angle were (4.50±1.43) mm, (12.83±3.10) °, (-21.50±3.38) ° respectively before treatment, and (8.90±1.24) mm, (21.20±2.91) °, (6.16±2.94) ° respectively at 8 weeks after treatment;there were no significant difference in radius height, ulnar deviation angle and palmar inclination between two groups before treatment (P>0.05);radius height, ulnar deviation angle and palmar inclination angle of between two groups were significantly improved at 8 weeks after treatment(P<0.05), and observation group was significantly better than that of control group (P<0.05). Green and O'Brien wrist score of observation group was 90.97±7.92 at follow-up ranged from 11 to 13 months with an average of (11.90±0.80) months, which was significantly higher than that of control group (84.77±9.14) (t=2.807, P<0.05);in observation group, 18 patients got excellent result, 10 good and 2 fair;in control group, 10 patients got excellent result, 15 good, 3 fair and 2 poor;there was siginifcantly difference between two groups (Z=-2.15, P<0.05). CONCLUSION Compared with conventional manual traction and reduction, pulley suspension traction reduction combined with self made splint fixation for the treatment of extended distal radius fracture has more advantages with stable and reliable traction, good reduction, and better wrist joint function. It could be selected and applied according to the actual situation of patients.
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Affiliation(s)
- Hai-Bin Hong
- Tong'an District Hospital of Traditional Chinese Medicine, Xiamen 361100, Fujian, China
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30
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Synek A, Baumbach SF, Pahr DH. Towards optimization of volar plate fixations of distal radius fractures: Using finite element analyses to reduce the number of screws. Clin Biomech (Bristol, Avon) 2021; 82:105272. [PMID: 33493739 DOI: 10.1016/j.clinbiomech.2021.105272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Using fewer distal screws in volar plate fixation of distal radius fractures could reduce treatment costs and complications. However, there is currently no consensus on the ideal screw configuration, likely due to experimental limitations and its subject-specific nature. In this study, finite element analysis was used to investigate (1) if reducing the number of screws is biomechanically feasible and (2) if an optimal screw configuration is subject-specific. METHODS Validated subject-specific finite element models of 16 human radii with extra articular distal radius fractures and volar plate fixation with six distal screws were used as a baseline. 41 additional configurations with three to six distal screws were simulated for each subject. Axial stiffness and peri-implant strains around the distal screws were evaluated. Subject-specific optimum configurations were determined using a lower bound for the axial stiffness and minimizing peri-implant strains. FINDINGS Even using three distal screws led to only minor deterioration of the biomechanical properties in the best configuration (axial stiffness: -11.2%, peri-implant strains: -35.0%), but a considerable deterioration in the worst configuration (axial stiffness: -46.2%, peri-implant strains: +112.4%). The optimization showed that the ideal screw configuration is subject-specific and on average 1.9 screws could be saved based on the herein used optimization criterion. INTERPRETATION This study highlights that not only how many, but which screws are used in volar plate fixation of distal radius fractures is critical. Using a patient-specific selection of distal screws bears potential to save costs and reduce complications.
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31
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Lawson A, Naylor J, Buchbinder R, Ivers R, Balogh Z, Smith P, Mittal R, Xuan W, Howard K, Vafa A, Yates P, Rieger B, Smith G, Elkinson I, Kim W, Sungaran J, Latendresse K, Wong J, Viswanathan S, Landale K, Drobetz H, Tran P, Page R, Hau R, Mulford J, Incoll I, Kale M, Schick B, Higgs A, Oppy A, Perriman D, Harris I. A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE): a statistical analyses plan. Trials 2020; 21:651. [PMID: 32669121 PMCID: PMC7364640 DOI: 10.1186/s13063-020-4228-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/18/2019] [Accepted: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Background We are performing a combined randomised and observational study comparing internal fixation to non-surgical management for common wrist fractures in older patients. This paper describes the statistical analysis plan. Methods/design A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE) is a randomised controlled trial comparing two types of usual care for treating wrist fractures in older patients, surgical fixation using volar locking plates and non-surgical treatment using closed reduction and plaster immobilisation. The primary aim of this comparative-effectiveness study is to determine whether surgery is superior to non-surgical treatment with respect to patient-reported wrist function at 12 months post treatment. The secondary outcomes include radiographic outcomes, complication rates and patient-reported outcomes including quality of life, pain, treatment success and cosmesis. Primary analysis will use a two-sample t test and an intention-to-treat analysis using the randomised arm of the study. Statistical analyses will be two-tailed and significance will be determined by p < 0.05. Sensitivity analyses will be conducted to assess for differences in intention-to-treat, per-protocol and as-treated analyses. Sensitivity analyses will also be conducted to assess selection bias by evaluating differences in participants between the randomised and observational study arms, and for bias relating to any missing data. An economic analysis will be conducted separately if surgery is shown to provide superior outcomes to a level of clinical significance. Discussion This statistical analysis plan describes the analysis of the CROSSFIRE study which aims to provide evidence to aid clinical decision-making in the treatment of distal radius fractures in older patients. Trial registration CROSSFIRE was approved by The Hunter New England Human Research Ethics Committee (HNEHREC Reference No: 16/02/17/3.04). Registered on 22 July 2016 with The Australian and New Zealand Clinical Trials Registry (ANZCTR Number; ACTRN12616000969460). This manuscript is based on v.11 of the statistical analysis plan. A copy of v.11, signed by the chief investigator and the senior statistician is kept at the administering institution.
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Affiliation(s)
- Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia. .,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia.
