1
|
Keçeci T, Karagöz B, Ağır İ. Effectiveness of Delayed Surgical Treatment for Distal Radius Fractures With Loss of Reduction. J Hand Surg Am 2024:S0363-5023(24)00312-5. [PMID: 39140918 DOI: 10.1016/j.jhsa.2024.07.006] [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] [Received: 10/06/2023] [Revised: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE This study investigated the effectiveness of volar plate surgery in patients with distal radius fractures (DRFs) initially treated nonsurgically but later experiencing reduction loss during follow-ups. Specifically, it assessed the impact of early surgery (E) (<3 weeks) versus delayed surgery (D) (3-6 weeks) on wrist function in surgically treated DRFs. METHODS This retrospective study included 131 patients who underwent surgery after loss of reduction. Among them, 42 patients had delayed surgery, whereas 89 received early surgical treatment. The mean follow-up duration was 18 months. The primary outcome measure was Disabilities of the Arm, Shoulder, and Hand scores. Secondary outcomes included Short Form-12 physical component summary and mental component summary scores, postoperative range of motion, and radiological measurements such as radial length, radial inclination angle, and volar tilt angle. Fracture types were categorized using Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification based on radiological images. RESULTS All 131 DRFs achieved radiological union. Mean Disabilities of the Arm, Shoulder, and Hand scores were 8.0 (range, 0-78) and 10.8 (range, 0-73) for groups E and D, respectively, and the difference was not considered clinically relevant. Short Form-12 physical component summary scores (49.4 for E; 45.3 for D) and Short Form-12 mental component summary scores (52.3 for E; 53.5 for D) were similar in the two groups. Radiological measurements and range of motion were similar in the two groups. Complications, including carpal tunnel syndrome, superficial radial nerve neuropraxia, and complex regional pain syndrome, occurred in 12 (13.5%) E group patients and 9 (21.4%) D group patients. CONCLUSIONS Clinical and radiological results of early and delayed surgery after loss of reduction in secondary displaced DRF were similar. However, complication rates were higher in delayed surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Tolga Keçeci
- Department of Orthopaedics and Traumatology, Ordu University Training and Research Hospital, Ordu, Türkiye.
| | - Bekir Karagöz
- Department of Orthopaedics and Traumatology, Eskisehir City Hospital, Eskisehir, Türkiye
| | - İsmail Ağır
- Department of Orthopaedics and Traumatology, Adıyaman University Training and Research Hospital, Adıyaman, Türkiye
| |
Collapse
|
2
|
Pacchiarini L, Massimo Oldrini L, Feltri P, Lucchina S, Filardo G, Candrian C. Complications after volar plate synthesis for distal radius fractures. EFORT Open Rev 2024; 9:567-580. [PMID: 38828969 PMCID: PMC11195338 DOI: 10.1530/eor-23-0188] [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: 06/05/2024] Open
Abstract
Purpose Distal radius fractures (DRFs) represent up to 18% of all fractures in the elderly population, yet studies on the rate of complications following surgery are lacking in the literature. This systematic review aimed to quantify the rate of complications and reinterventions in patients treated with volar plate for distal radius fractures, and analyze if there was any predisposing factor. Methods A comprehensive literature search was performed on three databases up to January 2023, following PRISMA guidelines. Studies describing volar plate complications and hardware removal were included. A systematic review was performed on complications and rate of reintervention. Assessment of risk of bias and quality of evidence was performed with the 'Down and Black's Checklist for measuring quality'. Results About112 studies including 17 288 patients were included. The number of complications was 2434 in 2335 patients; the most frequent was carpal tunnel syndrome (CTS), representing 14.3% of all complications. About 104 studies reported the number of reinterventions, being 1880 with a reintervention rate of 8.5%. About 84 studies reported the reason of reintervention; the most common were patient's will (3.0%), pain (1.1%), CTS (1.2%), and device failure (1.1%). Conclusion The complication rate after DRFs is 13.5%, with the main complication being CTS (14.3%), followed by pain and tendinopathy. The reintervention rate is 8.5%, mainly due to the patient's willingness, and all these patients had plate removal. Correct positioning of the plate and correct information to the patient before surgery can reduce the number of hardware removal, thereby reducing costs and the risk of complications associated with VLP for distal radius fractures.
Collapse
Affiliation(s)
- Luca Pacchiarini
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | | | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Stefano Lucchina
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Surgical Department, Hand Surgery Unit EOC, Locarno’s Regional Hospital, Locarno, Switzerland
- Locarno Hand Center, Locarno, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
3
|
Kong L, Li H, Zhou Y, Zhang B, Han Q, Fu M. Factors predicting complications following open reduction and internal fixation of intra-articular distal radius fracture. Front Surg 2024; 11:1356121. [PMID: 38586239 PMCID: PMC10998443 DOI: 10.3389/fsurg.2024.1356121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Objective This study aimed to determine the incidence and predictors of the complications after open reduction and internal fixation (ORIF) of intra-articular distal radius fracture (IADRF) with a minimum follow-up of 12 months. Methods Medical records and outpatient follow-up records were retrospectively reviewed to collect medical, surgical, and complication data on consecutive patients who had undergone an ORIF procedure for an IADRF between January 2019 and June 2022. Data included demographics, comorbidities, injury, surgical characteristics, and laboratory findings on admission. A multivariate logistic regression model was constructed to identify the significant predictors, with a composite of any complications occurring within 12 months after the operation as the outcome variable and potentially a range of clinical data as the independent variables. The magnitude of the relationship was indicated by the odds ratio (OR) and the 95% confidence interval (CI). Results During the study period, 474 patients were included, and 64 had documented complications (n = 73), representing an accumulated rate of 13.5%. Among them, carpal tunnel syndrome was the most common, followed by tenosynovitis caused by tendon irritation/rupture, superficial or deep wound infection, complex regional pain syndrome (CRPS) type 1, radial shortening (≥4 mm), plate/screw problems, and others. The multivariate results showed the following factors significantly associated with increased risk of complications: experience of DRF surgery with <30 cases (OR: 2.2, 95% CI: 1.6-3.5), AO type C fracture (OR: 1.7, 95% CI: 1.2-2.9), initial lunate facet collapse of ≥5 mm (OR: 4.2, 95% CI: 1.4-8.9), and use of temporary external fixation before index surgery (OR: 2.4, 95% CI: 1.5-4.3). Conclusions These findings may aid in patient counseling and quality improvement initiatives, and IADRF should be directed by an experienced surgeon.
