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Larose G, Roffey DM, Broekhuyse HM, Guy P, O'Brien P, Lefaivre KA. Trajectory of Recovery following ORIF for Distal Radius Fractures. J Wrist Surg 2024; 13:230-235. [PMID: 38808181 PMCID: PMC11129881 DOI: 10.1055/s-0043-1771045] [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: 02/06/2023] [Accepted: 06/15/2023] [Indexed: 05/30/2024]
Abstract
Background Distal radius fractures are commonly seen among the elderly, though studies examining their long-term outcomes are limited. Purpose The aim of this study was to describe the 5-year trajectory of recovery of distal radius fractures treated with open reduction and internal fixation (ORIF). Methods Patients with distal radius fractures (AO/OTA 23.A-C) treated by ORIF were prospectively studied. Patient-Rated Wrist Evaluation (PRWE) score was measured at baseline (preinjury recall) and postoperatively at 6 months, 1 year, and 5 years. Clinically relevant change in PRWE score was assessed using the minimal clinically important difference (MCID). Results A total of 390 patients were included, of which 75% completed 5-year follow-up. Mean baseline PRWE score was 1.25 (standard deviation, SD: 2.9). At 6 months, mean PRWE score was at its highest up to 20.2 (SD: 18.4; p < 0.01). A significant improvement in mean PRWE score was observed at 1 year down to 15.2 (SD: 17.6; p < 0.01); 44% of patients were still one MCID outside of their baseline PRWE score at 1 year. Further significant improvement in mean PRWE score occurred at 5 years down to 9.4 (SD: 13.4; p < 0.01); 29% of patients remained one MCID outside of their baseline PRWE score at 5 years. Conclusion Recovery after ORIF for distal radius fractures showed significant worsening after surgery, followed by significant improvements up to 1 year and between years 1 and 5, albeit to a lesser extent. Statistically and clinically relevant wrist pain and disability persisted at 5 years. Future research should examine different treatment modalities and include a nonoperative treatment arm for comparison. Level of Evidence Prognostic level II.
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Affiliation(s)
- Gabriel Larose
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Darren M. Roffey
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Henry M. Broekhuyse
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Pierre Guy
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter O'Brien
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Kelly A. Lefaivre
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
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2
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Sari M, Unver B, Kilinc HE, Tunc AR, Bek N. Effects of computer use on upper limb musculoskeletal disorders and function in academicians. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024:1-6. [PMID: 38766735 DOI: 10.1080/10803548.2024.2349408] [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: 05/22/2024]
Abstract
Objectives. This study aimed to investigate the effects of academician's demographic characteristics and computer usage habits on upper limb musculoskeletal disorders (MSDs) and function. Methods. A cross-sectional observational study was conducted with 100 academicians. Data were collected using questionnaires, which included the patient-rated wrist evaluation questionnaire - Turkish version (PRWE-T), the Cornell musculoskeletal discomfort questionnaire - Turkish version (CMDQ-T), the upper extremity functional index - Turkish version (UEFI-T), demographic characteristics and average daily computer usage time. Results. A low-level significant correlation was found between the age of the individuals and the CMDQ-T forearm (p = 0.044; r = 0.202) and CMDQ-T wrist (p = 0.001; r = 0.337) scores. Women had higher CMDQ-T neck scores and lower UEFI-T scores than men (p < 0.05). Academicians who used computers for 6 h a day or more had higher PRWE-T and CMDQ-T neck, shoulder, upper arm and forearm scores, and had a lower UEFI-T score (p < 0.05). Conclusion. Neck, shoulder, upper arm and forearm symptoms were higher and upper extremity function was impaired in academicians who used computers for 6 h a day or more. Besides, gender and age were associated with upper limb MSDs and function, but occupation duration did not affect those outcomes in academicians.
