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Jia Q, Peng Z, Huang A, Jiang S, Zhao W, Xie Z, Ma C. Is fracture management merely a physical process? Exploring the psychological effects of internal and external fixation. J Orthop Surg Res 2024; 19:231. [PMID: 38589910 PMCID: PMC11000308 DOI: 10.1186/s13018-024-04655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Internal and external fixation are common surgical procedures for treating fractures. However, the impact of different surgical approaches (including internal and external fixations) on patients' psychological status and Quality of Life (QoL) is rarely examined. Herein, we aimed to investigate the effects of internal and external fixation on anxiety, depression, insomnia, and overall mental and physical health in Distal Radius Fractures (DRF) patients. METHODS We performed a retrospective study on 96 fracture patients who underwent internal fixation (57 patients) or external fixation (39 patients). The Visual Analog Scale (VAS), the Hospital Anxiety and Depression Scale (HADS), the Athens Insomnia Scale (AIS), and the Medical Outcomes Study Short Form 36 (SF-36) questionnaire were used to assess the patients' pain, anxiety, depression, sleep, and QoL before surgery and at seven days, one month, and three months post-surgery. RESULTS The VAS scores were significantly lower in the Internal Fixation Group (IFG) than in the External Fixation Group (EFG) on the seventh day and one month postoperatively (P < 0.05). Although both groups showed no significant anxiety, depression, or insomnia before surgery (P > 0.05), the EFG showed significantly higher HADS-A, HADS-D, and AIS scores than the IFG at seven days and one and three months postoperatively (P < 0.05). Additionally, changes in HADS-A, HADS-D, and AIS scores were most significant at day seven post-surgery in the EFG (P < 0.05). Furthermore, no significant difference was found between the two groups in the average Physical Component Summary (PCS) and Mental Component Summary (MCS) scores before surgery (P > 0.05). However, both groups showed positive changes in PCS and MCS scores at postoperative day seven and one and three months postoperatively, with the IFG having significantly higher average PCS and MCS scores compared to the EFG (P < 0.05). CONCLUSION Compared to external fixation, internal fixation did not significantly impact patients' emotions regarding anxiety and depression in the early postoperative period, and physical and mental health recovery was better during the postoperative rehabilitation period. Furthermore, when there are no absolute indications, the impact on patients' psychological well-being should be considered as one of the key factors in the treatment plan during surgical approach selection.
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Affiliation(s)
- Qiyu Jia
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenlei Peng
- Xinjiang Clinical Research Center for Mental Health, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Anqi Huang
- Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Child Mental Health Research Center, Nanjing University, Nanjing, China
| | - Shijie Jiang
- Xinjiang Clinical Research Center for Mental Health, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wen Zhao
- Department of Orthopedics, Beijing Aerospace General Hospital, Beijing, China.
- Department of Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Zengru Xie
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Chuang Ma
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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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] [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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Stiehm M, Rinas I, Helfrich L, Martin H, Leuchter M, Fischer DC, Schmitz KP, Mittlmeier T. Development of a testing device for external wrist bridging dynamic fixators used for distal radius fractures. Clin Biomech (Bristol, Avon) 2023; 108:106056. [PMID: 37556921 DOI: 10.1016/j.clinbiomech.2023.106056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/04/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Stabilization of extra-articular distal radius fractures by wrist joint bridging (WB) dynamic fixation allows for early motion of the wrist, but relies on exact positioning of the device. In fact, physiological movement appeared to be compromised with even distinctly aberrant positioning of such device. To investigate this issue in more detail, we developed an in-vitro testing apparatus suitable for assessing the forces required for flexion and extension of the wrist. METHODS The experimental set-up enables the transmission of the translational movement of the traverse of a universal testing machine into the main physiological movement (flexion and extension) of the wrist. An external WB dynamic fixator was assembled to an artificial saw bone wrist model prior and after performing a wedge-shaped osteotomy on the distal radius about 1.5 cm proximal to the joint line, i.e. generation of a fracture model. The functionality of the fixator was evaluated under either condition and the effect of misalignment of the external WB dynamic fixator was quantified by purposeful violation of the manufacture's instructions. Results were statistically analyzed using the generalized linear mixed model. FINDINGS Significantly higher loading was noted as the degree of misalignment increased. The normalized force was significantly higher at a misalignment of 20° compared to 10° (10°: 4.13; 20°: 6.93, P < 0.001). INTERPRETATION The proposed set-up turned out to allow highly reproducible and sensitive recording of the reaction forces during flexion and extension of the wrist and thus is feasible for the evaluation and comparison of different external WB devices.
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Affiliation(s)
- Michael Stiehm
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany.
| | - Ingmar Rinas
- Department of Traumatology, Hand- and Reconstructive Surgery, Rostock University Medical Centre, Rostock, Germany
| | - Levke Helfrich
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany
| | - Heiner Martin
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany
| | - Matthias Leuchter
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Klaus-Peter Schmitz
- Institute of ImplantTechnology and Biomaterials e.V., Rostock-Warnemünde, Germany
| | - Thomas Mittlmeier
- Department of Traumatology, Hand- and Reconstructive Surgery, Rostock University Medical Centre, Rostock, Germany
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Longo UG, De Salvatore S, Mazzola A, Salvatore G, Mera BJ, Piergentili I, Denaro V. Colles' Fracture: An Epidemiological Nationwide Study in Italy from 2001 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3956. [PMID: 36900966 PMCID: PMC10002201 DOI: 10.3390/ijerph20053956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
The present study aimed to evaluate the yearly number of Colles' fractures in Italy from 2001 to 2016, based on official information found in hospitalization records. A secondary aim was to estimate the average length of hospitalization for patients with a Colles' fracture. A tertiary aim was to investigate the distribution of the procedures generally performed for Colles' fractures' treatment in Italy. An analysis of the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health, concerning the 15 years of our study (from 2001 to 2016) was performed. Data are anonymous and include the patient's age, sex, domicile, length of hospital stays (days), primary diagnoses and primary procedures. From 2001 to 2016, 120,932 procedures for Colles' fracture were performed in Italy, which represented an incidence of 14.8 procedures for every 100,000 adult Italian inhabitants. The main number of surgeries was found in the 65-69- and 70-74-year age groups. In the present study, we review the epidemiology of Colles' fractures in the Italian population, the burden of the disease on the national health care system (in terms of length of hospitalization) and the distribution of the main surgical procedures performed for the treatment of the disease.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 200-00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 21-00128 Roma, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 200-00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 21-00128 Roma, Italy
| | - Alessandro Mazzola
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 200-00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 21-00128 Roma, Italy
| | - Giuseppe Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 200-00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 21-00128 Roma, Italy
| | - Barbara Juliette Mera
- School of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 200-00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 21-00128 Roma, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 200-00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 21-00128 Roma, Italy
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Frank J. Diagnostics, incidence and treatment of the distal radius fractures: an area for many studies, opinions and treatment options. Eur J Trauma Emerg Surg 2022; 48:4315-4317. [PMID: 36450839 PMCID: PMC9712400 DOI: 10.1007/s00068-022-02150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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