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Doh CH, Kim YJ, Kim JK, Lee J, Shin YH. Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study. Medicine (Baltimore) 2024; 103:e37781. [PMID: 38640326 PMCID: PMC11029960 DOI: 10.1097/md.0000000000037781] [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: 12/09/2023] [Revised: 01/26/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024] Open
Abstract
Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients aged ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; P < .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819-4.193; P < .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749-1.860; P < .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens.
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Affiliation(s)
- Chang Hyun Doh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Kwang Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jongjin Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Ho Shin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Orbay JL, Gardner B, Heifner JJ, Martin A, Mercer DM. The Contribution of the Distal Oblique Band to Distal Radioulnar Joint Stability. J Hand Surg Am 2024:S0363-5023(24)00097-2. [PMID: 38597836 DOI: 10.1016/j.jhsa.2024.03.001] [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: 09/27/2023] [Revised: 02/10/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The distal radioulnar joint (DRUJ) is supported by an array of dynamic and static stabilizers, of which the triangular fibrocartilage complex (TFCC) is the most important, and the distal interosseous ligament is next in importance. The distal oblique band (DOB) is an identifiable component of the distal interosseous ligament, found in a subset of the population. Our objective was to determine the contribution of the DOB to DRUJ stability in the presence of a disrupted TFCC. METHODS Twenty-three above-elbow specimens were prepared by removing the TFCC and the DRUJ joint capsule, preserving the distal interosseous ligament and the pronator quadratus. Cadavers were stratified into two groups-those with, and those without a DOB. A bone plate and screws were attached to the ulna; then, a transverse load was applied to failure, creating a diastasis between the radius and ulna. RESULTS The group with a DOB had a mean load at failure of 160.7 ± 46.5 N. The group without a DOB had a mean load at failure of 148.0 ± 26.3 N. Stiffness prior to failure was 16.9 N/mm in the group with a DOB and 12.4 N/mm in the group without a DOB. CONCLUSIONS The current results indicate that the DOB may not substantially contribute to DRUJ stability in the presence of a disrupted TFCC. CLINICAL RELEVANCE Stability of the DRUJ after TFCC injury may not be substantially improved by the presence of a DOB. Thus, the clinical importance of DOB reconstruction remains unclear.
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Affiliation(s)
| | | | | | - Anthony Martin
- Department of Orthopaedic Surgery, University of Miami Health System, Miami, FL
| | - Deana M Mercer
- Department of Orthopedic Surgery, University of New Mexico Hospitals, Albuquerque, NM
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Bredy TM, Patterson F, Glasgow C. Current clinical practice patterns and perspectives of Australian hand therapists during the treatment of adults with distal radius fracture: A national survey. Aust Occup Ther J 2024; 71:265-278. [PMID: 38151897 DOI: 10.1111/1440-1630.12925] [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: 07/13/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Successful return to pre-injury occupational performance following distal radius fracture (DRF) may be influenced by person and environment factors such as pain, age, social support, and socioeconomic status. The primary aim of this study was to explore Australian hand therapists' current clinical practice and determine whether they consider these factors during the management of DRF. METHODS A mixed methods online survey was distributed to members of the Australian Hand Therapy Association. Descriptive statistics were used to examine the quantitative data, and the qualitative data were analysed by content analysis. RESULTS Of the 120 members who completed the survey, 68% were occupational therapists and 32% were physiotherapists with 74% in the private and 26% in the public health-care setting. Most factors perceived to influence recovery were consistent with person factors and a biomechanical approach. Other factors related to occupational performance, such as social and leisure skills, environment and culture were reported less often. When asked about defining occupational performance, the key categories identified through qualitative open responses were 'performing meaningful activities/occupations', 'performing work/employment', and 'completing activities/function'. CONCLUSION The data suggest that hand therapists in Australia primarily identify person factors as key to recovery after DRF. Context and environmental factors that influence occupational performance did not appear to be considered as often during treatment or when defining occupational performance. Further research is needed to explore the contextual and environmental factors that influence hand therapy intervention and determine whether they play a role in the successful return to pre-injury occupational performance following DRF. CONSUMER AND COMMUNITY INVOLVEMENT The survey was conceptualised by the research team, which included two experienced hand therapists and piloted with 10 consumers. Hand therapists (consumers) of various years of experience and discipline (i.e., occupational therapy and physiotherapy) provided feedback to improve the survey in terms of content, comprehensibility, and length. No clients/patients of hand therapists were involved in the development of the survey or the study, and the consumers of the study were considered hand therapists.
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Affiliation(s)
- Terra M Bredy
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Freyr Patterson
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Celeste Glasgow
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
- EKCO Hand Therapy, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Momtaz D, Ghali A, Ahmad F, Gonuguntla R, Kotzur T, Wang RJ, Ghilzai U, Abbas A, Wu C. Effective Risk Assessment for Distal Radius Fractures: A Rigorous Multivariable Regression Analysis, Using a Novel 8-Item Modified Frailty Index. J Wrist Surg 2024; 13:120-126. [PMID: 38505209 PMCID: PMC10948243 DOI: 10.1055/s-0043-1764203] [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: 10/11/2022] [Accepted: 01/24/2023] [Indexed: 03/21/2024]
Abstract
Introduction Distal radius fractures (DRFs) are among the most common orthopaedic injuries. The prevalence of DRFs is increasing across all age groups but remains the second most common fracture in the elderly. The modified frailty index (MFI) often predicts morbidity and mortality in orthopaedic injuries. This study aims to determine the predictive value of MFI on complication rates following DRF and the patient length of stay and discharge outcomes. Methods We utilized our MFI to perform a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Results In a total of 22,313 patients, the average age was 46 ± 16. An increase in MFI led to an increase in the odds ratio of readmission and reoperation ( p < 0.001). MFI predicted complications, doubling the rate as the score increased from 1 to 2 ( p < 0.001). An MFI of 2 also led to a delayed hospital stay of 5 days ( p < 0.001), as well as an increase in the odds of patients not being sent home at discharge ( p < 0.001). Finally, life-threatening complications were also predicted with an increased MFI, the odds of a life-threatening complication increasing 488.20 times at an MFI of 3 ( p < 0.001). Discussion and Conclusion While surgical decision-making for frail patients with DRFs remains contentious, this novel 8-item MFI score was significantly associated with the probability of hospital readmission/reoperation, postoperative complications, and delayed hospital length of stay. Three new parameters were incorporated into our 8-item score compared with the conventional 5; hypoalbuminemia status (< 3.5 mg/dL), previous diagnosis of osteoporosis, and severe obesity (body mass index > 35) enhancing its sensitivity. Future studies are warranted for its prospective utility in ruling out postsurgical comorbidity.
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Affiliation(s)
- David Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
| | - Farhan Ahmad
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - Rishi Gonuguntla
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Travis Kotzur
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Rebecca J. Wang
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Umar Ghilzai
- Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
| | - Adam Abbas
- Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
| | - Chia Wu
- Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
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Tordjman D, Younis M, Factor S, Eisenberg G, Atlan F, McBeth J, Pritsch T, Rosenblatt Y. Volar Locking Plating of Extra-articular Distal Radius Fracture: A Retrospective Clinical Study Comparing Locking Screws versus Smooth Locking Pegs. J Wrist Surg 2024; 13:151-157. [PMID: 38505202 PMCID: PMC10948244 DOI: 10.1055/s-0043-1771338] [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: 08/19/2022] [Accepted: 06/28/2023] [Indexed: 03/21/2024]
Abstract
Background Open reduction and internal fixation of distal radius fractures is one of the most common procedures performed in wrist surgery. The use of volar locking plate has gained increasing interest in the past decade. Epiphyseal fixation can be done either with locking screws or smooth locking pegs, with no evidence supporting the use of one rather than the other. Purpose The aim of this study is to compare the stability of distal radius fixation by volar locking plate using locking screws or smooth locking pegs. Methods Adult patients with A2-A3 AO fractures treated with a volar plate with locking screws only or smooth locking pegs only were retrospectively included. Radiographic assessment was performed to evaluate extra-articular parameters in the intraoperative postreduction and fixation period and after bony healing. Forty-seven distal radius fractures were included. Results Twenty-four fractures had fixation with locking screws and 23 had fixation with smooth locking pegs. For both groups, all radiographic parameters measured showed a statistically significant difference between the intraoperative postreduction and fixation period and the remote postoperative period after union of the fracture ( p < 0.05) attesting a slight loss of reduction. Nevertheless, there were no significant differences between the groups in radiographic extra-articular parameters. Conclusion This clinical study shows that there is no difference in stability fixation between locking screws or smooth locking pegs in A2-A3 distal radius fractures. Clinical Relevance The use of smooth locking pegs only for epiphyseal fixation appears to be safe in volar plating of A2-A3 distal radius fractures in adult patients and could be an alternative to locking screws. More clinical data are needed to confirm these results. Level of Evidence Level III; retrospective comparative study.
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Affiliation(s)
- Daniel Tordjman
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Younis
- Hand Surgery Unit, Division of Orthopedic, Hillel Yaffe Medical Center, Hadera, Israel
| | - Shai Factor
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Eisenberg
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jessica McBeth
- Division of Orthopedic, Santa Clara Valley Medical Center, San Jose, California
- Stanford University School of Medicine, Palo Alto, California
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Averkamp B, Li K, Wally MK, Roomian T, Griggs C, Runyon M, Hsu JR, Seymour RB, Beuhler M, Bosse MJ, Castro M, Gibbs M, Jarrett S, Leas D, Odum S, Yu Z, Rachal J, Saha A, Sullivan DM, Watling B. Opioid Prescribing Rate for Nonoperative Distal Radius Fractures and Clinician Response to a Clinical Decision Support Alert. J Emerg Med 2024; 66:e413-e420. [PMID: 38490894 DOI: 10.1016/j.jemermed.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Opioids are commonly prescribed for the management of acute orthopedic trauma pain, including nonoperative distal radius fractures. OBJECTIVES This prospective study aimed to determine if a clinical decision support intervention influenced prescribing decisions for patients with known risk factors. We sought to quantify frequency of opioid prescriptions for acute nonoperative distal radius fractures treated. METHODS We performed a prospective study at one large health care system. Utilizing umbrella code S52.5, we identified all distal radius fractures treated nonoperatively, and the encounters were merged with the Prescription Reporting with Immediate Medication Mapping (PRIMUM) database to identify encounters with opioid prescriptions and patients with risk factors for opioid use disorder. We used multivariable logistic regression to determine patient characteristics associated with the prescription of an opioid. Among encounters that triggered the PRIMUM alert, we calculated the percentage of encounters where the PRIMUM alert influenced the prescribing decision. RESULTS Of 2984 encounters, 1244 (41.7%) included an opioid prescription. Age increment is a significant factor to more likely receive opioid prescriptions (p < 0.0001) after adjusting for other factors. Among encounters where the physician received an alert, those that triggered the alert for early refill were more likely to influence physicians' opioid prescribing when compared with other risk factors (p = 0.0088). CONCLUSION Over 90% of patients (106/118) continued to receive an opioid medication despite having a known risk factor for abuse. Additionally, we found older patients were more likely to be prescribed opioids for nonoperatively managed distal radius fractures.
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Affiliation(s)
- Ben Averkamp
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Katherine Li
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Meghan K Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Tamar Roomian
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | | | - Michael Runyon
- Department of Emergency Medicine, Charlotte, North Carolina
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | | | - Michael J Bosse
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | | | - Michael Gibbs
- Department of Emergency Medicine, Charlotte, North Carolina
| | - Steven Jarrett
- Patient Safety, Atrium Health, Charlotte, North Carolina
| | - Daniel Leas
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Susan Odum
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Ziqing Yu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - James Rachal
- Department of Psychiatry, Charlotte, North Carolina
| | | | - D Matthew Sullivan
- Atrium Health Information and Analytic Services, Atrium Health, Charlotte, North Carolina
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Chen AL, Hernandez EJ, MacKay BJ. A case report of a distal radius fracture treated with a dorsal spanning plate augmented with fragment specific fixation. J Surg Case Rep 2024; 2024:rjae260. [PMID: 38666097 PMCID: PMC11045250 DOI: 10.1093/jscr/rjae260] [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: 01/27/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Dorsal spanning plates are frequently utilized to manage comminuted intra-articular distal radius fractures, but there is little literature on combining them with augmented fixation in complex cases. We present a 43-year-old man who fell 5 ft onto his outstretched right hand. On examination, there was gross swelling and tenderness of the right wrist with no neurovascular deficit. Radiographs confirmed a comminuted intra-articular displaced distal radius fracture. He was treated with a dorsal spanning plate fixation combined with radiostyloid and volar buttress plates. Follow-up at 2 months showcased intact hardware with good fracture healing. The dorsal spanning plate was removed 4 months after the procedure with radiographs demonstrating adequate alignment and healing without failure. The patient reported no complaints and minimal functional disability. We highlight a case of augmenting a dorsal spanning plate with fragment-specific plate fixation for a comminuted intra-articular displaced distal radius fracture.
