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Straatman L, Knowles N, Suh N, Walton D, Lalone E. The Utility of Quantitative CT (QCT) to Detect Differences in Subchondral Bone Mineral Density Between Healthy People and People with Pain Following Wrist Trauma. J Biomech Eng 2022; 144:1131490. [PMID: 35044448 DOI: 10.1115/1.4053594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Indexed: 11/08/2022]
Abstract
The mechanisms underlying chronic pain development following musculoskeletal trauma are complex and multifactorial. In their search, some researchers are turning to the subchondral bone as a potential contributor to pain due to its vascularity, using a depth-specific imaging technique. However, this technique has been mainly used in the knee. We propose the use of a quantitative computed tomography (QCT) depth-specific analysis to measure subchondral bone following wrist trauma. Ten participants (n=5 post-trauma; n=5 healthy) underwent bilateral CT scans of their wrist accompanied by a calibration phantom with known densities. Average subchondral vBMD was studied at three depths from the subchondral surface (0 to 2.5, 2.5 to 5, 5 to 7.5mm) according to radial articular surface contact in both wrists of each participant. Percentage differences and Cohen's d effect sizes were calculated to analyze bilateral vBMD and vBMD differences between groups. This image-based tool demonstrated subject-specific, depth-specific, and joint-specific measures of vBMD within the wrist. This methodology highlighted the differences between depth-specific vBMD in healthy people and people who have experienced wrist trauma. Overall, the healthy cohort demonstrated higher vBMD across all three depths and both articular surfaces. This imaging technique further distinguished between subchondral cortical and trabecular bone, wherein clinical implications can be drawn from these distinctions in future work. Our study therefore supports the utility of a QCT imaging technique in detecting differences in depth-specific vBMD in the wrist.
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Affiliation(s)
- Lauren Straatman
- Department of Health and Rehabilitation Sciences, Western University; Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre, Western University, Rm. EC1458, 1201 Western Rd.London, Ontario N6G 1H1
| | | | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre; Schulich School of Medicine and Dentistry, Western University
| | - David Walton
- Department of Health and Rehabilitation Sciences, Western University; School of Physical Therapy, Western University
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre
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Boersma EZ, Nijhuis-van der Sanden MWG, Edwards MJR, Ring D, Teunis T. Satisfaction with Alignment After Reduction of a Displaced Distal Radial Fracture. J Bone Joint Surg Am 2021; 103:483-488. [PMID: 33475312 DOI: 10.2106/jbjs.20.00482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alignment adequate to offer nonoperative treatment after reduction of a distal radial fracture is a matter of opinion. This study addressed factors associated with interobserver reliability of satisfaction with alignment after the reduction of a distal radial fracture. METHODS A survey sent to members of the Science of Variation Group divided the participants into 4 groups that each rated 24 sets of radiographs of adult patients with a distal radial fracture before and after manipulative reduction and cast or splint immobilization. This resulted in a total of 96 fractures rated by 111 participants. Observers indicated whether they were satisfied with the reduction, meaning that nonoperative treatment was an option, or not, meaning that they recommend surgery. The Fleiss kappa was used to measure reliability. RESULTS There was fair reliability of satisfaction with reduction of a distal radial fracture (kappa, 0.34 [95% confidence interval (CI), 0.28 to 0.41]). No surgeon factors were associated with variations in reliability. Multivariable linear regression analysis indicated that every degree decrease in dorsal angulation of the distal part of the radius on the lateral radiograph increased satisfaction by a mean of 1% (beta, -0.01 [95% CI, -0.02 to -0.006]; p = 0.001); each millimeter decrease in the anterior-to-posterior distance between the dorsal and volar articular margins on the lateral radiograph increased satisfaction by 3% (beta, -0.03 [95% CI, -0.04 to -0.005]; p = 0.014), and each millimeter decrease in ulnar positive variance increased satisfaction by 6% (beta, -0.06 [95% CI, -0.08 to -0.03]; p < 0.001), accounting for 44% of the observed variation. CONCLUSIONS Surgeons are influenced by radiographic deformity, but do not agree on adequate alignment after reduction of a distal radial fracture. CLINICAL RELEVANCE Greater involvement of patients in decisions with regard to acceptable deformity has the potential to decrease treatment variation.
