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Bates BD, Persitz J, Noori A, Chan AHW, Paul RA. Validation of the Lift-Off Screw Technique in Patients Undergoing Corrective Osteotomy for Malunited Distal Radius Fractures. J Hand Surg Am 2024:S0363-5023(24)00398-8. [PMID: 39340526 DOI: 10.1016/j.jhsa.2024.07.025] [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: 11/13/2023] [Revised: 07/14/2024] [Accepted: 07/31/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE The purpose of this study was to validate the clinical accuracy of the lift-off screw (LOS) technique for volar tilt correction (VTC) in patients undergoing corrective osteotomy for dorsally angulated distal radius fracture malunions. METHODS We conducted a retrospective review of 23 patients with dorsally angulated distal radius fracture malunions treated with corrective osteotomy using the LOS technique. The LOS equation Ls = [tan(Tc) ∗ Lp + C]/[cos(⍬s)] and standardized intraoperative fluoroscopic images were used to determine and compare the calculated and clinical VTC and final volar tilt. Correlations between the LOS length and the clinical VTC were calculated, as well as between the desired VTC and the correction accuracy. RESULTS Preoperative volar tilt ranged from -6° to -50° (mean = -22.9° ± 10.6°). The calculated VTC was 32.7° ± 9.4°, and the clinical VTC achieved was 25.8° ± 9.3°. The difference between the clinical and calculated correction was -6.9°, with an average postoperative clinical volar tilt of 2.8° ± 5.7°, compared with a calculated volar tilt of 9.7° ± 4.4°. There was a moderately strong positive correlation between LOS screw length and clinical VTC achieved, and a moderately weak negative correlation between the desired amount of correction and the accuracy of the correction. CONCLUSIONS The LOS technique is a reproducible method to plan the amount of sagittal plane correction during corrective osteotomy surgery for dorsally angulated distal radius fracture malunions. We demonstrate that this technique underestimates the clinical correction achieved by an average of 7°, with larger deformities experiencing greater undercorrection. Undercorrection of volar tilt during corrective osteotomy should be anticipated by surgeons and considered in future implant and cutting guide designs. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Brent D Bates
- Division of Orthopaedics, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Jonathan Persitz
- Hand Program, Division of Plastic, Reconstructive, and Aesthetic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Atefeh Noori
- Hand Program, Division of Plastic, Reconstructive, and Aesthetic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrea H W Chan
- Hand Program, Division of Plastic, Reconstructive, and Aesthetic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ryan A Paul
- Hand Program, Division of Plastic, Reconstructive, and Aesthetic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Kart H, Akça E. Do Patients With Dominant-side Distal Radius Fractures Have Greater Psychological Distress Than Those With Nondominant-side Fractures? Clin Orthop Relat Res 2024:00003086-990000000-01726. [PMID: 39239999 DOI: 10.1097/corr.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/13/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Distal radius fractures have a psychological impact on patients, with the pain and disability caused by these injuries potentially leading to psychological distress. It is not known whether dominant-side and nondominant-side distal radius fractures cause more psychological distress in patients. QUESTIONS/PURPOSES (1) Compared with patients who have distal radius fractures on the nondominant side, do patients with dominant-side fractures experience greater pain? (2) Do patients with dominant-side distal radius fractures have greater disability? (3) Do patients with dominant-side distal radius fractures have worse psychological adjustment? (4) What factors are associated with a worse quality of life mental component measure? METHODS This retrospective study was conducted by the departments of orthopaedics-traumatology and psychiatry in a multidisciplinary manner at our university hospital, which is a public hospital. The study included 172 patients with distal radius fractures who were treated nonoperatively. We excluded 2% (3 of 172) of patients who underwent surgery because of loss of reduction, 1% (2 of 172) of patients with bilateral distal radius fractures, and 9% (16 of 172) of patients who did not consent to participate in the study. After the exclusion of 12% (21 of 172) of ineligible patients, the study continued with 88% (151 of 172) of patients. Forty-six percent (70 of 151) of patients had dominant distal radius fractures and 54% (81 of 151) of patients had nondominant distal radius fractures. The evaluation was carried out face-to-face at the end of the sixth week of treatment in the orthopaedic outpatient clinic. The VAS score was used to assess pain (this score ranges from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2), the QuickDASH was used to assess disability (ranges from 0 to 100, representing best to worst, with an MCID of 15.9), the Brief Adjustment Scale-6 (BASE-6) was used to assess psychological adjustment (ranges from 6 to 42, lower scores indicate better outcomes), and the SF-12 was used to assess quality of life (ranges from 0 to 100, representing worst to best, with an MCID of 5). RESULTS At cast removal, patients with dominant-side distal radius fractures had higher levels of pain (dominant VAS median [IQR] 4 [4], nondominant VAS median 2 [3], median difference 2; p = 0.005), but the difference was not clinically important. There were no differences in disability (dominant QuickDASH median 63.6 [21], nondominant Quick DASH median 59.1 [25], median difference 4.5; p = 0.20). Psychological adjustment was worse in patients with dominant-side fractures (dominant BASE-6 median 22.5 [24.3], nondominant BASE-6 median 15 [23.5], median difference 7.5; p = 0.004). After accounting for variables such as age, occupation, and gender, a better quality of life mental component (SF-12 MCS) was associated with a lower BASE-6 (β = -0.67; p < 0.001) and nondominant fracture (β = -0.16; p = 0.006). CONCLUSION Dominant-side distal radius fractures have a negative impact on the psychological adjustment and quality of life of patients. Patients with dominant distal radius fractures are more susceptible to the development of psychological disorders. Future studies should assess whether providing appropriate counsel at the time of fracture may alleviate the psychological disorders experienced by patients with dominant-side distal radius fractures. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Hayati Kart
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Erdoğdu Akça
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
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Anand I, Jamal B, Ganti L, Sherin K. Distal Radius Fracture with Dislocation of the Radioulnar Joint. Orthop Rev (Pavia) 2024; 16:122125. [PMID: 39156914 PMCID: PMC11329378 DOI: 10.52965/001c.122125] [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: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024] Open
Abstract
The authors report on the case of a 30-year-old male who sustained a wrist injury following a motorcycle accident. Emergency department evaluation revealed a left open distal radius fracture with distal radioulnar joint dislocation. The patient underwent surgical fixation to restore full mobility of his wrist.
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Vincent JI, MacDermid JC, Bassim CW, Santaguida P. Cluster analysis to identify the profiles of individuals with compromised bone health versus unfortunate wrist fractures within the Canadian Longitudinal Study of Aging (CLSA) database. Arch Osteoporos 2023; 18:148. [PMID: 38036802 PMCID: PMC10689536 DOI: 10.1007/s11657-023-01350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
We used cluster analysis to determine the profiles of individuals who sustained wrist fractures. We found two groups: (1) young and active and (2) older and less active. This information may be used to identify individuals who require further bone health interventions to optimize healthy aging. INTRODUCTION Distal radial fractures (DRF) are the most common of all fractures, with 6% of males and 33% of females having one at some point in their lifetime. We hypothesize that DRF consists of two subpopulations: one with compromised bone health that is early in the osteoporosis (OP) trajectory and another which are active and healthy and suffer a misfortune fracture due to their high activity levels or risk-taking behaviors. The latter is likely to recover with a minimal disability, while the former may signal a negative health trajectory of disability and early mortality. OBJECTIVE To determine the profiles of individuals who sustained wrist fractures using cluster analysis within the Comprehensive Cohort of the Canadian Longitudinal Study on Aging (CLSA) database considering factors that reflect bone health and activity levels. METHODS We included all the individuals who had a wrist fracture within the CLSA comprehensive cohort of the database (n = 968). The baseline data was used for this analysis. A 2-step cluster analysis was used to identify profiles that were both statistically and clinically meaningful. Variables that were used in the cluster analysis include demographic variables, physical activity status indicators, general health indicators, mobility indicators, bone health indicators, comorbid conditions, and lifestyle factors. RESULTS We were able to identify two distinct profiles that were statistically and clinically meaningful confirming our hypothesis. One cluster included a predominantly younger cohort, who are physically active, with less comorbid conditions, better bone health, and better general health, while the opposite was true of the first cohort. CONCLUSION We were able to identify two clusters-a healthy profile and a bone health compromised profile. This information may be used to identify the subgroup of people who should be targeted in the future for more intensive preventive health services to optimize healthy aging.
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Affiliation(s)
- Joshua I Vincent
- School of Physical Therapy, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
- Roth│McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, 268 Grosvenor St, London, ON, N6A 4V2, Canada.
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
| | - Joy C MacDermid
- School of Physical Therapy, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
- Roth│McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, 268 Grosvenor St, London, ON, N6A 4V2, Canada
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Carol W Bassim
- Department of Research Methods, Evidence & Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Dept. of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Pasqualina Santaguida
- Department of Research Methods, Evidence & Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
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Palola V, Hevonkorpi TP, Ponkilainen VT, Launonen AP, Mattila VM. Sick leave length and the costs of operatively and conservatively treated distal radius fractures in the working age population: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:842. [PMID: 37880683 PMCID: PMC10601330 DOI: 10.1186/s12891-023-06963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Among the working population, a transient loss of working ability due to distal radius fracture (DRF) has a societal impact in terms of sick leave. Non-operative cast immobilization is the most common treatment option for DRF. However, these fractures are increasingly treated operatively. This retrospective cohort study of patients aged 20-64 with DRF compares the effects of different treatment strategies on sick leave length and overall cost of treatment. METHODS Multivariable regression analysis was used with treatment modality as an exposure and sick leave length as an outcome. Sick leave data were obtained from a national register. Costs were evaluated by adding the direct cost of the treatment modality to the mean cost of sick leave per patient in different treatment groups. RESULTS Of 614 working-age patients with a DRF who were treated at a tertiary hospital in Finland between January 2013 and December 2014, 521 were primarily treated non-operatively with cast immobilization and 93 were primarily operated. Of the primarily non-operatively treated patients, 48 were operated during follow-up. The mean follow-up was 5 years. The median time lost from work after DRF was 55 days (7.9 weeks), and the separated medians by treatment modality were 49 (7 weeks) and 70 days (10 weeks) for conservative and operative treatment, respectively. Multivariable linear regression analyses were performed for those patients who had sick leave (n = 292). Regression analysis also showed that operative treatment correlates with longer sick leave. CONCLUSIONS Operative treatment of distal radius fracture led more often to longer time lost from work than conservative treatment. Moreover, due to longer sick leave and the costs of the operation itself, operative treatment is over two times more expensive than conservative treatment. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Vili Palola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland.