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Affiliation(s)
- Mustafa Sari
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Lokman Hekim University, Turkey
| | - Banu Unver
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Lokman Hekim University, Turkey
| | - Hasan Erkan Kilinc
- Physical Therapy and Rehabilitation Faculty, Hacettepe University, Turkey
| | - Azize Reda Tunc
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Lokman Hekim University, Turkey
| | - Nilgun Bek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Lokman Hekim University, Turkey
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3
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van Es E, Dijkhof M, Souer J, van Ewijk F, Hoogendam L, Slijper H, Selles R. Forearm rotation improves after corrective osteotomy in patients with symptomatic distal radius malunion. Heliyon 2024; 10:e29570. [PMID: 38765076 PMCID: PMC11098778 DOI: 10.1016/j.heliyon.2024.e29570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/21/2024] Open
Abstract
Objectives Distal radius malunion can result in pain and functional complaints. One of the functional problems that can affect daily life is impaired forearm rotation. The primary aim of this study was to investigate the effect of corrective osteotomy for distal radius malunion on forearm rotation at 12 months after surgery. We secondarily studied the effect on grip strength, radiological measurements, and patient-reported outcome measurements (PROMs). Patients and methods This cohort study analysed prospectively collected data of adult patients with symptomatic distal radius malunion. All patients underwent corrective osteotomy for malunion and were followed for 1 year. We measured forearm rotation (pronation and supination) and grip strength and analysed radiographs. PROMs consisted of the Patient-Rated Hand/Wrist Evaluation (PRWHE) questionnaire, Visual Analogue Scale for pain, and satisfaction with hand function. Results Preoperative total forearm rotation was 112° (SD: 34°), of which supination of 49° (SD: 25°) was more impaired than pronation of 63° (SD: 17°). Twelve months after surgery, an unpaired Student's t-test showed a significant improvement of total forearm rotation to 142° (SD: 17°) (p < 0.05). Pronation improved to 72° (SD: 10°), and supination to 69° (SD: 13°) (p < 0.05). Grip strength, PROMs, as well as inclination and volar tilt on radiographs improved significantly during the first year after surgery (p < 0.05). Conclusion In patients with reduced forearm rotation due to distal radius malunion, corrective osteotomy is an effective treatment that significantly improves forearm rotation. In addition, this intervention improves grip strength, the PRWHE-score, pain, and satisfaction with hand function.
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Affiliation(s)
- E.M. van Es
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M. Dijkhof
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J.S. Souer
- Hand and Wrist Center, Xpert Clinics, Amsterdam, the Netherlands
| | - F.J. van Ewijk
- Center for Hand Therapy, Xpert Clinics, Utrecht, the Netherlands
| | - L. Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - H.P. Slijper
- Hand and Wrist Center, Xpert Clinics, Amsterdam, the Netherlands
| | - R.W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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4
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Schriever T, Swärd E, Wilcke M. Lunocapitate versus four-corner fusion in scapholunate or scaphoid nonunion advanced collapse: a randomized controlled trial. J Hand Surg Eur Vol 2024; 49:601-607. [PMID: 37903310 DOI: 10.1177/17531934231209872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
This pragmatic randomized controlled trial compared lunocapitate fusion (LCF) and four-corner fusion (4CF) for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) in 64 patients. The primary outcome was change in grip strength from preoperative to 1 year postoperatively. The secondary outcomes were Disability of the Hand, Arm, and Shoulder score, Patient Rated Wrist Evaluation score, EuroQol-5D-3L, range of motion, key pinch strength and complications 12 months postoperatively. Grip strength improved only to a small extent and there was no difference between the groups. No differences were found in the secondary outcomes. In conclusion, LCF is not inferior to 4CF regarding strength, range of motion or patient-reported outcome measures.Level of evidence: I.
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Affiliation(s)
- Thorsten Schriever
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
| | - Elin Swärd
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
| | - Maria Wilcke
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
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Yetiş M, Ceylan İ, Canlı M, Gürses ÖA, Aslan M, Horoz L, Tayfur A. Validity and Reliability of Turkish Version of the Munich Wrist Questionnaire in Patients With Wrist Problems. Eval Health Prof 2024; 47:105-110. [PMID: 37078390 DOI: 10.1177/01632787231172276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Evidence for the validity and reliability of the Turkish version of the Munich Wrist Questionnaire (MWQ), a patient reported outcome measurement tool (PROM) was evaluated. A total of 80 patients (54.1 ± 1.4 years, 68 females) with wrist problems were recruited. The MWQ was translated into Turkish (MWQ-TR). Criterion validity with Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder and Hand (DASH) was tested by using Pearson's correlation coefficients. Intraclass correlations coefficient (ICC) was used to analyze the test-retest reliability. There was a moderate correlation (r = -0.49, p < 0.001) between MWQ-TR and DASH, while correlations were strong between MWQ-TR and PRWE (r = 0.69, p < 0.001). Test-retest reliability of MWQ-TR was moderate (ICC = 0.67, 95% CI 0.26-0.84). The MWQ-Turkish version demonstrated evidence for its validity and reliability to evaluate pain, work/daily life activities and function in people with wrist problems in a Turkish population.