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Affiliation(s)
- Emily Z Boersma
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Michael J R Edwards
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Teun Teunis
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Li S, Zhang YQ, Wang GH, Li K, Wang J, Ni M. Melone's concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping. J Orthop Surg Res 2020; 15:222. [PMID: 32546176 PMCID: PMC7298813 DOI: 10.1186/s13018-020-01739-x] [Citation(s) in RCA: 3] [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: 02/16/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background There is no consensus in the literature about the ideal classification of the distal radius fracture for the clinical practice. The traditional Melone classification system divides the distal radius into four basic components, the shaft, radial styloid, dorsal medial fragment, and volar medial fragment. The aim of this study was to identify fracture lines in comminuted distal radius fractures using three-dimensional mapping of computed tomography (CT) images to test the hypothesis that fracture fragments can be divided according to the Melone classification. Methods Fifty-nine consecutive OTA/AO 23C3 fractures presented at the hospital between January 2018 and October 2019 were retrospectively reviewed. The fracture lines were characterized in the axial, sagittal, and coronal CT planes. After reducing the fractures in a three-dimensional (3D) model, the fracture lines were plotted from the CT images and were then superimposed on one another and oriented to fit a standard template. The area of articular surfaces was measured and compared to quantify the differences between the radial bone fragments. Results Thirty-five cases (59.3%) in this study fit the Melone classification and 24 cases (40.7%) did not. On the radiocarpal surface, there was a greater concentration of fracture lines in the dorsal area of the radius than in the volar area. On the distal radioulnar joint (DRUJ), the fracture lines were focused around two specific concentrated regions. For the articular surface area, the mean area of the radial styloid, volar medial fragment, and dorsal medial fragment was 141.13 ± 90.16 mm2, 147.79 ± 75.94 mm2, and 79.05 ± 70.73 mm2, respectively. There was a significant difference in articular surface area for the Melone fragments (P = 0.002). Conclusions The Melone classification system is not suitable for characterizing all C3 fractures. The findings of this study confirm that the dorsal medial fragments are relatively comminuted and small. Extra care should be given to these small fragments when reducing the fracture.
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Affiliation(s)
- Shuang Li
- Department of Orthopaedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine and Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai, 201299, People's Republic of China
| | - Ying-Qi Zhang
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University, 389 Xincun Road, Putuo District, Shanghai, 200065, People's Republic of China
| | - Gu-Heng Wang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226001, Jiangsu Province, People's Republic of China
| | - Kai Li
- Department of Orthopaedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine and Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai, 201299, People's Republic of China
| | - Jian Wang
- Department of Orthopaedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine and Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai, 201299, People's Republic of China
| | - Ming Ni
- Department of Orthopaedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine and Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai, 201299, People's Republic of China.
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Khan JI, Hussain FN, Mehmood T, Adil O. A comparative study of functional outcome of treatment of intra articular fractures of distal radius fixed with percutaneous Kirschner's wires vs T-plate. Pak J Med Sci 2017; 33:709-713. [PMID: 28811800 PMCID: PMC5510132 DOI: 10.12669/pjms.333.11421] [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: 09/06/2016] [Revised: 09/23/2016] [Accepted: 05/06/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND & OBJECTIVE Fractures of the distal radius are common with a variable prognosis in case of intra articular extension. The available options include Plaster, External fixation, Prefabricated Splintage using Ligamentotaxis, K-wire fixation, and open reduction internal fixation with T-plate without an as yet clear advantage of one over the others. If these fractures are allowed to collapse, radial shortening, angulation and articular incongruity may cause permanent deformity and loss of function. This limited small scale study was intended to compare the functional results of treatment of these fractures with a T plate and K-wires. METHODS This was a prospective experimental study conducted at department of Orthopedics of PGMI/Lahore General Hospital, Lahore. Total 30 patients were included and randomized into two groups of 15 patients each. Group-A patients were treated with Krischner's wires and Group-B patients were treated with a T-Plate with open reduction. Informed consent was taken. Post operative follow up was done for 12 weeks for the outcome parameters (Green and O'Brien score). RESULTS Mean age of patients in Group-A and B was 36.13±9.81 and 44.73±7.86 years respectively. In Group-A there were 10 male and 5 female patients and in Group-B there were 8 male and seven female patients respectively. In Group-A nine patients presented with Fernandez type-II and six patients presented with Fernandez type-III fracture. While in Group-B 10 patients presented with Fernandez type-II and five patients presented with Fernandez type-III fracture. Among Group-A patient's final outcome was excellent in 86.67% patients while in Group-B only 53.33% patients had excellent outcome at three months follow up. CONCLUSION Percutaneous Kirschner's wires appeared to be more effective as compared to T-Plate fixation in terms of functional outcome for treating intra-articular distal radius fractures.