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Affiliation(s)
- Andrew L Chen
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Evan J Hernandez
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Brendan J MacKay
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
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Yamamoto A, Yamada E, Ibara T, Nihey F, Inai T, Tsukamoto K, Waki T, Yoshii T, Kobayashi Y, Nakahara K, Fujita K. Using In-Shoe Inertial Measurement Unit Sensors to Understand Daily-Life Gait Characteristics in Patients With Distal Radius Fractures During 6 Months of Recovery: Cross-Sectional Study. JMIR Mhealth Uhealth 2024; 12:e55178. [PMID: 38506913 PMCID: PMC10993120 DOI: 10.2196/55178] [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: 12/05/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND A distal radius fracture (DRF) is a common initial fragility fracture among women in their early postmenopausal period, which is associated with an increased risk of subsequent fractures. Gait assessments are valuable for evaluating fracture risk; inertial measurement units (IMUs) have been widely used to assess gait under free-living conditions. However, little is known about long-term changes in patients with DRF, especially concerning daily-life gait. We hypothesized that, in the long term, the daily-life gait parameters in patients with DRF could enable us to reveal future risk factors for falls and fractures. OBJECTIVE This study assessed the spatiotemporal characteristics of patients with DRF at 4 weeks and 6 months of recovery. METHODS We recruited 16 women in their postmenopausal period with DRF as their first fragility fracture (mean age 62.3, SD 7.0 years) and 28 matched healthy controls (mean age 65.6, SD 8.0 years). Daily-life gait assessments and physical assessments, such as hand grip strength (HGS), were performed using an in-shoe IMU sensor. Participants' results were compared with those of the control group, and their recovery was assessed for 6 months after the fracture. RESULTS In the fracture group, at 4 weeks after DRF, lower foot height in the swing phase (P=.049) and higher variability of stride length (P=.03) were observed, which improved gradually. However, the dorsiflexion angle in the fracture group tended to be lower consistently during 6 months (at 4 weeks: P=.06; during 6 months: P=.07). As for the physical assessments, the fracture group showed lower HGS at all time points (at 4 weeks: P<.001; during 6 months: P=.04), despite significant improvement at 6 months (P<.001). CONCLUSIONS With an in-shoe IMU sensor, we discovered the recovery of spatiotemporal gait characteristics 6 months after DRF surgery without the participants' awareness. The consistently unchanged dorsiflexion angle in the swing phase and lower HGS could be associated with fracture risk, implying the high clinical importance of appropriate interventions for patients with DRF to prevent future fractures. These results could be applied to a screening tool for evaluating the risk of falls and fractures, which may contribute to constructing a new health care system using wearable devices in the near future.
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Affiliation(s)
- Akiko Yamamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eriku Yamada
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fumiyuki Nihey
- Biometrics Research Laboratories, NEC Corporation, Chiba, Japan
| | - Takuma Inai
- Biomechanics and Exercise Physiology Research Group, Health and Medical Research Institute, Department of Life Science and Technology, National Institute of Advanced Industrial Science and Technology, Kagawa, Japan
| | - Kazuya Tsukamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiko Waki
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyuki Kobayashi
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | | | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Division of Medical Design Innovations, Open Innovation Center, Institute of Research Innovation, Tokyo Medical and Dental University, Tokyo, Japan
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McCarty JC, Cross RE, Laane CLE, Hoftiezer YAJ, Gavagnin A, Regazzoni P, Fernandez Dell'Oca A, Jupiter JB, Bhashyam AR. Teardrop Alignment Changes After Volar Locking Plate Fixation of Distal Radius Fractures With Volar Ulnar Fragments. Hand (N Y) 2024:15589447241233762. [PMID: 38439630 DOI: 10.1177/15589447241233762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND We assessed factors associated with change in radiographic teardrop angle following volar locking plate (VLP) fixation of volarly displaced intra-articular distal radius fractures with volar ulnar fragments (VUF) within the ICUC database. The primary outcome was change in radiographic alignment on follow-up imaging, defined as a change in teardrop angle from intra-operative fluoroscopy greater than 5°. METHODS Patients with distal radius fractures treated with a VLP within the ICUC database, an international collaborative and publicly available dataset, were identified. The primary outcome was volar rim loss of reduction on follow-up imaging, defined as a change in radiographic alignment from intra-operative fluoroscopy, teardrop angle less than 50°, or loss of normal radiocarpal alignment. Secondary outcomes were final range of motion (ROM) of the affected extremity. Radiographic Soong classification was used to grade plate position. Descriptive statistics were used to assess variables' distributions. A Random Forest supervised machine learning algorithm was used to classify variable importance for predicting the primary outcome. Traditional descriptive statistics were used to compare patient, fracture, and treatment characteristics with volar rim loss of reduction. Volar rim loss of reduction and final ROM in degrees and as compared with contralateral unaffected limb were also assessed. RESULTS Fifty patients with volarly displaced, intra-articular distal radius fractures treated with a VLP were identified. Six patients were observed to have a volar rim loss of reduction, but none required reoperation. Volar ulnar fragment size, Soong grade 0, and postfixation axial plate position in relation to the sigmoid notch were significantly associated (P < .05) with volar rim loss of reduction. All cases of volar rim loss of reduction occurred when VUF was 10.8 mm or less. CONCLUSIONS The size of the VUF was the most important variable for predicting volar rim loss of reduction followed by postfixation plate position in an axial position to the sigmoid notch and the number of volar fragments in the Random Forest machine learning algorithm. There were no significant differences in ROM between patients with volar ulnar escape and those without.
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Affiliation(s)
- Justin C McCarty
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, USA
| | - Rachel E Cross
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Charlotte L E Laane
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yannick Albert J Hoftiezer
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Plastic, Reconstructive and Hand Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aquiles Gavagnin
- Department of Orthopedics, Hospital Britanico Montevideo, Uruguay
| | | | | | - Jesse B Jupiter
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
| | - Abhiram R Bhashyam
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
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Pisljagic S, Temberg JL, Steensbaek MT, Yousef S, Maagaard M, Chafranska L, Lange KHW, Rothe C, Lundstrøm LH, Nørskov AK. Peripheral nerve blocks for closed reduction of distal radius fractures-A protocol for a systematic review. Acta Anaesthesiol Scand 2024; 68:423-429. [PMID: 37932228 DOI: 10.1111/aas.14353] [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: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Current methods of anaesthesia used for closed reduction of distal radial fractures may be insufficient for pain relief and muscle relaxation, potentially compromising reduction quality and patient satisfaction. Peripheral nerve blocks have already been implemented for surgery of wrist fractures and may provide optimal conditions for closed reduction due to complete motor and sensory blockade of the involved nerves. However, existing literature on peripheral nerve blocks for closed reduction is sparse, and no updated systematic review or meta-analysis exists. AIMS This protocol is developed according to the PRISMA-P statement. The systematic review and meta-analysis aim to consolidate the literature regarding the effect and harm of peripheral nerve blocks compared with other anaesthesia modalities for closed reduction of distal radius fractures in adults. METHODS The two primary outcomes are the proportion of participants needing surgery after closed reduction and pain during closed reduction. We will only include randomised clinical trials. Two review authors will each independently screen literature, extract data, and assess risk of bias with Risk of Bias 2 Tool. Meta-analysis will be carried out with Rstudio. We will also perform a Trial Sequential Analysis. The certainty of evidence will be judged using GRADE guidelines. DISCUSSION We will use up-to-date methodology when conducting the systematic review outlined in this protocol. The results may guide clinicians in their decision-making regarding the use of anaesthesia for closed reduction of distal radius fractures in adults.
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Affiliation(s)
- Sanja Pisljagic
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Jens L Temberg
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Mathias T Steensbaek
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Sina Yousef
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Lana Chafranska
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Kai H W Lange
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Rothe
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Lars H Lundstrøm
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders K Nørskov
- Department of Anaesthesiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
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11
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Verdonckt A, Hollevoet N. Validation of radiographic assessment of radiocarpal (mal)alignment in a normal population. J Hand Surg Eur Vol 2024; 49:381-382. [PMID: 37882687 DOI: 10.1177/17531934231208589] [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: 10/27/2023]
Abstract
We measured radiocarpal alignment in 150 standard lateral radiographs of normal wrists. In 84% of the cases, the lines of the long axis of the capitate and radius did not cross within the carpus.
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Affiliation(s)
- Anthony Verdonckt
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Nadine Hollevoet
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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12
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Chaudhry YP, Morway GR, Papadelis EA, Doerr NA, Graf KW, Mashru RP, Dolch HJ. Comparison of Short-Arm Immobilization and Long-Arm Immobilization in Conservatively Managed Distal Radius Fractures: A Meta-Analysis and Systematic Review. Cureus 2024; 16:e55813. [PMID: 38590464 PMCID: PMC10999297 DOI: 10.7759/cureus.55813] [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] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Distal radius fractures are often treated conservatively with immobilization. Immobilizing above the elbow limits forearm rotation, though recent literature has suggested the effects on radiographic or functional outcomes may be negligible. This systematic review and meta-analysis aimed to analyze the radiographic and functional outcome scores of distal radius fractures managed with short-arm (SA) immobilization and long-arm (LA) immobilization. An electronic systematic search was performed of the PubMed and EMBASE databases from inception to October 5, 2022. All randomized controlled trials (RCTs) involving patients with acute distal radius fractures undergoing nonoperative treatment (involving application/maintenance of immobilization) comparing above-elbow versus below-elbow constructs were included. The outcomes of interest were changes in radiographic parameters (loss of volar tilt [VT], radial height [RH], and radial inclination [RI]), loss of reduction, requirement for surgery, and patient-reported functional outcomes (Disabilities of the Arm, Shoulder, or Hand [DASH] or Quick DASH survey). The Cochrane Risk of Bias Tool 2.0 was used for study quality assessment. The effect size of the interventions was assessed using random effect models to calculate mean differences (MDs) for continuous variables and odds ratios (ORs) for categorical variables. Standardized mean difference (SMD) was calculated for patient-reported functional outcome scores. Nine studies involving 983 cases were included, including 497 SA and 486 LA. No statistically significant differences were observed with regards to VT (P = 0.83), RH (P = 0.81), RI (P = 0.35), loss of reduction (P = 0.33), requirement for surgery (P = 0.33), or patient-reported functional outcomes (P = 0.10). There was no difference in radiographic outcomes, need for surgery, or functional scores among patients treated with SA and LA immobilization. Utilizing SA immobilization is a safe option for conservative management of distal radius fractures and the benefits of mitigating complications associated with LA immobilization may supersede the theoretical limited forearm rotational stability observed with SA immobilization. Further study is required to determine the optimal method of SA immobilization.
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Affiliation(s)
- Yash P Chaudhry
- Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Genoveffa R Morway
- Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | | | - Nikki A Doerr
- Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Kenneth W Graf
- Orthopedics and Traumatology, Cooper University Hospital, Camden, USA
| | - Rakesh P Mashru
- Orthopedics and Traumatology, Cooper University Hospital, Camden, USA
| | - Henry J Dolch
- Orthopedics and Traumatology, Cooper University Hospital, Camden, USA
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13
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Willinge GJA, Spierings JF, Weert T, Twigt BA, Goslings JC, van Veen RN. Efficiency of a virtual fracture care protocol in non-operative treatment of adult patients with a distal radial fracture. J Hand Surg Eur Vol 2024; 49:341-349. [PMID: 37458134 DOI: 10.1177/17531934231187830] [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: 07/18/2023]
Abstract
This study aimed to determine the effects of virtual fracture care (VFC) on secondary healthcare utilization in non-operative treatment of adult patients with a distal radial fracture. A retrospective cohort study was performed, including those who received non-operative treatment without VFC (pre-VFC) and with VFC (VFC). Outcomes included secondary healthcare utilization, calculated treatment costs, emergency department (ED) reattendances and complication rates. In total, 88 pre-VFC and 99 VFC patients were included. Pre-VFC patients had more follow-up appointments, with a median of 4 (IQR: 3) versus a median of 4 (IQR: 1) in VFC patients. In addition, 3% of follow-up appointments for pre-VFC patients were performed remotely compared to 18% for VFC patients. Complications and ED reattendances were comparable between groups. In this study, non-operative treatment of adult patients with a distal radial fracture through VFC reduced secondary healthcare utilization, with similar reported complication and ED reattendance rates compared with treatment without VFC.Level of evidence: III.