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Monash University, Melbourne, VIC, Australia.,Cabrini Institute, Melbourne, VIC, Australia
| | - Rebecca Ivers
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | | | - Paul Smith
- Canberra Hospital, Canberra, ACT, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Kirsten Howard
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Arezoo Vafa
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Piers Yates
- Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Geoff Smith
- St George and Sutherland Hospitals, Sydney, NSW, Australia
| | | | - Woosung Kim
- Wellington Hospital, Wellington, New Zealand
| | | | - Kim Latendresse
- Nambour Hospital and Sunshine Coast University Hospital, Nambour, QLD, Australia
| | - James Wong
- Westmead Hospital, Sydney, NSW, Australia
| | | | | | | | - Phong Tran
- Western Health, Melbourne, VIC, Australia
| | - Richard Page
- University Hospital Geelong, Barwon Health, Geelong, NSW, Australia.,School of Medicine, Deakin University, Geelong, VIC, Australia
| | | | | | - Ian Incoll
- Gosford and Wyong Hospitals, Gosford, NSW, Australia
| | - Michael Kale
- Gosford and Wyong Hospitals, Gosford, NSW, Australia
| | | | | | - Andrew Oppy
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia.,Liverpool Hospital, Sydney, NSW, Australia
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Cheng YB, Yang S. [Open pulling reduction and bone graft by overstretched wrist traction and internal fixation for the treatment of distal radius type Fernandez Ⅲ fractures]. Zhongguo Gu Shang 2020; 33:367-70. [PMID: 32351093 DOI: 10.12200/j.issn.1003-0034.2020.04.015] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore the clinical effect of the treatment of Fernandez type Ⅲ fracture of the distal radius with hyperextension traction prying, volar reduction, bone grafting and internal fixation. METHODS From February 2017 to March 2018, 11 cases of Fernandez type Ⅲ fracture of the distal radius were treated with intraoperative hyperextension traction and volar prying reduction and bone grafting and internal fixation, including 6 males and 5 females, aged 55 to 67 years. Preoperative X-ray and CT evaluated the distal radius fracture dorsal angulation with articular surface compression, collapse. According to Fernandez, all of them were type Ⅲ. After operation, the reduction of articular surface and fracture healing were evaluated. VAS score and Cooney wrist score were used to evaluate the curative effect. RESULTS All the patients were followed up for 12 to 14 months. All the fractures healed. Cooney wrist score scale was used to evaluate the curative effect, 9 cases were excellent, 1 case was good and 1 case was fair. CONCLUSION In the operation of Fernandez type Ⅲ fracture of the distal radius, hyperextension traction was used to enlarge the angle, and through the volar fracture end prying reduction and internal fixation with bone graft, the collapsed articular surface could be effectively reduced and fixed. The early functional exercise after the operation had satisfactory clinical effect.
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Affiliation(s)
- Ya-Bo Cheng
- Department of Orthopaedic Trauma and Hand Surgery, the Orthopaedic Hospital of Sichuan Province, Chengdu 610041, Sichuan, China
| | - Shun Yang
- Department of Orthopaedic Trauma and Hand Surgery, the Orthopaedic Hospital of Sichuan Province, Chengdu 610041, Sichuan, China
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Jung HS, Jung HS, Baek SH, Lee JS. How Many Screws Are Needed for Reliable Stability of Extra-articular Nonosteoporotic Distal Radius Fractures Fixed with Volar Locking Plates? Clin Orthop Surg 2020; 12:22-28. [PMID: 32117534 PMCID: PMC7031436 DOI: 10.4055/cios.2020.12.1.22] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/01/2019] [Indexed: 11/06/2022] Open
Abstract
Background We hypothesized that volar locking pate fixation using a minimum number of screws-four in the distal row and two in the shaft of the plate-will provide sufficient stability for unstable extra-articular fractures of the distal radius. We aimed to compare the biomechanical properties of different numbers and locations of screws in volar locking plate fixation and describe the clinical and radiological outcome of plate fixation using a minimum number of screws for distal radius fractures. Methods We divided 48 artificial radius fracture bones into four groups (group A-D) based on the number and location of screws used for fixation with volar locking plates. The artificial bone models were subjected to axial compression and volar bending load with a force of 250 N and 80 N, respectively, for 1,000 cycles at a frequency of 1 Hz. We also retrospectively reviewed 42 patients with unstable, extra-articular, distal radius fractures who were treated with volar locking plate fixation using a minimum number of screws. Results Group A (seven distal screws and three proximal screws) had the highest mean stiffness: 303.7 N/mm under axial compression and 61.1 N/mm under volar bending. Compared with group A, group D (four screws in the distal part and two screws in the shaft) showed significantly lower stiffness; therefore, group D was considered inferior in terms of stability. However, in the fatigue test, neither deformation of the metal plate nor detachment or breakage of the metal screws was observed in all groups. In the clinical study, all fractures united without displacement and satisfactory clinical outcome was obtained. Conclusions In the dorsally comminuted, extra-articular, nonosteoporotic distal radius fractures, the minimum number of screws-four in the distal row and two in the shaft-in volar locking plate fixation can provide sufficient stability. Further biomechanical studies involving osteoporotic bone will be necessary to confirm the results because volar plate fixation is most commonly used in patients with osteoporosis.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Han Sol Jung
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Suk-Ho Baek
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jae Sung Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea
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Shah GM, Gong HS, Chae YJ, Kim YS, Kim J, Baek GH. Evaluation and Management of Osteoporosis and Sarcopenia in Patients with Distal Radius Fractures. Clin Orthop Surg 2020; 12:9-21. [PMID: 32117533 PMCID: PMC7031429 DOI: 10.4055/cios.2020.12.1.9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 07/29/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Abstract
Distal radius fractures (DRFs) are one of the most common fractures seen in elderly people. Patients with DRFs have a high incidence of osteoporosis and an increased risk of subsequent fractures, subtle early physical performance changes, and a high prevalence of sarcopenia. Since DRFs typically occur earlier than vertebral or hip fractures, they reflect early changes of the bone and muscle frailty and provide physicians with an opportunity to prevent progression of frailty and secondary fractures. In this review, we will discuss the concept of DRFs as a medical condition that is at the start of the fragility fracture cascade, recent advances in the diagnosis of bone fragility including emerging importance of cortical porosity, fracture healing with osteoporosis medications, and recent progress in research on sarcopenia in patients with DRFs.
