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Hansen V, Jensen J, Kusk MW, Gerke O, Tromborg HB, Lysdahlgaard S. Deep learning performance compared to healthcare experts in detecting wrist fractures from radiographs: A systematic review and meta-analysis. Eur J Radiol 2024; 174:111399. [PMID: 38428318 DOI: 10.1016/j.ejrad.2024.111399] [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: 11/28/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of the diagnostic accuracy of deep learning (DL) algorithms in the diagnosis of wrist fractures (WF) on plain wrist radiographs, taking healthcare experts consensus as reference standard. METHODS Embase, Medline, PubMed, Scopus and Web of Science were searched in the period from 1 Jan 2012 to 9 March 2023. Eligible studies were patients with wrist radiographs for radial and ulnar fractures as the target condition, studies using DL algorithms based on convolutional neural networks (CNN), and healthcare experts consensus as the minimum reference standard. Studies were assessed with a modified QUADAS-2 tool, and we applied a bivariate random-effects model for meta-analysis of diagnostic test accuracy data. RESULTS Our study was registered at PROSPERO with ID: CRD42023431398. We included 6 unique studies for meta-analysis, with a total of 33,026 radiographs. CNN performance compared to reference standards for the included articles found a summary sensitivity of 92% (95% CI: 80%-97%) and a summary specificity of 93% (95% CI: 76%-98%). The generalized bivariate I-squared statistic indicated considerable heterogeneity between the studies (81.90%). Four studies had one or more domains at high risk of bias and two studies had concerns regarding applicability. CONCLUSION The diagnostic accuracy of CNNs was comparable to that of healthcare experts in wrist radiographs for investigation of WF. There is a need for studies with a robust reference standard, external data-set validation and investigation of diagnostic performance of healthcare experts aided with CNNs. CLINICAL RELEVANCE STATEMENT DL matches healthcare experts in diagnosing WFs, which potentially benefits patient diagnosis.
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Affiliation(s)
- V Hansen
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - J Jensen
- Department of Radiology, Odense University Hospital, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - M W Kusk
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Imaging Research Initiative Southwest (IRIS), Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark; Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield 4, Dublin, Ireland
| | - O Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H B Tromborg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
| | - S Lysdahlgaard
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Imaging Research Initiative Southwest (IRIS), Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark.
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Wieschollek S, Megerle K. [Concomitant injuries of the wrist, distal ulna and distal radioulnar joint in distal radius fractures : Primary operative cotreatment vs. healing with no additional treatment]. Unfallchirurgie (Heidelb) 2024:10.1007/s00113-024-01424-2. [PMID: 38592447 DOI: 10.1007/s00113-024-01424-2] [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: 03/04/2024] [Indexed: 04/10/2024]
Abstract
Distal radius fractures are the most common fractures in adults and account for one quarter of all fractures, with increasing incidence. The number of patients and the requirement of an exact treatment are high. Continuous developments in diagnostic and operative possibilities enable in many cases a high-quality treatment with good clinical outcome; however, radius fractures rarely occur alone but in combination with additional fractures or ligamentous injuries. The frequency and extent of these injuries are not linked to the complexity of the primary injury. The aim is to recognize and correctly diagnose potential concomitant injuries. Many injuries do not need immediate treatment but heal without additional treatment after the radius has been treated. It is important to recognize those injuries which can cause severe complications if untreated; however, exactly this is often difficult. In many cases there is still no consensus if and how concomitant injuries should be treated. This article highlights the most frequent concomitant injuries in distal radius fractures with the possible advantages and disadvantages of cotreatment in order to facilitate decision making.