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Affiliation(s)
- Mehmet Yetiş
- Department of Orthopaedics and Traumatology Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Ceylan
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Mehmet Canlı
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Ömer Alperen Gürses
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Mensure Aslan
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Levent Horoz
- Department of Orthopaedics and Traumatology Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Abdulhamit Tayfur
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Tijare C. The Medium-Term Outcomes of Patients With Suspected Scaphoid Fractures: A Single-Centre Retrospective Cohort Study. Cureus 2024; 16:e53361. [PMID: 38435207 PMCID: PMC10907903 DOI: 10.7759/cureus.53361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background The medium-term outcomes of patients (six to 14 months post-injury) with non-specific wrist injuries managed as suspected scaphoid fractures are not clear from the current literature. These patients' wrists are immobilized in casts or splints, and some receive physiotherapy. They receive serial imaging and follow-up appointments as needed. Aims This study aims to describe the medium-term outcomes of patients with non-specific wrist injuries managed as suspected scaphoid fractures. Methods This is a single-centre retrospective cohort study. Patients with suspected scaphoid fractures were identified from a consecutive database and were included. Patients diagnosed with a definitive scaphoid fracture at any point in time were excluded. Patients with any pre-existing wrist pathology were also excluded. In total 113 patients were posted the Patient-Rated-Wrist-Evaluation (PRWE) questionnaire at six to 14 months post-injury with a self-addressed return envelope. Demographic and PRWE data were collated and described. Results Twenty-two patients (19% of total patients) returned a completed questionnaire. The median PRWE score was 32 out of 100 indicating mild pain and disability. 45.5% of patients were in this category. A minority of patients (9%) continued to suffer severe or very severe pain and disability. Patients with PRWE scores <40, representing pain and disability that is mild or less, reported very low difficulty completing work and recreational activities. Patients tended not to have pain at rest and experienced the most difficulty lifting heavy objects. Conclusion Most patients with non-specific wrist injuries managed as suspected scaphoid fractures experience some pain and disability in the medium term. For most this is minimal or mild, however some patients experience significant pain and disability. This study adds to existing evidence that this is the case. The reasons why these patients suffer are unclear. This study highlights the need to refine clinical practice to improve the outcomes of these patients.
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Berduszek RJ, Reneman MF, Dekker R, van der Sluis CK. Measurement properties of the Dutch versions of QuickDASH and PRWHE in patients with complaints of hand, wrist, forearm and elbow. J Back Musculoskelet Rehabil 2024:BMR230225. [PMID: 38250756 DOI: 10.3233/bmr-230225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND The shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Rated Wrist/Hand Evaluation (PRWHE) are commonly used questionnaires to assess patient-reported hand function. Information about the measurement properties of the Dutch versions is scarce. OBJECTIVE To gain insight into the measurement properties of the Dutch language versions of the QuickDASH and the PRWHE in patients with (non)specific complaints of the hand, wrist, forearm and elbow. METHODS Internal consistency, construct validity, test-retest reliability, responsiveness, and floor and ceiling effects were assessed according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations. RESULTS Questionnaires were filled out by 132 patients. Internal consistency of QuickDASH (Cronbach's α= 0.92) and PRWHE (Cronbach's α= 0.97) was high. Predefined hypotheses for construct validity were not confirmed for 75% for both QuickDASH and PRWHE (accordance with 62% of predefined hypotheses for both questionnaires). Test-retest reliability of QuickDASH (ICC = 0.90) and PRWHE (ICC = 0.87) was good. Both QuickDASH (AUC = 0.84) and PRWHE (AUC = 0.80) showed good responsiveness. No floor or ceiling effects were present. CONCLUSIONS Measurement properties of the Dutch language versions of the QuickDASH and the PRWHE, applied to patients with (non)specific complaints of the hand, wrist, forearm and elbow, were very similar. Test-retest reliability and responsiveness were good for both QuickDASH and PRWHE. Construct validity could not be demonstrated sufficiently.
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8
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Tse YLF, Chau WW, Wong CWY. A structured non-operative treatment program for traumatic triangular fibrocartilage complex tear: A quasi-experimental study. HAND SURGERY & REHABILITATION 2023; 42:492-498. [PMID: 37490953 DOI: 10.1016/j.hansur.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Triangular fibrocartilage complex (TFCC) injury is a common cause of ulnar-sided wrist pain. However, treatment protocols vary across clinical settings and a standardized treatment protocol is needed to improve quality of care. We devised a rehabilitation regime which comprised both orthoses and exercises. We hypothesized that the program can effectively reduce pain and improve functional performance. MATERIALS AND METHODS Thirty-two subjects participated in the 5-phase rehabilitation program. Progress was monitored every 3 weeks. Outcome measures comprised numeric pain rating scale (NPRS), activities of daily living (ADL) pain score, wrist range of motion (ROM), ADL performance score, patient-rated wrist evaluation (PRWE), power grip and distal radioulnar joint (DRUJ) instability grade. RESULTS NPRS decreased from 5.3/10 to 0.5/10 while the ADL pain score improved from 10/20 to 19.1/20. ROM in flexion/extension and supination/pronation improved by 35%. Functional performance on ADL performance score and PRWE improved from 21/40 to 38/40 and 49.5/100 to 14.6/100, respectively. Power grip increased by 59.5%, and DRUJ stability improved. DISCUSSION The combination of orthoses and progressive strengthening and proprioception training was effective in re-establishing DRUJ stability, and improving wrist strength and functional performance. CONCLUSIONS This study provided insight for the development of a rehabilitation protocol for patients with TFCC injury.