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Affiliation(s)
- Jahangir Iqbal Khan
- Jahangir Iqbal Khan, MS Orthopedic, Post Graduate Medical Institute, Lahore General Hospital (LGH), Lahore, Pakistan
| | - Faisal Nazeer Hussain
- Faisal Nazeer Hussain, FCPS Orthopedic, Professor of Orthopedics, Avicenna Medical College, DHA 9, Lahore Cantt, Pakistan
| | - Tahir Mehmood
- Tahir Mehmood, MS Orthopedic, Assistant Professor, Post Graduate Medical Institute, Lahore General Hospital (LGH), Lahore, Pakistan
| | - Omer Adil
- Omer Adil, FRCS. Associate Professor, Post Graduate Medical Institute, Lahore General Hospital (LGH), Lahore, Pakistan
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Haluzan D, Davila S, Antabak A, Dobric I, Stipic J, Augustin G, Ehrenfreund T, Prlic I. Thermal changes during healing of distal radius fractures-Preliminary findings. Injury 2015; 46 Suppl 6:S103-6. [PMID: 26596415 DOI: 10.1016/j.injury.2015.10.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The bone healing process is very complex. In simple terms, bone healing comprises three basic steps, the inflammation phase, the repair phase and the remodelling phase. The increase in blood flow around the fracture during the healing process increases the temperature of the surrounding tissue. Infrared thermography is a method of measuring body temperature that can detect temperature changes during bone healing. Studies on the application of thermography in traumatology are scarce, and there are no studies of thermal changes during normal bone healing. The authors have tried to determine the dynamics of thermal changes during bone healing. MATERIAL AND METHODS The Flir ThermaCam B2 (FLIR Systems, Inc., Oregon, USA) was used for all measurements. Thermographic recordings were made one, three, five, 11 and 23 weeks after fracture. The contralateral, healthy, forearm was used for comparison. RESULTS A total of 25 patients of mean age 65.9±10.4 years (range 50-80 years) with fracture of the distal radius were examined in this study. The mean temperature difference between healthy and fractured distal forearm one week after fracture was 1.20±0.48°C, three weeks after fracture was 1.42±0.54°C, five weeks after fracture was 1.04±0.53°C, 11 weeks after fracture was 0.50±0.30°C, and 23 weeks after fracture was 0.22±0.25°C. CONCLUSION Preliminary findings during this research showed significant temperature changes during healing of distal radius fractures. Infrared thermography is a simple and reliable method in clinical practice that could be used as a good follow-up method in traumatology, but further investigations on more patients are needed.
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Affiliation(s)
- Damir Haluzan
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
| | - Slavko Davila
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; University of Zagreb, School of Medicine, Salata 3, 10 000 Zagreb, Croatia
| | - Anko Antabak
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; University of Zagreb, School of Medicine, Salata 3, 10 000 Zagreb, Croatia
| | - Ivan Dobric
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; University of Zagreb, School of Medicine, Salata 3, 10 000 Zagreb, Croatia
| | - Jagoda Stipic
- Department of Neurology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; University of Zagreb, School of Medicine, Salata 3, 10 000 Zagreb, Croatia
| | - Tin Ehrenfreund
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Ivica Prlic
- Institute for Medical Research and Occupational Health, Ksaverska cesta 2, 10000 Zagreb, Croatia
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Zhao K, Breighner R, Holmes D, Leng S, McCollough C, An KN. A technique for quantifying wrist motion using four-dimensional computed tomography: approach and validation. J Biomech Eng 2015; 137:2279319. [PMID: 25901447 DOI: 10.1115/1.4030405] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 12/21/2022]
Abstract
Accurate quantification of subtle wrist motion changes resulting from ligament injuries is crucial for diagnosis and prescription of the most effective interventions for preventing progression to osteoarthritis. Current imaging techniques are unable to detect injuries reliably and are static in nature, thereby capturing bone position information rather than motion which is indicative of ligament injury. A recently developed technique, 4D (three dimensions + time) computed tomography (CT) enables three-dimensional volume sequences to be obtained during wrist motion. The next step in successful clinical implementation of the tool is quantification and validation of imaging biomarkers obtained from the four-dimensional computed tomography (4DCT) image sequences. Measures of bone motion and joint proximities are obtained by: segmenting bone volumes in each frame of the dynamic sequence, registering their positions relative to a known static posture, and generating surface polygonal meshes from which minimum distance (proximity) measures can be quantified. Method accuracy was assessed during in vitro simulated wrist movement by comparing a fiducial bead-based determination of bone orientation to a bone-based approach. The reported errors for the 4DCT technique were: 0.00-0.68 deg in rotation; 0.02-0.30 mm in translation. Results are on the order of the reported accuracy of other image-based kinematic techniques.