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Affiliation(s)
- Stefanie Wieschollek
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland.
| | - Kai Megerle
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland
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Eyler Y, Sever M, Turgut A, Ocak NY, Onata A, Gürsoy O. External validation of the "deformity, edema, and pain in pronation" model for predicting wrist fractures. Am J Emerg Med 2024; 78:95-101. [PMID: 38244246 DOI: 10.1016/j.ajem.2024.01.011] [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: 08/20/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The aim of this study is to externally validate the "Deformity, Edema, and Pain in Pronation" model, which determines the necessity for radiography in patients with wrist trauma. METHODS This prospective, cross-sectional study was performed in a tertiary emergency department (ED). All patients admitted to the ED with wrist trauma aged 18 years and older were included in the study. Patients who did not have acute and blunt wrist trauma, those who could not be fully examined due to various reasons, and patients who did not wish to participate were excluded. Each patient was examined by their responsible physician, and imaging tests were requested based on the indications. All radiographic images were evaluated by an orthopedic surgeon who was blinded to the clinical information. This evaluation was accepted as the standard reference for diagnosing fractures. RESULTS 391 patients were included in the study. 170 patients (43.5%) had at least one fracture. The sensitivity and specificity of the model formed in our study in predicting wrist fractures were 98.77% (95% CI: 95.61-99.85) and 27.60% (95% CI 21.82-34.00), respectively. The area under the receiver operating characteristic curve (AUC) on external validation of the model was 0.878 (p < 0.001; 95% CI: 0.844-0.913). With the practice of this rule, there would be a 16% decrease in X-ray imaging request, while only 0.5% patients would have missed inoperable fractures. CONCLUSION The "deformity, edema, and pain in pronation" model is a reliable and practical clinical decision rule for determining the necessity of radiography in wrist trauma.
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Affiliation(s)
- Yesim Eyler
- Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Mustafa Sever
- Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Turgut
- Department of Orthopedics and Traumatology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Necmiye Yalcin Ocak
- Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ahmet Onata
- Emergency Department, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Olcay Gürsoy
- Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
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Murray NM, Shefrin A. CJEM Journal Club Snelling 2023: ultrasonography or radiography for suspected pediatric distal forearm fractures. CAN J EMERG MED 2024; 26:164-165. [PMID: 38198035 DOI: 10.1007/s43678-023-00643-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Nathaniel M Murray
- Department of Emergency Medicine, University of Ottawa, TOH-Civic Camps, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
| | - Allan Shefrin
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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Elbardesy H, Yousaf MI, Reidy D, Ansari MI, Harty J. Distal radial fractures in adults: 4 versus 6 weeks of cast immobilisation after closed reduction, a randomised controlled trial. Eur J Orthop Surg Traumatol 2023; 33:3469-3474. [PMID: 37191887 DOI: 10.1007/s00590-023-03574-2] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE In this study, we aim to evaluate whether the functional outcome of Distal Radius Fractures (DRFs) could be enhanced by shortening the period of immobilisation from six weeks to four weeks. METHODS This study is a single blinded randomised controlled trial. Four week plaster cast immobilisation was compared with six week plaster cast immobilisation in adult patients (older than 18 years) with adequately reduced DRFs. The primary outcome parameters were functional outcome measured by Quick DASH score after 1-year follow-up. Secondary outcomes were: Quick DASH after three months, 6 months, range of motion, and complications (such as number of re-interventions, secondary displacement, delayed and non-union). RESULTS 80 patients (16 male and 64 female, mean age, 61.76 years) were included and randomized. 65 patients completed the 1-year follow-up. After 1-year follow up, no significant differences were found between the two groups in the QUICK DASH score (P = 0.55). Moreover, no significant differences in DASH Score after three and six months (P = 0.24, 0.28, respectively). The complication rate among both cohorts was almost similar, (P = 0.51). CONCLUSION Reduction in the time of cast immobilisation in patients with DRFs in accepted position reported similar outcomes. Of note, the complication rate in the four and six weeks was also the same. Thus, 4 weeks in cast is a safe immobilisation period. Clinical Trials Number Trial registration number and date of registration for prospectively registered trials at http://ClinicalTrials.gov (NCT05012345), on 19/08/2021.