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Affiliation(s)
- Yancy Lai-Fan Tse
- Sports Medicine and Rehabilitation Centre, CUHK Medical Centre, Hong Kong.
| | - Wai-Wang Chau
- Department of Orthopaedics and Traumatology, the Chinese University of Hong Kong, Hong Kong
| | - Clara Wing-Yee Wong
- Department of Orthopaedics and Traumatology, the Chinese University of Hong Kong, Hong Kong
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9
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Stougie SD, van Doesburg MHM, Oonk JGM, Plugge L, Streekstra GJ, Dobbe JGG, Coert JH. Performance of the Aptis Distal Radioulnar Joint Implant: A Clinical Case Series Including Four-Dimensional Computed Tomography Kinematic Analysis. J Clin Med 2023; 12:5815. [PMID: 37762755 PMCID: PMC10532409 DOI: 10.3390/jcm12185815] [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: 08/23/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
High complication rates and surgical revision rates following Aptis implant placement have been reported in the literature. This study evaluates the performance of the Aptis implant of twelve patients using four-dimensional kinematic analysis. The (mean) follow-up was 58 months. Wrist motion, grip strength, and kinematic analysis of both arms were used to investigate possible causes of the reported complications. In nine cases (75%), the proximal to distal translation of the distal radius along the ulnar axis in the affected forearm was too little or absent. Significant correlations were found between postoperative extension and translation of the distal radius along the ulnar axis and between the radial deviation and combined error. The four-dimensional kinematic analysis suggests that the current design of the implant could lead to limited restoration of the position of the forearm rotation axis and the translation of the radius along the ulnar axis.
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Affiliation(s)
- Shirley D. Stougie
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Margriet H. M. van Doesburg
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joris G. M. Oonk
- Musculoskeletal Health—Restoration and Development, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lara Plugge
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Geert J. Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Johannes G. G. Dobbe
- Musculoskeletal Health—Restoration and Development, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jan Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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10
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Overduin I, Allen C, Aret J. The association between pain self-efficacy and patient-reported outcome measures for hand disorders: a cross-sectional study. HAND THERAPY 2023; 28:111-118. [PMID: 37904900 PMCID: PMC10581536 DOI: 10.1177/17589983231174800] [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: 01/21/2023] [Accepted: 04/20/2023] [Indexed: 11/01/2023]
Abstract
Introduction Multiple psychological factors influence the functioning of patients with hand disorders. Pain self-efficacy is a positive psychological factor, which concerns an individual's confidence to function despite experiencing pain. This study aimed to analyse the association between pain self-efficacy and a patient-reported outcome measure (PROM) for hand and wrist disorders. Methods Cross-sectional data from patient records were collected prior to hand therapy to analyse the correlation between pain self-efficacy and a PROM for hand and wrist disorders. The assessment tools consisted of the Dutch translations of the Pain Self-Efficacy Questionnaire Short Form (PSEQ-2) and the Patient Rated Wrist Hand Evaluation (PRWHE). Results The findings were reported for the entire sample of 185 respondents (61% women). The PSEQ-2 and the PRWHE were strongly and significantly correlated, which signifies that a higher pain self-efficacy was associated with less pain and disability as measured by the PRWHE. Within a multivariable regression model which accounted for confounding variables, pain self-efficacy independently predicted 28% of the PRWHE scores. Conclusions A strong association between the Dutch PSEQ-2 and the PRWHE was found in this sample of hand therapy patients. This study was limited by the use of retrospective data and by the lack of validation of the Dutch PSEQ-2. The findings were consistent with existing research which reported similar correlations between upper extremity PROM scores and pain self-efficacy. The positively worded PSEQ presents a chance to routinely assess pain self-efficacy as a key psychological factor while also affirming a positive coping strategy.