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Affiliation(s)
- Gajendra Mani Shah
- Department of Orthopedics and Trauma Surgery, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ju Chae
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeun Soo Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Pavone V, Vescio A, Lucenti L, Chisari E, Canavese F, Testa G. Analysis of loss of reduction as risk factor for additional secondary displacement in children with displaced distal radius fractures treated conservatively. Orthop Traumatol Surg Res 2020; 106:193-198. [PMID: 31843512 DOI: 10.1016/j.otsr.2019.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/15/2019] [Revised: 09/18/2019] [Accepted: 10/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The distal radius is the most common site of fracture in childhood, and the conservative treatment is widely used. The major casting complication is the loss of reduction and the redisplacement of the fracture. HYPOTHESIS According to the risk factors, close reduction and casting is the gold standard as first option of treatment of distal radius fractures (DRFs). METHODS According to 1-week X-ray, 101 pediatric conservatively treated for DRFs patients were divided into 2 groups: Group A (non-displaced) and Group B (secondary displacement). The sample underwent radiographic follow-ups at the emergency room, 1, 2 and 6 weeks after-treatment. The radiographic assessment included initial translation grade, following Mani criteria; initial reduction quality; if there were fractures of both bones; and the cast (CsI), padding (PI), canterbury (CaI), gap (GI), and three-point (3PI) indices. RESULTS Group A had 16 Mani grade III-IV initial translations; 37 anatomic reductions (47.4%); 48.7% fractures of both bones; and index means of CsI: 0.8, PI: 0.2, CaI: 1.0, GI: 0.16, and 3PI: 0.9. Group B had 13 Mani grade III-IV initial translations; 3 anatomic reductions (13.0%); 65.2% fractures of both bone; and index means of CsI: 0.9, PI: 0.3, CaI: 1.2, GI: 0.18, and 3PI: 1.0. The overall odds ratio indices were CsI: 4.7, CaI: 4.8, GI: 2.4, PI: 3.2, and 3PI: 3.6. CONCLUSION The study hypothesis was partially confirmed: Casting is a simple, safe, effective, and inexpensive treatment DRFs in childhood. In our opinion, after a good-quality reduction, conservative treatment should be the gold standard for non-displaced and <50% of displaced fractures. CsI, PI, and CaI calculations are recommended as secondary displacement predictors. LEVEL OF EVIDENCE III, retrospective case control study.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95124 Catania, Italy.
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95124 Catania, Italy
| | - Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95124 Catania, Italy
| | - Emanuele Chisari
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95124 Catania, Italy
| | - Federico Canavese
- Department of Pediatric Surgery, University Hospital Estaing, 63003 Clermont Ferrand, France
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95124 Catania, Italy
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Kim DG, Seo GW, Nam HW. Trends in the Diagnosis of Osteoporosis in Patients with Distal Radius Fractures Based on a National Claims Database. J Bone Metab 2019; 26:247-252. [PMID: 31832390 PMCID: PMC6901691 DOI: 10.11005/jbm.2019.26.4.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/06/2019] [Revised: 10/21/2019] [Accepted: 10/31/2019] [Indexed: 11/11/2022] Open
Abstract
Background A history of osteoporotic fractures is strongly associated with the subsequent osteoporotic fractures. To prevent subsequent fractures, the diagnosis and treatment of osteoporosis following osteoporotic fractures are very important. A distal radius fracture (DRF) is the second most common type of osteoporotic fracture in South Korea. We analyzed the rate of osteoporosis diagnosis within 6 months post-DRF. Methods We used data from the Korean Health Insurance Review and Assessment Service nationwide claims database from 2010 to 2016. International Classification of Diseases, 10th revision codes and procedures codes were used to identify patients aged over 50 years with newly diagnosed DRFs; the osteoporosis assessments of these patients were then analyzed. We used Cochran-Armitage trend test to examine trends in osteoporosis diagnosis. Results A search of database identified 77,209 DRFs in patient aged above 50 years of age from 2011 to 2016. Among these patients, only 19,305 (25.0%) underwent diagnostic examination for osteoporosis. The number of osteoporosis examinations increased slightly, but not significantly, every year (P=0.061). Conclusions Clinicians who treat DRFs shoulder also evaluated patients for osteoporosis after DRFs.
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Affiliation(s)
- Dae Geun Kim
- Department of Orthopedic Surgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Gi-Won Seo
- Department of Orthopedic Surgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Hye-Won Nam
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
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Dilek B, Ayhan C, Yagci G, Yakut Y. Effectiveness of the graded motor imagery to improve hand function in patients with distal radius fracture: A randomized controlled trial. J Hand Ther 2019; 31:2-9.e1. [PMID: 29122370 DOI: 10.1016/j.jht.2017.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Received: 04/11/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Single-blinded randomized controlled trial. INTRODUCTION Pain management is essential in the early stages of the rehabilitation of distal radius fractures (DRFx). Pain intensity at the acute stage is considered important for determining the individual recovery process, given that higher pain intensity and persistent pain duration negatively affect the function and cortical activity of pain response. Graded motor imagery (GMI) and its components are recent pain management strategies, established on a neuroscience basis. PURPOSE OF THE STUDY To investigate the effectiveness of GMI in hand function in patients with DRFx. METHODS Thirty-six participants were randomly allocated to either GMI (n = 17; 52.59 [9.8] years) or control (n = 19; 47.16 [10.5] years) groups. The GMI group received imagery treatment in addition to traditional rehabilitation, and the control group received traditional rehabilitation for 8 weeks. The assessments included pain at rest and during activity using the visual analog scale, wrist and forearm active range of motion (ROM) with universal goniometer, grip strength with the hydraulic dynamometer (Jamar; Bolingbrook, IL), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire, and the Michigan Hand Questionnaire. Assessments were performed twice at baseline and at the end of the eighth week. RESULTS The GMI group showed greater improvement in pain intensity (during rest, 2.24; activity, 6.18 points), wrist ROM (flexion, -40.59; extension, -45.59; radial deviation, -25.59; and ulnar deviation, -26.77 points) and forearm ROM (supination, -43.82 points), and functional status (Disability of the Arm, Shoulder and Hand Questionnaire, 38.00; Michigan Hand Questionnaire, -32.53 points) when compared with the control group (for all, P < .05). CONCLUSION The cortical model of pathological pain suggests new strategies established on a neuroscience basis. These strategies aim to normalize the cortical proprioceptive representation and reduce pain. One of these recent strategies, GMI appears to provide beneficial effects to control pain, improve grip strength, and increase upper extremity functions in patients with DRFx.