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Affiliation(s)
- Hany Elbardesy
- Department of Trauma and Orthopaedic, Cork University Hospital, Cork, Ireland.
| | | | - David Reidy
- Department of Trauma and Orthopaedic, Cork University Hospital, Cork, Ireland
| | | | - James Harty
- Department of Trauma and Orthopaedic, Cork University Hospital, Cork, Ireland
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Jacques T, Cardot N, Ventre J, Demondion X, Cotten A. Commercially-available AI algorithm improves radiologists' sensitivity for wrist and hand fracture detection on X-ray, compared to a CT-based ground truth. Eur Radiol 2023:10.1007/s00330-023-10380-1. [PMID: 37919408 DOI: 10.1007/s00330-023-10380-1] [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: 12/28/2022] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Algorithms for fracture detection are spreading in clinical practice, but the use of X-ray-only ground truth can induce bias in their evaluation. This study assessed radiologists' performances to detect wrist and hand fractures on radiographs, using a commercially-available algorithm, compared to a computerized tomography (CT) ground truth. METHODS Post-traumatic hand and wrist CT and concomitant X-ray examinations were retrospectively gathered. Radiographs were labeled based on CT findings. The dataset was composed of 296 consecutive cases: 118 normal (39.9%), 178 pathological (60.1%) with a total of 267 fractures visible in CT. Twenty-three radiologists with various levels of experience reviewed all radiographs without AI, then using it, blinded towards CT results. RESULTS Using AI improved radiologists' sensitivity (Se, 0.658 to 0.703, p < 0.0001) and negative predictive value (NPV, 0.585 to 0.618, p < 0.0001), without affecting their specificity (Sp, 0.885 vs 0.891, p = 0.91) or positive predictive value (PPV, 0.887 vs 0.899, p = 0.08). On the radiographic dataset, based on the CT ground truth, stand-alone AI performances were 0.771 (Se), 0.898 (Sp), 0.684 (NPV), 0.915 (PPV), and 0.764 (AUROC) which were lower than previously reported, suggesting a potential underestimation of the number of missed fractures in the AI literature. CONCLUSIONS AI enabled radiologists to improve their sensitivity and negative predictive value for wrist and hand fracture detection on radiographs, without affecting their specificity or positive predictive value, compared to a CT-based ground truth. Using CT as gold standard for X-ray labels is innovative, leading to algorithm performance poorer than reported elsewhere, but probably closer to clinical reality. CLINICAL RELEVANCE STATEMENT Using an AI algorithm significantly improved radiologists' sensitivity and negative predictive value in detecting wrist and hand fractures on radiographs, with ground truth labels based on CT findings. KEY POINTS • Using CT as a ground truth for labeling X-rays is new in AI literature, and led to algorithm performance significantly poorer than reported elsewhere (AUROC: 0.764), but probably closer to clinical reality. • AI enabled radiologists to significantly improve their sensitivity (+ 4.5%) and negative predictive value (+ 3.3%) for the detection of wrist and hand fractures on X-rays. • There was no significant change in terms of specificity or positive predictive value.
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Affiliation(s)
- Thibaut Jacques
- Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59000, Lille, France.
- IRIS Radiology - Clinique Lille Sud, SOS Hands and Fingers, 96 Rue Gustave Delory, 59810, Lesquin, France.
| | - Nicolas Cardot
- Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59000, Lille, France
| | | | - Xavier Demondion
- Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59000, Lille, France
- Lille University School of Medicine, 59000, Lille, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59000, Lille, France
- Lille University School of Medicine, 59000, Lille, France
- MABLab - Marrow Adiposity and Bone Lab ULR4490, University of Lille, 59000, Lille, France
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Lee JH, Lee H, Gong HS. Spinal Sagittal Imbalance is Associated with Vertebral Fracture without a Definite History of Falls: Cross-Sectional, Comparative Study of Cohort with and without a Distal Radius Fracture. J Bone Metab 2023; 30:339-346. [PMID: 38073267 PMCID: PMC10721377 DOI: 10.11005/jbm.2023.30.4.339] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Treating osteoporosis in patients with a distal radius fracture (DRF) became paramount at the Fracture Liaison Service. Spinal sagittal imbalance emerged as a risk factor for subsequent fractures. Therefore, here we investigated the spinal profile of patients with DRF to investigate its association with a history of falls and prevalent vertebral fractures. METHODS We reviewed the cases of 162 