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Affiliation(s)
- Ilona Overduin
- Physiotherapy Department, St Antonius Hospital, Nieuwegein, Netherlands
| | - Cate Allen
- Department of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Jomina Aret
- Occupational Therapy Department, St Antonius Hospital, Nieuwegein, Netherlands
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Bell KR, Oliver WM, White TO, Molyneux SG, Clement ND, Duckworth AD. QuickDASH and PRWE Are Not Optimal Patient-Reported Outcome Measures After Distal Radial Fracture Due to Ceiling Effect: Potential Implications for Future Research. J Bone Joint Surg Am 2023; 105:1270-1279. [PMID: 37399255 DOI: 10.2106/jbjs.22.01213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND The aim of this study was to determine the floor and ceiling effects for both the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) and the PRWE (Patient-Rated Wrist Evaluation) following a distal radial fracture (DRF). Secondary aims were to determine the degree to which patients with a floor or ceiling effect felt that their wrist was "normal" according to the Normal Wrist Score (NWS) and if there were patient factors associated with achieving a floor or ceiling effect. METHODS A retrospective cohort study of patients in whom a DRF was managed at the study center during a single year was undertaken. Outcome measures included the QuickDASH, PRWE, EuroQol-5 Dimensions-3 Levels (EQ-5D-3L), and NWS. RESULTS There were 526 patients with a mean age of 65 years (range, 20 to 95 years), and 421 (80%) were female. Most patients were managed nonsurgically (73%, n = 385). The mean follow-up was 4.8 years (range, 4.3 to 5.5 years). A ceiling effect was observed for both the QuickDASH (22.3% of patients with the best possible score) and the PRWE (28.5%). When defined as a score that differed from the best available score by less than the minimum clinically important difference (MCID) for the scoring system, the ceiling effect increased to 62.8% for the QuickDASH and 60% for the PRWE. Patients who had a ceiling score on the QuickDASH and the PWRE had a median NWS of 96 and 98, respectively, and those who had a score within 1 MCID of the ceiling score reported a median NWS of 91 and 92, respectively. On logistic regression analysis, a dominant-hand injury and better health-related quality of life were the factors associated with both QuickDASH and PRWE ceiling scores (all p < 0.05). CONCLUSIONS The QuickDASH and PRWE demonstrate ceiling effects when used to assess the outcome of DRF management. Some patients achieving ceiling scores did not consider their wrist to be "normal." Future research on patient-reported outcome assessment tools for DRFs should aim to limit the ceiling effect, especially for individuals or groups that are more likely to achieve a ceiling score. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Katrina R Bell
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - William M Oliver
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - Timothy O White
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - Samuel G Molyneux
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - Nicholas D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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12
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Twardowska M, Czarnecki P, Jokiel M, Bręborowicz E, Huber J, Romanowski L. Delayed Surgical Treatment in Patients with Chronic Carpal Tunnel Syndrome Is Still Effective in the Improvement of Hand Function. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1404. [PMID: 37629694 PMCID: PMC10456912 DOI: 10.3390/medicina59081404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Severe carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremities treated conservatively; later, when advanced, CTS is treated mostly surgically. The most prevalent symptoms comprise numbness, as well as sensation loss in the thumb, index, and middle finger, and thenar muscle strength loss, resulting in impaired daily functioning for patients. Data on the results of CTS treatment in patients with delayed surgical intervention are scarce. The aim of this study was to determine the postoperative results of chronic carpal tunnel syndrome treatment in patients with symptoms lasting for at least 5 years. Materials and Methods: A total of 86 patients (69 females, 17 males) with a mean age of 58 years reporting symptoms of CTS for at least 5 years (mean: 8.5 years) were prospectively studied. The average follow-up time was 33 months. All patients underwent the surgical open decompression of the median nerve at the wrist. A preoperative observation was composed of an interview and a clinical examination. The subjects completed the DASH (the Disabilities of the Arm, Shoulder, and Hand), PRWE (Patient-Rated Wrist Evaluation), and self-report questionnaires. Global grip strength, sensory discrimination, characteristic symptoms of CTS, and thenar muscle atrophy were examined. Postoperatively, clinical and functional examinations were repeated, and patients expressed their opinions by completing a BCTQ (Boston Carpal Tunnel Syndrome Questionnaire). Results: We found improvements in daily activities and hand function postoperatively. Overall, 88% of patients were satisfied with the outcome of surgery. DASH scores decreased after surgery from 44.82 to 14.12 at p < 0.001. PRWE questionnaire scores decreased from 53.34 to 15.19 at p < 0.001. The mean score of the BCTQ on the scale regarding the severity of symptoms was 1.48 and 1.62 on the scale regarding function after surgery. No significant differences were found in the scores between the male and female groups or between age groups (p > 0.05). A significant increase in global grip strength from 16.61 kg to 21.91 kg was observed postoperatively at p < 0.001. No significant difference was detected in the measurement of sensory discrimination (6.02 vs. 5.44). In most of the examined patients, night numbness and wrist pain subsided after surgery at p < 0.001. Thenar muscle atrophy diminished after surgery at p < 0.001. Conclusions: Most patients were satisfied with the results of CTS surgery regarding the open decompression of the median nerve even after 5 years of ineffective conservative treatment. Significant improvement of the hand function was confirmed in the functional studies.