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Affiliation(s)
- Gijs J A Willinge
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Jelle F Spierings
- Department of Trauma Surgery, St. Antonius Hospital Utrecht, Nieuwegein, the Netherlands
| | - Ton Weert
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Bas A Twigt
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Ruben N van Veen
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
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14
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Hubbard J, Berry D, Chauhan A, Casstevens C, Shin AY, Abrams RA. A three-dimensional computed tomography study of the palmar ulnar corner fragment in distal radial fractures. J Hand Surg Eur Vol 2024; 49:300-309. [PMID: 37974338 PMCID: PMC10882950 DOI: 10.1177/17531934231211570] [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: 11/19/2023]
Abstract
Fixing palmar ulnar corner fragments of distal radial fractures can be challenging. We described the palmar ulnar corner fragment morphology in a retrospective cohort study of 40 patients who underwent preoperative wrist computed tomography scans. Palmar ulnar corner fractures were categorized based on articular cross-sectional area, sagittal angulation relative to the radius long axis, palmar cortical length, radioulnar width and associated palmar radiocarpal subluxation. Three types emerged: type 1 fragments involved 37% (SD 10) of the radiocarpal articular surface and were extended in the sagittal plane; type 2 fragments involved 28% (SD 10) of the articular surface and had a long palmar cortex, of which 57% had palmar carpal subluxation; and type 3 fragments involved 13% (SD 2) of the articular surface, had a short palmar cortex and all had palmar carpal subluxation. Understanding palmar ulnar corner fragment morphology may guide optimal reduction and fixation strategy and prevent palmar radiocarpal subluxation, especially in type 3 fractures.Level of evidence IV.
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Affiliation(s)
- James Hubbard
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - David Berry
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Aakash Chauhan
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Chris Casstevens
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Reid A Abrams
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California, San Diego (UCSD), La Jolla, CA, USA
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15
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Gong JH, Azad CL, Zhang G, Aliu O, Giladi AM. Bone Health Screening Prior to Medicare Eligibility-Osteoporosis Screening and Fracture Prevention After Distal Radius Fractures in Patients Aged 50-59. J Hand Surg Am 2024; 49:203-211. [PMID: 38069952 DOI: 10.1016/j.jhsa.2023.10.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 03/08/2024]
Abstract
PURPOSE Current guidelines recommend bone mineral density (BMD) testing after fragility fractures in patients aged 50 years or older. This study aimed to assess BMD testing and subsequent fragility fractures after low-energy distal radius fractures (DRFs) among patients aged 50-59 years. METHODS We used the 2010-2020 MarketScan dataset to identify patients with initial DRFs with ages ranging between 50 and 59 years. We assessed the 1-year BMD testing rate and 3-year non-DRF fragility fracture rate. We created Kaplan-Meier plots to depict fragility fracture-free probabilities over time and used log-rank tests to compare the Kaplan-Meier curves. RESULTS Among 78,389 patients aged 50-59 years with DRFs, 24,589 patients met our inclusion criteria, and most patients were women (N = 17,580, 71.5%). The BMD testing rate within 1 year after the initial DRF was 12.7% (95% CI, 12.3% to 13.2%). In addition, 1-year BMD testing rates for the age groups of 50-54 and 55-59 years were 10.4% (95% CI, 9.9% to 11.0%) and 14.9% (95% CI, 14.2% to 15.6%), respectively. Only 1.8% (95% CI, 1.5% to 2.1%) of men, compared with 17.1% (95% CI, 16.5% to 17.7%) of women, underwent BMD testing within 1 year after the initial fracture. The overall 3-year fragility fracture rate was 6.0% (95% CI, 5.6% to 6.3%). The subsequent fragility fracture rate was lower for those with any BMD testing (4.4%; 95% CI, 3.7% to 5.2%), compared with those without BMD testing (6.2%; 95% CI, 5.9% to 6.6%; P < .05). CONCLUSIONS We report a low BMD testing rate for patients aged between 50 and 59 years after initial isolated DRFs, especially for men and patients aged between 50 and 54 years. Patients who received BMD testing had a lower rate of subsequent fracture within 3 years. We recommend that providers follow published guidelines and initiate an osteoporosis work-up for patients with low-energy DRFs to ensure early diagnosis. This provides an opportunity to initiate treatment that may prevent subsequent fractures. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis II.
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Affiliation(s)
- Jung Ho Gong
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; The Warren Alpert Medical School of Brown University, Providence, RI
| | - Chao Long Azad
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Gongliang Zhang
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Oluseyi Aliu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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16
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Laane CLE, Dijkmans AL, Messinger CJ, Wijffels MME, Bhashyam AR, Chen NC. Cause of Extensor Pollicis Longus Ruptures After Distal Radius Fracture Fixation Using a Volar Plate. Hand (N Y) 2024:15589447241233763. [PMID: 38420781 DOI: 10.1177/15589447241233763] [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] [Indexed: 03/02/2024]
Abstract
BACKGROUND This research sought to analyze a cohort of patients with extensor pollicis longus (EPL) ruptures after volar locked plating of a distal radius fracture (DRF) to characterize the incidence of ruptures that are unlikely to be related to dorsal screw prominence. METHODS This is a retrospective, observational, descriptive cohort study of adults with operative fixation of a closed DRF and an EPL rupture between 2002 and 2022. Eighteen patients with operative fixation using a volar plate of a closed DRF had an EPL rupture. The cohort consisted of 66% women with an average age of 57.5 years. Median follow-up was 14.5 months. RESULTS The incidence of EPL rupture was 0.4% (18/4768). The average time from DRF and DRF fixation to EPL rupture was 3.7 and 3.4 months, respectively. Based on the operative record, in 2 of the 18 patients (11%), the rupture was directly attributable to prominent hardware; however, in 4 of the 18 patients (22%), the rupture was not related to prominent hardware, and the cause was indeterminate in 12 patients (67%). Radiologic analysis of those in the indeterminate group demonstrated that 5 of the 12 patients had screws that had a high probability of being prominent. CONCLUSIONS The incidence of EPL rupture after volar plating of DRF is between 0% and 1% and usually occurs about 3 months after fixation. Approximately 50% of EPL ruptures are attributable to prominent dorsal screws. Although screw prominence is an important cause of EPL rupture, it is not the sole cause of rupture.
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Affiliation(s)
- Charlotte L E Laane
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Anjuli L Dijkmans
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
| | - Chelsea J Messinger
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mathieu M E Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Abhiram R Bhashyam
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Neal C Chen
- Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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17
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Seok HG, Park WT, Park SJ, Park SG. Small volar fragment in the lunate fossa leads to volar tilt loss after volar plate fixation for AO/OTA type-C distal radius fracture. Hand Surg Rehabil 2024:101674. [PMID: 38431044 DOI: 10.1016/j.hansur.2024.101674] [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: 01/11/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The relationship between volar fragment size and postoperative volar tilt loss in complete articular distal radius fracture is not well known. In this study, we measured precise radiological parameters to help identify other factors that might contribute to volar tilt loss. MATERIAL AND METHODS We retrospectively reviewed the radiological examinations and charts of 256 patients with distal radial fracture who underwent volar locking plate fixation between March 2014 and July 2022. Radiological parameters were measured based on preoperative CT and immediate postoperative radiographs. Univariate and multivariate linear regression analysis was performed to identify relevant factors associated with volar tilt loss following volar locking plate fixation. The receiver operating characteristic curve was used to identify the cutoff value of the independent parameters. RESULTS On univariate analysis, 2 radiologic parameters on preoperative CT (volar fragment length at the lunate fossa, and teardrop angle) and 4 on immediate postoperative X-ray (radial inclination, radial length, capitate shift, and volar tilt) were significantly associated with postoperative volar tilt loss. On multivariate linear regression analysis, the risk of volar tilt loss increased as the capitate moved toward the back of the radial shaft. The cut-off for anteroposterior length in the lunate fossa was 6.5 mm. CONCLUSIONS AO/OTA type-C distal radius fractures with <6.5 mm anteroposterior length in the lunate fossa had significantly higher rates of malunion with dorsal deformity. In addition, preoperative teardrop angle < 37.2 ° and immediate postoperative volar tilt < 3.7º are also predictors of postoperative volar tilt loss.
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Affiliation(s)
- Hyun-Gyu Seok
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Wook Tae Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Sung-Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Sam-Guk Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea.
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18
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Grogan G, Stephens KL, Chou J, Abdalla J, Wagner R, Peek KJ, Freilich AM, DeGeorge BR. The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture. Hand (N Y) 2024:15589447241233369. [PMID: 38411105 DOI: 10.1177/15589447241233369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries. METHODS PearlDiver Mariner insurance claims database was analyzed for treatment patterns of DRF in patients aged 18 to 65 years based on the presence or absence of social determinants of health disparities (SDHDs). Outcome variables included the primary mode of management of DRF, including operative versus non-operative, as well as concomitant procedures. Multivariate logistic regression was used to compare fracture management modality in patients with and without SDHDs. RESULTS Of 161 704 patients identified with DRF, 38.3% had at least 1 reported SDHD. The majority of SDHDs were economic. Patients identified with 1 or more SDHDs had a higher medical comorbidity index. Patients with environmental SDHD were more likely to receive non-operative management. Within any SDHD and economic subgroups, odds of operative management were higher. No relationship was identified between SDHD and concomitant procedures. CONCLUSIONS The presence of environmental disparities in SDH may predispose patients disproportionately to non-operative management. The presence of SDHDs may influence medical decision-making in favor of open reduction and internal fixation in patients with DRF treated operatively. In treating at-risk populations, providers should be aware of the potential for implicit bias associated with SDHDs and prioritize shared decision-making between patients and physicians.
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Affiliation(s)
- Graham Grogan
- University of Mississippi Medical Center, Jackson, USA
| | - Kristen L Stephens
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
| | - Jesse Chou
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
| | - Jasmina Abdalla
- University of Virginia School of Medicine, Charlottesville, USA
| | - Ryan Wagner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Kacy J Peek
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Aaron M Freilich
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Brent R DeGeorge
- Department of Plastic Surgery, University of Virginia, Charlottesville, USA
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
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19
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Liu C, Seyok T, Moye S, Sugita L, Eltouny E, Carrera C, Denagamage P, Charles J, Fitz W, Chen AF, Earp B. High rates of vitamin D insufficiency among patients presenting for total knee arthroplasty. J Orthop Res 2024. [PMID: 38414362 DOI: 10.1002/jor.25811] [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: 03/03/2023] [Revised: 10/20/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024]
Abstract
Widely varying prevalence of vitamin D deficiency has been reported in patients presenting for total knee arthroplasty (TKA). The primary aim of this study was to determine vitamin D levels in TKA patients and to compare to patients already routinely evaluated for vitamin D levels, patients with fragility fractures of the distal radius (DRF). There is significant overlap between patients presenting for TKA and with DRF, both in terms of medical comorbidities and overall health status, making these populations suitable comparative cohorts. Wefound that all patients presenting for TKA consultation had vitamin D insufficiency and 33% had vitamin D deficiency, compared to only 37% and 14% in the DRF cohort, a patient population routinely evaluated for vitamin D due to the high risk of deficiency. Furthermore, patients with DRF had higher levels of vitamin D before (38 ± 16 vs. 23 ± 5) and after vitamin D supplementation (39 ± 17 vs. 33 ± 10), suggesting that patients presenting for TKA are at even higher risk of vitamin D insufficiency than patients presenting with DRF. Reassuringly, supplementation successfully corrected 39.0% and 55.8% of patients in the DRF and TKA cohorts, respectively.