| | - Teemu P Hevonkorpi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyvaskyla, Finland
| | - Ville T Ponkilainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Surgery, Central Finland Central Hospital Nova, Jyvaskyla, Finland
| | - Antti P Launonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Hassellund SS, Oftebro I, Williksen JH, Søreide E, Madsen JE, Frihagen F. Closed reduction of dorsally displaced distal radius fractures in the elderly provided improved final radiographic results. J Orthop Surg Res 2023; 18:247. [PMID: 36967433 PMCID: PMC10041711 DOI: 10.1186/s13018-023-03733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/18/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND Recent guidelines recommend non-operative treatment as primary treatment in elderly patients with displaced distal radius fractures. Most of these fractures are closely reduced. We aimed to evaluate the radiological results of closed reduction and casting of dorsally displaced distal radius fractures in patients 65 years or older. METHODS A total of 290 patients treated during the years 2015, 2018 and 2019 in an urban outpatient fracture clinic with complete follow-up at least 5 weeks post-reduction were available for analysis. Closed fracture reduction was performed by manual traction under hematoma block. A circular plaster of Paris cast was used. Radiographs pre- and post-reduction and at final follow-up were analyzed. RESULTS Mean age was 77 years (SD 8) and 258 (89%) were women. Dorsal tilt improved from mean 111° (range 83-139) to 89° (71-116) post-reduction and fell back to mean 98° (range 64-131) at final follow-up. Ulnar variance was 2 mm ((-1)-12) pre-reduction, 0 mm ((-3)-5) post-reduction and ended at mean 2 mm (0-8). Radial inclination went from 17° ((-6)-30) to 23° (SD 7-33), and then back to 18° (0-32) at final follow-up. 41 (14%) patients had worse alignment at final follow-up compared to pre-reduction. 48 (17%) obtained a position similar to the starting point, while 201 (69%) improved. Fractures with the volar cortex aligned after reduction retained 0.4 mm (95% Confidence Interval (CI) 0.1 to 0.7; p = 0,022) more radius length during immobilization. In a regression analysis, less ulnar variance in initial radiographs (OR 1.8 (95% CI 1.4 to 2.3) per mm, p < 0.001) and lower age (OR 1.06 (95% CI 1.02 to 1.09) per year, p < 0.003) protected against loss of reduction. CONCLUSION Subsequent loss of reduction after initial closed reduction was seen in most distal radius fractures. Reduction improved overall alignment in 2/3 of the patients at final follow-up. An aligned volar cortex seemed to protect partially against loss of radial length.
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Affiliation(s)
- Sondre Stafsnes Hassellund
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ingrid Oftebro
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Endre Søreide
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jan Erik Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
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Scollan JP, Ohliger E, Emara AK, Grits D, McConaghy K, Ng M, Styron J. Prolonged Operative Time Associated with Increased Healthcare Utilization after Open Reduction and Internal Fixation of Intra-Articular and Extra-Articular Distal Radial Fractures: An Analysis of 17,482 Cases. J Wrist Surg 2022; 11:307-315. [PMID: 35971471 PMCID: PMC9375674 DOI: 10.1055/s-0041-1736606] [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: 07/19/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Background The current literature does not contain a quantitative description of the associations between operative time and adverse outcomes after open reduction and internal fixation (ORIF) of distal radial fractures (DRF). Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative health care utilization and 2) the incidence of local wound complications. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for DRF ORIF cases (January 2012-December 2018). A total of 17,482 cases were identified. Primary outcomes included health care utilization (length of stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time category. Secondary outcome was incidence of wound complications per operative-time category. Multivariate regression was conducted to determine operative-time categories associated with increased risk while adjusting for demographics, comorbidities, and fracture type. Spline regression models were constructed to visualize associations. Results The 121 to 140-minute category was associated with significantly higher risk of a LOS > 2 days (odds ration [OR]: 1.64; 95% confidence interval [CI]:1.1-2.45; p = 0.014) and nonhome discharge (OR: 1.72; 95% CI:1.09-2.72; p = 0.02) versus 41 to 60-minute category. The ≥ 180-minute category exhibited highest odds of LOS > 2 days (OR: 2.08; 95%CI: 1.33-3.26; p = 0.001), nonhome discharge disposition (OR: 1.87; 95% CI: 1.05-3.33; p = 0.035), and 30-day reoperation occurrence (OR: 3.52; 95% CI: 1.59-7.79; p = 0.002). There was no association between operative time and 30-day readmission ( p > 0.05 each). Higher odds of any-wound complication was first detected at 81 to 100-minute category (OR: 3.02; 95% CI: 1.08-8.4; p = 0.035) and peaked ≥ 181 minutes (OR: 9.62; 95% CI: 2.57-36.0; p = 0.001). Spline regression demonstrated no increase in risk of adverse outcomes if operative times were 50 minutes or less. Conclusion Our findings demonstrate that prolonged operative time is correlated with increased odds of health care utilization and wound complications after DRF ORIF. Operative times greater than 60 minutes seem to carry higher odds of postoperative complications.
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Affiliation(s)
- Joseph P. Scollan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Erin Ohliger
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmed K. Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kara McConaghy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mitchell Ng
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joseph Styron
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Südow H, Severin S, Wilcke M, Saving J, Sköldenberg O, Navarro CM. Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years - a three year follow-up of a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:447. [PMID: 35549696 PMCID: PMC9097389 DOI: 10.1186/s12891-022-05394-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023] Open
Abstract
Background Surgical treatment of displaced distal radius fractures (DRF) in older patients has increased, despite lacking evidence of its superiority over non-operative treatment. How treatment choice affects these patients after the initial 12-month period remains unknown. This study presents a clinical and radiographic follow up at an average of 3 years after treatment in the context of a randomized clinical trial comparing outcomes in patients aged ≥70 years, with a dorsally displaced distal radius fracture treated either surgically with volar locking plate or non-operatively. Methods Between 2009 and 2017, 140 patients aged ≥70 years with dorsally displaced DRF were randomized to surgery with volar locking plate (VLP) or non-operative treatment. At an average of 3 years after inclusion the participants were invited to an additional follow-up. The primary outcome was Patient Rated Wrist Evaluation (PRWE). Secondary outcomes included additional Patient Reported Outcome Measures (PROM), grip strength, range of motion, complications and radiological results. Results Sixty six patients were available for a 3 year follow-up, 33 in the non-operatively treated group and 33 in the VLP-group. The mean age at injury was 77 years. At 3 years the median PRWE was better (0 points) in the VLP-group than in the non-operative treatment group (9 points) p-value: 0.027. No statistically significant difference was found in Disabilities of the Arm, Hand, and Shoulder (DASH), EuroQol 5 Dimensions (EQ-5D) or grip strength. Total arc of range of motion was larger in the operatively treated group. No significant difference in osteoarthritis was found. Both groups had regained grip strength. The complication rate was similar. Outcomes improved from the 1 year to the 3 year follow-up. Conclusions Surgery with volar locking plate gave less long-term disability compared to non-operative treatment for severely displaced distal radius fractures in patients aged ≥70 years. Our findings were statistically significant but in the lower range of clinical importance. Trial registration The study was registered at : NCT02154620 03/06/2014 and NCT01268397 30/12/2010. Ethical approval was obtained from Ethical Committee in Stockholm, Sweden (2009/37–31/3, 2013/105–31/2, 2014/1041–32, 2017/611–32).
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Affiliation(s)
- Hanna Südow
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden. .,Department of Orthopedics, Södersjukhuset Hospital, Stockholm, Sweden.
| | - Sara Severin
- Karolinska Institute, Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden.,Department of Orthopedics, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Maria Wilcke
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset Hospital, Stockholm, Sweden
| | - Jenny Saving
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Capio Artro Clinic, Stockholm, Sweden
| | - Olof Sköldenberg
- Karolinska Institute, Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden.,Department of Orthopedics, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, SE-118 83, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset Hospital, Stockholm, Sweden
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9
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Milner Z, Klaic M, Withiel T, O'Sullivan H. Targeted sensorimotor retraining in the clinical setting: Improving patient outcomes following distal upper extremity injury. J Hand Ther 2022; 35:107-114. [PMID: 33573827 DOI: 10.1016/j.jht.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 10/28/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Existing theoretical evidence indicates sensorimotor retraining is beneficial following wrist injury. However, there are no large cohort studies applying the knowledge in a clinical setting. PURPOSE OF THE STUDY To Determine the clinical benefits of sensorimotor rehabilitation following distal upper extremity injury. STUDY DESIGN Prospective cohort study. METHODS A sensorimotor rehabilitation program was evaluated following distal upper extremity injury. A battery of clinical and patient-rated outcome measures (PROM) were taken before and after group completion. RESULTS Ninety-three patients, 49 males (53%) and 44 females (47%), completed the program. There were statistically significant improvements in 12 clinical measures. However, improvements in 11 of the clinical measures only had a small effect size (<0.5). Joint position sense had the greatest clinical change with a median improvement of 4° on the left and 3.9° on the right, and these had moderate effect sizes of 0.5 and 0.7, respectively. There were statistically significant improvements in all PROMs. PRWE had a median improvement of 21 (ES = 1.2). UEFI showed median improvements of 19.7 (ES = 1.4) and NRS (pain) median improved 2.5 (ES = 1.2). All PROM improvements had mean change greater than associated MCIDs. DISCUSSION These results indicate the benefits of sensorimotor group rehabilitation and supports existing literature regarding the importance of sensorimotor control for JPS accuracy and function. Group based sensorimotor programs present an efficient and low-cost opportunity to provide intervention to patients following upper extremity injury. CONCLUSION A sensorimotor group rehabilitation program may improve patient outcomes following distal upper extremity injury. LEVEL OF EVIDENCE Level 2b prospective cohort.
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Affiliation(s)
- Zoe Milner
- Masters Health Sciences (Occupational Therapy), Allied Health (Occupational Therapy), Clinical Lead Hand Therapy, Royal Melbourne Hospital, Victoria, Australia.
| | - Marlena Klaic
- Allied Health (Research and Translation Leader) Royal Melbourne Hospital, Victoria, Australia
| | - Toni Withiel
- Allied Health (Psychology) Royal Melbourne Hospital, Victoria, Australia
| | - Hayley O'Sullivan
- Allied Health (Occupational Therapy), Senior Clinician Hand Therapy, Victoria, Australia
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Babatunde OO, Bucknall M, Burton C, Forsyth JJ, Corp N, Gwilym S, Paskins Z, van der Windt DA. Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis. Osteoporos Int 2022; 33:753-782. [PMID: 34766193 DOI: 10.1007/s00198-021-06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning. PURPOSE To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over. METHODS Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes. RESULTS 78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5-78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10-20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes. CONCLUSION Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further. PROSPERO CRD42018116478.