Collapse
Affiliation(s)
- Lingde Kong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hua Li
- Department of Hand and Foot Surgery, Hengshui People’s Hospital, Hengshui, Hebei, China
| | - Yanqing Zhou
- Department of Hand and Foot Surgery, Hengshui People’s Hospital, Hengshui, Hebei, China
| | - Bing Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Quan Han
- Department of Orthopaedic Surgery, Hengshui Sixth People’s Hospital, Hengshui, Hebei, China
| | - Meng Fu
- Medical Examination Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
4
|
Jabara JT, Gannon NP, Marsh JL, Vallier HA, Nguyen MP. Comparisons of Procedures Performed in Training vs in Early Practice by Orthopaedic Trauma Surgeons. J Am Acad Orthop Surg 2023; 31:e727-e735. [PMID: 37531555 DOI: 10.5435/jaaos-d-23-00212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/16/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION The Orthopaedic Trauma Association (OTA) has maintained an accreditation process of orthopaedic trauma fellowships with various requirements including an annually reviewed list of qualifying trauma cases in the form of American Medical Association Current Procedural Terminology (CPT) codes. The correlation between these established and monitored CPTs and the actual practices of orthopaedic trauma surgeons has not been studied. METHODS American Board of Orthopaedic Surgery part II case logs (trauma subspecialty) (2012 to 2018) were compared with OTA fellowship case logs (2015 to 2019). Case logs from 447 surgeons and 166 trauma fellowship programs were compared. Four CPT code categories were defined: complex trauma (OTA required CPT codes, excluding Accreditation Council for Graduate Medical Education [ACGME] orthopaedic residency requirements), general trauma (ACGME residency required trauma codes), general orthopaedics (nontrauma ACGME residency requirements), and others (codes not included in residency or trauma fellowship requirements). RESULTS OTA fellows performed a higher median percentage of complex trauma compared with American Board of Orthopaedic Surgery candidates (34% vs. 21%, P < 0.001): Both cohorts performed a similar percentage of general trauma (23%). OTA fellows performed more general orthopaedics (40% vs. 1%, P < 0.001). Several OTA required codes were performed infrequently (0 to 3 during board collection) by most surgeons, and several procedures are being performed that are not included in current CPT code requirements. DISCUSSION Early-career traumatologists are performing orthopaedic trauma procedures they were trained on during residency and fellowship, with varying complexity. Trauma fellows perform a higher percentage of complex trauma compared with early-career trauma surgeons. Continued surveillance is necessary such that educational improvements can be made to maximize the quality of trauma fellowship education. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Justin T Jabara
- From the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Jabara, Gannon, and Nguyen), the Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA (Marsh), the Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH (Vallier), and the Department of Orthopaedic Surgery, Regions Hospital, Saint Paul, MN (Nguyen)
| | | | | | | | | |
Collapse
|
5
|
Julian KR, Truong NM, Leversedge C, Kwong JW, Rosinski A, Kamal RN, Shapiro LM. Does Time to Surgery for Distal Radius Fractures Impact Clinical and Radiographic Outcomes? A Systematic Literature Review. CURRENT ORTHOPAEDIC PRACTICE 2023; 34:229-235. [PMID: 38264709 PMCID: PMC10802167 DOI: 10.1097/bco.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Distal radius fractures are one of the most common upper extremity fractures across all age groups. Although the American Academy of Orthopaedic Surgery (AAOS) Clinical Practice Guidelines have defined recommendations for the treatment of distal radius fractures, the optimal time to surgery was not included. There remains relatively little guidance or consensus regarding the optimal timing of surgical intervention for distal radius fractures and the impact of time to surgery on outcomes. As such, the purpose of this investigation is to systematically review clinical and radiographic outcomes associated with time to surgical management of distal radius fractures.
Collapse
Affiliation(s)
- Kaitlyn R Julian
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Nicole M Truong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Chelsea Leversedge
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street Redwood City, CA
| | - Jeffrey W Kwong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Alexander Rosinski
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program 450 Stanyan Street San Francisco, CA 94117
| | - Robin N Kamal
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street MC: 6342 Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| |
Collapse
|
6
|
Meng H, Xu B, Xu Y, Niu H, Liu N. Incidence and risk factors for surgical site infection following volar locking plating (VLP) of unstable distal radius fracture (DRF). J Orthop Surg Res 2022; 17:549. [PMID: 36529774 PMCID: PMC9762064 DOI: 10.1186/s13018-022-03440-7] [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] [Received: 08/30/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Volar locking plating (VLP) is the mainstay of treatment for distal radius fracture (DRF) but may be compromised by postoperative surgical site infection (SSI). This study aimed to identify the incidence and the risk factors for SSI following VLP of DRF. METHODS This retrospective study identified consecutive patients who underwent VLP for closed unstable DRFs in our institution between January 2015 and June 2021. Postoperative SSI was identified by inquiring the medical records, the follow-up records or the readmission medical records for treatment of SSI. The potential factors for SSI were extracted from the medical records. Univariate and multivariate logistic regression analyses were performed to identify the independent factors. RESULTS There were 930 patients included, and 34 had an SSI, representing an incidence of 3.7% (95% CI 2.4-4.9%). Patients with an SSI had threefold extended hospitalization stay (44.1 ± 38.2 versus 14.4 ± 12.5 days) as did those without. In univariate analysis, 18 variables were tested to be statistically different between SSI and non-SSI group. In multivariate analysis, 6 factors were identified as independently associated with SSI, including sex (male vs. female, OR 3.5, p = 0.014), ASA (III and IV vs. I, OR 3.2, p = 0.031), smoking (yes vs. no, OR 2.4, p = 0.015), bone grafting (OR 4.0, p = 0.007), surgeon volume (low vs. high, OR 2.7, p 0.011) and operation at night-time (vs. day-time, OR 7.8, p < 0.001). CONCLUSION The postoperative SSI of VLP of DRF was not uncommon, and the factors identified in this study, especially those modifiable, would help identify individual SSI risk, target clinical surveillance and inform patient counseling.
Collapse
Affiliation(s)
- Hongyu Meng
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China ,grid.452209.80000 0004 1799 0194Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China ,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Bin Xu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Yi Xu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Haiyun Niu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Ning Liu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
| |
Collapse
|
7
|
Risk Factors for Complications following Volar Locking Plate (VLP) Fixation of Unstable Distal Radius Fracture (DRF). BIOMED RESEARCH INTERNATIONAL 2022; 2022:9117533. [PMID: 36483632 PMCID: PMC9726249 DOI: 10.1155/2022/9117533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
Objective To evaluate the incidence and risk factors for complications following volar locking plate (VLP) fixation of unstable distal radius fracture (DRF). Methods This retrospective study identified patients who underwent VLP fixation of unstable DRF between 2017 and 2020 with a minimum 12-month follow-up assessments. By reviewing electronic medical records and follow-up notes, patients were categorized complication or noncomplication group. Differences in variables were detected by using univariate analyses, and independent factors were identified using multivariate logistic regression analysis. Results During this study period, 423 patients were included, and 63 (rate, 14.9%) complications in 58 patients were documented. Wound infection (17, 4.0%) was most common, followed in decreasing frequency by carpal tunnel syndrome (13, 3.1%), tendon rupture/irritation (10, 2.4%), complex regional pain syndrome (8, 1.9%), and plate/screw-related complications (5, 1.7%). In the univariate analyses, 18 variables were found to be significantly different (p < 0.05). Logistic regression analysis identified 5 independent factors, including being male (OR, 3.5; p = 0.014), type C fracture (vs. type A, OR: 2.7, and p = 0.035), general anesthesia (vs. regional, OR: 2.4, and p = 0.045), bone grafting (OR, 6.3; p < 0.001), and surgery performed by less experienced surgeons (OR, 3.1; p = 0.003). The goodness-of-fit of the final model was acceptable. Conclusions These factors will help surgeons individualize and stratify the risk of complications and help patients for risk counselling; especially, an informed clinical decision targeting those modifiable factors (anesthesia mode, bone grafting, and surgeon experience) can be considered, when indicated.
Collapse
|
8
|
Wang CC, Chen SA, Cheng CT, Tee YS, Chan SY, Fu CY, Liao CA, Hsieh CH, Kuo LW. The role of acute care surgeons in treating rib fractures-a retrospective cohort study from a single level I trauma center. BMC Surg 2022; 22:271. [PMID: 35836219 PMCID: PMC9281009 DOI: 10.1186/s12893-022-01720-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/05/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Rib fractures are the most common thoracic injury in patients who sustained blunt trauma, and potentially life-threatening associated injuries are prevalent. Multi-disciplinary work-up is crucial to achieving a comprehensive understanding of these patients. The present study demonstrated the experience of an acute care surgery (ACS) model for rib fracture management from a single level I trauma center over 13 years. METHODS Data from patients diagnosed with acute rib fractures from January 2008 to December 2020 were collected from the trauma registry of Chang Gung Memorial Hospital (CGMH). Information, including patient age, sex, injury mechanism, Abbreviated Injury Scale (AIS) in different anatomic regions, injury severity score (ISS), index admission department, intensive care unit (ICU) length of stay (LOS), total admission LOS, mortality, and other characteristics of multiple rib fracture, were analyzed. Patients who received surgical stabilization of rib fractures (SSRF) were analyzed separately, and basic demographics and clinical outcomes were compared between acute care and thoracic surgeons. RESULTS A total of 5103 patients diagnosed with acute rib fracture were admitted via the emergency department (ED) of CGMH in the 13-year study period. The Department of Trauma and Emergency Surgery (TR) received the most patients (70.8%), and the Department of Cardiovascular and Thoracic Surgery (CTS) received only 3.1% of the total patients. SSRF was initiated in 2017, and TR performed fixation for 141 patients, while CTS operated for 16 patients. The basic demographics were similar between the two groups, and no significant differences were noted in the outcomes, including LOS, LCU LOS, length of indwelling chest tube, or complications. There was only one mortality in all SSRF patients, and the patient was from the CTS group. CONCLUSIONS Acute care surgeons provided good-quality care to rib fracture patients, whether SSRF or non-SSRF. Acute care surgeons also safely performed SSRF. Therefore, we propose that the ACS model may be an option for rib fracture management, depending on the deployment of staff in each institute.