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Affiliation(s)
- Christina Liu
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Thany Seyok
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephen Moye
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ehab Eltouny
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christopher Carrera
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Prabhavi Denagamage
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julia Charles
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wolfgang Fitz
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Antonia F Chen
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon Earp
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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20
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van Veelen NM, van de Wall BJM, Hoepelman RJ, IJpma FFA, Link BC, Babst R, Groenwold RHH, van der Velde D, Diwersi N, van Heijl M, Houwert RM, Beeres FJP. Let's Agree to Disagree on Operative Versus Nonoperative Treatment for Distal Radius Fractures in Older People: Protocol for a Prospective International Multicenter Cohort Study. JMIR Res Protoc 2024; 13:e52917. [PMID: 38349719 PMCID: PMC10900084 DOI: 10.2196/52917] [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: 09/27/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Distal radius fractures are the most frequently encountered fractures in Western societies, typically affecting patients aged 50 years and older. Although this is a common injury, the best treatment for these fractures in older patients is still under debate. OBJECTIVE This prospective study aims to compare the outcome of operatively and nonoperatively treated distal radius fractures in the older population. Only patients with distal radius fractures for which equipoise regarding the optimal treatment exists will be included. METHODS This prospective international multicenter observational cohort study will be designed as a natural experiment. Natural experiments are observational studies in which treatment allocation is determined by factors outside the control of the investigators but also (largely) independent of patient characteristics. Patients aged 65 years and older with an acute distal radius fracture will be considered for inclusion. Treatment allocation (operative vs nonoperative) will be based on the local preferences of the treating hospital either in Switzerland or the Netherlands. Hence, the process governing treatment allocation resembles that of randomization. Patients will be identified after treatment has been initiated. Based on the radiographs and baseline information of the patient, an expert panel of 6 certified trauma surgeons from 2 regions will provide their treatment recommendation. Only patients for whom the experts disagree on treatment recommendations will ultimately be included in the study (ie, for whom there is a clinical equipoise). For these patients, both operative and nonoperative treatment of distal radius fractures are viable, and treatment choice is predominantly determined by personal or local preference. The primary outcome will be the Patient-Rated Wrist Evaluation score at 12 weeks. Secondary outcomes will include the Physical Activity Score for the Elderly, the EQ questionnaire, pain, the living situation, range of motion, complications, and radiological outcomes. By including outcomes such as living situation and the Physical Activity Score for the Elderly, which are not relevant for younger cohorts, valuable information to tailor treatment to the needs of the older population can be gained. According to the sample size collection, which was based on the minimal important clinical difference of the Patient-Rated Wrist Evaluation, 92 patients will have to be included, with at least 46 patients in each treatment group. RESULTS Enrollment began in July 2023 and is expected to continue until summer 2024. The final follow-up will be 2 years after the last patient is included. CONCLUSIONS Although many trials on this topic have previously been published, there remains an ongoing debate regarding the optimal treatment for distal radius fractures in older patients. This observational study, which will use a fairly new methodological study design, will provide further information on treatment outcomes for older patients with distal radius fractures for which to date equipoise exists regarding the optimal treatment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52917.
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Affiliation(s)
- Nicole Maria van Veelen
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Ruben J Hoepelman
- Department of Trauma Surgery, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Universitair Medisch Centrum Leiden, Leiden, Netherlands
| | | | - Nadine Diwersi
- Department of General and Trauma Surgery, Kantonsspital Obwalden, Sarnen, Switzerland
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, Netherlands
| | - R Marijn Houwert
- Department of Trauma Surgery, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
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21
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Lee HW, Kim KT, Lee S, Yoon JH, Kim JY. Fracture Severity and Triangular Fibrocartilage Complex Injury in Distal Radius Fractures with or without Osteoporosis. J Clin Med 2024; 13:992. [PMID: 38398305 PMCID: PMC10889725 DOI: 10.3390/jcm13040992] [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: 01/19/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The purpose of this study was to investigate the fracture morphology of distal radius fractures (DRFs) with the status of triangular fibrocartilage complex (TFCC) foveal insertion in patients with or without osteoporosis and to identify the relationship between osteoporosis and foveal tear. Seventy-five patients who underwent surgery for DRF from January 2021 to September 2023 were included. All patients were evaluated by standard radiography and dual-energy X-ray absorptiometry and underwent a 3.0 T magnetic-resonance imaging examination of the involved wrist to identify TFCC foveal tear. Patients were allocated into two groups according to the presence of osteoporosis: patients with osteoporosis (group I) and those without osteoporosis (group II). Group I showed a significantly larger displacement of fractures compared to group II (radial inclination; 13.7 ± 5.4 vs. 17.9 ± 4.2; p < 0.001, dorsal angulation; 22.2 ± 12.1 vs. 16.5 ± 9.4; p = 0.024, ulnar variance; 4.15 ± 2.1 vs. 2.2 ± 1.9; p < 0.001). Dorsal angulation and ulnar variance were found to be independent prognostic factors for TFCC foveal tear in logistic regression analysis. Displacement of fractures was related to osteoporosis, and dorsal angulation and ulnar variance were independent prognostic factors for TFCC foveal tear. However, osteoporosis was not identified as a factor associated with TFCC foveal tears.
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Affiliation(s)
- Ho-Won Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea; (H.-W.L.); (S.L.); (J.-H.Y.)
| | - Ki-Tae Kim
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of Korea;
| | - Sanghyeon Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea; (H.-W.L.); (S.L.); (J.-H.Y.)
| | - Joon-Hyeok Yoon
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea; (H.-W.L.); (S.L.); (J.-H.Y.)
| | - Jung-Youn Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea; (H.-W.L.); (S.L.); (J.-H.Y.)
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22
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Román-Veas J, Gutiérrez-Espinoza H, Campos-Jara C, Martínez-García D. Arthroscopic Assistance in Surgical Management of Distal Radius Fractures: A Systematic Review and Meta-analysis. J Wrist Surg 2024; 13:86-95. [PMID: 38264129 PMCID: PMC10803148 DOI: 10.1055/s-0042-1757768] [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: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 10/17/2022]
Abstract
Background Wrist arthroscopy has become a commonly used tool for the management of adults with distal radius fractures (DRFs), although its implementation requires technical competence. This systematic review and meta-analysis appraised the available evidence concerning the contribution of wrist arthroscopy to the functional and radiological outcomes of patients with DRFs operated with arthroscopic assistance. Methods Randomized control trials were identified through five principal electronic databases on May 31, 2022: Web of Science, Scopus, EBSCO, Embase, and PubMed. Two authors independently performed the search and data extraction and assessed risk of bias (RoB) using the Cochrane RoB tool. Results A total of 1,780 relevant abstracts and citations were extracted in the preliminary search, which yielded 6 trials that met the eligibility criteria, and 3 studies were included in the quantitative synthesis. The overall pooled mean difference (MD) estimate showed no significant difference in the Disabilities of the Arm, Shoulder, and Hand scores between surgical groups with and without arthroscopic assistance (MD = 0.77 points, 95% confidence interval = -6.58 to 5.03, p = 0.79), with substantial heterogeneity (I 2 = 85%). Conclusion There was low-quality evidence that wrist arthroscopy conveyed not clinically or statistically significant difference to functional outcomes of patients with DRFs. However, our findings are limited by the numbers of studies included and lack of long-term follow-up, although they do provide a good starting point for future quality research.
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Affiliation(s)
| | | | - Christian Campos-Jara
- Exercises and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Darío Martínez-García
- Department of Physical Education and Sports, Faculty of Sports Sciences, University of Granada, Granada, Spain
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23
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Fones L, O'Mara LC, Gallant G, Kwok M, Abboudi J, Beredjiklian P. Distal Radius Fracture Therapy Utilization Following Traditional Open Reduction and Internal Fixation and Dorsal Bridge Plate Fixation. Cureus 2024; 16:e54875. [PMID: 38533157 PMCID: PMC10964216 DOI: 10.7759/cureus.54875] [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] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Background Many distal radius fractures are treated with a volar locking plate, but a minority undergo dorsal bridge plate fixation. This study's primary purpose was to compare therapy utilization following distal radius fractures treated with traditional open reduction and internal fixation (ORIF) versus dorsal bridge plate fixation. Secondary outcomes were time to first and last therapy visits and therapy costs. Methods Patients over 18 years old who underwent distal radius ORIF between January 2021 and August 2022 at a single regional orthopedic practice were identified. Patients who underwent post-operative hardware removal were retrospectively reviewed to identify dorsal bridge plate fixation patients. This resulted in "traditional ORIF" and "dorsal bridge plate" groups. Therapy visit number, cost, and payor (insurance type including Medicare, private insurance, worker's compensation, automobile policy, and private pay) were collected. Results In total, 1,376 patients met the inclusion criteria. Of these, 713 of the 1,283 (55.6%) patients in the traditional ORIF group and 25 of the 44 patients (56.8%) in the dorsal bridge plate group attended therapy at our institution. Traditional ORIF and dorsal bridge plate patients averaged 12.6(±10) and 24(±18.7) therapy visits in the one-year following ORIF, respectively. Time to last therapy visit was 90.9(±60) and 175.2(±72.1) days in the traditional ORIF and dorsal bridge plate groups, respectively. Total therapy cost was $1,219(±$1,314) and $2,015(±$1,828) in the traditional ORIF and dorsal bridge plate groups with similar out-of-pocket costs. Conclusions Dorsal bridge plate fixation patients attended a greater number of therapy sessions, had a longer time from surgery until therapy end, and had a higher therapy total cost relative to traditional ORIF, but both groups had similar patient out-of-pocket therapy costs.
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Affiliation(s)
- Lilah Fones
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Lauren C O'Mara
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Gregory Gallant
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Moody Kwok
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Jack Abboudi
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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24
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Bhakaney PR, Wadhokar OC, Upase S. Matrix Rhythm Therapy as a Novel Clinical Approach in the Rehabilitation of Surgically Treated Distal Radius Fracture: A Single Case Study. Cureus 2024; 16:e54785. [PMID: 38529418 PMCID: PMC10961651 DOI: 10.7759/cureus.54785] [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: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Distal radius fractures (DRFs) are prevalent among all hand injuries, commonly due to a fall on an outstretched hand. Not being treated properly can cause many complications such as malunion, non-union, reduced range of motion, and muscle strength. This case report presents a multidisciplinary approach to the physiotherapeutic management of a DRF treated with closed reduction internal fixation using K-wires. The rehabilitation protocol incorporated matrix rhythm therapy (MRT), a novel therapeutic technique, in combination with targeted therapeutic exercises. The study outlines the patient's journey from injury to recovery, detailing the integration of MRT sessions alongside conventional physiotherapy exercises. The comprehensive rehabilitation aimed to enhance pain relief, restore range of motion, and improve functional outcomes. The case highlights the synergistic benefits of incorporating MRT into traditional rehabilitation strategies through assessment, personalized treatment planning, and regular progress evaluations. The outcomes underscore the potential of this combined approach in optimizing the recovery process.
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Affiliation(s)
- Pallavi R Bhakaney
- Cardiorespiratory Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pune, IND
| | - Om C Wadhokar
- Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sakshi Upase
- Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pune, IND
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25
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Philip S, MacDermid J, Rushton A, Parikh P, Seens H. Patients' and therapists' perspective of integrating home and family work roles into rehabilitation following distal radius fracture. Disabil Rehabil 2024:1-11. [PMID: 38284803 DOI: 10.1080/09638288.2024.2305297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE To explore distal radius fracture (DRF) patients' and hand therapist/occupational therapist/physiotherapists' perceptions of integrating home and family work roles (HFWR) into rehabilitation. METHODS Eighteen patients and eleven therapists completed a semi-structured telephone interview three months after DRF. Reflexive thematic analysis of the interviews and triangulation of patients' and therapists' themes was performed. RESULTS The patient interview yielded five themes: the experience of rehabilitation; predetermined expectations of rehabilitation; incorporating HFWR into therapy sessions; varying patient needs for addressing HFWR; and determination to return to valued activities drives behavioral choices. The therapists' interview yielded five themes: The challenges in integrating HFWR into rehabilitation; HFWR addressed when brought up by a patient; working context and referral sources influence the rehabilitation plan; rehabilitation is not explicitly tailored according to sex and gender; and utilizing HFWR as a rehabilitation strategy is perceived beneficial. CONCLUSIONS Patients have predetermined rehabilitation expectations primarily focused on mobility and strengthening exercises. Therapists and patients agree that adapting home and family work roles is beneficial but was not a major focus for either therapists' or patients' expectations during therapy. An unfavourable environment, patient budget constraints, and limited time were identified as challenges to integrating family roles.