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Affiliation(s)
- Marta Twardowska
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Marta Jokiel
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Ewa Bręborowicz
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Juliusz Huber
- Department of Pathophysiology of Locomotor Organs, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland;
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
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13
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d'Ailly PN, Deugd C, Schep NWL, Kuijper TM, Kok MR, Willemze A, Coert JH, de Jong PHP, Lam-Tse WK, van der Helm-van Mil AHM, Tchetverikov I, Weel-Koenders AEAM, Bisoendial RJ. Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial). Trials 2023; 24:229. [PMID: 36966310 PMCID: PMC10039772 DOI: 10.1186/s13063-023-07129-y] [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: 07/13/2022] [Accepted: 01/31/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. METHODS This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0-100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. DISCUSSION Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. TRIAL REGISTRATION Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. CLINICALTRIALS gov NCT04755127. Registered after the start of inclusion on 15 February 2021.
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Affiliation(s)
- P N d'Ailly
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
| | - C Deugd
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - T M Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - M R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - A Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - J H Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P H P de Jong
- Department of Rheumatology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - W K Lam-Tse
- Department of Rheumatology, Franciscus Gasthuis en Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - A H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - I Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - A E A M Weel-Koenders
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - R J Bisoendial
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Reck A, Pillukat T, van Schoonhoven J. Results of primary radial corrective osteotomy in Madelung's deformity. Arch Orthop Trauma Surg 2022; 143:2797-2803. [PMID: 36564532 DOI: 10.1007/s00402-022-04731-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The purpose of this study was the evaluation of surgical outcomes in a series of wrists with Madelung's deformity treated with radial corrective osteotomy. We hypothesize that this surgical technique is a suitable and safe way of treatment. MATERIALS AND METHODS A retrospective review of patients with Madelung's deformity treated with radial corrective osteotomy between January 2001 and June 2017 at a single large department of hand surgery in Germany was performed. Patients who met the inclusion criteria were invited for follow-up and outcome variables including pain, range of motion, patient-rated outcome measures, and radiographic measurements were obtained for comparison with preoperative data collected from the patients' medical records. RESULTS 14 wrists were included. The average age at the time of surgery was 21.9 years, and the average follow-up was 7.2 years. The average visual analog pain scale at rest decreased from preoperative 2.6 points to postoperative 0.7 points. Under strain, the average VAS declined from 7.4 to 4.9 points. The mean DASH Score decreased from 42.9 before surgery to 22.0 points after surgery. Range of motion improved slightly in five out of six directions of motion, with the greatest increase seen in average supination from preoperative 68.5° to postoperative 82.0°. Averages of all five measured McCarroll's parameters and ulnar variance decreased, as expected from corrective surgery. Four wrists (26.8%) needed subsequent procedures. CONCLUSION Radial corrective osteotomy was a suitable treatment of Madelung's deformity in our collective, although surgical outcomes are not yet fully satisfying.
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Affiliation(s)
- Alexander Reck
- Department of Hand Surgery, RHÖN-KLINIKUM Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany.
| | - Thomas Pillukat
- Department of Hand Surgery, RHÖN-KLINIKUM Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Joerg van Schoonhoven
- Department of Hand Surgery, RHÖN-KLINIKUM Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
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15
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Teunissen JS, Duraku LS, Feitz R, Zuidam JM, Selles RW, Wouters RM. Routinely-Collected Outcomes of Proximal Row Carpectomy. J Hand Surg Am 2022:S0363-5023(22)00539-1. [PMID: 36372595 DOI: 10.1016/j.jhsa.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe patient-reported pain and function 12 months after proximal row carpectomy (PRC). Secondary outcomes included return to work, grip strength, range of wrist motion, satisfaction with treatment results, and complications. METHODS This cohort study was part of the British Society for Surgery of the Hand Studyathon 2021, using ongoing routinely-collected data of 304 eligible patients who underwent PRC (73% scapholunate advanced collapse, 11% scaphoid nonunion advanced collapse wrist; 11% Kienböck, 5% other indications) from Xpert Clinics, the Netherlands between 2012-2020. The primary outcome was the Patient Rated Wrist/Hand Evaluation total score (range, 0-100, lower scores indicate better performance). RESULTS Of the 304 patients, the primary outcome was available in 217 patients. The total Patient Rated Wrist/Hand Evaluation score improved from 60 (95% confidence interval [CI], 57-63) to 38 (95% CI, 35-41) at 3 months, and 26 (95% CI, 23-29) at 12 months. The pain and function subscales improved by 18 (95% CI, 17-20) and 16 (95% CI, 14-18) points, respectively. At 12 months, 82% had returned to work at a median time of 12 (95% CI, 9-14) weeks following PRC. Grip strength did not improve. Wrist flexion and extension demonstrated a clinically irrelevant decrease. Satisfaction with treatment result was excellent in 27% of patients, good in 42%, fair in 20%, moderate in 6%, and poor in 5%. Complications occurred in 11% of patients, and conversion to wrist arthroplasty occurred in 2 patients. CONCLUSION A clinically relevant improvement in patient-reported pain and function was observed at 3 months after PRC, with continued improvement to 12 months. These data can be used for shared-decision making and expectation management. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Joris S Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands.