Collapse
Affiliation(s)
- Chia-Cheng Wang
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Szu-An Chen
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Chi-Tung Cheng
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Yu-San Tee
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Sheng-Yu Chan
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Chih-Yuan Fu
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Chien-An Liao
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Chi-Hsun Hsieh
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| | - Ling-Wei Kuo
- grid.413801.f0000 0001 0711 0593Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Guishan District, Taoyuan, 333 Taiwan
| |
Collapse
|
9
|
Abstract
In the recent years, treatment of distal radius fractures (DRF) has advanced considerably. Surgical fixation with palmar angular stable plate has gained popularity, due to a reported lower complication rate when compared to dorsal fixation. The type of trauma or injury, surgical procedure and impaired bone quality are all contributors to complications in DRF. The main aim of this review is to summarize the most common complications and possible therapeutic solutions. In addition, strategies for minimizing these complications will be discussed.
Collapse
|
10
|
Risk factors for carpal tunnel syndrome or trigger finger following distal radius fracture: a nationwide study. Sci Rep 2020; 10:469. [PMID: 31949231 PMCID: PMC6965085 DOI: 10.1038/s41598-020-57415-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 12/20/2019] [Indexed: 11/09/2022] Open
Abstract
New-onset carpal tunnel syndrome (CTS) and trigger finger after distal radius fractures (DRFs) with or without open reduction and internal fixation (ORIF) have been reported inconsistently across different studies. This study assessed the incidence of CTS and trigger finger after DRFs using Taiwan National Health Insurance Research Database. In total, 1454 patients in the case (ORIF) cohort and 1454 patients in the control (non-ORIF) cohort were included in this retrospective study. The mean age was approximately 55 years old, and the female to male ratio was approximately 3/2. Nine patients underwent carpal tunnel release (CTR) surgery after diagnosis of CTS in the case group, and no patients did in the control group; whereas 19 cases of CTS were diagnosed without CTR in the case group, and 4 such cases were observed in the control group. Five cases of trigger finger were diagnosed in the case group, and 3 cases were diagnosed in the control group. CTS were significantly associated with ORIF for DRFs within 9 months after the fracture, whereas trigger finger was not significantly different between groups. Diabetes mellitus was a significant risk factor for CTS and trigger finger within 9 months after the incidence of DRFs.
Collapse
|
11
|
Delft EAV, Gelder TGV, Vries RD, Vermeulen J, Bloemers FW. Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review. J Wrist Surg 2019; 8:430-438. [PMID: 31579555 PMCID: PMC6773589 DOI: 10.1055/s-0039-1683433] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/28/2019] [Indexed: 01/07/2023]
Abstract
Objective The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures. Level of Evidence This is a Level II study. Systematic Review Registration Number PROSPERO 2018 CRD42018085524.
Collapse
Affiliation(s)
- Eva A.K. van Delft
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tamara G. van Gelder
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jefrey Vermeulen
- Department of Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Frank W. Bloemers
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Li Y, Zhou Y, Zhang X, Tian D, Zhang B. Incidence of complications and secondary procedure following distal radius fractures treated by volar locking plate (VLP). J Orthop Surg Res 2019; 14:295. [PMID: 31484547 PMCID: PMC6727499 DOI: 10.1186/s13018-019-1344-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/22/2019] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the incidence of postoperative overall complications or secondary procedures following distal radius fractures treated by volar locking plate (VLP) Methods Electronic medical records (EMR) of 1152 patients with 1175 distal radius fractures treated by volar locking plate between January 2013 and September 2018 were retrospectively reviewed and the data were extracted. The picture archiving and communication system (PACS) was inquired to assess the fracture severity and to determine the fracture type. Univariate and multivariate logistic regression analyses were used to identify the associated risk factors. Results During the median follow-up period of 6 months, a total of 138 complications in 131 patients were determined, indicating the accumulated rate of 11.7%; there were 68 cases of secondary procedures, with the rate of 5.8%. The independent associated factors for postoperative overall complications were AO type C fracture (OR, 2.6; 95%CI, 1.2 to 4.0), open fracture (OR, 4.2; 95%CI, 1.9 to 6.5), and significant collapse of the lunate fossa (OR, 2.9; 95%CI, 13 to 4.3), and for secondary procedures were significant collapse of the lunate fossa (OR, 3.7; 95%CI, 1.7 to 6.4) and the low-volume of surgeons (OR, 95%CI, 1.2 to 3.6) Conclusions Identification of these factors is of importance for the risk assessment of postoperative complications and the additional need of surgery. For patients with the above factors, especially those with combined risk factors, optimized operation scheme and high-volume surgeon should be considered to prevent or reduce the complications.
Collapse
Affiliation(s)
- Yansen Li
- Department of Foot and Ankle Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanqing Zhou
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiong Zhang
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Dehu Tian
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Bing Zhang
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| |
Collapse
|
13
|
Sirniö K, Flinkkilä T, Vähäkuopus M, Hurskainen A, Ohtonen P, Leppilahti J. Risk factors for complications after volar plate fixation of distal radial fractures. J Hand Surg Eur Vol 2019; 44:456-461. [PMID: 30426821 DOI: 10.1177/1753193418811559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study assessed risk factors for complications after volar plate fixation of distal radial fractures. An assessment of electronic patient records from 2008 to 2016 identified 867 patients with a total of 881 distal radial fractures who underwent volar plating in our hospital. A total of 132 complications after volar plate fixation of distal radial fractures were observed (complication rate 15%). Surgery performed by a low-volume surgeon and patient age less than 40 years were the most important risk factors for plate-related complications. In logistic regression analysis, operation performed by a low-volume surgeon and patient age less than 40 years were independent predictors of plate-related complications. Patient age less than 40 years and low-volume surgeon were also found to be independent risk factors for plate-related secondary operations. Surgical delay had no effect on the complication rate. Level of evidence: IV.