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Theoretical distribution of load in the radius and ulna carpal joint. Comput Biol Med 2015; 60:100-6. [DOI: 10.1016/j.compbiomed.2015.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/21/2015] [Accepted: 02/25/2015] [Indexed: 11/17/2022]
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O'Brien L, Hardman A. Developing hand therapy skills in Bangladesh: experiences of Australian volunteers. J Hand Ther 2014; 27:30-7. [PMID: 24290873 DOI: 10.1016/j.jht.2013.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/20/2013] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Bangladesh is a developing country whose health system is highly dependent on project funding from foreign countries. Interplast Australia & New Zealand have supported volunteer hand therapists to provide training to local staff in the management of hand injuries and burns since 2006. OBJECTIVES We aimed to explore and describe the volunteers' own experience and provide recommendations for future therapy capacity building projects in developing countries. METHODS This qualitative study involved nine volunteer therapists, who attended a focus group to discuss their experiences, including the key milestones, challenges, and progress achieved. The two authors analyzed transcripts independently and emergent themes were discussed and identified by consensus. RESULTS Overall the experience was extremely positive and rewarding for volunteers. Key learnings and challenges encountered in this project were cultural differences in learning styles, the need to adapt our approach to 2 facilitate sustainable local solutions, attrition of skilled local staff, and concerns regarding volunteer health and safety. Recommendations for similar projects include allowing adequate time for in-country scoping and planning, coordination and pooling of resources, and the use of strategies that encourage the shift to confident local ownership of ongoing learning and skill development. CONCLUSION Volunteering in a health capacity building program in developing countries can be a challenging but immensely rewarding experience. Programs designed to meet the health demands in developing countries should emphasize adequate training of professionals in the use of transferable, sustainable and cost effective techniques. Time spent in the scoping and planning phase is crucial, as is coordination of efforts and pooling of resources. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
- Lisa O'Brien
- Monash University, McMahon's Rd Frankston, Victoria 3199, Australia; Occupational Therapy, The Alfred, Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Alison Hardman
- Monash University, McMahon's Rd Frankston, Victoria 3199, Australia
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Malone PSC, Hutchinson CE, Kalson NS, Twining CJ, Terenghi G, Lees VC. Subluxation-related ulnar neuropathy (SUN) syndrome related to distal radioulnar joint instability. J Hand Surg Eur Vol 2012; 37:652-64. [PMID: 22193951 DOI: 10.1177/1753193411432707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ulnar neuropathy coexistent with distal radioulnar joint (DRUJ) instability has previously been observed in our practice. The aim of this study was to define this phenomenon and investigate the hypothesis that the cause of this intermittent, positional ulnar neuropathy is related to kinking of the ulnar nerve about the DRUJ. Ulna neuropathy was present in 10/51 (19.6%) of a historical cohort of patients who presented with DRUJ instability. Nine subsequent patients with DRUJ instability and coexistent ulnar neuropathy underwent 3-T magnetic resonance imaging to better understand the mechanism of the observed syndrome. Both 3D qualitative and quantitative analyses were used to assess the presence of nerve 'kinking', displacing the nerve from its normal course and causing nerve compression/distraction in the distal forearm and Guyon's canal. Results of the quantitative analysis were statistically significant (p < 0.05). The clinical features of the condition have been delineated and termed subluxation-related ulnar neuropathy or SUN syndrome. The imaging study was a level II diagnostic study.