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Affiliation(s)
- Burcu Dilek
- Department of Physical Therapy and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey.
| | - Cigdem Ayhan
- Physiotherapy and Rehabilitation Department, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Gozde Yagci
- Physiotherapy and Rehabilitation Department, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Yavuz Yakut
- Department of Physical Therapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
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Hiraga Y, Hisano S, Mizunoe A, Nomiyama K. The mediating effect of psychological factors on the relationship between pain intensity and wrist joint function: a longitudinal study with mediation analysis. Disabil Rehabil 2019; 43:1814-1818. [PMID: 31599170 DOI: 10.1080/09638288.2019.1676318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Psychological factors and pain intensity are associated with wrist function. However, the mediating role of psychological factors in the relationship between pain intensity and wrist function in distal radius fractures remains unclear. We performed mediation analysis to investigate how psychological factors mediate the relationship between pain intensity and wrist function. METHODS Twenty-one patients with distal radius fractures were included in this longitudinal study. Patient-rated wrist evaluation, one pain intensity-related outcome measure (numerical rating scale), and three psychological outcome measures (pain catastrophizing scale, hospital anxiety and depression scale, and pain self-efficacy questionnaire) were assessed. The mediation analysis with a bootstrap sampling procedure was used to assess indirect effects. The level of significance was set at 5%. RESULTS Mediation analysis showed that the pain intensity, as measured by patient-rated wrist evaluation, had significant indirect effects on the hospital anxiety and depression scale-anxiety (95% bootstrapped confidence interval: 0.96-9.62) and pain self-efficacy questionnaire (95% bootstrapped confidence interval: 0.43-8.11) scores. CONCLUSIONS The relationship between pain intensity and wrist function was mediated by anxiety and self-efficacy. Our findings suggest that interventions focused on psychological factors, particularly anxiety and self-efficacy, may be important in distal radius fractures rehabilitation.IMPLICATIONS FOR REHABILITATIONIn patients with distal radius fractures, early post-operative pain mediates psychological factors and affects wrist function.Anxiety and self-efficacy are psychological factors that should be noted, and rehabilitation, including self-management, should be considered.Rehabilitative interventions for distal radius fractures should focus on psychological factors and management of post-operative pain.
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Affiliation(s)
- Yuki Hiraga
- Fukuoka Rehabilitation Hospital, Fukuoka, Japan.,Department of Health Care Administration and Management, Graduate School of Kyushu University, Fukuoka, Japan
| | - Shinya Hisano
- Department of Occupational Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Aya Mizunoe
- Fukuoka Rehabilitation Hospital, Fukuoka, Japan
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Lee DY, Park YJ, Park JS. A Meta-analysis of Studies of Volar Locking Plate Fixation of Distal Radius Fractures: Conventional versus Minimally Invasive Plate Osteosynthesis. Clin Orthop Surg 2019; 11:208-219. [PMID: 31156774 PMCID: PMC6526124 DOI: 10.4055/cios.2019.11.2.208] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/13/2018] [Revised: 12/05/2018] [Accepted: 12/19/2018] [Indexed: 02/04/2023] Open
Abstract
Background Open reduction and internal fixation using a volar locking plate has been increasingly performed for distal radius fractures. Both conventional and minimally invasive plate osteosynthesis (MIPO) techniques are widely used to treat distal radius fractures. However, it is unclear which of the techniques yields better outcomes after surgery for distal radius fractures. The purpose of this meta-analysis was to compare the benefits of conventional and MIPO techniques for distal radius fractures in terms of clinical outcomes. Methods Medline, Embase, and the Cochrane Central Register of Controlled Trials electronic databases were searched for articles comparing the outcomes of the conventional and MIPO techniques and published up until July 2017. Data search, extraction, analysis, and quality assessment were performed based on the Cochrane Collaboration guidelines. Clinical outcomes were evaluated using various outcome measures. Results Four clinical studies were included in the analysis. No significant clinical differences were found between the techniques in clinical hand scoring, grip strength, and range of motion. However, patient satisfaction after surgery was significantly higher in the MIPO group than that in the conventional group (standard mean difference, −0.54; 95% confidence interval [CI], −0.79 to −0.29; I2 = 0%). Furthermore, although there were no significant differences in volar tilt and ulnar variance between the two groups, radial inclination revealed a significant difference between the two groups (radial inclination: weighted mean difference, 1.20; 95% CI, 0.25 to 2.15; I2 = 19%). Conclusions Both conventional and MIPO techniques were effective for patients with distal radius fractures. Despite limited high quality evidence to compare osteosynthesis with a volar locking plate via the conventional and MIPO techniques, the present study showed that the MIPO technique was associated with more favorable patient satisfaction.