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Affiliation(s)
- O O Babatunde
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK.
| | - M Bucknall
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - C Burton
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - J J Forsyth
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, UK
| | - N Corp
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - S Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Z Paskins
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK
| | - D A van der Windt
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
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11
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Hevonkorpi TP, Raittio L, Vähä-Tuisku S, Launonen AP, Mattila VM. Long-term subjective results and radiologic prognosis of a distal radius fracture in working-aged patients - a prognostic cohort study of 201 patients. J Int Med Res 2021; 49:3000605211060985. [PMID: 34929107 PMCID: PMC8733368 DOI: 10.1177/03000605211060985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate long-term outcomes associated with distal radius fracture (DRF) in working-aged patients. The authors hypothesized that the majority of patients experience no permanent loss of function when measured with patient-rated wrist evaluation (PRWE). METHODS This was a retrospective cohort study of patients with a DRF aged between 18 and 65 years. The primary outcome measure was PRWE score at a minimum of 4 years after DRF. Secondary outcome measures were pain catastrophizing scale (PCS) and radiographic measurements. RESULTS Of 201 patients included, 179 were primarily treated non-operatively with a 5-week cast treatment and 22 were primarily operated. The mean follow-up duration was 5 years. The mean PRWE score was 10.9 (95% confidence interval 8.4, 13.4) and median PRWE was 3.5 (interquartile range, 0.0-13.0). There was minor correlation between PCS and PRWE score (correlation coefficient [CC] 0.3), and between PRWE score and dorsal angulation of the fracture measured after closed reduction (CC 0.2) and in one-week follow-up radiographs (CC 0.2). CONCLUSIONS Working-aged patients seem to gain nearly normal wrist function after DRF in longer follow-up. Pain catastrophizing appears to correlate with long-term treatment outcome.
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Affiliation(s)
- Teemu P Hevonkorpi
- Department of Surgery, 236131Central Finland Central Hospital, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland
| | - Lauri Raittio
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland.,Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
| | - Susanna Vähä-Tuisku
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland
| | - Antti P Launonen
- Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, 7840Tampere University, Tampere University, Tampere, Finland.,Department of Orthopaedics, and Traumatology, 60670Tampere University Hospital, Tampere, Finland
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12
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Abstract
BACKGROUND Osteotomy-site nonunion after distal radius corrective osteotomy is a detrimental complication. This retrospective study aims to identify patient and surgical factors associated with nonunion risk to help mitigate this. The authors hypothesize that patient factors and potentially modifiable surgical factors are contributory. METHODS Thirty-three patients who underwent corrective osteotomy of the distal radius for prior fracture malunion were identified. Radiographs and patient records were reviewed for demographics, comorbidities, nutritional status, plate position, angle and length of osteotomy correction, and graft used. The primary study outcome was osteotomy nonunion. Descriptive and bivariate statistics were used to identify covariates relevant to nonunion. Backward, stepwise logistic regression was applied to investigate the multivariate effects on outcome, and regression analysis was adjusted for confounders. RESULTS Seven patients (21 percent) experienced nonunion after initial corrective osteotomy. Risk factors associated with nonunion included correction length of osteotomy of 5 mm or greater and prior treatment with open reduction and internal fixation. Autograft use was protective against nonunion. History of osteoporosis showed a trend toward increased risk. Angle of osteotomy correction, nutritional deficit, age, diabetes, smoking status, and obesity were not identified as risk factors by the multivariate model. CONCLUSIONS Distraction length at the osteotomy site, graft selection, and prior internal fixation were significant risk factors for distal radius osteotomy nonunion, but other factors traditionally associated with nonunion did not appear to impact risk. The authors recommend using autograft bone augmentation, particularly when distracting the osteotomy beyond 5 mm or after prior internal fixation. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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13
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Wood D, Reddy M, Postma I, Bromley P, Hambridge J, Wickramarachchi C, Hameed AS. Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures. Emerg Radiol 2021; 28:1107-1112. [PMID: 34235602 DOI: 10.1007/s10140-021-01957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Point of Care Ultrasound (PoCUS) is a safe, non-invasive tool for identifying distal radius fractures and can potentially be utilised to assist clinicians to reduce displaced fractures. We aim to test whether PoCUS is accurate to identify distal radius fractures and to determine how PoCUS performs as a tool to confirm a successful fracture reduction. METHODS A pragmatic prospective observational study was done in adult patients presenting with forearm injuries resulting in Colle's type distal radius fractures. Adults who presented to the emergency department (ED) with a suspected distal forearm fracture from August 2018 to July 2019 were conveniently sampled for inclusion into the study when a trained ED ultra-sonographer was available. PoCUS scans over the point of maximal tenderness were done using a high frequency linear transducer (7.5-10 mHz) prior to X-ray. Patients who required a manipulation of the fracture had a second ultrasound scan immediately after the procedure before the second X-ray was ordered. PoCUS scans were compared to X-rays for accuracy in both groups. RESULTS Fractures were identified in 44 out of 47 included patients using both PoCUS and X-ray modalities. This showed a sensitivity of 100% (95% CI: 90-100%) and specificity of 100% (95% CI: 31-100%). Fracture manipulation was required in 35 out of 44 patients. The sensitivity and specificity of PoCUS in determining alignment accuracy when compared to X-ray were 100% (95% CI: 83-100%) and 64% (95% CI: 32-88%) respectively. The PPV and NPV were 86% (95% CI: 66-95%) and 100% (95% CI: 56-100%) respectively. Ten out of 44 (23%) patients with distal radius fractures ultimately required an Open Reduction and Internal Fixation (ORIF). CONCLUSION Our study supports the use of PoCUS for identifying distal radius forearm fractures and may have some value in assisting clinicians to determine post reduction success. We still advocate using standard X-ray radiographs to confirm successful or adequate cortical alignment following a manipulation.
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Affiliation(s)
- Darryl Wood
- Barking, Havering and Redbridge University Hospitals Trust, Queens Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK.
| | - Maruteshwar Reddy
- Barking, Havering and Redbridge University Hospitals Trust, Queens Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK
| | - Ignatius Postma
- Barking, Havering and Redbridge University Hospitals Trust, Queens Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK
| | - Paul Bromley
- Barking, Havering and Redbridge University Hospitals Trust, Queens Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK
| | - John Hambridge
- Barking, Havering and Redbridge University Hospitals Trust, Queens Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK
| | - Chandu Wickramarachchi
- Barking, Havering and Redbridge University Hospitals Trust, Queens Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK
| | - Ahamed Syed Hameed
- Barking, Havering and Redbridge University Hospitals Trust, Queens Hospital, Rom Valley Way, Romford, London, RM7 0AG, UK
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14
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Development of the Home Fall Hazard Checklist. Rehabil Res Pract 2021; 2021:5362197. [PMID: 34158978 PMCID: PMC8187056 DOI: 10.1155/2021/5362197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Home hazard assessment is particularly important following a fracture as a means of preventing subsequent fractures. The purpose of this study was to evaluate current checklists and evidence on home hazard to develop a usable self-administered checklist that could be used by adults to assess home hazards. Design Review and observational, prospective study. Setting. Community dwelling. Participants. Nine adults (4 men, 5 women) were asked to review the checklist and provide feedback on whether items were relevant, comprehensive, and easy to understand. Intervention. A search for literature examining the causes of falls that focused on home hazards or behaviours was conducted, and causes were extracted. Using the combined list of home hazards, a draft checklist was created. The participants were asked to pilot the checklist through their home. Primary and Secondary Outcome. An initial iteration of the checklist was modified to reduce redundancy (by grouping certain items together), improve usability (by adding a “not applicable category”), and improve readability (by removing double-barrelled questions or rewriting certain items). Results This process resulted in 74 items in 10 areas. On average, it took 10 minutes for the participants to complete the home walk-through while filling out the checklist. Conclusion The fall hazard-home checklist is a new checklist designed to identify home fall hazards with the intended use of being either administered by self-report through memory or supported by a walk-about, and that could potentially be completed by a patient who has incurred a fall, fracture, a family member, or caregiver. Given the expense of home hazard assessments that involve a home visit, the validity of this method of detection warrants further investigation.
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15
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Visser D, Mathijssen NMC, van Outeren MV, Colaris JW, de Vries MR, Kraan GA. Long-term follow-up of distal radius fractures, an evaluation of the current guideline: the relation between malunion, osteoarthritis and functional outcome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1357-1362. [PMID: 32458129 DOI: 10.1007/s00590-020-02700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Last decades there is an increased tendency of performing surgery on displaced distal radius fractures. However, it is unclear whether this affects the development of osteoarthritis. This study aims to determine the relation between anatomical position, radiological osteoarthritis and functional outcome of the elderly wrist, 10-15 years after a distal radius fracture. PATIENTS AND METHODS 173 patients between the age of 50 and 70 at time of trauma were included in this retrospective cohort study with a 10-15-year follow-up. Based on the reassessed initial X-rays, the patients were placed into 4 groups (1: anatomical, 2a: acceptable, 2b: current operative indication but treated conservative, 2c: operative indication and operated). Functional outcome was measured, questionnaires were answered, and new bilateral X-rays of the wrist were obtained. Factors influencing osteoarthritis, the difference in osteoarthritis between the groups and the difference between the fractured and non-fractured wrists were studied. RESULTS Group 2b showed a significantly higher degree of osteoarthritis in comparison with the contralateral wrist. In the other groups, this difference was not observed. We found no significant difference in OA and functional outcomes between the groups. The degree of osteoarthritis of the non-fractured wrist appeared to be highly associated with osteoarthritis of the fractured wrist. CONCLUSION The results of this study showed that the degree of radiocarpal osteoarthritis is higher in conservatively treated patients that should have been operated on according to current guidelines in comparison with patients without an indication for surgery. This might suggest that our current guidelines can be effective in prevention of posttraumatic osteoarthritis. However, the effect on the functional outcome is very limited. Since the degree of radiocarpal osteoarthritis of the non-fractured wrist appeared to be highly associated with the degree of osteoarthritis of the fractured wrist, future studies should always assess osteoarthritis of both wrists in order to study the real posttraumatic effect of a fracture.