Collapse
Affiliation(s)
- Kai Sirniö
- 1 Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Tapio Flinkkilä
- 1 Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Marko Vähäkuopus
- 1 Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Antti Hurskainen
- 1 Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- 2 Division of Operative Care and MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | | |
Collapse
|
14
|
Bentohami A, van Delft EAK, Vermeulen J, Sosef NL, de Korte N, Bijlsma TS, Goslings JC, Schep NWL. Non- or Minimally Displaced Distal Radial Fractures in Adult Patients: Three Weeks versus Five Weeks of Cast Immobilization-A Randomized Controlled Trial. J Wrist Surg 2019; 8:43-48. [PMID: 30723601 PMCID: PMC6358449 DOI: 10.1055/s-0038-1668155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
Background Patients with non- or minimally displaced distal radial fractures, that do not need repositioning, are mostly treated by a short-arm cast for a period of 4 to 6 weeks. A shorter period of immobilization may lead to a better functional outcome. Purpose We conducted a randomized controlled trial to evaluate whether the duration of cast immobilization for patients with non- or minimally displaced distal radial fractures can be safely shortened toward 3 weeks. Materials and Methods The primary outcomes were patient-reported outcomes measured by the Patient-Related Wrist Evaluation (PRWE) and Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after 1-year follow-up. Secondary outcome measures were: PRWE and QuickDASH earlier in follow-up, pain (Visual Analog Scale), and complications like secondary displacement. Results Seventy-two patients (male/female, 23/49; median age, 55 years) were included and randomized. Sixty-five patients completed the 1-year follow-up. After 1-year follow up, patients in the 3 weeks immobilization group had significantly better PRWE (5.0 vs. 8.8 points, p = 0.045) and QuickDASH scores (0.0 vs. 12.5, p = 0.026). Secondary displacement occurred once in each group. Pain did not differ between groups ( p = 0.46). Conclusion Shortening the period of immobilization in adult patients with a non- or minimally displaced distal radial fractures seems to lead to equal patient-reported outcomes for both the cast immobilization groups. Also, there are no negative side effects of a shorter period of cast immobilization. Therefore, we recommend a period of 3 weeks of immobilization in patients with distal radial fractures that do not need repositioning.
Collapse
Affiliation(s)
- A. Bentohami
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - E. A. K. van Delft
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
- Department of Surgery, VU University Medical Center, VU University, Amsterdam, The Netherlands
| | - J. Vermeulen
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - N. L. Sosef
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - N. de Korte
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - T. S. Bijlsma
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - J. C. Goslings
- Department of Trauma Surgery, OLVG West, Amsterdam, The Netherlands
| | - N. W. L. Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Norum J, Balteskard L, Thomsen MW, Kvernmo HD. Wrist malpractice claims in Northern Norway 2005-2014. Lessons to be learned. Int J Circumpolar Health 2018; 77:1483690. [PMID: 29912658 PMCID: PMC6008599 DOI: 10.1080/22423982.2018.1483690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/24/2018] [Indexed: 12/03/2022] Open
Abstract
Rough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims due to wrist surgery, performed at the public hospitals in Northern Norway, during 2005-2014 were analyzed. We employed the ICD-10 classification codes S52.5 (fracture of distal end of radius) and S52.6 (fracture of distal end of radius and ulna). Treatment was defined by NCSP codes. 84 patients (0.3%) complained. Females complained four times more often than males did (P = 0.005) and received five times more frequently a compensation (P < 0.001). NPE accepted 34 claims (40%) for injury compensation (0.1% of patients). The percentage of claims accepted for compensation decreased from 48% to 30% during study period, probably due to delay in filling claims. The main causes of complains were pain, reduced range of motion, malfunction and weakness (35/84). The main causes of compensation were "operative treatment should have been performed" (14/34) and "wrong operative method applied" (13/34). The mean amount per compensation was €14,927 (€0-€52,995). Stonger focus on quality of care, updated guidelines and shared decission-making may reduce the number og complains and compensations.
Collapse
Affiliation(s)
- Jan Norum
- Department of Clinical Medicine, Medical Imaging Research Group, Faculty of Health Sciences, UiT- The Arctic University of Norway, Tromsø, Norway
- Department of Surgery, Finnmark hospital trust, Hammerfest, Norway
| | - Lise Balteskard
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority trust, Tromsø, Norway
| | | | - Hebe Desiree Kvernmo
- Department of Clinical Medicine, Medical Imaging Research Group, Faculty of Health Sciences, UiT- The Arctic University of Norway, Tromsø, Norway
- Department of Orthopaedic, Hand and Plastic Surgery, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
16
|
Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg 2018; 138:1773-1782. [PMID: 30341694 DOI: 10.1007/s00402-018-3051-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Distal radius fractures (DRF) are the most common fractures of the upper extremities. The incidence is expected to continue rising in the next years due to the increased life expectancy. Palmar locking plate stabilizing has since become the standard treatment for dorsally displaced DRF with a complication rate of 8-39% reported in the literature. Main aim of this study was to investigate the incidence of complications after DRF stabilization using palmar angular stable locking plate. METHODS A retrospective medical records review conducted from January 2013 to December 2016 included a total of 392 patients with DRF, that were stabilized using palmar angular stable locking plate and showed a minimum follow-up of 3 months. The group comprised 259 female and 133 male patients with a mean follow-up interval of 11 months (range 3-52 months). All recorded complications were documented. Range of motion (ROM) in extension, flexion, supination, pronation, radial- and ulnar deviation of the last follow-up was noted. Age was divided into younger than 65 years (< 65 years) and older than 65 years (≥ 65 years). The primary, immediate postoperative and final checkup radiographs were scrutinized for alignment and intra-articular step-off. RESULTS A total of 51 (13%) early and 17 late (4%) complications were recorded in 392 patients. The most common complications included carpal tunnel syndrome (3%), complex regional pain syndrome (3%) and loss of reduction (2%). Of the 68 complications, only 25 (6%) were directly related to the plate. 73% of all complications occurred in AO type C fractures. Patients without complications showed a significantly better ROM in extension, flexion, pronation and supination than patients with complications. No significant differences in incidence of complications, ROM or loss of reduction could be found between patients over and under 65 years of age. Gender and type of immobilization showed no significant influence on the complication rate. CONCLUSIONS Stabilization of DRF by palmar angular stable locking plate is a safe form of treatment. In the majority of the cases a good clinical and radiological outcome with no complications was documented. Gender and type of immobilization had no impact on the complication rate and an age over 65 years is not associated with an increased risk for complications or restricted ROM.
Collapse
|
17
|
Ax M, Reito A, Koskimaa M, Uutela A, Paloneva J. Scheduled Emergency Trauma Operation: The Green Line Orthopedic Trauma Surgery Process Of Care. Scand J Surg 2018; 108:250-257. [PMID: 30278834 DOI: 10.1177/1457496918803015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Traditionally, patients requiring an orthopedic emergency operation were admitted to an inpatient ward to await surgery. This often led to congestion of wards and operation rooms while, for less urgent traumas, the time spent waiting for the operation often became unacceptably long. The purpose of this study was to evaluate the flow of patients coded green in a traffic light-based coding process aimed at decreasing the burden on wards and enabling a scheduled emergency operation in Central Finland Hospital. MATERIALS AND METHODS Operation urgency was divided into three categories: green (>48 h), yellow (8-48 h), and red (<8 h). Patients, who had sustained an orthopedic trauma requiring surgery, but not inpatient care (green), were assigned an operation via green line process. They were discharged until the operation, which was scheduled to take place during office hours. RESULTS Between January 2010 and April 2015, 1830 green line process operations and 5838 inpatient emergency operations were performed. The most common green line process diagnoses were distal radial fracture (15.4% of green line process), (postoperative) complications (7.7%), and finger fractures (4.9%). The most common inpatient emergency operation diagnosis was hip fracture (24.3%). Green line process and inpatient emergency operation patients differed in age, physical status, diagnoses, and surgical procedures. CONCLUSION The system was found to be a safe and effective method of implementing orthopedic trauma care. It has the potential to release operation room time for more urgent surgery, shorten the time spent in hospital, and reduce the need to operate outside normal office hours.