women presenting with DRF and 162 age-matched women without fracture who underwent an osteoporosis evaluation including bone mineral density (BMD) and lateral spine imaging. We compared the incidence of prevalent vertebral fracture and sagittal vertical axis (SVA) to measure spinal sagittal imbalance. We also performed a regression analysis of the risks of prevalent vertebral fracture, such as age, body mass index (BMI), BMD, and SVA. RESULTS The SVA was significantly smaller (indicating more stable sagittal balance) in patients with a DRF versus controls (16 mm vs. 34 mm, respectively; p<0.001). The incidence of a prevalent vertebral fracture was similar between groups (12% vs. 15%, respectively; p=0.332). In both groups, the SVA was significantly greater in those with versus without a vertebral fracture. The vertebral fracture was significantly associated with age and SVA but not BMI or spinal BMD. CONCLUSIONS Spinal sagittal balance was superior in DRF patients, yet the frequency of prevalent vertebral fractures was similar. The identification of this unique spinal profile in patients with DRF may increase our understanding of osteoporotic fractures.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seoul,
Korea
| | - Hansang Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
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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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Maliyappa C, Raghupathi A, Rupasinghe D, Iancu P, Mohamed M, Qazzaz L. Outcome Analysis of Adult Distal Radius Fractures Managed during COVID-19 Pandemic. J Orthop Case Rep 2023; 13:53-57. [PMID: 37885643 PMCID: PMC10599360 DOI: 10.13107/jocr.2023.v13.i10.3934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/16/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction COVID-19 pandemic created extreme pressure situation on health care services across the globe with shortage of medical staff and beds. The management of fragility fracture also affected significantly. The distal radius fractures (DRFs) are one of the common frailty fractures. There was a significant shift in the treatment of such injuries with new guidelines leaning toward more of non-operative management. Case Report A retrospective cross-sectional study of DRFs (DRF) treated during COVID pandemic for a period of 1 year in the United Kingdom. This included all radiologically confirmed cases of DRFs with isolated adult injuries excluding polytrauma, same limb other injuries, associated neurovascular injuries, and age below 18 years. All patient's data were collected from hospital records retrospectively from April 2020 to March 2021. There were a total of 179 patients with distal radius fracture, of which 141 (78.8%) were females and 38 (21.2%) males. The mean age was 68.2 years (SD 68.20 ± 15.63) and there were greater number of patients with intra-articular fracture. There were 28.5% (Grades 1 and 2, Group I) extra-articular fractures; 69.8% (Grades 3-8, Group II) were intra-articular fractures and 3 Barton's fractures (Group III) accounted to 1.7%. 137 patients were (76.5%) treated to non-operatively and 42 (23.5%) were treated surgically. 135 (75.4%) patients had good and 43 (24%) satisfactory clinical outcomes. 3 (1.6%) patients required osteotomy for malunited fractures. Fracture grade I and II is significantly associated with non-operative procedure (100.0% vs 84.3%) with P < 0.001. Conclusion This study confirmed that non-operative treatment is still a good option even in intra-articular fractures. Surgical fixation should be considered in young patients and those with higher grade of fracture classification and greater angulation at presentation. A virtual physiotherapy is still a good option.
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Affiliation(s)
- Chandrashekara Maliyappa
- Department of Trauma and Orthopaedics, Southend University Hospital, Westcliff on Sea, Essex, United Kingdom
| | - Anantha Raghupathi
- Department of Trauma and Orthopaedics, Southend University Hospital, Westcliff on Sea, Essex, United Kingdom
| | - Dilupa Rupasinghe
- Department of Trauma and Orthopaedics, Southend University Hospital, Westcliff on Sea, Essex, United Kingdom
| | - Persidiu Iancu
- Department of Trauma and Orthopaedics, Southend University Hospital, Westcliff on Sea, Essex, United Kingdom
| | - Muawia Mohamed
- Department of Trauma and Orthopaedics, Southend University Hospital, Westcliff on Sea, Essex, United Kingdom
| | - Layth Qazzaz
- Department of Trauma and Orthopaedics, Southend University Hospital, Westcliff on Sea, Essex, United Kingdom