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Affiliation(s)
- D Visser
- Reinier de Graaf Hospital, Delft, The Netherlands.
| | | | | | - J W Colaris
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - M R de Vries
- Reinier de Graaf Hospital, Delft, The Netherlands
| | - G A Kraan
- Reinier de Graaf Hospital, Delft, The Netherlands
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16
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Erickson J, Lopez W, Shonuga O, Azzolini A, Tyler D, Monica J. Volar Cortical Integrity in Non-Operatively Treated Adult Distal Radius Fractures. J Hand Surg Asian Pac Vol 2020; 25:192-198. [PMID: 32312211 DOI: 10.1142/s2424835520500228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: We sought to independently validate published data that volar cortical integrity (VCI) is an independent predictor of maintenance of closed reduction in a series of non-surgically treated distal radius fractures, while simultaneously investigating previously reported predictors of instability. Our null hypothesis was that volar cortical integrity would not affect maintenance of reduction. Methods: Four hundred thirty-three adult distal radius fractures were screened from our Orthopedic database with 112 meeting inclusion criteria. Two groups were determined on the basis of maintenance of reduction (MOR) or loss of reduction (LOR) at 5-6 weeks post-reduction. Bivariate analysis was applied to previously published instability factors along with VCI. A forward stepwise logistic regression was then used to identify instability factors that, as a group, are most predictive of outcome. Results: Results of 112 patients were collected. Reduction was maintained in 62 patients (55.35%) at 5-6 weeks Biivariate analysis showed a statistically significant difference in volar cortical integrity between the 2 groups (80.6% MOR vs 59.2% LOR). Forward stepwise logistic regression analysis of subgroups revealed that post-reduction radial height and VCI were together statistically significant in the model. The presence of VCI, post-reduction radial height greater than or equal to ulnar neutral at the time of initial reduction resulted in a 67.8% successful MOR. Conclusions: We were able to confirm the importance of volar cortical integrity as a predictor of successful maintenance of reduction in non-surgically managed distal radius fractures. When combined with post-reduction radial height greater than or equal to ulnar neutral at the time of initial reduction, it showed a 67.8% MOR with non-operative management in our data-set.
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Affiliation(s)
- John Erickson
- Department of Orthpaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Wylie Lopez
- Department of Orthpaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Owolabi Shonuga
- Department of Orthpaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anthony Azzolini
- Department of Orthpaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - David Tyler
- Department of Orthpaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - James Monica
- Department of Orthpaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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17
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Recovery patterns over 4 years after distal radius fracture: Descriptive changes in fracture-specific pain/disability, fall risk factors, bone mineral density, and general health status. J Hand Ther 2019; 31:451-464. [PMID: 28993002 DOI: 10.1016/j.jht.2017.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/14/2017] [Accepted: 06/15/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Descriptive/Longitudinal cohort. INTRODUCTION Distal radius fracture (DRF) is a common fall related fragility fracture that is known to be an early and independent predictor of secondary osteoporotic (OP) fractures. Changes in falls risk status, bone status and general health has not been evaluated prospectively in a population that has sustained a DRF. PURPOSE OF THE STUDY The purpose of our study was to describe the status of fracture-specific pain/disability, fall risk factors such as physical activity (PA) and fear of falling (FOF), bone mineral density (BMD) and general health status (HS) in people with a DRF and how these variables change over four years with respect to sex, age, incidence of secondary falls and secondary OP fractures. METHODS Patients (n = 94) self-reported their fracture-specific pain and disability (Patient-Rated Wrist Evaluation), PA (Rapid Assessment of Physical Activity), FOF (Modified Fall Efficacy Scale), HS (12-item Short Form Health Survey) and completed dual-energy X-ray absorptiometry scan based BMD assessment (lumbar spine and total hip) at baseline (1-2 weeks post-fracture), six months and four years after DRF. Descriptive statistics and general linear models were used to describe changes in recovery patterns over four years. RESULTS There was significant (p<0.001) improvement in fracture-specific pain/disability (60 points), FOF (1 point) and physical HS (11 points) between baseline and 4 year follow-up. There were no significant changes in PA and BMD. When stratified with respect to age, sex, presence of subsequent falls and OP fractures, there were no significant differences in fracture-specific pain/disability, PA, FOF, and BMD at baseline, six months or four years after DRF. The physical HS was significantly (p<0.05) less/poorer among those with secondary falls (lower by 2-6 points) and fractures (lower by 5-6 points) compared to those without. Similarly, mental HS was significantly (p<0.05) poorer among people with secondary falls (lower by 2-6 points) and in 50-64 year age group (lower by 3-5 points) than those without secondary falls and in 65-80 year age group, respectively. CONCLUSION Post DRF, the majority of the improvement in fracture-specific pain/disability, FOF and HS was completed at six months and very small changes were observed between the six month and four year follow-up. LEVEL OF EVIDENCE NA.
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18
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Xu J, Zhang G, He Z, Zhong S, Chen Y, Wei C, Zheng Y, Lin H, Li W, Huang W. Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 43:10.1007/s13246-019-00795-w. [PMID: 31641940 PMCID: PMC7026237 DOI: 10.1007/s13246-019-00795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/10/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022]
Abstract
To evaluate and precisely internal fix intra-articular distal radial fracture (IDRF) using the virtual X-ray and three-dimensional (3D) printing technologies. Twenty-one patients with IDRF were recruited, and the data from digital design group (DDG) and real surgery group (RSG) were collected and analyzed. In DDG, the data from thin-slice computed tomography scan, virtual X-ray measurement parameters, including volar tilt, palmar tilt, radius length (D1), ulnar variation (D2), locking plate position parameter (D3) and distance between key nail and joint surface (D4) were collected. The bone was virtually fixed with the locking plate, and the final model of radius with the screw was obtained by 3D printing. In RSG, the locking plate was precisely pre-bended and used in surgery. During the surgery, the key K-wire was accurately placed and the locking plate was adjusted with the aid of the U-shaped navigation arm. The C-arm was used to observe the positions of key K-wires and the locking plate, and the same above-mentioned parameters were measured intra- and post-operatively. The data from RSG and DDG were compared statistically by t test. This approach proved to be successful in all 21 patients, and none of the screws pierced through the wrist joint surface. All the measured parameters, including the volar tilt, palmar tilt, D1-4, in RSG were not significantly different from preoperative DDG data. Virtual X-ray measurement of anatomical reduction parameters and 3D printing can help the anatomical reduction and precise internal fixation by providing quantitative references, preoperatively, intraoperatively and postoperatively.
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Affiliation(s)
- Jing Xu
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Guodong Zhang
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Zaopeng He
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Shizhen Zhong
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Yongshao Chen
- Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Chunrong Wei
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Yudong Zheng
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Wei Li
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
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Heyer FL, de Jong JJA, Willems PC, Arts JJ, Bours SGP, van Kuijk SMJ, Poeze M, Geusens PP, van Rietbergen B, van den Bergh JP. Long-term functional outcome of distal radius fractures is associated with early post-fracture bone stiffness of the fracture region: An HR-pQCT exploratory study. Bone 2019; 127:510-516. [PMID: 31226529 DOI: 10.1016/j.bone.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
Identifying determinants of long-term functional outcome after a distal radius fracture is challenging. Previously, we reported on the association between early HR-pQCT measurements and clinical outcome 12 weeks after a conservatively treated distal radius fracture. We extended the follow-up and assessed functional outcome after two years in relation to early HR-pQCT derived bone parameters. HR-pQCT scans of the fracture region were performed in 15 postmenopausal women with a distal radius fracture at 1-2 (baseline), 3-4 weeks and 26 months post-fracture. Additionally, the contralateral distal radius was scanned at baseline. Bone density, micro-architecture parameters and bone stiffness using micro-finite element analysis (μFEA) were evaluated. During all visits, wrist pain and function were assessed using the patient-rated wrist evaluation questionnaire (PRWE), quantifying functional outcome with a score between 0 and 100. Two-year PRWE was associated with torsional and bending stiffness 3-4 weeks post-fracture (R2: 0.49, p = 0.006 and R2: 0.54, p = 0.003, respectively). In contrast, early micro-architecture parameters of the fracture region or contralateral bone parameters did not show any association with long-term outcome. This exploratory study indicates that HR-pQCT with μFEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice.
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Affiliation(s)
- F L Heyer
- Research School NUTRIM, Maastricht University, the Netherlands; Department of Surgery, Maastricht University Medical Center, the Netherlands; Department of Internal Medicine, VieCuri Medical Center Venlo, the Netherlands.
| | - J J A de Jong
- Department of Radiology, Maastricht University Medical Center, the Netherlands
| | - P C Willems
- Research school CAPHRI, Maastricht University, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, the Netherlands
| | - J J Arts
- Research school CAPHRI, Maastricht University, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, the Netherlands
| | - S G P Bours
- Department of Rheumatology, Maastricht University Medical Center, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology & Medical Technology Assessment, Maastricht University Medical Center, the Netherlands
| | - M Poeze
- Research School NUTRIM, Maastricht University, the Netherlands; Department of Surgery, Maastricht University Medical Center, the Netherlands
| | - P P Geusens
- Research school CAPHRI, Maastricht University, the Netherlands; Department of Rheumatology, Maastricht University Medical Center, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - B van Rietbergen
- Faculty of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - J P van den Bergh
- Research School NUTRIM, Maastricht University, the Netherlands; Department of Internal Medicine, VieCuri Medical Center Venlo, the Netherlands; Department of Rheumatology, Maastricht University Medical Center, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium
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20
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Wilson JM, Holzgrefe RE, Staley CA, Schenker ML, Meals C. The Effect of Malnutrition on Postoperative Complications Following Surgery for Distal Radius Fractures. J Hand Surg Am 2019; 44:742-750. [PMID: 31300228 DOI: 10.1016/j.jhsa.2019.05.004] [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: 06/29/2018] [Revised: 03/25/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Malnutrition is known to negatively affect outcomes after arthroplasty, hip fracture, and spine surgery. Although distal radius fracture surgery may be considered in a similar patient cohort, the effect of malnutrition in this scenario is unknown. We hypothesized that admission serum albumin level, as a marker for malnutrition, would correlate with the rate of postoperative complications following surgery for distal radius fracture. METHODS We performed a retrospective cohort study of the American College of Surgeons National Surgery Quality Improvement database. Patients undergoing open reduction and internal fixation of a distal radius fracture were identified using Current Procedural Terminology codes. We excluded patients who were septic at presentation, were multiply injured, or had open fractures. We collected patient demographics, length of stay, 30-day complications, reoperation, and readmission rates. We performed multivariable linear regression analysis controlling for age, sex, body mass index, operative time, discharge destination, and modified Frailty Index score. RESULTS We identified 1,989 patients (mean age, 56 years; range, 18-90 years) with available albumin levels, and 14.7% had hypoalbuminemia (albumin, < 3.5 g/dL). Multivariable regression revealed that malnourished patients had higher rates of postoperative complications (6.5% vs 1.3%; odds ratio [OR] 4.88; 95% confidence interval [95% CI], 2.47-9.66). Specifically, these patients had increased rates of Clavien-Dindo IV (life-threatening) complications (2.4% vs 0%), readmission (7.2% vs 2%; OR, 3.37; 95% CI, 1.88-6.03), and mortality (1.7% vs 0.1%; OR, 9.23; 95% CI, 1.55-54.87). Malnourished patients had significantly longer length of stay (3.55 vs 0.73 days). Albumin concentration was inversely associated with risk of death (OR, 0.12; 95% CI, 0.03-0.52). CONCLUSIONS Malnutrition, indicated by albumin less than 3.5 g/dL, is a powerful predictor of uncommon, but important, postoperative complications, including mortality, following surgery for distal radius fracture. Evaluation of preoperative albumin level may, therefore, help surgeons provide individualized counseling and more accurately stratify the risk of patients. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
| | | | | | | | - Clifton Meals
- Emory University Orthopedics and Spine, Atlanta, GA.