Collapse
Affiliation(s)
- M Ax
- 1 Central Finland Hospital, Jyväskylä, Finland
| | - A Reito
- 1 Central Finland Hospital, Jyväskylä, Finland
| | - M Koskimaa
- 1 Central Finland Hospital, Jyväskylä, Finland
| | - A Uutela
- 2 Helsinki University Hospital, Helsinki, Finland
| | - J Paloneva
- 1 Central Finland Hospital, Jyväskylä, Finland
| |
Collapse
|
18
|
Varghese VD, Smitham P, Howell S, Edwards S, Rickman M. POWIFF- Prospective study of wrist internal fixation of fracture: A protocol for a single centre, superiority, randomised controlled trial to study the efficacy of the VRP (2.0) distal radius plate (Austofix) versus the VA-LCP (Depuy-Synthes) for distal radius fractures. BMC Musculoskelet Disord 2018; 19:131. [PMID: 29712566 PMCID: PMC5928597 DOI: 10.1186/s12891-018-2052-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 04/23/2018] [Indexed: 01/02/2023] Open
Abstract
Background Distal radial fractures are one of the most common orthopaedic cases that present to the A&E department. Surgical intervention is warranted in displaced intraarticular fractures and fractures with more than the recommended angulation or shortening, and is most commonly treated with volarly placed fixed angle locking plates. The aim of this study is to determine and compare the efficacy of two different plates for surgical treatment of distal radius fractures. The VRP 2.0 is a new plate produced by the Austofix company and this system will be compared against the VA-LP (Variable angle-locking plate) produced by Depuy-Synthes which has been used as the standard treatment device. Methods and Design Patients between the ages of 18 and 80 presenting to the Royal Adelaide Hospital with isolated closed distal radial fractures will be invited to participate in this study. A total of 200 patients are required to provide 90% statistical power at a 5% alpha level to detect a difference of 11.5 points on the PRWE (Patient rated Wrist evaluation) score. The primary outcome measure will be the PRWE score while the secondary outcome measures will include the DASH score, EQ5D score, clinical range of movements, grip strength as well as patient perceived return of function at the wrist and time to resumption to work. These will be measured at 6 weeks, 3 months and 12 months. Radiographic indices including the radial tilt, length, volar inclination and plate prominence will also be measured. Complications will be recorded up to 12 months. Post hoc comparisons will be done using paired t tests. An intention to treat and a per protocol analysis will be done to compare the 2 groups. Discussion Distal radial fractures are increasingly being treated by internal fixation using volar locking plates. However, there is no prospective study to date comparing one plate against another in terms of outcome and complications. This study could provide more information about the best way to treat these injuries surgically. Trial registration The trial is registered with the Australia New Zealand Clinical Trials Registry (ANZCTR). Trial registration date-17/11/2016. Trial registration number-ACTRN12616001590459. Electronic supplementary material The online version of this article (10.1186/s12891-018-2052-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- V D Varghese
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
| | - Peter Smitham
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Stuart Howell
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Mark Rickman
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| |
Collapse
|
19
|
Intraoperative three-dimensional imaging in the treatment of distal radius fractures. Arch Orthop Trauma Surg 2018; 138:487-493. [PMID: 29322319 DOI: 10.1007/s00402-018-2867-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION In operative treatment of distal radius fractures satisfying outcome mainly relies on anatomical fracture reduction and correct implant placement. Examination with two-dimensional fluoroscopy may not provide reliable information about this. The aim of this study was to determine the effectiveness of additional intraoperative three-dimensional imaging in the operative treatment of comminuted distal radius fractures. MATERIALS AND METHODS From August 2001 to June 2015, patients with a distal radius fracture who were treated operatively and received intraoperative three-dimensional scan were included. The findings of the three-dimensional scan were documented by the operative surgeon and analyzed retrospectively with regard to incidence and the need for intraoperative revisions. Clinical evaluation included the patient's medical history, the injury pattern of the affected wrist (according to the OTA/AO fracture classification) and concomitant injuries. Intraoperative and postoperative complications and revision surgeries were evaluated as well. RESULTS Of 4515 operatively treated distal radius fractures, 307 (6.8%) received additional intraoperative three-dimensional imaging during surgery. 263 of 307 patients (85.7%) had a distal radius fracture type C. Intraoperative three-dimensional imaging revealed findings in 125 patients (40.7%) that were not detected on conventional two-dimensional fluoroscopy. In 54 patients (17.6%) these findings led to an immediate revision. Most commonly, revision was done in the case of remaining steps in the articular surface ≥ 1 mm (n = 25, 8.1%) followed by intra-articular screw placement (n = 23, 7.5%). CONCLUSIONS Intraoperative three-dimensional imaging can provide additional information compared to conventional two-dimensional fluoroscopy in the operative treatment of distal radius fractures with the possibility of immediate intraoperative revision.
Collapse
|
20
|
Rajan PV, Qudsi RA, Dyer GS, Losina E. The Cost-Effectiveness of Surgical Fixation of Distal Radial Fractures: A Computer Model-Based Evaluation of Three Operative Modalities. J Bone Joint Surg Am 2018; 100:e13. [PMID: 29406347 PMCID: PMC6819022 DOI: 10.2106/jbjs.17.00181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is no consensus on the optimal fixation method for patients who require a surgical procedure for distal radial fractures. We used cost-effectiveness analyses to determine which of 3 modalities offers the best value: closed reduction and percutaneous pinning, open reduction and internal fixation, or external fixation. METHODS We developed a Markov model that projected short-term and long-term health benefits and costs in patients undergoing a surgical procedure for a distal radial fracture. Simulations began at the patient age of 50 years and were run over the patient's lifetime. The analysis was conducted from health-care payer and societal perspectives. We estimated transition probabilities and quality-of-life values from the literature and determined costs from Medicare reimbursement schedules in 2016 U.S. dollars. Suboptimal postoperative outcomes were determined by rates of reduction loss (4% for closed reduction and percutaneous pinning, 1% for open reduction and internal fixation, and 11% for external fixation) and rates of orthopaedic complications. Procedural costs were $7,638 for closed reduction and percutaneous pinning, $10,170 for open reduction and internal fixation, and $9,886 for external fixation. Outputs were total costs and quality-adjusted life-years (QALYs), discounted at 3% per year. We considered willingness-to-pay thresholds of $50,000 and $100,000. We conducted deterministic and probabilistic sensitivity analyses to evaluate the impact of data uncertainty. RESULTS From the health-care payer perspective, closed reduction and percutaneous pinning dominated (i.e., produced greater QALYs at lower costs than) open reduction and internal fixation and dominated external fixation. From the societal perspective, the incremental cost-effectiveness ratio for closed reduction and percutaneous pinning compared with open reduction and internal fixation was $21,058 per QALY and external fixation was dominated. In probabilistic sensitivity analysis, open reduction and internal fixation was cost-effective roughly 50% of the time compared with roughly 45% for closed reduction and percutaneous pinning. CONCLUSIONS When considering data uncertainty, there is only a 5% to 10% difference in the frequency of probability combinations that find open reduction and internal fixation to be more cost-effective. The current degree of uncertainty in the data produces difficulty in distinguishing either strategy as being more cost-effective overall and thus it may be left to surgeon and patient shared decision-making. LEVEL OF EVIDENCE Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Prashant V. Rajan
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Rameez A. Qudsi
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - George S.M. Dyer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| |
Collapse
|
21
|
Yuan ZZ, Yang Z, Liu Q, Liu YM. Complications following open reduction and internal fixation versus external fixation in treating unstable distal radius fractures: Grading the evidence through a meta-analysis. Orthop Traumatol Surg Res 2018; 104:95-103. [PMID: 29031702 DOI: 10.1016/j.otsr.2017.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/11/2017] [Accepted: 08/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The common fixation techniques for unstable distal radius fractures include open reduction and internal fixation (ORIF) with plates and closed reduction and external fixation (EF). There is controversy over the choice of surgical approach in treating unstable distal radius fractures. HYPOTHESIS This meta-analysis was performed to compare complication rates in patients treated with ORIF or EF for unstable distal radius fractures and to develop GRADE (grading of recommendations, assessment, development, and evaluation)-based recommendations for using the procedures to treat unstable distal radius fractures. MATERIALS AND METHODS A systematic search of all the studies published was conducted using the Pubmed, ScienceDirect, Embase, BIOSIS, Springer, Cochrane Library databases. The randomized controlled trials (RCTs) that compared ORIF with EF in treating adult patients with unstable distal radius fractures and provided data regarding the complication were identified. The demographic characteristics and adverse events were manually extracted from all of the included studies. RevMan 5.1 was used for data analysis. PRISMA guidelines were followed. RESULTS Sixteen studies that included a total of 1280 patients met the inclusion criteria. Compared with ORIF, EF results in higher incidence of total complications, infection and malunion. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DISCUSSION This meta-analysis indicates that ORIF and EF are both effective procedures for treating unstable distal radius fractures. ORIF may be superior to EF in the treatment of unstable distal radius fractures. Because of the low quality evidence currently available, high-quality RCTs are required. LEVEL OF EVIDENCE Level II: low-powered prospective randomized trial meta-analysis.