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Affiliation(s)
- Sheena Philip
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Joy MacDermid
- Health and Rehabilitation Sciences, Western University, London, Canada
- School of Physical Therapy, Western University, London, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Canada
| | - Pulak Parikh
- School of Physical Therapy, Western University, London, Canada
| | - Hoda Seens
- Health and Rehabilitation Sciences, Western University, London, Canada
- Windsor University, School of Medicine, Cayon, St Kitts & Nevis
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26
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Değer G, Demirdas AB, Akbaba D, Afacan MY. Allergic Contact Dermatitis in the Right Forearm Following Splint Application for Distal Radius Fracture: A Rare Case of Plaster Cotton Allergy. Cureus 2024; 16:e51802. [PMID: 38322073 PMCID: PMC10846668 DOI: 10.7759/cureus.51802] [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] [Accepted: 01/07/2024] [Indexed: 02/08/2024] Open
Abstract
Allergic contact dermatitis (ACD) after splint or cast application (plaster of Paris) is infrequently encountered in orthopedic and traumatology clinical practice. This case study aims to elucidate the identification of ACD after splint application, highlight the conditions that warrant vigilance, and outline the precautions and optional treatment methods available in such instances. A 56-year-old right-hand dominant female presented to the emergency department after a fall on her right hand, manifesting pain, swelling, and tenderness without neurovascular injury. Radiographs revealed a distal radius fracture, leading to the application of a plaster of Paris splint. Within one day, she returned to the emergency department with severe itching and burning in the right arm. The splint was removed, and a dermatology consultation confirmed ACD due to undercast cotton padding. After splint removal, the patient's fracture treatment continued using a shoulder-arm sling until the lesion healed. Topical antihistamine ointment and oral corticosteroids were prescribed. Regular follow-up revealed the healing and union of the fracture by the fifth week, with minimal residual skin color changes. This case underscores the importance of prompt diagnosis and appropriate treatment in managing such occurrences. A key takeaway is the crucial need to schedule a follow-up appointment with the patient within one day of applying the cast or splint. Skin problems can emerge rather than neurovascular issues following casts or splints. Educating patients on warning signs, including skin irritation, neurovascular deficits, and symptoms of compartment syndrome, ensures the timely identification of significant issues. Healthcare practitioners should inquire about patients' histories of allergic skin reactions, taking a proactive approach to prevent ACD through early intervention and preventive measures.
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Affiliation(s)
- Göker Değer
- Department of Orthopaedics and Traumatology, Beykoz State Hospital, Istanbul, TUR
| | - Ahmet Burak Demirdas
- Department of Orthopaedics and Traumatology, Istanbul University - Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, TUR
| | - Derya Akbaba
- Department of Orthopaedics and Traumatology, Istanbul University - Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, TUR
| | - Muhammed Yusuf Afacan
- Department of Orthopaedics and Traumatology, Istanbul University - Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, TUR
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27
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Sochol KM, Gluck M, McGough J, Hausman M. Optimizing Volar Tilt Restoration and Plate Position in Distal Radius Fractures. J Hand Surg Am 2024; 49:64.e1-64.e7. [PMID: 35843762 DOI: 10.1016/j.jhsa.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/02/2020] [Revised: 03/31/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius fractures are common and often treated surgically with a volar plate. A complication of volar plating includes tendonitis or rupture of the flexor pollicis longus (FPL) tendon. We hypothesize that failure to restore the volar tilt of the distal radius results in increased pressure on the FPL tendon. METHODS Ten fresh-frozen cadaveric wrists were assessed for this study. During testing, weights were suspended from the FPL tendon to stimulate muscle contraction. Reproducible fractures were created and fixed via volar plating. The contact force between FPL and the bone or plate edge was measured with a force transducer in 5 surgical conditions. These were assessed to evaluate whether failure to restore the volar tilt increases the pressure with a plate proximal or distal to the watershed line. RESULTS Significant increases in contact forces were observed between the control and both conditions in which volar tilt was not restored, with mean increases of 1.9 N and 3.0 N. A significant increase in the contact force was found when placing the plate distal to the watershed line with a mean increase of 2.03 N comparing the failure to restore volar tilt and after restoring the volar tilt. Significant increases in contact force were also observed between the dorsal plate condition, which failed to restore the volar tilt, and both plate conditions with placement distal to the watershed line, with mean differences of 0.94 N and 1.09 N, respectively. CONCLUSIONS Failure to restore the volar tilt in surgically treated distal radius fractures causes increased pressure on the FPL tendon. Plate placement distal to the watershed line also causes increased FPL tendon pressure over the plate edge. CLINICAL RELEVANCE This study demonstrates the importance of restoring the volar tilt of the distal radius in surgically treated distal radius fractures and confirms that plate placement distal to the watershed line will increase pressure on the FPL tendon.
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Affiliation(s)
- Kristen M Sochol
- Icahn School of Medicine at Mount Sinai, New York, NY; Department of Orthopedic Surgery, Zucker School of Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, NY.
| | - Matthew Gluck
- Icahn School of Medicine at Mount Sinai, New York, NY
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28
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Hama S, Moriya K, Matsuyama Y, Maki Y, Nakamura H. Low-Intensity Pulsed Ultrasound for Delayed Union of Distal Radius Fracture After Palmar Locking Plate Fixation: A Case Report. Cureus 2024; 16:e51468. [PMID: 38298325 PMCID: PMC10829889 DOI: 10.7759/cureus.51468] [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] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
Delayed union and non-union of distal radial fractures (DRFs) are rare, and there are a few reports of delayed union and nonunion of DRFs after palmar locking plate (PLP) fixation. A 68-year-old female patient presented to our hospital with left-sided wrist pain. Radiographs and computed tomography revealed a displaced DRF and ulnar styloid fracture. We performed open reduction and internal fixation with a PLP for the DRF and tension band wiring for the ulnar styloid fracture. However, bone union was not completed three months after the operation. We initiated low-intensity pulsed ultrasound (LIPUS) to achieve fracture healing. Complete bone union was confirmed radiographically five months after LIPUS. There have been few case reports on the delayed union or nonunion of DRFs after PLP fixation treated with LIPUS. LIPUS might be an effective option for the delayed union of DRFs after PLP fixation.
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Affiliation(s)
- Shunpei Hama
- Department of Orthopedic Surgery, Niigata Hand Surgery Foundation, Seiro-machi, JPN
| | - Koji Moriya
- Department of Orthopedic Surgery, Niigata Hand Surgery Foundation, Seiro-machi, JPN
| | - Yoshiyuki Matsuyama
- Department of Orthopedic Surgery, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, JPN
| | - Yutaka Maki
- Department of Orthopedic Surgery, Niigata Hand Surgery Foundation, Seiro-machi, JPN
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
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29
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Huang CY, Lee CC, Chen CW, Hu MH, Wu KW, Wang TM, Wang JH, Tseng TH. The Outcome of under 10 mm Single-Incision Surgery Using a Non-Specialized Volar Plate in Distal Radius Fractures: A Retrospective Comparative Study. J Clin Med 2023; 12:7670. [PMID: 38137740 PMCID: PMC10743621 DOI: 10.3390/jcm12247670] [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: 11/16/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The distal radius fracture is a common orthopedic injury. We aimed to share the surgical steps and investigate the outcomes of treating distal radius fractures with wounds ≤10 mm using a globally accessible locking plate. METHODS We collected 46 patients who underwent surgery via a <10 mm wound, with a control group consisting of 40 patients who underwent conventional procedures. Both groups were treated using the same volar plate. We compared the radiographic reduction quality, including volar tilt angle, radial inclination angle, and ulna variance. Additionally, clinical outcomes, such as pain assessed using VAS, Q-Dash score, and PRWE, were evaluated. Patient satisfaction with the wound was also analyzed. The follow-up time for the clinical outcomes was 24.2 ± 13.47 months. RESULTS There were no differences in the quality of reduction in parameters such as the volar tilt angle (p = 0.762), radial inclination angle (p = 0.986), and ulna variance (p = 0.166). Both groups exhibited comparable results in pain VAS (p = 0.684), Q-Dash score (p = 0.08), and PRWE (p = 0.134). The ≤10 mm incision group displayed an increase in satisfaction with the wound (p < 0.001). CONCLUSIONS Treating distal radius fractures with a <10 mm wound using a non-specialized locking plate is a feasible approach. It does not compromise the quality of fracture reduction or functional scores and improves wound satisfaction.
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Affiliation(s)
- Chang-Yu Huang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
- Department of Orthopaedic Surgery, En Chu Kong Hospital, New Taipei City 237, Taiwan
| | - Chia-Che Lee
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Chih-Wei Chen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Ming-Hsiao Hu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Kuan-Wen Wu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Jyh-Horng Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Tzu-Hao Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
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30
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Dande V, D'Souza D, Mangal R, Daniel AR, Ganti L. Frykman VIII Fracture Secondary to Falling Onto an Outstretched Hand (FOOSH). Cureus 2023; 15:e50641. [PMID: 38229785 PMCID: PMC10789654 DOI: 10.7759/cureus.50641] [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] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
This is the case of a 41-year-old woman who presented with pain in the wrist after a fall from her bicycle, after which she tried to block her fall by outstretching her hand. She sustained a Frykman VIII fracture, with a fracture of the distal radius and ulnar styloid. Her labs were unremarkable, and she had no previous medical history. Her case was an example of a classic fracture due to FOOSH (falling onto an outstretched hand) which can easily be avoided by learning how to break falls properly. The patient's symptoms, diagnosis, treatment, and ways to avoid this injury are presented.
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Affiliation(s)
- Vedha Dande
- Biomedical Sciences, University of Central Florida, Orlando, USA
| | - Dwayne D'Souza
- Emergency Medicine and Orthopedics, Vanderbilt University Medical Center, Nashville, USA
| | - Rohan Mangal
- Medicine, University of Miami Miller School of Medicine, Miami, USA
| | | | - Latha Ganti
- Medical Sciences, The Warren Alpert Medical School of Brown University, Providence, USA
- Emergency Medicine and Neurology, University of Central Florida College of Medicine, Orlando, USA
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Quan T, Chen FR, Manzi JE, Mcdaniel L, Howard P, Marquardt C, Ranson R, Tabaie S. The Association between Bleeding Disorders and Postoperative Complications Following Operative Treatment of Distal Radius Fracture. J Wrist Surg 2023; 12:493-499. [PMID: 38213556 PMCID: PMC10781517 DOI: 10.1055/s-0043-1761295] [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: 05/17/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2024]
Abstract
Background While previous studies have investigated the association between bleeding disorders and outcomes with hip or knee surgeries, no studies have investigated the association between bleeding disorders and outcomes in upper extremity surgery. Questions/Purposes The purpose of this study was to investigate if a past history of bleeding disorders is associated with which, if any postoperative complications for patients receiving distal radius fracture open reduction internal fixation. Patients and Methods Patients undergoing operative treatment for distal radius fracture from 2007 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were stratified into two cohorts: patients with a bleeding disorder and patients without a bleeding disorder. In this analysis, 30-day postoperative complications were assessed, as well as mortality, extended length of stay, reoperation, and readmission. Bivariate and multivariate analyses were performed. Results Of the 16,489 total patients undergoing operative treatment for distal radius fracture, 16,047 patients (97.3%) did not have a bleeding disorder, whereas 442 (2.7%) had a bleeding disorder. Following adjustment on multivariate analyses, an increased risk of postoperative transfusion requirement (odds ratio [OR] 17.437; p = 0.001), extended length of hospital stay more than 3 days (OR 1.564; p = 0.038), and readmission (OR 2.515; p < 0.001) were seen in patients with a bleeding disorder compared to those without a bleeding disorder. Conclusion History of bleeding disorders is an independent risk factor for transfusions, extended length of stay, and readmission. We recommend a multidisciplinary team approach to addressing bleeding disorders before patients receive distal radius fracture open reduction internal fixation. Level of Evidence Level III, retrospective study.