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Wollstein R, Allon R, Zvi Y, Katz A, Werech S, Palmon O. Association between Functional Outcomes and Radiographic Reduction Following Surgery for Distal Radius Fractures. J Hand Surg Asian Pac Vol 2019; 24:258-263. [DOI: 10.1142/s2424835519500310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Quality of reduction in distal radius fractures (DRF) is assessed using radiographic parameters, however few studies examine the association between radiographic measurements and functional outcomes. Our purpose was to evaluate the relationship between radiographic measurements and clinical outcome measures following surgery for DRF using detailed testing to demonstrate further associations between post-surgical radiographic measurements and function. Methods: Measurements were performed on postoperative radiographs of 38 patients following ORIF of DRF. Measurements included: radial inclination, radial height, ulnar variance, volar tilt, radiocarpal interval (d2/w2), and the intra-articular step-off. Clinical outcome measures included motion, grip strength, functional dexterity testing, Moberg pick-up test, specific activities of daily living, DASH score, pain scale, manual-assessment questionnaire. Results: Different radiographic parameters correlated with different specific tasks. The parameter correlated with most functional tasks was ulnar-variance. Radial inclination, radial-styloid scaphoid distance, and fracture classification correlated with some functions. Intraarticular step-off, and radial height were not associated with functional testing. Conclusions: Surgical radiographic results may affect post-operative function. Detailed task specific testing may enable a better evaluation of surgical outcomes. Further study and refinement of functional assessment may change our surgical goals in DRF.
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Affiliation(s)
- Ronit Wollstein
- Department of Orthopaedic Surgery, New York University, School of Medicine, New York, NY, USA
- Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Raviv Allon
- Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Yoav Zvi
- Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Alan Katz
- Technion Israel Institute of Technology, School of Medicine, Haifa, Israel
| | - Sharon Werech
- Lin Medical Center, Kupat Holim Clalit, Haifa, Israel
| | - Orit Palmon
- Lin Medical Center, Kupat Holim Clalit, Haifa, Israel
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First Place Award: A radiographic analysis of closed reduction and casting of distal radial fractures with consideration of candidacy. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Objective: This mixed methods study analyzed the factors that led to a fall in a cohort of patients with distal radius fracture (DRF). Methods: A sample of 1,453 patients (430 men; 1,023 women; age range: 18-89 years) supplemented by new interview data from 29 patients (19 women) were examined. Chi-square and descriptive analysis of quantitative data and descriptive thematic analysis of qualitative data were compared to determine data convergence and divergence. Results: A higher number of DRF were observed in the 45- to 64-year-old group (44%), employed people (48%), in winter months (41%), and in low-energy fractures (75%). Themes emerged from qualitative data on the cause of the fracture, including environmental factors, behavioral factors, physical factors, and sports activities. Conclusion: Reasons for DRF are multifactorial. Preventive strategies with an emphasis on environmental and behavioral factor modifications are likely to decrease the number of DRF.
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Andreasson I, Kjellby-Wendt G, Fagevik-Olsén M, Karlsson J, Carlsson G. Life has become troublesome - my wrist bothers me around the clock: an interview study relating to daily life with a malunited distal radius fracture. Disabil Rehabil 2019; 42:2344-2350. [PMID: 30696287 DOI: 10.1080/09638288.2018.1561954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The aim of this study was to explore the everyday life experiences of people suffering from a symptomatic, malunited, distal radius fracture.Method: Qualitative interviews were conducted with twenty respondents, median age 59 [16-85] years. The interviews were subjected to qualitative content analysis.Results: The result, presented as one main theme with categories and subcategories, describes the impact of the injury. Everyday life was affected in all participants, very much in a few highly valued activities such as sports and work, whenever the hand was used, or even at rest. This study indicates that the injury has an impact on the ability to move around, other parts of the body, sleep, emotions, self-perception and relationships. It also shows that the patients used several strategies to manage the situation.Conclusion: The malunion of a distal radius fracture has a negative impact on a wide range of daily activities, as well as other aspects of daily life. There is a need for information between caregivers and patients, and clear routines, once a malunion has occurred.Implications for rehabilitationThe symptomatic malunion of a distal radius fracture should be acknowledged as a complex condition requiring comprehensive interventionsTechnical equipment, braces and new solutions on practical problems was necessary to manage everyday life and should be a focus of intervention for this patient groupThe consequences of the injury was not only restricted activity performance but also affected social relationships and emotionsInformation about fracture healing and how a malunion can occur, as well as information on how much the wrist can be loaded at different time points, is important to reduce anxiety.
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Affiliation(s)
- Ingrid Andreasson
- Department of Orthopedics, Clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Kjellby-Wendt
- Department of Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik-Olsén
- Department of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopedics, Clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Carlsson
- Section of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Wilson JM, Holzgrefe RE, Staley CA, Schenker ML, Meals CG. Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures. J Hand Surg Am 2018; 43:701-709. [PMID: 29980394 DOI: 10.1016/j.jhsa.2018.05.029] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries. We hypothesized that this index would predict, and might ultimately prevent, complications in patients older than 50 years with distal radius fractures. METHODS We retrospectively reviewed the American College of Surgeons-National Surgery Quality Improvement Program (ACS-NSQIP) database, including patients older than 50 years who underwent open reduction and internal fixation of a distal radius fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates, as well as length of stay (LOS) were recorded. Bivariate and multivariable statistical analysis was then performed. RESULTS We identified 6,494 patients (mean age, 65 years). Compared with patients with mFI of 0, patients with mFI of 2 or greater were nearly 2.5 times as likely to incur a postoperative complication (1.7% vs 7.4%). Specifically, the rates of Clavien-Dindo IV, wound, cardiac, and renal complications were increased significantly in patients with mFI of 2 or greater. In addition, as mFI increased from 0 to 2 or greater, 30-day reoperation rate increased from 0.8% to 2.4%, 30-day readmission from 0.8% to 4.6%, and LOS from 0.5 days to 1.44 days. Frailty was associated with increased complications as well as rates of readmission and reoperation even when controlling for demographic data, LOS, and operative time. Age alone was not significantly associated with postoperative complications, readmission, reoperation, or LOS. CONCLUSIONS A state of frailty is highly predictive of postoperative complications, readmission, reoperation, and increased LOS following open reduction and internal fixation of distal radius fractures. Our data suggest that a simple frailty evaluation can help inform surgical decision making in patients older than 50 years with distal radius fractures. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Raudasoja L, Vastamäki H, Raatikainen T. The importance of radiological results in distal radius fracture operations: Functional outcome after long-term (6.5 years) follow-up. SAGE Open Med 2018. [PMID: 29854401 DOI: 10.1177/2050312118776578.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Whether or not radiological results correlate with functional outcome after operative treatment of distal radius fractures still remains controversial. We carried out a retrospective study to analyse the long-term (6.5 year) outcome of radius fractures treated by means of surgery in our hospital. The aim of the study was to explore whether step-off on radius joint surface, shortening of the radius versus ulnar height and dorsal or volar tilt of the radius correlate with long-term Patient-Rated Wrist Evaluation or Quick Disability of the Arm, Shoulder and Hand scores among 100 consecutive patients after surgical treatment. Materials and Methods Of these, 60 patients (63 wrists) participated. They were examined radiologically, clinically and by means of a questionnaire. Results Shortening of the radius correlated significantly with both Patient-Rated Wrist Evaluation and Quick Disability of the Arm, Shoulder and Hand scores. Step-off on the radius joint surface correlated significantly with worse PRWE scores, with no difference in Quick Disability of the Arm, Shoulder and Hand evaluation. Dorsal or volar tilt showed no statistical correlation (though it was mild in this group). The age of the patients (below 60 years vs 60 years or above) did not affect the PRWE or Quick Disability of the Arm, Shoulder and Hand results. Conclusion Our results indicate that when it comes to conserving the radial height and congruence of the joint surface, the more precise the reduction of the fracture achieved by surgical means, the better the functional outcome.
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Affiliation(s)
- L Raudasoja
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Vastamäki
- Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - T Raatikainen
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Raudasoja L, Vastamäki H, Raatikainen T. The importance of radiological results in distal radius fracture operations: Functional outcome after long-term (6.5 years) follow-up. SAGE Open Med 2018; 6:2050312118776578. [PMID: 29854401 PMCID: PMC5968661 DOI: 10.1177/2050312118776578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/18/2018] [Indexed: 01/30/2023] Open
Abstract
Background and Aims: Whether or not radiological results correlate with functional outcome after operative treatment of distal radius fractures still remains controversial. We carried out a retrospective study to analyse the long-term (6.5 year) outcome of radius fractures treated by means of surgery in our hospital. The aim of the study was to explore whether step-off on radius joint surface, shortening of the radius versus ulnar height and dorsal or volar tilt of the radius correlate with long-term Patient-Rated Wrist Evaluation or Quick Disability of the Arm, Shoulder and Hand scores among 100 consecutive patients after surgical treatment. Materials and Methods: Of these, 60 patients (63 wrists) participated. They were examined radiologically, clinically and by means of a questionnaire. Results: Shortening of the radius correlated significantly with both Patient-Rated Wrist Evaluation and Quick Disability of the Arm, Shoulder and Hand scores. Step-off on the radius joint surface correlated significantly with worse PRWE scores, with no difference in Quick Disability of the Arm, Shoulder and Hand evaluation. Dorsal or volar tilt showed no statistical correlation (though it was mild in this group). The age of the patients (below 60 years vs 60 years or above) did not affect the PRWE or Quick Disability of the Arm, Shoulder and Hand results. Conclusion: Our results indicate that when it comes to conserving the radial height and congruence of the joint surface, the more precise the reduction of the fracture achieved by surgical means, the better the functional outcome.