Collapse
Affiliation(s)
- Z Z Yuan
- Department of Integrated Traditional Chinese and Western Medicine, Tianjin Hospital, Tianjin, China
| | - Z Yang
- Graduate School, Tianjin Medical University, Tianjin, China; Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
| | - Q Liu
- Department of Integrated Traditional Chinese and Western Medicine, Tianjin Hospital, Tianjin, China
| | - Y M Liu
- Department of Integrated Traditional Chinese and Western Medicine, Tianjin Hospital, Tianjin, China
| |
Collapse
|
22
|
Thorninger R, Madsen ML, Wæver D, Borris LC, Rölfing JHD. Complications of volar locking plating of distal radius fractures in 576 patients with 3.2 years follow-up. Injury 2017; 48:1104-1109. [PMID: 28336098 DOI: 10.1016/j.injury.2017.03.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Volar plating of unstable distal radius fractures (DRF) has become the favoured treatment. The complication rates vary from 3 to 36%. The purpose of the study was to estimate the complication rate of volar plating of DRF and its association with AO/OTA fracture type, surgeon experience and type of volar plate. METHODS Retrospectively, all patients treated with volar plating of a DRF between February 2009 and June 2013 at Aarhus University Hospital, Denmark were included. AO/OTA fracture type, surgeon experience (1st year, 2nd-5th year resident or consultant), type of plate (VariAx®, Acu-Loc®) and complications were extracted from the electronic medical records. Complications were categorized as carpal tunnel syndrome, other sensibility issues, tendon complications including irritation and rupture, deep infections, complex regional pain syndrome and unidentified DRUJ or scapholunar problems. Reoperations including hardware removal were also charted. RESULTS 576 patients with a median age of 63 years (min: 15; max: 87) were included. 78% were female and the mean observation time was 3.2 years (min: 2.0; max: 5.4). 78% (n=451) of the patients were treated with VariAx® and 22% (n=125) with Acu-Loc®. The overall complication rate was 14.6% (95% CI 11.8-17.7) including carpal tunnel syndrome or change in sensibility in 5.2% and tendon complications in 4.7%. Five flexor tendon ruptures and 12 extensor tendon ruptures were observed. The reoperation rate was 10.4% including 41 cases of hardware removal. A statistically significant association between AO/OTA fracture type C and complications was found. No statistically significant association between complication rate and surgeon experience and type of plate was observed. CONCLUSION The majority of DRF patients treated with a volar plate suffer no complications. However, the overall complication rate of 14.6% is substantial. Intra-articular fractures, e.g. AO/OTA-type 23C1-3, had significantly higher complication rates. Neither surgeon experience, nor type of volar plate was able to predict complications.
Collapse
Affiliation(s)
- Rikke Thorninger
- Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark.
| | - Mette Lund Madsen
- Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark
| | - Daniel Wæver
- Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark; Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - Lars Carl Borris
- Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | | |
Collapse
|
23
|
Khader BA, Towler MR. Common treatments and procedures used for fractures of the distal radius and scaphoid: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 74:422-433. [DOI: 10.1016/j.msec.2016.12.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
|
24
|
Boretto JG, Zaidenberg E, Gallucci GL, Alfie V, De Carli P. Delayed Repair of Ulnar Artery at the Distal Forearm. Hand (N Y) 2017; 12:150-153. [PMID: 28344526 PMCID: PMC5349407 DOI: 10.1177/1558944716643275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:The purpose of this study was to evaluate the rate of patency after delayed repair of the ulnar artery following primary ligation. Methods: Adult patients with primary ligation of the injured ulnar artery at the forearm who had a delayed repair of the artery were included. Postoperative arterial patency was determined by either physical examination or color Doppler ultrasonographic imaging. Postoperative complications and Disabilities of the Arm, Shoulder and Hand score were recorded. Results: Eight consecutive patients during a 3-year period were included. The mean age was 35 years. Four cases were women. The surgery was performed at a mean of 5 days after the injury and ligation. At a mean follow-up of 22 months, 7 patients had a patent artery. One patient suffered a hematoma. Conclusions: A high rate of patency can be obtained after delayed repair of the ulnar artery at the forearm.
Collapse
Affiliation(s)
- Jorge G. Boretto
- Hospital Italiano de Buenos Aires, Argentina,Jorge G. Boretto, Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Potosí 4247, Ciudad Autónoma de Buenos Aires C1199ACK, Argentina.
| | | | | | | | | |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW Distal radius fractures are one of the most common upper extremity fractures. Athletes with distal radius fractures are treated according to the same principles as non-athletes but present several unique considerations. At all levels of sport, injured athletes desire to return to play as rapidly as possible. RECENT FINDINGS Earlier operative fixation may allow an athlete to return to play more quickly. Volar locking plates are most commonly used for operative treatment of distal radius fractures due to their stability and low incidence of complications. Although the majority of distal radius fractures in athletes are treated non-operatively, operative intervention is offered when required to restore and maintain acceptable skeletal alignment. Return to sport is individualized guided by fracture stability, athlete age, and wrist-specific demands for competition.
Collapse
Affiliation(s)
- Casey Beleckas
- Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St Louis, MO, 63108, USA
| | - Ryan Calfee
- Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St Louis, MO, 63108, USA.
| |
Collapse
|
26
|
Childs S, Mann T, Dahl J, Ketz J, Hammert WC, Murray PM, Elfar J. Differences in the Treatment of Distal Radius Fractures by Hand Fellowship Trained Surgeons: A Study of ABOS Candidate Data. J Hand Surg Am 2017; 42:e91-e97. [PMID: 28027845 PMCID: PMC5292287 DOI: 10.1016/j.jhsa.2016.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 11/04/2016] [Accepted: 11/09/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The management of distal radius fractures differs based on the nature of the fracture and the experience of the surgeon. We hypothesized that patients requiring surgical intervention would undergo different procedures when in the care of a surgeon with subspecialty training in hand surgery as compared with surgeons with no subspecialty training in hand surgery. METHODS We queried the ABOS database for case log information submitted for part II of the ABOS examination. Queries for all codes involved with distal radius fracture management were combined with associated codes for the management of median nerve neuropathy, triangular fibrocartilage complex tears, ulnar shaft, and styloid fractures. Hand fellowship trained orthopedic surgeons were compared with those completing other fellowships and non-fellowship trained orthopedic surgeons during their board collection period. RESULTS During the study period, 2,317 orthopedic surgeons reported treatment of 15,433 distal radius fractures. Of these surgeons, 411 had hand fellowship training. On a per surgeon basis, fellowship trained hand surgeons operatively treated more multifragment intra-articular distal radius fractures than their non-hand fellowship trained counterparts (5.3 vs 1.2). Additional procedures associated with the management of distal radius fractures were also associated with the fellowship training of the treating surgeon. CONCLUSIONS Among orthopedic surgeons taking part II of the ABOS certifying examination, differences exist in the type, management, and reporting of distal radius fractures among surgeons with different areas of fellowship training. CLINICAL RELEVANCE This study describes the association of hand surgery fellowship training on the choice of intervention for distal radius fractures and associated conditions.