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Affiliation(s)
- Dong-Yeong Lee
- Department of Orthopaedic Surgery, Armed Forces Daegu Hospital, Gyeongsan, Korea
| | - Young-Jin Park
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Sung Park
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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He HY, Zhang JZ, Wang XW, Liu Z. [Acumed intramedullary nail for the treatment of adult diaphyseal both-bone forearm fractures]. Zhongguo Gu Shang 2019; 31:803-807. [PMID: 30332871 DOI: 10.3969/j.issn.1003-0034.2018.09.005] [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] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the results of Acumed intramedullary nail for the treatment of adult diaphyseal fractures of both-bone forearm fractures. METHODS From January 2009 to December 2016, 86 adult patients with both forearm fractures were treated by intramedullary nail including 54 males and 32 females with an average age of 36.8 years old ranging from 18 to 72 years old;There were 50 cases were on the right and 36 cases on the left. The operation time, blood loss and X-ray expose time intra-operation, time of fracture union, complications, DASH(Disabilities of the Arm, Shoulder and Hand questionnaire), Grace-Eversman criteria were recorded to evaluate the clinical outcomes of intramedullary nail for the treatment of forearm fractures. RESULTS All patients were followed up from 48 to 144 weeks with an average of 86.8 weeks; the blood loss intraoperation was 30 to 80 ml with an average of 52 ml; the the X-ray expose time was 1 to 6 min with an average of 2.5 min;the operation time was 31 to 55 min with an average of 46 min; Among them, 85 cases healed successfully, the union time was 10 to 16 weeks with an average of 13.3 weeks. There were 1 case of hypertrophic nonunion, 1 case of ulnar radial bone bridge formation, and 1 case of extensor hallucis longus tendon injury. The DASH score was 4 to 37(means 15.6); according to Grace-Eversman criteria, the results were excellent in 65 cases, good in 15, acceptable in 5, poor in 1. CONCLUSIONS Intramedullary fixation method in treating both-bone forearm fractures has advantages of closed application, short operation time, little complication, and clinical outcomes is satisfied.
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Affiliation(s)
- Hong-Ying He
- Department of Orthopedics, General Hospital of PLA, Beijing 100700, China
| | - Jian-Zheng Zhang
- Department of Orthopedics, General Hospital of PLA, Beijing 100700, China
| | - Xiao-Wei Wang
- Department of Orthopedics, General Hospital of PLA, Beijing 100700, China
| | - Zhi Liu
- Department of Orthopedics, General Hospital of PLA, Beijing 100700, China;
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Akma Kamaludin NA, Ferdaus Kamudin NA, Abdullah S, Sapuan J. Ipsilateral proximal and distal radius fractures with unstable elbow joint: Which should we address first? Chin J Traumatol 2019; 22:59-62. [PMID: 30745113 DOI: 10.1016/j.cjtee.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/27/2018] [Accepted: 07/06/2018] [Indexed: 02/04/2023] Open
Abstract
Simultaneous ipsilateral fractures involving radial head and distal end of radius are uncommon. We present our thoughts on which fracture should be addressed first. A 68-year-old lady sustained an ipsilateral fracture of the right radial head and distal end of radius following a fall. Clinically her right elbow was posteriorly dislocated and right wrist was deformed. Plain radiographs showed an intraarticular fracture of the distal end of radius and a comminution radial head fracture with a proximally migrated radius. Magnetic resonance imaging (MRI) showed no significant ligament injuries. We addressed her distal radius first with an anatomical locking plate followed by her radial head with a radial head replacement. Our rationale to treat the distal end radius: first was to obtain a correct alignment of Lister's tubercle and correct the distal radius height. Lister's tubercle was used to guide for the correct rotation of the radial head prosthesis. Correcting the distal end fracture radial height helped us with length selection of the radial head prosthesis and address the proximally migrated radial shaft and neck. Postoperative radiographs showed an acceptable reduction. The Cooney score was 75 at 3 months postoperatively, which was equivalent to a fair functional outcome.
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Li SL, Li A, Cui P, Zhang YZ. [Epidemic characteristics of adult Barton's fractures between Western and Eastern of China from 2010 to 2011]. Zhonghua Yi Xue Za Zhi 2019; 99:62-6. [PMID: 30641668 DOI: 10.3760/cma.j.issn.0376-2491.2019.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare and analyze the epidemiological features of adult patients with Barton's fractures between Western and Eastern in China. Methods: The data of adult patients with Barton's fractures treated from January 2010 to December 2011 in 63 hospitals in Western and Eastern of China were collected through the picture archiving and communication systems (PACs) and case reports checking system. The data of 28 hospitals in Western China were classified as group Western, while data of 35 hospitals in Eastern China were classified as group Eastern, and the analytic items included gender, age and age distribution. The counting data were tested by chi-square test, and the measurement data were compared with the corresponding statistical methods according to the normality. Results: A total of 1 191 cases were collected, accounted for 4.0% of all the distal radius fracture (1 191/29 825). The total male/female ratio was 1∶1.02. The adult Barton's fractures predominated in an age range from 51 to 60 years (21.4%). There were 736 cases of volar Barton's fractures (61.8%), and 455 cases of dorsal Barton's fractures (38.2%). The patients were divided into group Western (403 cases) and group Eastern (788 cases) respectively. There were 222(55.1%) males and 181(44.9%) females in group Western, while 368(46.7%) males and 420(53.3%) females in group Eastern (χ(2)=7.502, P<0.05). The median age of the two groups were 44(16-94) years and 51(16-91) years (Z=-5.079, P<0.05). Cases of volar and dorsal Barton's fractures in group Western were 238 and 165 cases, while there were 498 and 290 cases in Group Eastern (χ(2)=1.937, P>0.05). Conclusions: The peak age of adult Barton's fractures is from 51 to 60 years with more female patients than male. Volar Barton's fractures outnumbers dorsal type. In Western China, the majority are male patients, which differs from Eastern. The patient age in Western China is significantly lower than it in Eastern.