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Baruth JM, Lapid MI, Clarke B, Shin AY, Atkinson EJ, Eberhard J, Zavatta G, Åstrand J. Distal radius fractures and risk of incident neurocognitive disorders in older adults: a retrospective cohort study. Osteoporos Int 2022; 33:2307-2314. [PMID: 35835861 DOI: 10.1007/s00198-022-06497-6] [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: 01/31/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Distal radius fractures (DRF) are associated with increased risk of subsequent fractures and physical decline in older adults. This study aims to evaluate the risk cognitive decline following DRF and potential for timely screening and intervention. METHODS A cohort of 1046 individuals 50-75 years of age with DRF were identified between 1995 and 2015 (81.5% female; mean age 62.5 [± 7.1] years). A control group (N = 1044) without history of DRF was matched by age, sex, and fracture date (i.e., index). The incidence of neurocognitive disorders (NCD) in relation to DRF/index was determined. Group comparisons were adjusted by age and comorbidity measured by the Elixhauser index. RESULTS The DRF group had a greater incidence of NCD compared to the control group (11.3% vs. 8.2%) with a 56% greater relative risk (HR = 1.56, 95% Cl: 1.18, 2.07; p = 0.002) after adjusting for age and comorbidity. For every 10-year age increase, the DRF group was over three times more likely to develop a NCD (HR = 3.23, 95% Cl: 2.57, 4.04; p < 0.001). CONCLUSION DRF in adults ages 50 to 75 are associated with increased risk of developing neurocognitive disorders. DRF may represent a sentinel opportunity for cognitive screening and early intervention. Distal radius fractures (DRF) have been associated with greater risk of future fractures and physical decline. This study reports that DRF are also associated with greater risk of developing neurocognitive disorders in older adults. Timely intervention may improve early recognition and long-term outcomes for older adults at risk of cognitive decline.
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Affiliation(s)
- Joshua M Baruth
- Dept. of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Maria I Lapid
- Dept. of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bart Clarke
- Dept. of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jonas Eberhard
- Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Guido Zavatta
- Dept. of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Abstract
Fractures of the distal radius are the most common upper limb fracture and account for over a sixth of all fractures seen in emergency departments. Although most of these fractures are managed non-operatively, a significant number of complex injuries undergo operative management. This educational review of up to date guidelines discusses the perioperative management of distal radius fractures and provides readers with continuing professional development activities.
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Affiliation(s)
- Jiang An Lim
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Bryan Lc Loh
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - George Sylvestor
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK
| | - Wasim Khan
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK
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Bruno F, Arrigoni F, Palumbo P, Natella R, Maggialetti N, Reginelli A, Splendiani A, Di Cesare E, Bazzocchi A, Guglielmi G, Masciocchi C, Barile A. The Acutely Injured Wrist. Radiol Clin North Am 2019; 57:943-955. [PMID: 31351543 DOI: 10.1016/j.rcl.2019.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/11/2022]
Abstract
Wrist traumas are a frequent clinical emergency for which instrumental imaging assessment is required. The purpose of this article is to review the role of imaging assessment of traumatic wrist injuries, with particular reference to fractures and associated lesions.
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Affiliation(s)
- Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, Coppito, L'Aquila (AQ) 67100, Italy
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, Coppito, L'Aquila (AQ) 67100, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, Coppito, L'Aquila (AQ) 67100, Italy
| | - Raffaele Natella
- Department of Precision Medicine, University of Campania "L.Vanvitelli", Via Santa Maria di Costantinopoli 104, 80138 Naples, Italy
| | - Nicola Maggialetti
- Department Life and Health "V. Tiberio", University of Molise, Via Francesco De Sanctis, 86100 Campobasso, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L.Vanvitelli", Via Santa Maria di Costantinopoli 104, 80138 Naples, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, Coppito, L'Aquila (AQ) 67100, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, Coppito, L'Aquila (AQ) 67100, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via C. Pupilli 1, 40136 Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, Coppito, L'Aquila (AQ) 67100, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, Coppito, L'Aquila (AQ) 67100, Italy.