| | - Liron S Duraku
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Reinier Feitz
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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Samade R, Campbell AB, Awan HM, Goyal KS. Total Wrist Fusion with an Intramedullary Device: A Single-Institution Series with a Minimum of One Year Follow-Up. J Wrist Surg 2022; 11:395-405. [PMID: 36339084 PMCID: PMC9633137 DOI: 10.1055/s-0041-1740404] [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: 06/29/2020] [Accepted: 10/22/2021] [Indexed: 01/09/2023]
Abstract
Objective The primary purpose of this study was to evaluate the functional and surgical outcomes of total wrist fusion (TWF) following the use of a locked intramedullary nail (IMN). Methods A single institution study was performed, which entailed in-person reexamination of 18 patients ( n = 19 wrists), out of 35 eligible patients, who underwent TWF with an IMN from 2010 to 2017. For each patient, demographic, preoperative diagnosis, physical examination, wrist radiograph, and outcome questionnaire data were obtained. The questionnaires included the visual analog scale (VAS), quick disabilities of the arm, shoulder, and hand (QuickDASH), and Mayo Wrist Score assessments. In addition, complication and reoperation data for all TWFs with an IMN during the 2010 to 2017 period (35 patients, n I = 38 wrists) were noted. Results In the 18 patients, age was 47.6 ± 13.9 years, 12 (63.2%) were female, and median follow-up was 150 weeks (range: 74-294). The VAS score was 0 ± 0 in 5 of 19 wrists with rheumatoid arthritis (RA) and 1.82 ± 2.78 in 14 of 19 wrists without RA. It was found that 21 of 38 wrists (55.3%) had an implant-related complication and 5 wrists (13%) underwent a reoperation due to the implant itself. Conclusions To date, no sufficient data are present demonstrating a clear advantage of an IMN over dorsal plating for TWF at intermediate-term follow-up. Surgeons should be knowledgeable of the several potential complications of this IMN prior to its use for TWF. Level of Evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew B. Campbell
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Hisham M. Awan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kanu S. Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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17
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Teunissen JS, van der Oest MJW, Selles RW, Ulrich DJO, Hovius SER, van der Heijden B. Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years. Bone Jt Open 2022; 3:375-382. [PMID: 35514114 PMCID: PMC9134835 DOI: 10.1302/2633-1462.35.bjo-2022-0031.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome. Methods Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores. Results Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%). Conclusion Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common. Cite this article: Bone Jt Open 2022;3(5):375–382.
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Affiliation(s)
- Joris S. Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Mark J. W. van der Oest
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Steven E. R. Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Brabant, The Netherlands
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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: 0] [Impact Index Per Article: 0] [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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Janakiramanan N, Miles O, Collon S, Crammond B, McCombe D, Tham SK. Functional Recovery Following Trapeziectomy and Ligament Reconstruction and Tendon Interposition: A Prospective Longitudinal Study. J Hand Surg Am 2021; 46:963-971. [PMID: 34154852 DOI: 10.1016/j.jhsa.2021.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/11/2021] [Accepted: 04/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients undergoing surgery for trapeziometacarpal (TMC) joint arthritis require preoperative counseling on the expectations of surgery. This study aims to document the objective and functional recovery over the initial 12 months following trapeziectomy and ligament reconstruction with tendon interposition (LRTI). METHODS We prospectively followed 55 patients with symptomatic TMC joint osteoarthritis after trapeziectomy and LRTI. Patients were assessed on functional outcome measures, pain, and objective outcomes of grip, tip and key pinch strength, and range of motion. Outcomes were recorded preoperatively and at 3, 6, 9, and 12 months after surgery. RESULTS Outcome measures of Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and pain, improved significantly after surgery at each 3-month interval up to 9 months. Palmar and radial abduction were significantly improved compared to their preoperative ranges, but opposition was unchanged. Power grip significantly exceeded the preoperative strength at 6 months and further increased at 9 months. Tip pinch significantly exceeded the preoperative strength at 12 months. There was no difference in the key pinch strength compared to the preoperative strength. CONCLUSIONS Over a follow-up period of 12 months, trapeziectomy and LRTI is an effective treatment in significantly reducing pain in 80% of patients. Although normal patient-reported outcome measures of DASH and PRWE are not regained, when compared to normative values, these measures are significantly improved; the improvement plateaus at 9 months. Patients can expect to attain 37% and 46% of their eventual measured DASH and PRWE scores, respectively, at 3 months, and 82% and 79% of their eventual measured DASH and PRWE scores, respectively, at 6 months. Grip strength exceeded the preoperative strength by 15% at 6 months and by 30% at 9 months. Tip pinch strength significantly exceeded the preoperative strength by 20% at 9 months. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
| | - Oliver Miles
- Hand Surgery Unit, Department of Plastic Surgery, St Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St Vincent Institute, Melbourne, Australia
| | - Sylvie Collon
- Victorian Hand Surgery Associates, Melbourne, Australia
| | - Bradley Crammond
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - David McCombe
- Victorian Hand Surgery Associates, Melbourne, Australia; Hand Surgery Unit, Department of Plastic Surgery, St Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St Vincent Institute, Melbourne, Australia
| | - Stephen K Tham
- Victorian Hand Surgery Associates, Melbourne, Australia; Hand Surgery Unit, Department of Plastic Surgery, St Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St Vincent Institute, Melbourne, Australia.