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Affiliation(s)
- Theodore Quan
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Frank R. Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Pennsylvania
| | - Joseph E. Manzi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Lea Mcdaniel
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Peter Howard
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Caillin Marquardt
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Rachel Ranson
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Health System, Washington, District of Columbia
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du Plessis P, Fournier MC. Management of complex wrist fractures with volar and dorsal locked (double-locked) K-lock. OTA Int 2023; 6:e286. [PMID: 37744996 PMCID: PMC10516386 DOI: 10.1097/oi9.0000000000000286] [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: 11/29/2022] [Revised: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 09/26/2023]
Abstract
This article is a technical note to outline a novel technique of fixation in complex, comminuted distal radius fractures using a double-locked K-wire construct using a new implant called K-lock. In these (AO) C-type fractures, with significant dorsal comminution, it is often difficult to attain stable and secure fixation of the dorsal rim fragments, especially the dorsal lunate fossa fragment. This often results in patients being treated by temporary spanning devices or asking to have a restricted use of the hand during a given period to avoid loss of position. If dorsal plating is necessary, because of the severity of the comminution, a double-locked K-wire (locked in both the dorsal and volar plates) offers a fixation option and may create a significantly stronger construct and allow confident early mobilization. The K-lock was recently launched by Newclip Technics as an adjunct to the Xpert Wrist 2.4 set as a fragment-specific fixation option. The wire has less chance of displacing or fracturing the fragment and has a smooth surface compared with a screw; this wire would be safer close to the joint in severe distal intra-articular comminution. Of the 9 cases performed so far (as is our usual practice), despite the complexity of the fractures, none were immobilized postoperatively and all started hand therapy in the first week. Most were driving by 2 weeks and returned to light work at 4 weeks and heavy work or sports at 6 to 8 weeks. This principle of fixation may also be extended to other fractures where dual plating is used.
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Pien IJ, Jain NS, Benhaim P, Yaghoubian A, Azari KK. The Use of Montage Bone Putty in Assisting in the Maintenance of Reduction in Comminuted Distal Radius Fractures. J Wrist Surg 2023; 12:509-516. [PMID: 38213557 PMCID: PMC10781572 DOI: 10.1055/s-0043-1761946] [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: 10/15/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023]
Abstract
Background The distal radius fracture is the most common fracture in the United States. Achieving stable reduction and fixation of complex fracture patterns can be challenging. In order to help maintain reduction of comminuted fracture to simplify plating, the calcium phosphate-based bone putty Montage has been developed. Questions/Purposes Does Montage assist in achieving stable reduction and fixation of complex distal radius fractures with an acceptable complication profile? Patient and Methods We retrospectively analyzed all patients who were treated intraoperatively with Montage bone putty along with volar plate fixation at a large-volume urban county hospital. Preoperative, intraoperative, and postoperative measurements of radiographic features were recorded at 2 and 6 months, as were any complications. Statistical analysis was then performed on these values. Results Preoperative and postoperative radiographs demonstrated significant improvement in standard distal radius fracture measurements, reflecting adequate reduction with the use of Montage intraoperatively. Critically, radiographs demonstrated maintenance of reduction compared to intraoperative fluoroscopy images at 2 months, showing short-term stability of the use of Montage in these fracture patterns as well as long-term stability at 6 months in a subset of patients. There were no major complications in this study. Conclusion In this study, we demonstrate the utility of Montage bone putty for complex distal radius fractures with short-term follow-up and limited long-term follow-up. This initial study underlines its efficacy in maintaining reduction without major complications. Level of Evidence IV, Therapeutic.
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Affiliation(s)
- Irene J. Pien
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California
| | - Nirbhay S. Jain
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California
| | - Prosper Benhaim
- Department of Orthopaedic Surgery, University of California, Los Angeles, California
| | - Arezou Yaghoubian
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California
| | - Kodi K. Azari
- Department of Orthopaedic Surgery, University of California, Los Angeles, California
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Li C, Kong L, Shi X, Zhang Z, Lu J, Zhang B. Predictive factors of distal radioulnar joint instability after surgical treatment of distal radius fractures. Medicine (Baltimore) 2023; 102:e36505. [PMID: 38050192 PMCID: PMC10695496 DOI: 10.1097/md.0000000000036505] [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: 09/13/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
Distal radioulnar joint (DRUJ) instability is a common postoperative complication of distal radius fractures, seriously impacting patients' quality of life. This study investigated its possible influencing factors to determine prognosis and to guide treatment better. We retrospectively included a series of patients with distal radius fractures that underwent volar locking plate fixation. Basic patient information and imaging parameters were collected. The incidence of DRUJ instability during follow-up was recorded, and factors associated with DRUJ instability were determined using univariate analysis and multifactorial logistic regression analysis. A total of 159 patients were enrolled in this study. At 6 months of follow-up, 54 patients (34.0%) had DRUJ instability, and multivariate analysis showed coronal plane displacement (OR, 1.665; 95% CI, 1.091-2.541), fracture classification (OR, 0.679; 95% CI, 0.468-0.984) and DRUJ interval (OR, 1.960; 95% CI, 1.276-3.010) were associated with DRUJ instability after volar locking plate. DRUJ interval, coronal plane displacement, and fracture classification are associated with DRUJ instability during follow-up. Therefore, preoperative risk communication and intraoperative attention to recovering relevant imaging parameters are necessary for these patients.
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Affiliation(s)
- Chenfei Li
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Lingde Kong
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xuyang Shi
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Zuzhuo Zhang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Jian Lu
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Bing Zhang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Hustedt JW, Chartrand N, Merrell D, Reichenbach R, Pinkston E, Stecher C. The Moderating Effect of Age on Patient-Reported Benefits From Operative Management of Intra-Articular Distal Radius Fractures: A Meta-Regression Analysis. J Hand Surg Am 2023; 48:1193-1199. [PMID: 37831017 DOI: 10.1016/j.jhsa.2023.09.001] [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: 04/04/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE The optimal treatment of intra-articular distal radius fractures in older adults (>65 years) remains uncertain despite numerous randomized trials. The purpose of this study was to examine the moderating effect of age on patient-reported benefits of volar locked plating versus cast immobilization for intra-articular distal radius fractures. METHODS A meta-analysis of randomized controlled trials was conducted to compare volar locked plating and cast immobilization of intra-articular distal radius fractures. Meta-regression analyses were used to examine the moderating effect of age on improvements in patient-reported outcome measures from operative treatment of distal radius factures. Modeling results were then used to estimate improvements in Disability of the Arm, Shoulder, and Hand (DASH) scores from surgery that are associated with ages ranging from 65 to 90 years. RESULTS Twelve randomized controlled trials including 1,806 patients were included. Age was a significant moderator of patient-reported benefits after operative treatment, with decreasing DASH score benefits from surgery associated with older ages. Model predictions show that a majority of patients aged <70 years will experience a clinically meaningful improvement in DASH scores from surgery. Patients aged 70-80 years have decreasing DASH benefits with age, but many may still experience a clinically meaningful improvement from surgery. Patients aged >80 years are unlikely to experience a clinically meaningful improvement in DASH scores with surgical management. CONCLUSIONS Older ages are associated with decreased benefits from surgical management with volar locked plating as compared to cast immobilization. Patients aged >80 years are unlikely to experience a clinically significant improvement with surgery. Surgeons and policymakers may use these data to counsel patients, health systems, and professional organizations on the risks and benefits of operative treatment in older adults. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis 1, Meta-Analysis of Randomized Controlled Trials.
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Affiliation(s)
- Joshua W Hustedt
- Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.
| | - Nicholas Chartrand
- Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Dallin Merrell
- Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Rachel Reichenbach
- Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Eric Pinkston
- Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ
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Burton H, Bodansky D, Silver N, Yao J, Horwitz M. Assessing Bone Mineral Density Using Radiographs of the Hand: A Multicenter Validation. J Hand Surg Am 2023; 48:1210-1216. [PMID: 37737801 DOI: 10.1016/j.jhsa.2023.08.009] [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: 04/14/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Osteoporosis and fragility fractures incur substantial costs to quality of life and global health care systems. The current gold standard for quantifying bone density is dual-energy X-ray absorptiometry. Our hypothesis is that bone density can be accurately predicted with a simpler method using plain radiographs of the hand. METHODS This retrospective cohort study was undertaken in two centers in the United Kingdom, where the second metacarpal cortical percentage (2MCP) scores were calculated from radiographs. This study included patients who had sustained a distal radius fracture between 2020 and 2022 and had received both a posteroanterior radiograph of the hand and a dual-energy X-ray absorptiometry scan within 12 months of their radiograph and fracture. The Pearson correlation coefficient was calculated to determine the correlation between 2MCP scores and t-scores of the femoral neck on dual-energy X-ray absorptiometry scans. RESULTS Of the 188 patients, the 2MCP score significantly correlated with bone density t-scores of the femoral neck. A 2MCP score <50% demonstrated 100% sensitivity and 100% specificity for differentiating osteoporotic from normal subjects, whereas a 2MCP score <60% demonstrated 94.4% sensitivity and 83.0% specificity in differentiating osteopenic from normal subjects. CONCLUSIONS These data confirm that the likelihood of osteoporosis being present can be determined via the 2MCP score. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic I.
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Affiliation(s)
- Harry Burton
- Department of Hand and Wrist Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - David Bodansky
- Department of Hand and Wrist Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Natan Silver
- Department of Hand and Wrist Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Maxim Horwitz
- Department of Hand and Wrist Surgery, Chelsea and Westminster Hospital, London, United Kingdom
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Shapiro LM, Xiao M, Zhuang T, Ruch DS, Richard MJ, Kamal RN. Variations in Treatment and Costs for Distal Radius Fractures in Patients Over 55 Years of Age: A Population-Based Study. J Hand Microsurg 2023; 15:351-357. [PMID: 38152674 PMCID: PMC10751197 DOI: 10.1055/s-0042-1749460] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective To evaluate the rate of surgery for symptomatic malunion after nonoperatively treated distal radius fractures in patients aged 55 and above, and to secondarily report differences in demographics, geographical variation, and utilization costs of patients requiring subsequent malunion correction. Methods We identified patients aged 55 and above who underwent nonoperative treatment for a distal radius fracture between 2007 and 2016 using the IBM MarketScan database. In the nonoperative cohort, we identified patients who underwent malunion correction between 3 months and 1 year after distal radius fracture. The primary outcome was rate of malunion correction. Multivariable logistic regression controlling for sex, region, and Elixhauser Comorbidity Index (ECI) was used. We also report patient demographics, geographical variation, and utilization cost. Results The rate of subsequent malunion surgery after nonoperative treatment was 0.58%. The cohort undergoing malunion surgery was younger and had a lower ECI. For every 1-year increase in age, there was a 6.4% decrease in odds of undergoing surgery for malunion, controlling for sex, region, and ECI (odds ratio = 0.94 [0.93-0.95]; p < 0.01). The southern United States had the highest percentage of patients initially managed operatively (30.7%), the Northeast had the lowest (22.0%). Patients who required a malunion procedure incurred higher costs compared with patients who did not ($7,272 ± 8,090 vs. $2,209 ± 5,940; p < 0.01). Conclusion The rate of surgery for symptomatic malunion after initial nonoperative treatment for distal radius fractures in patients aged 55 and above is low. As younger and healthier patients are more likely to undergo malunion correction with higher associated costs, surgeons may consider offering this cohort surgical treatment initially.
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Affiliation(s)
- Lauren M. Shapiro
- Department of Orthopaedic Surgery, University of California, San Francisco, California, United States
| | - Michelle Xiao
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
| | - Thompson Zhuang
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
| | - David S. Ruch
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States
| | - Marc J. Richard
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States
| | - Robin N. Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
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Nunotani M, Naito K, Nagura N, Kawakita S, Ishijima M. Locked Wire Fixator for a Distal Radius Fracture With Malunion: A Case Report. Cureus 2023; 15:e50193. [PMID: 38186455 PMCID: PMC10771860 DOI: 10.7759/cureus.50193] [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] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Surgical treatment for a distal radius fracture using a volar locking plate is difficult if the distal radius malunion remains. Therefore, a different surgical method from volar locking plate fixation should be required. We report the case of an 83-year-old woman with a left dorsal displaced distal radius fracture. However, the deformity of the volar cortex of the radius was recognized because of a previous distal radius fracture. Therefore, osteosynthesis with a locked wire fixator was performed. At 12 months after surgery, the patient has returned to daily activities without difficulty. A locked wire fixator can be useful for treating a distal radius fracture with malunion of the volar cortex of the distal radius.