Collapse
Affiliation(s)
- Sean Childs
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Tobias Mann
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Jason Dahl
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - John Ketz
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Warren C Hammert
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
| | - Peter M Murray
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL
| | - John Elfar
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY.
| |
Collapse
|
27
|
Shakir S, Naran S, Neral M, Wollstein R. Titanium versus Stainless-Steel Plating in the Surgical Treatment of Distal Radius Fractures: A Randomized Trial. J Hand Microsurg 2016; 8:155-158. [PMID: 27999458 DOI: 10.1055/s-0036-1593731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022] Open
Abstract
Our purpose was to compare postoperative complications and rate of plate removal in titanium and stainless-steel plating of distal radius fractures (DRF). Patients following DRF were randomly fixed with titanium or stainless-steel plates using the same plating system. Complications, second surgeries, and plate prominence were documented. A total of 41 patients were treated with stainless-steel and 22 with titanium plates. Average follow-up was 60 ± 5.6 months. There was no difference in demographics, fracture characteristics, or follow-up between the groups. Plate prominence was found in 50% of radiographs (mean distance: 1.4 mm). Four titanium plates and three stainless-steel plates were removed (11%). Mean time to plate removal was 18.4 ± 4.6 months. There was no difference in removal rates between the groups. Plate material and prominence, age, fracture comminution and smoking status were not associated with plate removal. Our results support using volar and dorsal plates regardless of the plate material.
Collapse
Affiliation(s)
- Sameer Shakir
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Sanjay Naran
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Mithun Neral
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Ronit Wollstein
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Technion Israel Institute of Technology School of Medicine, Haifa, Israel
| |
Collapse
|
28
|
Hinds RM, Capo JT, Kakar S, Roberson J, Gottschalk MB. Early Complications Following Osteosynthesis of Distal Radius Fractures: A Comparison of Geriatric and Nongeriatric Cohorts. Geriatr Orthop Surg Rehabil 2016; 8:30-33. [PMID: 28255508 PMCID: PMC5315248 DOI: 10.1177/2151458516681636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/19/2016] [Accepted: 11/06/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Distal radius fractures (DRFs) are common geriatric fractures with the overall incidence expected to increase as the population continues to age. The purpose of this investigation was to compare the short-term complication rates in geriatric versus nongeriatric cohorts following osteosynthesis of DRFs. METHODS The American Board of Orthopaedic Surgery (ABOS) part II database was queried for adult DRF cases performed from 2007 to 2013. Current Procedural Terminology codes were used to identify cases treated via osteosynthesis. Patient demographic information and reported complication data were analyzed. Comparisons between geriatric (age ≥65 years) and nongeriatric (age <65 years) patients were performed. RESULTS From 2007 to 2013, a total of 9867 adult DRFs were treated via osteosynthesis by ABOS part II candidates. Geriatric patients comprised 28% of the study cohort. Mean age of the geriatric and nongeriatric cohorts was 74 ± 7 and 46 ± 13 years, respectively. There was a greater proportion of female patients (P < .001) in the geriatric cohort as compared with the nongeriatric cohort. The geriatric cohort demonstrated higher rates of anesthetic complications (P = .021), iatrogenic bone fracture (P = .021), implant failure (P = .031), loss of reduction (P = .001), unspecified medical complications (P = .007), and death (P = .017) than the nongeriatric cohort. The geriatric cohort also showed lower rates of nerve palsy (P = .028) when compared with the nongeriatric cohort, though no differences in rates of secondary surgery were noted between the two cohorts. CONCLUSION Increased rates of complications related to poor bone quality and poor health status may be expected among geriatric patients following osteosynthesis of DRFs. However, geriatric and nongeriatric patients have similarly low rates of secondary surgery. Future studies are needed to delineate the economic, functional, and societal impact of geriatric DRFs treated via osteosynthesis.
Collapse
Affiliation(s)
- Richard M Hinds
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - John T Capo
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Sanjeev Kakar
- Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - James Roberson
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael B Gottschalk
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
29
|
Abstract
PURPOSE There has recently been an increase in the number of fellowship trained orthopaedic trauma surgeons, raising concerns that the surgical experience of early career surgeons may be diluted. We sought to evaluate the change in complex trauma case volume of orthopaedic trauma surgeons sitting for Part II of the American Board of Orthopaedic Surgeons certification examination. METHODS The case log data from all surgeons taking Part II of the American Board of Orthopaedic Surgeons examination over a 13-year period (2003-2015) was evaluated. Any surgeon who examined in the trauma subspecialty was included. We defined pelvis, acetabulum, and periarticular fracture surgeries as complex trauma procedures and evaluated changes in case volume over time. RESULTS We included 468 candidates who examined as trauma subspecialists and performed 90,261 procedures. The number of candidates testing in trauma per year ranged from 15 to 65 and increased significantly over time [β = 4.05 (0.37), P < 0.0001]. Their case volume was stable over time [β = -1.7 (1.1), P = 0.16]. The number of acetabulum fracture surgeries performed decreased significantly over time from a mean of 10.1 cases in 2003 to 5.2 cases in 2015 [β = -0.34 (0.08), P = 0.0015]. There was no significant change in the number of pelvic fracture surgeries [β = -0.1 (0.1), P = 0.285]. There was a trend toward less periarticular fracture surgeries [β = -0.3 (0.1), P = 0.072]. CONCLUSIONS Although pelvic ring and periarticular fracture case volume have remained stable, early career surgeons have experienced a significant decrease in acetabular fracture case volume. The implications of this decreased surgical experience warrant careful consideration as the orthopaedic trauma workforce evolves.
Collapse
|
30
|
Abstract
INTRODUCTION Adverse events and associated morbidity and subsequent costs receive increasing attention in clinical practice and research. As opposed to complications, errors are not described or analysed in literature on fracture surgery. The aim of this study was to provide a description of errors and complications in relation to fracture surgery, as well as the circumstances in which they occur, for example urgency, type of surgeon, and type of fracture. METHODS All errors and complications were recorded prospectively in our hospital's complication registry, which forms an integral part of the electronic medical patient file. All recorded errors and complications in the complication registry linked to fracture surgery between 1 January, 2000 and 31 December, 2010 were analysed. RESULTS During the study period 4310 osteosynthesis procedures were performed. In 78 (1.8 %) procedures an error in osteosynthesis was registered. The number of procedures in which an error occurred was significantly lower (OR = 0.53; p = 0.007) when an orthopaedic trauma surgeon was part of the operating team. Of all 3758 patients who were admitted to the surgical ward for osteosynthesis, 745 (19.8 %) had one or more postoperative complications registered. There was no significant difference in the number of postoperative complications after osteosynthesis procedures in which an orthopaedic trauma surgeon was present or absent (16.7 vs. 19.1 %; p = 0.088; OR 0.85). DISCUSSION In the present study the true error rate after osteosynthesis may have been higher than the rate found. Errors that had no significant consequence may be especially susceptible to underreporting. CONCLUSION The present study suggests that an osteosynthesis procedure performed by or actively assisted by an orthopaedic trauma surgeon decreases the probability of an error in osteosynthesis. Apart from errors in osteosynthesis, the involvement of an orthopaedic trauma surgeon did not lead to a significant reduction in the number of postoperative complications.