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Vilaca T, Walsh J, Eastell R. Discordant pattern of peripheral fractures in diabetes: a meta-analysis on the risk of wrist and ankle fractures. Osteoporos Int 2019; 30:135-143. [PMID: 30306223 DOI: 10.1007/s00198-018-4717-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
UNLABELLED To clarify if the peripheral microarchitectural abnormalities described in diabetics have clinical consequences, we evaluated the risk of wrist and ankle fractures. The meta-analysis resulted in an increase in the risk of ankle fractures and a decrease in wrist fractures risk, suggesting that microarchitecture may not be the major fracture determinant. INTRODUCTION There is evidence for an increase in the risk of hip fractures in diabetes (both in type 1 and 2), but the risk is not established for other skeletal sites. Microarchitecture evaluations have reported a decrease in volumetric bone mineral density and an increase in cortical porosity at the radius and tibia. To investigate if there is a clinical consequence for these microarchitectural abnormalities, we performed a systematic review and meta-analysis on the risk of ankle and wrist fractures in diabetes. METHODS Medline and Embase were searched using the terms 'diabetes mellitus', 'fracture', 'ankle', 'radius' and 'wrist'. Relative risks and 95% confidence intervals were calculated using random effects model. RESULTS For ankle fractures, six studies were selected including 2,137,223 participants and 15,395 fractures. For wrist fractures, 10 studies were eligible with 2,773,222 subjects and 39,738 fractures. The studies included men and women, ages 20 to 109 years for the wrist and 27 to 109 years for the ankle. The vast majority of subjects had type 2 diabetes. Diabetes was associated with an increase in the risk of ankle fractures (RR 1.30 95%CI 1.15-1.48) and a decrease in wrist fractures (RR 0.85 95%CI 0.77-0.95). In the studies that reported body mass index (BMI), the mean values were 10% higher in the diabetic groups than controls. CONCLUSION The risk of fractures is increased in diabetes at the ankle and decreased at the wrist. The same pattern is observed in obesity. Although bone microarchitectural features are different in obesity and diabetes, the epidemiology of peripheral fractures is similar in both diseases suggesting that microarchitecture may not be the major determinant of peripheral fractures in these populations.
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Affiliation(s)
- T Vilaca
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
- Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, S5 7AU, England
| | - J Walsh
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
- Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, S5 7AU, England
| | - R Eastell
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK.
- Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, S5 7AU, England.
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Sever M, Eyler Y, Suner A. A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules. Am J Emerg Med 2017; 36:161-162. [PMID: 28754319 DOI: 10.1016/j.ajem.2017.07.045] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/13/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Mustafa Sever
- Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Yesim Eyler
- Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Aslı Suner
- Department of Biostatistics and Medical Informatics, Ege University, School of Medicine, Izmir, Turkey
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15
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Uzoigwe C, Johnson N. Wrist function in malunion: Is the distal radius designed to retain function in the face of fracture? Ann R Coll Surg Engl 2016; 98:442-5. [PMID: 27376442 PMCID: PMC5210014 DOI: 10.1308/rcsann.2016.0191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 02/01/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Fractures of the distal radius are the most common fracture in humans and are the sempiternal hazard of 3.5 million years of bipedalism. Despite the antiquity of the injury, one of the most controversial topics in current orthopaedics is the management of distal radius fractures. It has been suggested that radiographic appearances rarely correlate with functional outcomes. As the success of the human species is predicated almost exclusively on its dexterity and intelligence, it is conceivable that the distal radius has evolved to preserve function even in the face of injury. We therefore hypothesise that the distal radius is designed to accommodate the possibility of fracture. Methods We conducted a review of studies comparing fracture pattern and form with function. We also explore the paleoanthropological evidence and comparative studies with other primates. Findings The evidence points to the human distal radius being highly tolerant of post-fracture deformity in terms of preservation of function. In addition, the distal radius appears to have apparently anatomically 'redundant' features that confer this capability. We believe these phenomena to be an evolved trait that developed with bipedalism, increasing the chances of survival for a species whose success depends upon its dexterity.
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Affiliation(s)
- C Uzoigwe
- University Hospitals of Leicester NHS Trust , Leicester , UK
| | - N Johnson
- University Hospitals of Leicester NHS Trust , Leicester , UK
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16
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Abstract
Carpal fractures are uncommon, but if missed, can lead to morbidity and loss of function, especially in an athlete. Early diagnosis through physical examination, plain radiographs, and possibly advanced imaging is paramount. Treatment is specific to each fracture type, and return to play varies with each clinical scenario. This article organizes current knowledge of these potentially difficult fractures with a table of diagnoses and treatment guidelines.
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Affiliation(s)
- Ekaterina Y Urch
- Department of Hand, Upper Extremity and Microsurgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Steve K Lee
- Department of Hand, Upper Extremity and Microsurgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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