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Hu ZJ, Li M, Liu X, Liu CK. Palmar approach with Kirschner-wire fixation in the treatment of children's distal radius extension type fracture. Chin J Traumatol 2018; 21:301-303. [PMID: 30340978 PMCID: PMC6235786 DOI: 10.1016/j.cjtee.2018.08.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/29/2018] [Accepted: 09/02/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To explore the advantages of palmar approach with Kirschner-wire (K-wire) fixation in the treatment of children's distal radius extension type fracture. METHODS Thirty patients, average age of 8.5 years ranging from 5 to 13 years, with distal radius extension type fracture and undergoing a failed manual reposition in our hospital were included, and treated by palmar approach with K-wire fixation between May 2014 and December 2017. Among these patients (21 male and 9 female), 5 patients had chronic injuries over 10 days, and 6 patients had fracture of the distal radius epiphysis. The time between injury and treatment ranged from 1 to 30 days. Among them, 11 patients with right-sided fractures and 19 patients with left-sided fractures were operated via the palmar longitudinal incision approach. RESULTS The results were evaluated after an average of 18 months ranging from 5 to 36 months after operation. The recovery time of fracture was from 4 to 8 weeks and all incisions were primary healing with an average of 6 weeks. Nonunion, delayed union, early closure of distal radial epiphysis, and wrist varus/valgus deformity were not found in all the cases. Based on Gartland and Wereley wrist score assessment undertaken three months after operation, excellent scores were achieved in 24 cases, good scores in 3 cases, acceptable scores in 3 cases. CONCLUSION The palmar approach with K-wire fixation via a front longitudinal incision in the treatment of children's distal radius extension type fracture has following advantages: (1) easy to reposition for both fresh and old fractures; (2) less damage to surrounding tissues and epiphysis; (3) quick recovery. It is suitable to treat children's distal radius extension type fracture.
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Lin HM, Ma YP, Hu CT, Zhou ZJ. [Modified Metaizeau's technique for the treatment of radial neck fractures of Judet III or IV in children]. Zhongguo Gu Shang 2018; 31:790-793. [PMID: 30332868 DOI: 10.3969/j.issn.1003-0034.2018.09.002] [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] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the clinical effect of modified Metaizeau's technique for radial neck fractures of Judet II or IV in children, summarizing the value of clinical application. METHODS From May 2014 to March 2017, 32 children of Judet III or IV radial neck fractures were treated with percutaneous Kirschner wire poking reduction and closed reduction with elastic intramedullary nailing fixation, including 21 boys and 11 girls, aged from 5.7 to 10.6 years old with a mean of 7.2 years old. The modified An-Morrey functional rating index were used to evaluate elbow range of motion, myodynamia, stability, and pain preoperatively and 1 year postoperatively in all the patients. RESULTS All patients were available for an average follow-up from 12 to 15 months. No complications such as incision infection, wire or nail tail irritation and avascular necrosis of radial head and epiphyses was occurred. The fracture achieved solid healing at 8 to 10 weeks after operation. The modified An and Morrey functional score improved from 58.69±5.80 before operation to 99.13±1.79 at 1 year after operation, there was obvious difference of scores between preoperative and postoperative at 1 year. CONCLUSIONS Modified Metaizeau's technique is a reliable and good treatment for Judet III or IV radial neck fractures in children, which has advantages of few complication, minimal invasion, quick fracture union and good recovery of elbow joint.
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Affiliation(s)
- Hong-Ming Lin
- Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China;
| | - Yi-Ping Ma
- Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China
| | - Cheng-Ting Hu
- Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China
| | - Zhi-Juan Zhou
- Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China
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Cheng YB, Yang S. [Open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures]. Zhongguo Gu Shang 2018; 31:651-655. [PMID: 30103589 DOI: 10.3969/j.issn.1003-0034.2018.07.012] [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] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore clinical effect of open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures. METHODS From January 2015 to June 2016, 13 patients with type B4 distal radius fractures treated with bone graft with internal fixation through bone window, including 9 males and 4 females aged from 18 to 36 years old with an average of 26.3 years old. Fractures were classified to type B4 according to AO/OTA classification. Fracture healing and postoperative complication were observed, VAS score was used to evaluate pain, and Cooney wrist scoring was applied to evaluate recovery of function. RESULTS All patients were followed up from 10 to 14 months with an average of 12.4 months. Fracture healed from 4 to 6months with an average of 5.2 months. According to Cooney wrist scoring, 10 got excellent results, 2 good and 1 moderate. VAS score was 1.0±1.1, grip strength of contralateral ratio was (88.2±2.7)%, palmer tilt angle was (12.2±3.8)°, ulnar drift angle was (19.3±5.4)°, wrist flexion mobility was (118.1±2.3)°, forearm rotation motion was (158.0±13.0)°. No osteoarthritis occurred and symptoms occurred during follow-up. CONCLUSIONS Open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures, which has advantages of satisfied clinical effects, less complications, is one of the effective method for type B4 distal radius fractures.
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Affiliation(s)
- Ya-Bo Cheng
- Department of Wrist, Sichuan Provincial Orthopedic Hospital, Chengdu 610041 Sichuan, China;
| | - Shun Yang
- Department of Wrist, Sichuan Provincial Orthopedic Hospital, Chengdu 610041 Sichuan, China
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Lee JK, Yoon BH, Oh CH, Kim JG, Han SH. Is Sarcopenia a Potential Risk Factor for Distal Radius Fracture? Analysis Using Propensity Score Matching. J Bone Metab 2018; 25:99-106. [PMID: 29900159 PMCID: PMC5995757 DOI: 10.11005/jbm.2018.25.2.99] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 12/15/2022] Open
Abstract
Background Cases of low-energy-induced distal radius fracture (DRF) are increasing. Sarcopenia is considered to be an independent risk factor for fragility fractures. We compared body appendicular lean muscle mass (ALM) and bone mineral density (BMD) in patients with DRF and a comparable control population. This study aimed to investigate the correlation between skeletal muscle mass and DRF. Methods We performed a retrospective review of patients diagnosed with fragility DRF. The DRF group included 87 patients treated at our institute. The control group comprised data for 87 individuals in the general population from among 2,124 selected using nearest-neighbor propensity scoring, based on age, weight, height, and body mass index. All medical conditions and past history were also compared between the two groups. Results The relative overall ALM, combining arm and leg lean body mass divided by height squared, was not significantly different (DRF group, 6.093 kg/m2; controls, 5.945 kg/m2). T-score, a parameter of BMD, was significantly different between groups (DRF, −2.42; controls, −2.05). The proportion of patients with osteoporosis was significantly different (DRF, 44 [50.6%] vs. control, 29 [33.3%], respectively). Conclusions Patients with DRF did not have significantly lower average lean body mass. BMD was significantly lower in patients with DRF than in controls.