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Affiliation(s)
- L Raudasoja
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Vastamäki
- Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - T Raatikainen
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Ali M, Brogren E, Wagner P, Atroshi I. Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations: A Long-Term Follow-up. J Bone Joint Surg Am 2018; 100:633-639. [PMID: 29664849 DOI: 10.2106/jbjs.17.00107] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations. METHODS In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of ≥10°, ulnar variance of ≥3 mm, and/or radial inclination of ≤15°. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up. RESULTS Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Malunion was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p < 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p > 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength. CONCLUSIONS Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Muhanned Ali
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Hässleholm, Sweden
| | - Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Hässleholm, Sweden.,Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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Lameijer CM, Ten Duis HJ, Dusseldorp IV, Dijkstra PU, van der Sluis CK. Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 2017; 137:1499-1513. [PMID: 28770349 PMCID: PMC5644687 DOI: 10.1007/s00402-017-2765-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The objective of this systematic review was to analyze (1) prevalence of radiological posttraumatic arthritis (PA), (2) associations of PA with outcome measures and (3) predictors of PA following distal radius fractures in non-osteoporotic patients. MATERIALS AND METHODS Nineteen studies were included (10 open source data). RESULTS In total, 733 patients were described with a weighted mean age of 37 years (range 25-54) at the time of the injury. Follow-up ranged from 13 months to 38 years. Overall prevalence of PA was 50% and 37% in the open source data. Radial deviation was significantly worse in patients with PA (N = 49, mean 14°, SD 6° versus N = 55, mean 17°, SD 6°, p = 0.037). No analysis could be performed regarding patient reported outcome measures, because of limited data. Articular incongruence was a significant predictor for PA. CONCLUSIONS A high prevalence of PA was found in non-osteoporotic patients following a distal radius fracture. PA following a distal radial fracture was associated with a limited radial deviation and flexion, but not with grip strength. Articular incongruence predicted PA. Patient reported outcome measures should be investigated more thoroughly to be able to understand the value of using these instruments in interpreting outcome in follow-up of non-osteoporotic patients following a distal radius fracture. LEVEL OF EVIDENCE Level of evidence 3 (Phillips et al. Levels of Evidence-Oxford Centre for Evidence-based Medicine, 1).
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Affiliation(s)
- C M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 30.001, Huispostcode BA51, 9700 RB, Groningen, The Netherlands.
| | - H J Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 30.001, Huispostcode BA51, 9700 RB, Groningen, The Netherlands
| | - I van Dusseldorp
- Medical Center Leeuwarden, MCL Academy, Leeuwarden, The Netherlands
| | - P U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Brown B, Koval K, Langford J, Bhullar IS. Novel Management for Distal Radius Fracture after Trauma. Am Surg 2017. [DOI: 10.1177/000313481708300820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bryan Brown
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
| | - Kenneth Koval
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
| | - Joshua Langford
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
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Bemgård M, Archenholtz B. Developing an instrument for the measurement of grip ability after distal radius fracture. Scand J Occup Ther 2017; 25:466-474. [PMID: 28475403 DOI: 10.1080/11038128.2017.1323950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Distal radius fracture (DRF) often causes reduced ability to perform activities of daily living (ADLs). There is a need for recurrent evaluation of the ability to perform ADL in the early stage of rehabilitation as a complement to traditional functional measures. AIM Develop a short and simple performance test for use in clinical practice through modification of the Sollerman Grip Function Test (GFT). METHOD DRF patients and controls performed the GFT. The tasks that discriminated patients from controls were calculated for sensitivity to change and correlated to the QuickDASH questionnaire at three subsequent occasions. Interrater reliability was tested. RESULTS Twelve GFT tasks discriminated DRF patients from healthy controls. One task was excluded due to heavy load. Remaining 11 tasks were all sensitive to change. Four tasks with correlation to the QuickDASH and representing the grip types most frequently used in ADL came to constitute the Wrist Performance Test (WPT). A test-retest showed satisfactory interrater reliability (rs = 0.87). CONCLUSION A short performance test was developed through modification of the GFT. It is easy to use in clinical practice to evaluate the rehabilitation process after DRF.
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Affiliation(s)
- Marianne Bemgård
- a Department of Occupational Therapy , Sahlgrenska University Hospital Mölndal , Mölndal , Sweden
| | - Birgitha Archenholtz
- b Strategic Department of Quality Development , Sahlgrenska University Hospital , Göteborg , Sweden
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MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 2017; 29:136-45. [PMID: 27264899 DOI: 10.1016/j.jht.2016.03.003] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Literature Review. INTRODUCTION For optimal Distal Radius Fracture (DRF) rehabilitation and fracture prevention, it is important to understand the epidemiology and factors predictive of injury, chronic pain, chronic disability, and subsequent fracture. PURPOSE To summarize the literature reporting on DRF epidemiology, risk factors, and prognostic factors. METHODS Literature synthesis. RESULTS Although incidence varies globally, DRFs are common across the lifespan and appear to be on the rise. Risk of DRF is determined by personal factors (age, sex/gender, lifestyle, health condition) and environmental factors (population density, climate). For example, age and sex influence risk such that DRF is most common in boys/young men and older women. The most common causes of DRF in the pediatric and young adult age groups include playing/sporting activities and motor vehicle accidents. In contrast, the most common mechanism of injury in older adults is a low-energy trauma because of a fall from a standing height. Poorer health outcomes are associated with older age, being female, poor bone healing (or having an associated fracture of the ulnar styloid), having a compensated injury, and a lower socioeconomic status. CONCLUSIONS Risk stratification according to predictors of chronic pain and disability enable therapists to identify those patients who will benefit from advocacy for more comprehensive assessment, targeted interventions, and tailored educational strategies. The unique opportunity for secondary prevention of osteoporotic fracture after DRF has yet to be realized by treating therapists in the orthopedic community. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Norma J MacIntyre
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| | - Neha Dewan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Mulders MAM, d'Ailly PN, Cleffken BI, Schep NWL. Corrective osteotomy is an effective method of treating distal radius malunions with good long-term functional results. Injury 2017; 48:731-737. [PMID: 28179058 DOI: 10.1016/j.injury.2017.01.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Malunion occurs in approximately 23% of non-operatively treated and 11% of operatively treated distal radius fractures. The decision whether to correct a malunion is primarily based on functional impairment and wrist pain. The purpose of this study was to assess the long-term functional outcomes of corrective osteotomies for symptomatic malunited distal radius fractures. METHODS All consecutive corrective osteotomies of the distal radius performed in one centre between January 2009 and January 2016 were included. The primary outcome was the functional outcome assessed with the Disability of the Arm, Shoulder and Hand (DASH) and the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes were range of motion, grip strength, pain as indicated on the Visual Analogue Scale (VAS) before and after corrective osteotomy, radiological parameters, time to union and complications. Additionally, we aimed to determine if there were any difference in graft versus no graft usage. RESULTS A total of 48 patients were included. The median age was 54.5 years (IQR 39-66) and 71% was female. The median time to follow-up was 27 months. The median DASH and PRWE score were respectively 10.0 (IQR 5.8-23.3) and 18.5. (6.5-37.0). Except for pronation and supination, range of motion and grip strength of the injured wrist were significantly less compared to the uninjured side. Palmar and dorsal flexion and radial and ulnar deviation of the injured wrist were significantly less compared with the uninjured side. VAS pain scores decreased significantly from 6.5 preoperative to 1.0 postoperative. The median time to union was 23 weeks (IQR 12-29.5). Eighteen patients (38%) had a complication for which additional treatment was required. Except for a significant difference in radial inclination and length after the corrective osteotomy in favour of graft usage, there were no significant differences between graft an no graft usage. CONCLUSIONS Corrective osteotomy is an effective method of treating symptomatic distal radius malunions with good long-term functional results, measured with the DASH and PRWE score, and improvement in radiographic parameters and pain scores. Additionally, no differences in functional outcomes were found between graft and no graft usage.
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Affiliation(s)
- M A M Mulders
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - P N d'Ailly
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - B I Cleffken
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
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Foster BD, Sivasundaram L, Heckmann N, Pannell WC, Alluri RK, Ghiassi A. Distal Radius Fractures Do Not Displace following Splint or Cast Removal in the Acute, Postreduction Period: A Prospective, Observational Study. J Wrist Surg 2017; 6:54-59. [PMID: 28119796 PMCID: PMC5258127 DOI: 10.1055/s-0036-1588006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
Background Displacement of distal radius fractures has been previously described in the literature; however, little is known about fracture displacement following splint or cast removal at the initial clinic visit following reduction and immobilization. Purpose The purpose of this study was to evaluate risk factors for fracture displacement following splint or cast removal and physical examination in the acute postinjury period. Methods All patients with a closed distal radius fracture who presented to our orthopedic hand clinic within 3 weeks of injury were prospectively enrolled in our study. Standard wrist radiographs were obtained prior to splint or cast removal. A second wrist series was obtained following physical exam and application of immobilization at the end of the clinic visit. Radiographic parameters for displacement were measured by two independent reviewers and included dorsal angulation, radial inclination, articular step-off, radial height, and ulnar variance. Displacement was assessed using predefined, radiographic criteria for displacement. Results A total of 64 consecutive patients were enrolled over a period of 12 weeks. Of these, 37.5% were classified as operative according to American Academy of Orthopaedic Surgeons guidelines and 37.5% met LaFontaine instability criteria. For each fracture, none of the five measurements exceeded the predefined clinically or statistically significant criteria for displacement. Conclusion Splint removal in the acute postinjury period did not result in distal radius fracture displacement. Clinicians should feel comfortable removing splints and examining underlying soft tissue in the acute setting for patients with distal radius fractures after closed reduction. Level of Evidence Level II, prospective comparative study.
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Affiliation(s)
- Brock D. Foster
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | | | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - William C. Pannell
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
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Christersson A, Larsson S, Östlund B, Sandén B. Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study. J Orthop Surg Res 2016; 11:145. [PMID: 27871284 PMCID: PMC5117580 DOI: 10.1186/s13018-016-0478-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to examine whether reduced distal radius fractures can be treated with early mobilisation without affecting the radiographic results. Methods In a prospective randomised study, 109 patients (mean age 65.8 (range 50–92)) with moderately displaced distal radius fractures were treated with closed reduction and plaster cast fixation for about 10 days (range 8–13 days) followed by randomisation to one of two groups: early mobilisation (n = 54, active group) or continued plaster cast fixation for another 3 weeks (n = 55, control group). Results For three patients in the active group (6%), treatment proved unsuccessful because of severe displacement of the fracture (n = 2) or perceived instability (n = 1). From 10 days to 1 month, i.e. the only period when the treatment differed between the two groups, the active group displaced significantly more in dorsal angulation (4.5°, p < 0.001), radial angulation (2.0°, p < 0.001) and axial compression (0.5 mm, p = 0.01) compared with the control group. However, during the entire study period (i.e. from admission to 12 months), the active group displaced significantly more than the controls only in radial angulation (3.2°, p = 0.002) and axial compression (0.7 mm, p = 0.02). Conclusions Early mobilisation 10 days after reduction of moderately displaced distal radius fractures resulted in both an increased number of treatment failures and increased displacement in radial angulation and axial compression as compared with the control group. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures. Trial registration ClinicalTrail.gov, NCT02798614. Retrospectively registered 16 June 2016.