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Affiliation(s)
- P S C Malone
- Blond McIndoe Laboratories, University of Manchester, Department of Reconstructive Plastic Surgery, University Hospital South Manchester, Wythenshawe, UK
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Toemen A, Dalton S, Sandford F. The intra- and inter-rater reliability of manual muscle testing and a hand-held dynamometer for measuring wrist strength in symptomatic and asymptomatic subjects. HAND THERAPY 2011. [DOI: 10.1258/ht.2011.011010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective The objective of this study was to assess the intra- and inter-rater reliability of manual muscle testing (MMT) and hand-held dynamometer (HHD) in the measurement of isometric wrist strength in asymptomatic and symptomatic (distal radius fractures [DRF] and non-specific wrist pain [NSWP]) populations. Method Thirty-nine adults participated in an intra session, repeat measure, crossover study design. MMT and HHD isometric wrist strength was tested in six standardized test positions by two raters. Results Poor-to-excellent intra- and inter-rater reliability with MMT was found in all patient populations (ICC = 0.04–1.00). Excellent intra-rater reliability with HHD in the DRF (ICC = 0.86–0.95) and NSWP (ICC = 0.92–0.97) populations and excellent inter-rater reliability in the asymptomatic (ICC = 0.77–0.93) and DRF (ICC = 0.82–0.95) populations. Fair to excellent intra-rater reliability with HHD was seen in the asymptomatic population (ICC = 0.71–0.94) and fair to excellent inter-rater reliability in the NSWP population (ICC = 0.59–0.90). Conclusion MMT is shown to have variable reliability when assessing isometric wrist strength and is insensitive to small strength changes. HHD has been shown to be an objective and reliable measure of isometric wrist strength in specific positions in asymptomatic, DRF and NSWP populations. Further studies are required to ensure adequate dynamometry stabilization and obtain an optimal testing procedure for these populations.
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Affiliation(s)
| | - Sarah Dalton
- Guy's & St Thomas NHS Foundation Trust, London, UK
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van de Giessen M, Streekstra GJ, Strackee SD, Maas M, Grimbergen KA, van Vliet LJ, Vos FM. Constrained registration of the wrist joint. IEEE TRANSACTIONS ON MEDICAL IMAGING 2009; 28:1861-1869. [PMID: 19423432 DOI: 10.1109/tmi.2009.2021432] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Comparing wrist shapes of different individuals requires alignment of these wrists into the same pose. Unconstrained registration of the carpal bones results in anatomically nonfeasible wrists. In this paper, we propose to constrain the registration using the shapes of adjacent bones, by keeping the width of the gap between adjacent bones constant. The registration is formulated as an optimization involving two terms. One term aligns the wrist bones by minimizing the distances between corresponding bone surfaces. The second term constrains the registration by minimizing the distances between adjacent sliding surfaces. The registration is based on the Iterative Closest Point algorithm. All bones are registered concurrently so that no bias is introduced towards any of the bones. The proposed registration method delivers anatomically correct configurations of the bones. The registration errors are in the order of the voxel size of the acquired CT data (0.3 x 0.3 x 0.3 mm(3)). The standard deviation in the widths of gaps between adjacent bones is in the order of 10% with an insignificant bias. This is a large improvement over the standard deviations of 30%-80% encountered in unconstrained registration. The value of this method is its capability of accurately registering joints in varying poses resulting in physiological joint configurations.
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Affiliation(s)
- Martijn van de Giessen
- Faculty of Applied Sciences, Quantitative Imaging Group, Delft University of Technology, 2600 AA Delft, The Netherlands.
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van Manen CJ, Dekker ML, van Eerten PV, Rhemrev SJ, van Olden GDJ, van der Elst M. Bio-resorbable versus metal implants in wrist fractures: a randomised trial. Arch Orthop Trauma Surg 2008; 128:1413-7. [PMID: 18379802 DOI: 10.1007/s00402-008-0573-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Distal radius fractures are often surgically treated if insufficient reduction has been achieved or after conservative treatment has failed. Treatment using metal implants often demands a secondary operation to remove the implant. A bio-resorbable implant (in this study the Reunite osteosynthesis plate by Biomet Inc) should obviate the need for a secondary operation with equal functional results. MATERIALS AND METHODS Thirty-two patients with a distal radius fracture were assigned to treatment with either a bio-resorbable implant (N = 19) or a metal implant (N = 13). Both groups received the same postoperative care and were followed for 52 weeks in the outpatient clinic. The hypothesis of this study was a decrease in re-operation rate in the experimental group with equal functional results. RESULTS Five out of 19 patients treated with the Reunite plate were re-operated and four out of 13 treated with metal implants needed a secondary operation. In both implants, equal functional results in Range of Motion and DASH scores were found. CONCLUSION There were no significant differences between the experimental and control group with respect to re-operations, DASH scores and Range of Motion. Because of the higher initial costs and equal results, the use of bio-resorbable implants must be considered carefully.
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Affiliation(s)
- C J van Manen
- Department of Surgery and Traumatology, Reinier de Graaf Gasthuis, postbus 5011, 2600 GA Delft, The Netherlands
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