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Affiliation(s)
- Jun-Ku Lee
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Chi Hoon Oh
- Department of Orthopaedic Surgery, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Soo-Hong Han
- Department of Orthopaedic Surgery, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
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Nietschke R, Burkhart KJ, Hollinger B, Dehlinger FI, Zimmerer A, Schneider MM. Reasons for surgical revision after conservatively treated radial head fractures-retrospective study of 70 patients. Obere Extrem 2018; 13:112-20. [PMID: 29887917 DOI: 10.1007/s11678-018-0456-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 04/16/2018] [Indexed: 11/23/2022]
Abstract
Background An inadequate clinical outcome after conservatively treated radial head fractures is not uncommon. We analyzed the subjective limitations, objective complaints, and surgical procedures for radial head fractures initially treated conservatively. Patients and method Between 2007 and 2016, 70 patients (42 men, 28 women) who suffered from fracture sequelae after conservatively treated radial head fractures were examined. Demographic (age, 41.8 years, range, 16–75 years) and clinical data (pain, range of motion, instability) were retrospectively evaluated. Results The average time to surgery after trauma was 50 months (range, 5–360 months). In 38 cases, radial head fractures were initially treated with immobilization for 3.4 weeks (range, 1–8 weeks). Physiotherapeutic treatment was performed in 39 cases. In only half of the cases was retrospective Mason classification possible: 20 type I, 8 type II, 5 type III, and 2 type IV. Of the 70 patients, 53 had posttraumatic elbow stiffness; 34 had isolated lateral and four patients isolated medial ligament instability. There were eight cases with a combination of lateral and medial ligament instability and 27 cases of elbow stiffness combined with instability. An average of 1.2 (range, 1–4) surgical procedures per patient were performed. In all, 64 patients underwent elbow arthroscopy with arthrolysis and additional treatment depending on other injuries. The range of motion improved on average from preoperative flexion/extension of 131–15–0° to postoperative flexion/extension of 135–5–0° (gain in flexion: 4.2° and extension: 10.6°). Conclusion Conservative treatment of radial head fractures does not always yield good results. Reasons for a poor outcome include chronic instability, cartilage damage, stiffness, or a combination thereof. Improved outcomes can be achieved via arthroscopic arthrolysis.
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Xu SQ, Zhang Y, Zhang WJ, Li P. [Treatment of distal radius fracture with manual reduction and external fixation with small splint steel support external fixation]. Zhongguo Gu Shang 2018; 31:436-440. [PMID: 29890803 DOI: 10.3969/j.issn.1003-0034.2018.05.008] [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] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the short-term result for the treatment of distal radius fracture with manual resetting and fixing with small splint. METHODS From January 2015 to December 2016, 60 cases of distal radial fractures were treated by manual resetting and small splint fixation including 39 males and 21 females with an average age of (43.50±10.56) years old ranging from 18 to 65 years old. According to AO classification, 38 cases were type A, 19 cases were type B, 3 cases were type C. The anteroposterior and lateral X-ray of the wrist joint was performed before reduction, 1, 2, 4 weeks after reduction, and the removal of the small splint, the palm inclination angle, ulnar deviation angle and radius height were measured. At 8, 24 and 48 weeks after reduction, the wrist extensor, palmar flexion, pronation, supination, ulnar deviation and radial deviation were measured. Wrist strength was measured at 4, 8, 24 and 48 weeks after fracture reduction. After the distal radius fracture healed, the splint support was removed. After dismantling small splint steel support, Mayo score of wrist joint was performed. RESULTS All cases of distal radius fractures were followed up, the healing time of fracture was 6 to 8 (7.1±0.9) weeks. The difference of palmar obliquity, ulnar deviation angle and radius shortening between before reduction and 2 weeks after reduction was statistically significant. There was no significant difference in palmar inclination, ulnar deviation and radius shortening between 2 and 4 weeks after reduction. After 24 weeks and 8 weeks, 48 weeks and 24 weeks after reduction, there was significant difference in wrist extensor, palmar flexion, pronation, supination, ulnar deviation and radial deviation. The grip strength was statistically significant between after reduction and 4 weeks after reduction, 8 weeks and 4 weeks after reduction, 16 weeks and 8 weeks after reduction, 24 and 16 weeks after reduction. There was no significant difference in grip strength between 48 weeks and 24 weeks after reduction. The Mayo wrist function scoring system was used to evaluate the curative effect, the results were excellent in 50 cases, good in 8 cases, fair in 1 case and poor in 1 case. CONCLUSIONS The treatment of distal radius fracture with the method of manual resetting and fixing with plywood is simple and the clinical efficacy is accurate.