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Affiliation(s)
- Albert Christersson
- Department of Surgical Science, Orthopaedics, Uppsala University, S-75185, Uppsala, Sweden.
| | - Sune Larsson
- Department of Surgical Science, Orthopaedics, Uppsala University, S-75185, Uppsala, Sweden
| | - Bengt Östlund
- Department of Orthopedics, Nyköping Hospital, S-61185, Nyköping, Sweden
| | - Bengt Sandén
- Department of Surgical Science, Orthopaedics, Uppsala University, S-75185, Uppsala, Sweden
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Jordan RW, Naeem R, Jadoon S, Parsons H, Shyamalan G. Cast Immobilisation versus Wire Fixation in the Management of Middle-aged and Elderly Patients with Distal Radius Fractures. J Hand Surg Asian Pac Vol 2016; 21:18-23. [PMID: 27454497 DOI: 10.1142/s2424835516500016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Distal radius fractures are common and traditionally these injuries are treated non-operatively. Percutaneous wiring has been recommended as simple method to provide extra stability in distal radius fractures but their exact role is uncertain. The aim of this study was to retrospectively compare the radiographic and functional outcomes following cast immobilisation and those following wire fixation in the management of distal radius fractures and investigate which method produced better outcomes. METHODS A retrospective parallel case series was performed between April 2011 and April 2013 of patients over 50 years treated with either cast immobilisation or wire fixation. Both intra- and extra-articular fractures were included. Radiographic measurements were made pre-operatively and at three months follow up. The QuickDASH was recorded by postal questionnaire at a mean of 2 years. RESULTS 159 patients were included; 85 cast immobilisation group and 74 wire fixation group. Improvement in radiological parameters was seen in both groups but this was significantly better after wire fixation ([Formula: see text]). QuickDASH scores were available in 64%; no significant difference in mean scores was seen after (p = 0.147); cast immobilisation 27.1 and wire fixation 26.6. CONCLUSIONS Cast immobilisation can produce comparable functional results to wire fixation despite worse radiological outcomes.
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Affiliation(s)
| | - Rahil Naeem
- † Birmingham Heartlands Hospital, Birmingham, UK, B9 5SS, UK
| | - Saqiba Jadoon
- † Birmingham Heartlands Hospital, Birmingham, UK, B9 5SS, UK
| | - Helen Parsons
- ‡ Division of Health Sciences, Warwick Medical School, Coventry, UK, CV4 7AL, UK
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Watson NJ, Asadollahi S, Parrish F, Ridgway J, Tran P, Keating JL. Reliability of radiographic measurements for acute distal radius fractures. BMC Med Imaging 2016; 16:44. [PMID: 27443373 PMCID: PMC4957423 DOI: 10.1186/s12880-016-0147-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of distal radial fractures is guided by the interpretation of radiographic findings. The aim of this investigation was to determine the intra- and inter-observer reliability of eight traditionally reported anatomic radiographic parameters in adults with an acute distal radius fracture. METHODS Five observers participated. All were routinely involved in making treatment decisions based on distal radius fracture radiographs. Observers performed independent repeated measurements on 30 radiographs for eight anatomical parameters: dorsal shift (mm), intra-articular gap (mm), intra-articular step (mm), palmar tilt (degrees), radial angle (degrees), radial height (mm), radial shift (mm), ulnar variance (mm). Intraclass correlation coefficients (ICCs) and the magnitude of retest errors were calculated. RESULTS Measurement reliability was summarised as high (ICC > 0.80), moderate (0.60-0.80) or low (<0.60). Intra-observer reliability was high for dorsal shift and palmar tilt; moderate for radial angle, radial height, ulnar variance and radial shift; and low for intra-articular gap and step. Inter-observer reliability was high for palmar tilt; moderate for dorsal shift, ulnar variance, radial angle and radial height; and low for radial shift, intra-articular gap and step. Error magnitude (95 % confidence interval) was within 1-2 mm for intra-articular gap and step, 2-4 mm for ulnar variance, 4-6 mm for radial shift, dorsal shift and radial height, and 6-8° for radial angle and palmar tilt. CONCLUSIONS Based on previous reports of critical values for palmar tilt, ulnar variance and radial angle, error margins appear small enough for measurements to be useful in guiding treatment decisions. Our findings indicate that clinicians cannot reliably measure values ≤1 mm for intra-articular gap and step when interpreting radiographic parameters using the standardised methods investigated in this study. As a guide for treatment selection, palmar tilt, ulnar variance and radial angle measurements may be useful, but intra-articular gap and step appear unreliable.
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Affiliation(s)
- Narelle J. Watson
- />Allied Health Department & School of Primary Health Care, Western Health & Monash University, Melbourne, Victoria Australia
| | - Saeed Asadollahi
- />Nepean hospital, Penrith, NSW Australia
- />Orthopaedic Department Western Health, Melbourne, Victoria Australia
| | - Frank Parrish
- />Peninsula Health, Melbourne, Victoria Australia
- />I-TeleRAD, Melbourne, Victoria Australia
| | | | - Phong Tran
- />Orthopaedic Department Western Health, Melbourne, Victoria Australia
| | - Jennifer L. Keating
- />Department of Physiotherapy, School of Primary Health Care, Faculty Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria Australia
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Dacombe PJ, Amirfeyz R, Davis T. Patient-Reported Outcome Measures for Hand and Wrist Trauma: Is There Sufficient Evidence of Reliability, Validity, and Responsiveness? Hand (N Y) 2016; 11:11-21. [PMID: 27418884 PMCID: PMC4920509 DOI: 10.1177/1558944715614855] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are important tools for assessing outcomes following injuries to the hand and wrist. Many commonly used PROMs have no evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. This systematic review examines the PROMs used in the assessment of hand and wrist trauma patients, and the evidence for reliability, validity, and responsiveness of each measure in this population. METHODS A systematic review of Pubmed, Medline, and CINAHL searching for randomized controlled trials of patients with traumatic injuries to the hand and wrist was carried out to identify the PROMs. For each identified PROM, evidence of reliability, validity, and responsiveness was identified using a further systematic review of the Pubmed, Medline, CINAHL, and reverse citation trail audit procedure. RESULTS The PROM used most often was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; the Patient-Rated Wrist Evaluation (PRWE), Gartland and Werley score, Michigan Hand Outcomes score, Mayo Wrist Score, and Short Form 36 were also commonly used. Only the DASH and PRWE have evidence of reliability, validity, and responsiveness in patients with traumatic injuries to the hand and wrist; other measures either have incomplete evidence or evidence gathered in a nontraumatic population. CONCLUSIONS The DASH and PRWE both have evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. Other PROMs used to assess hand and wrist trauma patients do not. This should be considered when selecting a PROM for patients with traumatic hand and wrist pathology.
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Affiliation(s)
- Peter Jonathan Dacombe
- University Hospitals Bristol, Bristol Royal Infirmary, Bristol, England,Peter Jonathan Dacombe, University Hospitals Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, England.
| | - Rouin Amirfeyz
- University Hospitals Bristol, Bristol Royal Infirmary, Bristol, England
| | - Tim Davis
- Queen’s Medical Centre, Nottingham, England
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da Silva Rodrigues EK, de Cássia Registro Fonseca M, MacDermid JC. Brazilian version of the Patient Rated Wrist Evaluation (PRWE-BR): Cross-cultural adaptation, internal consistency, test-retest reliability and construct validity. J Hand Ther 2016; 28:69-75; quiz 76. [PMID: 25446520 DOI: 10.1016/j.jht.2014.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/23/2014] [Accepted: 09/30/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical measurements. PURPOSE Perform the translation and cross-cultural adaptation of the Patient Rated Wrist Evaluation (PRWE) into a Brazilian version (PRWE-BR), and assess its internal consistency, test-retest reliability and construct validity. METHODS PRWE-BR was developed using standardized guidelines. Sixty-one patients with different wrist injuries were recruited. They were submitted to two assessments, 2-7 days apart. Reliability was measured by internal consistency (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficient). Construct validity was determined via hypothesis testing (Spearman's correlation) of correlations with subscales of SF-36 and DASH. RESULTS PRWE-BR and its subscales achieved high internal consistency (Cronbach's alpha ≥ 0.85) and excellent test-retest reliability (ICC ≥ 0.90). Construct validity was established by confirmation of 85.7% of our previously formulated hypotheses. CONCLUSIONS PRWE-BR is a valid and reliable tool for the assessment of pain and dysfunction in Brazilian patients with injuries involving the wrist joint. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Eula Katucha da Silva Rodrigues
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil.
| | - Marisa de Cássia Registro Fonseca
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil
| | - Joy C MacDermid
- Clinical Research, Hand and Upper Limb Centre, St Joseph's Health Centre, London, ON, Canada; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Cai L, Zhu S, Du S, Lin W, Wang T, Lu D, Chen H. The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients. Orthop Traumatol Surg Res 2015; 101:827-31. [PMID: 26188877 DOI: 10.1016/j.otsr.2015.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 03/21/2015] [Accepted: 04/27/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE OF THE STUDY Treatment of distal radius fractures in elderly patients is controversial. This study explored the relationship between radiographic parameters and clinical outcomes of patients with distal radius fractures following conservative treatment. The study was done using radiographic measurements of distal radius fractures in elderly patients. PATIENTS AND METHODS Ninety-two active, healthy patients with conservatively managed distal radius fractures were included in the study. Functional and radiographic assessments were made 1 year after injury. Fifty patients who underwent corrective osteotomy comprised the control group. Radiographic parameters and clinical outcomes were compared between the two groups. The correlation coefficients of the radiographic parameters were analysed using multiple regression. RESULT Radius height (RH), volar tilt (VT) and Mayo wrist and Disabilities of the Arm, Shoulder and Hand (DASH) scores in the experimental group were significantly superior to those of the control group. There was no significant group difference in radial inclination. Multiple regression analysis revealed that the most important factor affecting functional outcome was RH, followed by VT. DISCUSSION RH and VT were significantly correlated with the clinical outcomes of conservative treatment of distal radius fractures. RH should be given foremost consideration in elderly patients. Preoperatively, surgeons should evaluate this parameter carefully and be prepared to treat injuries accordingly. LEVEL OF EVIDENCE Level IV retrospective study.