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Affiliation(s)
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University, Tokyo, JPN
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, JPN
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University, Tokyo, JPN
| | - So Kawakita
- Department of Orthopaedics, Juntendo University, Tokyo, JPN
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, JPN
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University, Tokyo, JPN
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, JPN
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Bowers M, Gruenberger E, Jardaly AH, Wood M, Ko A, D'Almeida S, Rubin TA. Does Construct Type Matter? A Retrospective Review Comparing Outcomes of Distal Radius Fractures Treated with Standard Volar Plating versus Fragment-Specific Fixation. J Wrist Surg 2023; 12:500-508. [PMID: 38213565 PMCID: PMC10781579 DOI: 10.1055/s-0043-1761286] [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: 07/06/2022] [Accepted: 12/22/2022] [Indexed: 02/24/2023]
Abstract
Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP. Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020. Patients < 18 years old, < 8 weeks' follow-up, open fractures, ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient demographics, specific construct type, AO fracture classification, ROM, and complications were assessed. ROM was calculated using average flexion, extension, supination, and pronation. t -Tests were used to determine differences in ROM among construct types. Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation. No significant differences were identified when comparing final wrist flexion ( p = 0.08), extension ( p = 0.33), supination ( p = 0.35), or pronation ( p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%). Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4). Conclusion Construct type does not appear to affect final ROM if stable internal fixation is achieved. SVP and FSF had similar complication rates; however, double volar hook constructs resulted in increased reoperations likely from fixation failure and plate prominence. Level of Evidence Level IV, retrospective review.
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Affiliation(s)
- Mitchell Bowers
- Department of Orthopaedics, Vanderbilt University, Nashville, Tennessee
| | - Eric Gruenberger
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Achraf H. Jardaly
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Madison Wood
- Medical College of Georgia, Medical College of Georgia, Augusta, Georgia
| | - Andrew Ko
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Stacey D'Almeida
- Hughston Foundation Research Program, The Hughston Clinic, Columbus, Georgia
| | - Todd A. Rubin
- Hand and Upper Extremity Surgery Department, Hughston Clinic Orthopaedics, TriStar Centennial Medical Center, Nashville, Tennessee
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40
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Gordon AM, Golub IJ, Diamond KB, Kang KK, Choueka J. Cannabis Abuse Is Associated With Greater Medical Complications, Emergency Department Visits, and Readmissions Following Open Reduction and Internal Fixation for Distal Radius Fractures. Hand (N Y) 2023:15589447231210948. [PMID: 38006235 DOI: 10.1177/15589447231210948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND Despite increased legalization, little is known about the influence of cannabis use disorder (CUD) following open reduction and internal fixation (ORIF) for distal radius fractures (DRFs). The aims were to determine whether CUD patients undergoing ORIF for DRF have increased: (1) medical complications; and (2) health care utilization (emergency department [ED] visits and readmission rates). METHODS Patients were identified from an insurance database from 2010 to 2020 using Current Procedural Terminology codes: 25607, 25608, and 25609. Patients with a history of CUD were 1:5 ratio matched to controls by age, sex, tobacco use, alcohol abuse, opioid dependence, and comorbidities. This yielded 13,405 patients with (n = 2,297) and without (n = 11,108) CUD. Outcomes were to compare 90-day medical complications, ED visits, and readmissions. Multivariable logistic regression models computed the odds ratios of CUD on dependent variables. P values less than .005 were significant. RESULTS The incidence of CUD among patients aged 20 to 69 years undergoing ORIF increased from 4.0% to 8.0% from 2010 to 2020 (P < .001). Cannabis use disorder patients incurred significantly higher rates and odds of developing 90-day medical complications (15.24% vs 5.76%), including pneumoniae (3.66% vs 1.67%), cerebrovascular accidents (1.04% vs 0.32%), pulmonary emboli (0.57% vs 0.16%), respiratory failures (1.00% vs 0.48%), and surgical site infections (1.70% vs 1.04%; all P < .004). Emergency department visits (2.53% vs 1.14%) and readmission rates (5.79% vs 4.29%) within 90 days were higher among cannabis abusers. CONCLUSIONS With a greater number of states legalizing cannabis, hand surgeons should be cognizant of the association with increased 90-day complications and health care utilization parameters.
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Affiliation(s)
- Adam M Gordon
- Maimonides Medical Center, Brooklyn, NY, USA
- Questrom School of Business, Boston University, MA, USA
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Hosokawa T, Tajika T, Suto M, Chikuda H. Surgical Treatment of Distal Radius Fractures Complicated by Concomitant Flexor Carpi Radialis Brevis: A Case Series and Surgical Techniques. J Orthop Case Rep 2023; 13:18-23. [PMID: 38025351 PMCID: PMC10664228 DOI: 10.13107/jocr.2023.v13.i11.3990] [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: 08/18/2023] [Revised: 09/07/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The flexor carpi radialis brevis (FCRB) is a rare anatomical variation, with a reported prevalence ranging from 0.9% to 8.7%. Our previous report showed three cases of FCRB in distal radius fracture (DRF) and found that hypoplastic pronator quadratus (PQ) adjacent to the FCRB muscle made it difficult to cover a volar locking plate (VLP). As we subsequently experienced additional six FCRBs, we report on new findings and surgical tips. Case Report VLP fixation was performed on DRF with FCRB in nine limbs of eight patients. The prevalence was 2.9% (9 of 310 limbs). Of the seven patients that underwent unilateral surgery, six were muscle type and one was tendon type. One patient who underwent bilateral surgery had a muscle type on the left and a tendon type on the right. In three muscle types, as the FCRB muscle belly was widely attached to the radial side of the radius and the radial side of the PQ was hypoplastic, postoperative covering of the plate by repair of the PQ was impossible. Then, in two of those cases, the PQ and FCRB were sutured and the plate was covered. FCRB muscle could be retracted to the radial side in all cases. One patient with a tendon type had a ruptured tendon, which was left unrepaired. All patients had no postoperative problems. Conclusion In the muscle-type FCRB, the muscle should be retracted to the radial side for VLP fixation. The muscle belly might occupy the radial side of the radius, and the PQ might be hypoplastic and unrepairable. However, the plate can be covered by suturing the PQ and FCRB.
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Affiliation(s)
- Takafumi Hosokawa
- Department of Orthopaedics Surgery, Tone Chuo Hospital, Numasu-machi, Numata, Japan
| | - Tsuyoshi Tajika
- Department of Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Morimichi Suto
- Department of Orthopaedics Surgery, Tone Chuo Hospital, Numasu-machi, Numata, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedics Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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McEntee RM, Tulipan J, Beredjiklian PK. Risk Factors and Outcomes in Carpal Tunnel Syndrome Following Distal Radius Open Reduction Internal Fixation. J Hand Surg Am 2023; 48:1157.e1-1157.e7. [PMID: 35562282 DOI: 10.1016/j.jhsa.2022.03.016] [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: 04/13/2020] [Revised: 01/30/2022] [Accepted: 03/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Carpal tunnel syndrome (CTS) is a common complication following the operative repair of distal radius fractures. It is unclear who is at risk of developing this complication in the postoperative period. This study sought to identify risk factors for developing CTS and to evaluate patient-reported outcomes in patients who develop postoperative CTS. METHODS A retrospective review of all distal radius fractures treated surgically at a single private academic center was performed from January 2007 to October 2019. Of the 4,487 patients, 68 were identified to have an ipsilateral carpal tunnel release within 6 months of the distal radius injury. Collected data comprised patient demographics, medical history, and functional outcome scores. RESULTS Carpal tunnel syndrome was more likely to develop in older patients (62.9 years vs 57.4 years). Sex, body mass index, smoking history, and the type of insurance were not found to be significantly different between the groups. Medical history of kidney disease, psychiatric conditions, and peripheral vascular disease were found to be associated with developing CTS. Patients who developed CTS had higher average Disabilities of the Arm, Shoulder, and Hand scores than patients without CTS (28.1 vs 20.0) at the final follow-up. In a multivariable analysis, patients who developed CTS were found to be older (Odds ratio, 1.03) and less likely to be smokers (Odds ratio, 0.46). CONCLUSIONS In our cohort, we observed that older patients were more likely to require carpal tunnel release following distal radius fracture. In addition, nonsmokers were more likely to require subsequent carpal tunnel release, probably as a result of confounding effects. Special care should be taken to monitor these patients for CTS in the postoperative period following a distal radius open reduction and internal fixation. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Roh YH, Park SG, Lee SH. Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials. J Pers Med 2023; 13:1543. [PMID: 38003859 PMCID: PMC10671853 DOI: 10.3390/jpm13111543] [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: 09/23/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Distal radius fractures are the most prevalent upper extremity fractures, posing a significant public health concern. Recent studies comparing regional and general anesthesia for postoperative pain management after these fractures have yielded conflicting results. This meta-analysis aimed to compare the effectiveness of regional and general anesthesia concerning postoperative pain management and opioid consumption following distal radius fracture surgery. A comprehensive search was conducted in PubMed, Cochrane Library, and EMBASE databases to identify relevant randomized controlled trials. Four randomized trials involving 248 participants were included in the analysis. A pooled analysis revealed that regional anesthesia led to significantly reduced postoperative pain scores at 2 h compared to general anesthesia (SMD -2.03; 95% CI -2.88--1.17). However, no significant differences in pain scores were observed between the two anesthesia types after 12 h post-surgery. Regional anesthesia was associated with lower total opioid consumption (SMD -0.76; 95% CI -1.25--0.26) and fewer occurrences of nausea and vomiting compared to the general anesthesia. Nonetheless, opioid consumption on the first day post-discharge was significantly higher in the regional anesthesia group (SMD 0.83; 95% CI 0.47-1.20). The analgesic superiority of regional anesthesia is confined to the early postoperative hours with overall lower opioid use but a notable increase in opioid consumption on the first day post-discharge, potentially attributable to rebound pain.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea; (S.G.P.); (S.H.L.)
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Livesey MG, Bains SS, Stern JM, Chen Z, Dubin JA, Monárrez R, Remily EA, Ingari JV. Cannabis Use in Patients With Distal Radius Fractures: A Moment of Unity? Hand (N Y) 2023:15589447231196905. [PMID: 37787484 DOI: 10.1177/15589447231196905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND As legalization of cannabis spreads, an increasing number of patients who use cannabis are being seen in the clinical setting. This study examined the impact of cannabis and tobacco use on postoperative complications following open reduction and internal fixation (ORIF) of distal radius fractures. METHODS A national, all-payer database was queried to identify patients who underwent ORIF of a distal radius fracture between 2015 and 2020 (n = 970 747). Patients were stratified into the following groups: (1) tobacco use (n = 86 941), (2) cannabis use (n = 898), (3) tobacco and cannabis use (n = 9842), and (4) neither tobacco nor cannabis use ("control", 747 892). Multivariable logistic regression was used to identify risk factors for infection, nonunion, and malunion within the first postoperative year. RESULTS Concomitant use of tobacco and cannabis was associated with a higher rate of nonunion (5.0%) compared to tobacco or cannabis use alone (P < .001). Multivariate analysis identified cannabis-only use (odds ratio [OR] 1.25), tobacco-only use (OR 2.17), and concurrent tobacco and cannabis use (OR 1.78) as risk factors for infection within the first postoperative year. Similarly, cannabis-only use (OR 1.47), tobacco-only use (OR 1.92), and concurrent tobacco and cannabis use (OR 2.52) were associated with an increased risk of malunion. CONCLUSIONS Cannabis use is associated with an elevated risk of infection and malunion following operative management of a distal radius fracture. Concomitant use of cannabis and tobacco poses an elevated risk of nonunion and malunion compared to tobacco use alone.