Collapse
|
31
|
Fernandez MS. Avoiding complication of volar locked plates. BMC Proc 2015. [PMCID: PMC4444936 DOI: 10.1186/1753-6561-9-s3-a42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
32
|
Koehler DM, Gao Y, Guan JJ, Lawler EA, Adams BD, Shah AS. Postsurgical complications following distal radius volar plating in a diabetic population at short-term follow-up. Hand (N Y) 2015; 10:670-7. [PMID: 26568721 PMCID: PMC4641081 DOI: 10.1007/s11552-015-9777-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diabetes mellitus increases the risk of complications following operative treatment of lower extremity fractures. There is little published data establishing the impact of diabetes following surgical treatment of upper extremity fractures. This investigation aimed to compare the incidence of short-term postsurgical complications following volar locked plating of distal radius fractures in patients with and without diabetes. METHODS A retrospective matched cohort investigation of 33 diabetics matched 1:2 to 66 non-diabetics was performed, accounting for age, gender, fracture type, and smoking status. Electronic medical records and radiographs were reviewed for all major and minor postsurgical complications. Demographic characteristics, postoperative radiographic parameters, and final range of motion were also compared. Mean follow-up was 5.3 ± 8.2 and 5.5 ± 7.8 months for diabetics and non-diabetics, respectively. RESULTS The diabetic cohort had a significantly higher overall complication rate with 24 postsurgical complications affecting 12 patients (36 %) compared to 16 complications affecting 12 patients (18 %) in the non-diabetic cohort. There was no difference in the incidence of major complications requiring operative intervention. Minor complications were significantly more common in the diabetic group and were largely accounted for by peripheral neuritis with an incidence of 30 %. Final radiographic outcomes and range of motion were similar. CONCLUSIONS Diabetics experienced a greater incidence of minor postsurgical complications following volar locked plating of distal radius fractures when compared to a matched, control population. The difference in outcomes is largely accounted for by the increased incidence of peripheral neuritis among diabetics. Diabetic patients should be counseled pre-operatively regarding their elevated risk profile.
Collapse
Affiliation(s)
- Daniel M. Koehler
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa, IA 52242 USA
| | - Yubo Gao
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa, IA 52242 USA
| | - Justin J. Guan
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa, IA 52242 USA
| | - Ericka A. Lawler
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa, IA 52242 USA
| | - Brian D. Adams
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa, IA 52242 USA
| | - Apurva S. Shah
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa, IA 52242 USA
| |
Collapse
|
33
|
Loisel F, Bouilloux X, Uhring J, Rochet S, Obert L. Early postoperative improvements in the QuickDASH score after distal radius fracture are related to the type of surgical treatment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:865-9. [PMID: 25893608 DOI: 10.1007/s00590-015-1626-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
The goal of this prospective study was to evaluate the real-life experience of 52 patients and their recovery kinetics in the first 6 weeks after surgical treatment of distal radius fractures. The fractures were treated with either a fourth-generation volar locking plate (34 patients, mean age 67 years, range 54-82) or by percutaneous pinning (18 patients, mean age 56 years, range 43-69). These patients were evaluated every week for 6 weeks with the QuickDASH (QD) questionnaire. A lower QD score indicated that the patient's physical function and symptoms had improved. At postoperative week 1, all the patients who had undergone percutaneous pinning had a QD of 80 (out of 100). One-third of patients who had undergone plate fixation had a QD of 80, while the remainder had a QD of 65. Out of all the patients who had a QD of 80 at postoperative week 1, the patients who had undergone plate fixation improved more quickly. After 6 weeks, the patients who had undergone plate fixation had a greater reduction in the QD (50 points) than the ones who had undergone pinning (30 points). Although the direct costs of locking plate fixation are 10 times higher than those of K-wire pinning, evidence suggests that these plates reduce the indirect costs. This study has shown that a patient's recovery rate, day-to-day life and physical function are better over the first 6 weeks postsurgery when the distal radius fracture is fixed with a locking plate.
Collapse
Affiliation(s)
- François Loisel
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, EA 4268 Innovation, Imagerie, Ingénierie et Intervention en santé « I4S » IFR 133 INSERM, C.H.U. Besançon, 25033, Besançon, France,
| | | | | | | | | |
Collapse
|
34
|
Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures. INTERNATIONAL ORTHOPAEDICS 2015; 39:2381-7. [DOI: 10.1007/s00264-015-2763-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
|
35
|
Divani K, Subramanian P, Goldie B. Avoiding extensor tendon rupture after the use of palmar locking plates for distal radial fractures. J Hand Surg Eur Vol 2015; 40:215-6. [PMID: 24194612 DOI: 10.1177/1753193413511575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- K Divani
- Whipps Cross University Hospital, Leytonstone, London UK
| | - P Subramanian
- Whipps Cross University Hospital, Leytonstone, London UK
| | - B Goldie
- Whipps Cross University Hospital, Leytonstone, London UK
| |
Collapse
|
36
|
Schick CW, Koehler DM, Martin CT, Gao Y, Pugely AJ, Shah A, Adams BD. Risk factors for 30-day postoperative complications and mortality following open reduction internal fixation of distal radius fractures. J Hand Surg Am 2014; 39:2373-80.e1. [PMID: 25447003 DOI: 10.1016/j.jhsa.2014.09.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/06/2014] [Accepted: 09/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the incidence and risk factors for 30-day postoperative morbidity and mortality following operative treatment of distal radius fractures in a multicenter cohort. METHODS We retrospectively queried the American College of Surgeons National Surgical Quality Improvement Program database for the years 2005-2011 for cases of closed distal radius fractures treated operatively with internal fixation. Patient demographics, comorbidities, and operative characteristics were analyzed. Thirty-day postoperative complications were identified and separated into categories of major morbidity or mortality, minor morbidity, and any complication. Risk factors were identified using univariate and multivariate analyses. RESULTS We identified 1,673 cases of closed distal radius fractures managed with internal fixation. The overall incidence of having any early complication was 3%. Major morbidity was 2.1%, which included 4 patient deaths, and minor morbidity was 1%. The most common major morbidity was a return to the operating room (16 patients). The most common minor morbidity was urinary tract infection (6 patients). The multivariate analysis demonstrated ASA class III or IV, dependent functional status, hypertension, and myocardial infarction/congestive heart failure to be significant risk factors for any early complication. There was a 10.0% complication rate in the inpatient group and a 1.3% complication rate in the outpatient group. CONCLUSIONS The incidence of early complications following internal fixation for closed distal radius fractures was low, especially in the outpatient group. In the setting of an isolated injury to the distal radius, the data presented here can provide prognostic information for patients during informed consent for what is considered to be an elective procedure. Surgeons should consider risk of morbidity and mortality when considering surgery for patients with noteworthy cardiopulmonary disease, increased ASA class, or poor functional status. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Cameron W Schick
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Daniel M Koehler
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Christopher T Martin
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Yubo Gao
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Andrew J Pugely
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Apurva Shah
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brian D Adams
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| |
Collapse
|
37
|
Bentohami A, de Burlet K, de Korte N, van den Bekerom MPJ, Goslings JC, Schep NWL. Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg Eur Vol 2014; 39:745-54. [PMID: 24262583 DOI: 10.1177/1753193413511936] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this systematic review is to assess the prevalence of complications following volar locking plate fixation of distal radial fractures. A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Only prospective comparative and prospective cohort studies that presented data concerning complications after treatment of distal radial fractures with a volar locking plate in human adults with a minimal follow-up of 6 months were included. Two quality assessment tools were used to assess the methodological quality of the studies (level of evidence rating according to the Oxford Centre of Evidence Based Medicine and the modified version of the Cochrane Bone, Joint and Muscle Trauma Group's former quality assessment tool). Thirty three studies were eligible for final assessment. Most complications were problems with nerve and tendon function as well as complex regional pain syndrome. With an overall complication rate of 16.5%, most of which were 'minor' complications and low rates of nonunion and malunion, volar locking plate fixation can be considered a reasonably safe treatment option for patients with distal radial fractures.
Collapse
Affiliation(s)
- A Bentohami
- Department of Surgery Spaarne Hospital, Spaarnepoort, The Netherlands
| | - K de Burlet
- Department of Surgery Spaarne Hospital, Spaarnepoort, The Netherlands
| | - N de Korte
- Department of Surgery Spaarne Hospital, Spaarnepoort, The Netherlands
| | | | - J C Goslings
- Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - N W L Schep
- Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
38
|
Complications after volar plating of distal radius fractures. J Hand Surg Am 2014; 39:1183-5; quiz 1186. [PMID: 24810935 DOI: 10.1016/j.jhsa.2014.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
|