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Affiliation(s)
- L Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - S Zhu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - S Du
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - W Lin
- Department of Radiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - T Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - D Lu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China
| | - H Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, PR China.
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Jung HW, Hong H, Jung HJ, Kim JS, Park HY, Bae KH, Jeon IH. Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors. Clin Orthop Surg 2015. [PMID: 26330962 DOI: 10.4055/cios.2015.7.3.377.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To evaluate risk factors of redisplacement and remind surgeons of key factors regarding conservative treatment of distal radius fracture. METHODS A total of 132 patients who received conservative treatment for distal radius fractures between March 2008 and February 2011 were included in this study. Radial inclination, radial length, volar tilting angle, ulnar variance, fragment translation, and presence of dorsal metaphyseal comminution were measured on the X-rays taken immediately after reduction, one week after injury during the first follow-up outpatient clinic visit, and after the gain of radiological union. Secondary displacement was defined as a loss of reduction during the follow-up period, and was divided into 'early' and 'late' categories. We analyzed the influence of initial displacement radiologic variables, dorsal cortex comminution, and patient age on the development of secondary displacement. RESULTS Development of secondary displacement was significantly associated only with initial displacement radiologic variables (p < 0.001), development of the late secondary displacement was significantly associated with age (p = 0.005), and initial displacement radiologic variables were associated significantly with a serial increase in ulnar variance (p = 0.003). CONCLUSIONS Greater displacement on the initial radiographs indicates a higher possibility of development for secondary displacement, and older patients had a higher probability of late secondary displacement development. Furthermore, dorsal comminutions did not affect secondary displacement directly.
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Affiliation(s)
- Ho-Wook Jung
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanpyo Hong
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Jun Jung
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sam Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Youn Park
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Kun Hyung Bae
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Brogan DM, Richard MJ, Ruch D, Kakar S. Management of Severely Comminuted Distal Radius Fractures. J Hand Surg Am 2015; 40:1905-14. [PMID: 26243322 DOI: 10.1016/j.jhsa.2015.03.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/02/2015] [Accepted: 03/07/2015] [Indexed: 02/02/2023]
Abstract
Distal radius fractures are among the most common fractures of the upper extremity. Indications for operative and nonsurgical management have evolved over time, as have fixation techniques. Volar locking plates are commonly used in the treatment of selected distal radius fractures such as low-energy or relatively uncomplicated fractures. They have limitations, however, in the management of highly comminuted fracture patterns and in polytrauma patients. In these patients, other methods ranging from spanning fixation to fragment-specific fixation have emerged as useful alternatives in the surgeon's armamentarium for treatment of these challenging fractures.
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Affiliation(s)
- David M Brogan
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - Marc J Richard
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - David Ruch
- Division of Hand Surgery, Department of Orthopedic Surgery, Duke University, Durham, NC
| | - Sanjeev Kakar
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Jung HW, Hong H, Jung HJ, Kim JS, Park HY, Bae KH, Jeon IH. Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors. Clin Orthop Surg 2015; 7:377-82. [PMID: 26330962 PMCID: PMC4553288 DOI: 10.4055/cios.2015.7.3.377] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/30/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To evaluate risk factors of redisplacement and remind surgeons of key factors regarding conservative treatment of distal radius fracture. METHODS A total of 132 patients who received conservative treatment for distal radius fractures between March 2008 and February 2011 were included in this study. Radial inclination, radial length, volar tilting angle, ulnar variance, fragment translation, and presence of dorsal metaphyseal comminution were measured on the X-rays taken immediately after reduction, one week after injury during the first follow-up outpatient clinic visit, and after the gain of radiological union. Secondary displacement was defined as a loss of reduction during the follow-up period, and was divided into 'early' and 'late' categories. We analyzed the influence of initial displacement radiologic variables, dorsal cortex comminution, and patient age on the development of secondary displacement. RESULTS Development of secondary displacement was significantly associated only with initial displacement radiologic variables (p < 0.001), development of the late secondary displacement was significantly associated with age (p = 0.005), and initial displacement radiologic variables were associated significantly with a serial increase in ulnar variance (p = 0.003). CONCLUSIONS Greater displacement on the initial radiographs indicates a higher possibility of development for secondary displacement, and older patients had a higher probability of late secondary displacement development. Furthermore, dorsal comminutions did not affect secondary displacement directly.
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Affiliation(s)
- Ho-Wook Jung
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanpyo Hong
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Jun Jung
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sam Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Youn Park
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Kun Hyung Bae
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Filipova V, Lonzarić D, Jesenšek Papež B. Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: randomized controlled trial. Wien Klin Wochenschr 2015; 127 Suppl 5:S282-7. [DOI: 10.1007/s00508-015-0812-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
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Smedes F, van der Salm A, Koel G, Oosterveld F. Manual mobilization of the wrist: a pilot study in rehabilitation of patients with a chronic hemiplegic hand post-stroke. J Hand Ther 2015; 27:209-15; quiz 216. [PMID: 24508316 DOI: 10.1016/j.jht.2013.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 12/11/2013] [Accepted: 12/30/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective pilot cohort study, quasi-experimental design. INTRODUCTION Restricted hand mobility, limitation in activities and participation, due to relative immobilization of the hemiplegic hand are frequently reported after stroke. PURPOSE OF THE STUDY To establish whether manual mobilization of the wrist has an additional value in the treatment of the hemiplegic hand. METHODS Eighteen patients received treatment twice a week for a period of 6 weeks. Both treatment groups received therapy based upon the Dutch guidelines for stroke. In the intervention group, a 10-min manual mobilization of the wrist was integrated. The primary outcomes were active and passive wrist mobility and activity limitation. The secondary outcomes were spasticity, grip strength, and pain. Data were collected at 0, 6 and 10 weeks. Statistical analysis was performed using the Friedman's test, related t-test, Wilcoxon test, independent t-test, and Mann-Whitney U-test. RESULTS Statistically significant differences were found in the intervention group; between T0 and T2 measurements in active wrist extension (+18°; p < 0.001), in passive wrist extension (+15°; p < 0.001), and in the Frenchay Arm Test (+2 points, 18%; p = 0.038). This significant improvement was not found in the control group. Statistically significant differences were found between the two groups in active and passive wrist extension (p < 0.001; p = 0.002), as well as a change in Frenchay Arm Test (p = 0.01). CONCLUSION This study suggests that manual mobilization of the wrist has a positive influence on the recovery of the hemiplegic hand. Replication of the results is needed in a large scale randomized controlled trial. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Fred Smedes
- Saxion University of Applied Sciences, Department of Physical Therapy, Enschede, the Netherlands; Practice for Physical Therapy, Losser, the Netherlands.
| | - Arjan van der Salm
- Saxion University of Applied Sciences, Expertise Centre for Health, Social Care & Technology, Enschede, the Netherlands
| | - Gerard Koel
- Saxion University of Applied Sciences, Expertise Centre for Health, Social Care & Technology, Enschede, the Netherlands; Practice for Physical Therapy-Wooldersteen, Hengelo, the Netherlands
| | - Frits Oosterveld
- Saxion University of Applied Sciences, Expertise Centre for Health, Social Care & Technology, Enschede, the Netherlands
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Correlation between functional outcome and radiological parameters of healed fracture of distal radius after closed reduction with plaster or percutaneous fixation. J ANAT SOC INDIA 2014. [DOI: 10.1016/j.jasi.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
The "restoring symmetry" hypothesis poses that cross-education of strength--a crossed-limb adaptation after unilateral training--is best applied to clinical conditions presenting with asymmetries. Cross-education mechanisms should be viewed as evolutionarily conserved circuits that have a small impact on daily life but a meaningful impact for rehabilitation. Two recently published examples are hemiparesis after stroke and unilateral orthopedic injury.
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Affiliation(s)
- Jonathan P Farthing
- 1College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan; and 2Rehabilitation Neuroscience Laboratory, 3Centre for Biomedical Research, 4Division of Medical Sciences, and 5School of Exercise Science, Physical and Health Education, University of Victoria, Victoria; and 6Human Discovery Science, International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
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Sreedharan S, Mohd Fadil MF, Lim WSR. Intra-operative correction of volar tilt of distal radius fractures using volar locking plate as reduction tool: review of 24 cases. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2014; 19:363-8. [PMID: 25288285 DOI: 10.1142/s0218810414500282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In surgical fixation of distal radius fractures with metaphyseal comminution, volar tilt can be restored using an anatomical volar locking plate as a reduction tool. The purpose of our study is to assess the degree of over or under correction of volar tilt that can result with our 'lift' technique and to determine the ratio between theoretical and actual angular correction. We retrospectively reviewed 24 patients who underwent distal radius fracture fixation using this technique and assessed intra-operative radiographs for parameters including pre-'lift' and post-'lift' volar tilt and pre-'lift' plate-shaft angles. The ratio between actual angular correction and theoretical angular correction was calculated. The 'lift' technique is found to be reliable in restoring volar tilt in most fractures. Over- or under-correction does occur due to errors in visual estimation and actual angular correction is generally less than the theoretical angular correction.
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Affiliation(s)
- Sechachalam Sreedharan
- Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Boretto JG, Pacher N, Giunta D, Gallucci GL, Alfie V, De Carli P. Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures. J Hand Surg Eur Vol 2014; 39:755-60. [PMID: 24401740 DOI: 10.1177/1753193413517806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present study was performed to test the null hypothesis on no difference in stability of fixation after volar plating of intra-articular distal radius fractures (AO C2-C3) with either locking smooth pegs or locking screws in a clinical setting. A retrospective evaluation included adult patients with C2-C3 AO fractures treated with a volar plate with locking smooth pegs or locking screws. Radiographic assessment was performed to evaluate extra- and intra-articular parameters in the early postoperative period and after bone union. Twenty-seven consecutive patients were included. Thirteen cases had fixation with locking screws and 14 had fixation with locking smooth pegs. Both groups had bone fragment displacement after fixation. However, there were no significant differences between the groups either in extra- or intra-articular parameters defined by Kreder et al. (1996). Our study shows that, in a clinical setting, there is no difference in stability fixation between locking screws or smooth locking pegs in C2-C3 distal radius fractures.
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Affiliation(s)
- J G Boretto
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N Pacher
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - D Giunta
- Internal Medicine Research Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G L Gallucci
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - V Alfie
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P De Carli
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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