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Affiliation(s)
- Michael G Livesey
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | | | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Rubén Monárrez
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ethan A Remily
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - John V Ingari
- Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Ayik Ö, Bayram S, Altan M, Engin MÇ. A New Repair Technique in Pronator Quadratus in Management of Distal Radius Fracture: Comparison with Primary Repair and Unrepaired Techniques. J Wrist Surg 2023; 12:390-399. [PMID: 37841351 PMCID: PMC10569836 DOI: 10.1055/s-0043-1760734] [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: 09/10/2022] [Accepted: 11/28/2022] [Indexed: 01/22/2023]
Abstract
Objective We aimed to compare the functional and clinical results between our new repair technique in the groups with and without pronator quadratus (PQ) repair in distal radius fractures treated with plate fixation using the volar approach. Methods The medical records of patients who underwent open reduction and volar plate fixation due to distal radius fracture between 2018 and 2020 were studied. In group A, PQ cannot be sutured or tension may occur, the intact radial fascia of the deep anterior fascia (DAF) was placed under the flexors toward the PQ and it was sutured with a 3-0 slow-absorbable monofilament suture to DAF. In group B, no repair was performed. In group C, PQ was sutured with traditional method. Range of motion (ROM) of wrist and handgrip strengths were measured at final examination. Pain was assessed with Visual Analogue Score (VAS), and functional status was evaluated with Quick - Disabilities of the Arm, Shoulder, and Hand (DASH). Complications which included tendinopathy, neuritis, tendon rupture due to plate irritation, implant failure, and malunion were also compared. Results Seventy-seven patients (group A, 21, group B, 24, group C, 32 patients) were included in the final follow-up examination who met our inclusion criteria. Among the clinical, functional, and radiological results such as ROM, VAS, DASH, grip strength, and complications in the all group at a mean postoperative of 16.6 months no significant difference was observed. Conclusion Although there was no significant difference between the groups in this study, we think that covering the plate may prevent long-term complications.
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Affiliation(s)
- Ömer Ayik
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Altan
- Department of Orthopaedic and Traumatology, Sarikamiş State Hospital, Kars, Turkey
| | - Muhammed Çağatay Engin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Holc F, Bronenberg Victorica P, Avanzi R, Huespe IA, De Carli P, Boretto JG. Risk of Volar Locking Plate Removal After Distal Radius Fractures: Time-to-Event Analysis. J Hand Surg Am 2023; 48:1011-1017. [PMID: 37578402 DOI: 10.1016/j.jhsa.2023.06.023] [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: 02/25/2023] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The primary purpose of this study was to describe the rate of volar locking plate (VLP) removal after distal radius fracture and how long it takes for the risk of VLP removal to stabilize. The secondary purpose was to describe the reasons for VLP removal and analyze the relationship between it and the Soong index. METHODS This was a single-center retrospective cohort study. Patients aged >18 years with distal radius fracture who underwent VLP fixation were included. Hardware removal, time until VLP removal, and the primary reason for removal were recorded. The implant prominence was measured as described by Soong. We used Kaplan-Meier curves and risk tables to describe the risk of VLP removal and variation over time. Multivariable logistic regression was used to assess the relationship between Soong grade and VLP removal. RESULTS A total of 313 wrists were included. There were 35 cases of VLP removal, with an overall incidence of 11.2% at 15 years of follow-up. The incidence rate was 1.2 per 100 individuals per year for the entire cohort. The risk of VLP removal decreased from 6.2% in the first postoperative year to 1.7% in the second year and 1.4% in the third year. Beyond that, the rate remained <1% per year throughout the follow-up period. The median hardware removal time was 11 months. The main reasons for VLP removal were tenosynovitis, implant-associated pain, and screw protrusion. We found no association between Soong grade and VLP removal. CONCLUSIONS Volar locking plate removal after distal radius fracture was more common in the first year after surgery and remained notable until the third year. Regular monitoring and patient education to assess possible complications related to hardware are important during this period. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Fernando Holc
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Pedro Bronenberg Victorica
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rocio Avanzi
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ivan A Huespe
- Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo De Carli
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge G Boretto
- Hand and Upper Extremity Department, Instituto de Ortopedia y Traumatología "Prof. Dr. Carlos Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Baek JH, Lee JH, Ku KH. Ulnar-Sided Sclerosis of the Lunate Does Not Affect Outcomes in Patients Undergoing Volar Locking Plate Fixation for Distal Radius Fracture. J Clin Med 2023; 12:6003. [PMID: 37762943 PMCID: PMC10532306 DOI: 10.3390/jcm12186003] [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: 08/18/2023] [Revised: 08/29/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND AND AIM Radial shortening after distal radius fracture causes ulnar impaction, and a mild reduction loss of radial height occurs even after volar locking plate fixation. This study aimed to determine whether preoperative ulnar-sided sclerosis affects clinical outcomes after volar locking plate fixation for distal radius fracture (DRF). METHOD Among 369 patients who underwent volar locking plate fixation for DRF, 18 with preoperative ulnar-sided sclerosis of the lunate were included in Group A and compared to a 1:4 age-, sex- and fracture-pattern-matched cohort without sclerosis (72 patients, Group B). The visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and grip strength were assessed as clinical outcomes. Ulnar variance (UV), radial inclination, radial length, and volar tilt at two weeks after surgery and the final follow-up were measured as radiographic outcomes. RESULTS The mean VAS and DASH scores and grip strength did not differ between the two groups. The mean UV at two weeks after surgery and the last follow-up was significantly higher in Group A. The mean changes in UV were +0.62 mm in Group A and +0.48 mm in Group B. There were no significant intergroup differences. Neither UV nor its changes showed any association with DASH and VAS scores. CONCLUSIONS Preoperative ulnar-sided sclerosis of the lunate did not affect clinical outcomes after volar locking plate fixation, even if UV increased postoperatively.
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Affiliation(s)
- Jong-Hun Baek
- Department of Orthopedic Surgery, Kyung Hee University School of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea;
| | - Jae-Hoon Lee
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon 14555, Republic of Korea;
| | - Ki-Hyeok Ku
- Department of Orthopedic Surgery, Graduate School, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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Zha Q, Xu Z, Cai X, Zhang G, Shen X. Wearable rehabilitation wristband for distal radius fractures. Front Neurosci 2023; 17:1238176. [PMID: 37781255 PMCID: PMC10536142 DOI: 10.3389/fnins.2023.1238176] [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: 06/11/2023] [Accepted: 08/07/2023] [Indexed: 10/03/2023] Open
Abstract
Background Distal radius fractures are a common type of fracture. For patients treated with closed reduction with splinting, a period of rehabilitation is still required after the removal of the splint. However, there is a general lack of attention and low compliance to rehabilitation training during this period, so it is necessary to build a rehabilitation training monitoring system to improve the efficiency of patients' rehabilitation. Methods A wearable rehabilitation training wristband was proposed, which could be used in the patient's daily rehabilitation training scenario and could recognize four common wrist rehabilitation actions in real-time by using three thin film pressure sensors to detect the pressure change curve at three points on the wrist. An algorithmic framework for classifying rehabilitation training actions was proposed. In our framework, an action pre-detection strategy was designed to exclude false detections caused by switching initial gestures during rehabilitation training and wait for the arrival of the complete signal. To classify the action signals into four categories, firstly an autoencoder was used to downscale the original signal. Six SVMs were then used for evaluation and voting, and the final action with the highest number of votes would be used as the prediction result. Results Experimental results showed that the proposed algorithmic framework achieved an average recognition accuracy of 89.62%, an average recognition recall of 88.93%, and an f1 score of 89.27% on the four rehabilitation training actions. Conclusion The developed device has the advantages of being small size and easy to wear, which can quickly and accurately identify and classify four common rehabilitation training actions. It can easily be combined with peripheral devices and technologies (e.g., cell phones, computers, Internet) to build different rehabilitation training scenarios, making it worthwhile to use and promote in clinical settings.
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Affiliation(s)
- Qing Zha
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, China
| | - Zeou Xu
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, China
| | - Xuefeng Cai
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Guodong Zhang
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Xiaofeng Shen
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
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Ding D, Zhu H, Zheng M, Kang C. Effect of platelet content on occurrence and prognosis of distal radius fracture. Medicine (Baltimore) 2023; 102:e35043. [PMID: 37682171 PMCID: PMC10489189 DOI: 10.1097/md.0000000000035043] [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: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Fractures of the distal radius are a common fracture with an increasing incidence. However, the underlying factors for distal radius fractures (DRFs) remain unclear. A total of 123 patients with distal radial fractures were recruited. To document clinical and follow-up data, and measure the levels of white blood cells, hemoglobin, platelets, and red blood cells in the bloodstream for qualitative observation of their expression effects within the human body, specifically assessing whether the magnitudes of these indicators are associated with potential factors influencing DRF. Pearson chi-square test and Spearman correlation were used to analyze the relationship between DRF and related parameters. Univariate and multivariate logistic regression and multivariate Cox proportional risk regression were used for further analysis. Pearson chi-square test and Spearman correlation analysis showed a significant correlation between platelet and red blood cell levels and the occurrence of DRFs. Univariate logistic regression analysis demonstrated a significant correlation between platelet count (OR [odds ratio] = 6.286, 95% CI [confidence interval]: 2.862-13.808, P < .001) and red blood cell count (OR = 2.780, 95% CI: 1.322-5.843, P = .007) with DRFs. Increasing levels of both indicators were associated with a higher susceptibility to DRFs. Multivariate logistic regression showed that platelets (OR = 6.344, 95% CI: 2.709-14.855, P < .001) were significantly associated with DRFs. Multivariate Cox regression analysis showed sex (HR [hazard ratio] = 0.596, 95% CI: 0.381-0.931, P = .023) and platelet (HR = 3.721, 95% CI: 2.364-5.855, P < .001) were significantly associated with maintenance time from recovery to recurrence (MTRR) of DRFs. In other words, the platelet content in the body of different genders is different, and the MTRR of DRF is different. Platelets were significantly associated with DRFs. The higher the platelet count, the higher the risk of DRF and the shorter the time of DRF recurrence.
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Affiliation(s)
- Danyang Ding
- Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Shijingshan District, Beijing, P.R. China
| | - Hao Zhu
- Department of Orthopedics, Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, P.R. China
| | - Meiliang Zheng
- Department of Orthopedics, Second Central Hospital of Baoding, Zhuozhou City, Hebei Province, P.R. China
| | - Chunbo Kang
- Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Shijingshan District, Beijing, P.R. China
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Jensen J, Graumann O, Gerke O, Torfing T, Precht H, Rasmussen BS, Tromborg HB. Accuracy of radiographic measurements of fracture-induced deformity in the distal radius. Acta Radiol Open 2023; 12:20584601231205986. [PMID: 37767057 PMCID: PMC10521277 DOI: 10.1177/20584601231205986] [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] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Background Management of the distal radius fracture (DRF) is to some extent based on radiographic characterization of fracture displacement. It remains unclear, however, if the measurements used to quantify displacement are accurate. Purpose To quantify accuracy of two radiographic measurements: dorsal/volar tilt and fracture compression, measured indirectly as ulnar variance (UV), using radiostereometric analyses (RSA) as reference standard. Material and Methods Twenty-one fresh frozen non-fractured human cadaveric forearms (right = 11, left = 10) were thawed and eligible for inclusion. The forearms were mounted on a custom made platform that allowed for controlled forearm rotation, and they underwent two rounds of imaging (both rounds consisted of RSA and radiographs). In round one, the non-fractured forearms were radiographed. In round two, artificial DRF´s with compression and dorsal angulation were created and imaging procedures repeated. Change in tilt and UV between the non-fractured and later fractured forearms was defined as fracture-induced deformity. Deformity was measured radiographically and additionally calculated using RSA. Bland Altman analyses were used to estimate agreement between radiographically measured, and RSA calculated, fracture-induced deformity. Results Our results indicated that radiographs underestimate the amount of fracture-induced deformity. Mean measured differences (bias) in dorsal tilt deformity between radiographs and RSA were -2.5° for both observers. The corresponding values for UV were -1.4 mm and -1.5 mm. Conclusion Quantifying fracture-induced deformity on radiographs underestimated the actual deformity when compared to RSA calculated deformity. These findings suggest that clinicians, at least in part, base fracture management and potentially corrective surgery on inaccurate measurements.
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Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Trine Torfing
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Helle Precht
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Radiology, Kolding, Lillebaelt Hospital, University Hospitals of Southern, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Benjamin S Rasmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- CAI-X (Centre for Clinical Artificial Intelligence), University of Southern, Odense, Denmark
| | - Hans B Tromborg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
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