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Affiliation(s)
- Shan-Qiang Xu
- The 2nd Department of Foot and Ankle, Sichuan Provincial Orthopaedics Hospital, Sichuan 610041, Chengdu, China;
| | - Yu Zhang
- The 2nd Department of Foot and Ankle, Sichuan Provincial Orthopaedics Hospital, Sichuan 610041, Chengdu, China
| | - Wen-Ju Zhang
- The 2nd Department of Foot and Ankle, Sichuan Provincial Orthopaedics Hospital, Sichuan 610041, Chengdu, China
| | - Ping Li
- The 2nd Department of Foot and Ankle, Sichuan Provincial Orthopaedics Hospital, Sichuan 610041, Chengdu, China
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Lee JK, Lee SH, Sim YS, Kim TH, Baek E, Han SH. Juxta-articular Plate Fixation in Distal Radius Intra-articular Fractures with Accompanying Volar Free Fragments beyond the Watershed Line. Clin Orthop Surg 2018; 10:135-141. [PMID: 29854335 PMCID: PMC5964260 DOI: 10.4055/cios.2018.10.2.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/20/2017] [Accepted: 02/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background Although distal radius fractures (DRF) are common fractures, intra-articular comminuted DRF with volar free fragments are uncommon. There is considerable difficulty in the fixation of free fragments beyond the watershed line using the existing volar locking plate. We aimed to examine the efficacy and potential complications associated with the use of juxta-articular volar plates in intra-articular DRF accompanied by free fragments beyond the watershed line. Methods The patients were enrolled in a consecutive manner between 2007 and 2016. In cases of DRF with free fragments beyond the watershed line, we employed a 2.4-mm small fragment juxta-articular volar locking compression plate using a volar Henry approach. A total of 32 patients were included in this study. There were 15 males and 17 females with a mean age of 52.3 years (range, 33 to 69 years). The mean follow-up period was 14.5 months (range, 10 to 24 months). Preoperative radiographs and three-dimensional computed tomography images were used to analyze fracture patterns and assess the free fragments beyond the watershed line. The mean number of free fracture fragments beyond the watershed line was 2.33. Plain radiographs of immediate postoperative and last follow-up were used to confirm fracture union, incongruence, radial height, volar tilt, radial inclination, and arthritic changes. For functional assessment, we measured grip strength, range of motion (ROM), modified Mayo wrist score (MMWS) and determined Disabilities of Arm, Shoulder and Hand (DASH) scores at the last follow-up. Postoperative complications were monitored during the follow-up period. Results All patients obtained sound union without significant complications. At the last follow-up, 16 cases presented with an articular step-off of more than 1 mm (mean, 1.10 mm). The mean MMWS was 76.3 (range, 55 to 90), mean DASH score was 15.38 (range, 9 to 22), mean visual analogue scale score for pain was 1.2 and mean grip strength was 75.5% of the opposite side. The mean ROM was 74.3° for volar flexion and 71.5° for dorsiflexion. Conclusions In cases of intra-articular DRF with free fragments beyond the watershed line, a volar approach with use of a juxtaarticular plate provided favorable outcomes without significant complications.
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Affiliation(s)
- Jun-Ku Lee
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Soo-Hyun Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Young-Suk Sim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Tae-Ho Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eugene Baek
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Soo-Hong Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Liu T, Bao FL, Kang SJ, Jiang T, Huang DS, Gao W, Geng LJ, Hu YM. [Operative strategy and clinical results of complex four part distal radius fractures by combined palmar and dorsal internal fixation]. Zhonghua Wai Ke Za Zhi 2018. [PMID: 29534411 DOI: 10.3760/cma.j.issn.0529-5815.2018.03.004] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore a standard procedure for the treatment of combined dorsal and palmar internal fixation for complex four part distal radius fractures and assess its clinical results. Methods: From May 2009 to October 2016, 38 patients(39 sides)who suffered from complex four part distal radius fractures were performed operatively with open reduction and internal fixation via combined dorsal and palmar approach in Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao). The series included 22 males(22 sides) and 16 females(17 sides). Age of the patients was 53.5 years ranging from 25 to 79 years.According to Melone classification, there were 34 sides of type of Ⅳ, 5 of type Ⅴ.According to Frykman classification, there were 15 sides of type Ⅶ, 24 sides of type Ⅷ, and all the cases were type C3 according to AO/OTA classification.Preoperatively, the key articular fragments in four part distal radius fractures were identified and the individual fracture patterns from conventional X-ray and CT-scan were analyzed. All the patients were performed combined volar and dorsal fixation.Firstly, a palmar approach which gave access to and fix the palmar-ulnar fragment and the radial styloid fragment was performed.Then a limited dorsal approach across the third extensor compartment which gave access to the dorso-ulnar fragment and a limited dorsal arthrotomy to visualize the radiocarpal joint when necessary were performed.Through dorsal approach, we can address the dorso-ulnar fragment, free intra-articular fragment and direct visualize the joint.Use of a retinacular flap was routinely advocated to help prevent against tendon irritation and rupture.The follow-up control included conventional X-ray, range of motion(ROM), grip strength, and the disabilities of the arm, shoulder and hand index(DASH), as well as the patient-rated wrist evaluation(PRWE) score for functional outcome at 6 and 12 months. Results: Thirty-three patients(34 sides) were followed up for at least 12 months.The would healed well in all cases 2 weeks postoperatively, and no soft tissue infections, necrosis or neurovascular complications occurred.All the fractures of 38 cases(39 sides)healed averaged 3.6 months(ranging from 2.5-5.7 months), and no loss of reduction occurred postoperatively.Anatomic reconstruction with a step or gap of <1 mm was achieved in 37 cases(38 sides), Whereas 5 patients were lost to follow-up at 12 months postoperatively.ROM and grip strength were all recovered to over 85% of the unaffected side(exception of the bilateral patient). Median DASH-index and PRWE were 6.5(0-17) and 9.3(0-20)respectively. Conclusion: Combined volar and dorsal approaches allow achieving anatomic reconstruction in complex four part intra-articular distal radius fractures and reveal good functional outcomes at intermediate follow-up.
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Affiliation(s)
- T Liu
- Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao), Qingdao 266035, China
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