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20
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Berduszek RJ, Reinders-Messelink HA, Dijkstra PU, van der Sluis CK. Comparison between patient-reported and physician-estimated pain and disability in hand and wrist disorders. Musculoskeletal Care 2021; 20:354-362. [PMID: 34704346 PMCID: PMC9297919 DOI: 10.1002/msc.1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022]
Abstract
Background Pain and disability are important components of the assessment of hand problems, but it is unknown how physician estimates compare to patient self‐reports. Objective To analyse differences between patient‐reported and physician‐estimated pain and disability in patients with hand or wrist disorders and to analyse factors influencing these differences. Methods Observational study of patients with hand or wrist disorders seen during multidisciplinary outpatient consultations. Patients, rehabilitation medicine (RM) consultants, RM trainees and plastic surgeons completed visual analogue scales (VASs) to rate the level of self‐reported (patients) or estimated (physicians) pain and disability. Multilevel analyses were performed to evaluate differences in VAS‐pain and VAS‐disability scores between patients and physicians and to evaluate the influences of diagnosis, physician experience and medical specialty. Results Complete data were obtained for 250 patients. Levels of pain and disability estimated by physicians were lower compared to patient self‐reports. Ratings differed among medical specialties. Pain was underestimated to a greater extent by plastic surgeons compared to RM consultants. Disability was underestimated to a greater extent by RM consultants compared to plastic surgeons. Estimates of pain and disability did not differ between consultants and trainees in RM. Type of diagnosis did not influence the degree of underestimation of pain and disability. Conclusions Physicians underestimate pain and disability compared to self‐reports in patients with hand or wrist disorders. Ratings differ among medical specialties: plastic surgeons underestimate pain more, while RM consultants underestimate disability more. Physician experience and diagnosis do not influence the degree of underestimation of pain and disability.
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Affiliation(s)
- Redmar J Berduszek
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Heleen A Reinders-Messelink
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Rehabilitation Center Revalidatie Friesland, Beetsterzwaag, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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21
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Eikrem M, Brannsten H, Bjørkøy D, Lian T, Madsen JE, Figved W. Volar Locking Plate Versus Dorsal Locking Nail-Plate Fixation for Dorsally Displaced Unstable Extra-Articular Distal Radial Fractures: Functional and Radiographic Results from a Randomized Controlled Trial. JB JS Open Access 2021; 6:JBJSOA-D-21-00068. [PMID: 34651093 PMCID: PMC8509916 DOI: 10.2106/jbjs.oa.21.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The use of low-profile dorsal and volar locking plates for distal radial fracture surgery has improved results and lowered the complication rate compared with older plate designs. The purpose of the present randomized controlled trial was to compare patient-reported outcomes as well as radiographic and functional results between patients who underwent stabilization with a volar locking plate or a dorsal locking nail-plate for the treatment of dorsally displaced unstable extra-articular distal radial fractures.
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Affiliation(s)
- Morten Eikrem
- Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway.,Orthopaedic Department, Aalesund Hospital, Moere and Romsdal Hospital Trust, Aalesund, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hege Brannsten
- Department of Radiology, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Dagfinn Bjørkøy
- Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Tom Lian
- Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan Erik Madsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Wender Figved
- Orthopaedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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22
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Björk M, Niklasson J, Westerdahl E, Sagerfors M. Self-efficacy corresponds to wrist function after combined plating of distal radius fractures. J Hand Ther 2021; 33:314-319. [PMID: 32088082 DOI: 10.1016/j.jht.2020.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/06/2019] [Accepted: 01/12/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A prospective cohort single-center study. INTRODUCTION Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability will more likely reach a good outcome. PURPOSE OF THE STUDY The aim of this study was to examine if SE has an effect to physical functioning, pain and patient-rated wrist function three months postoperatively in patients undergoing plating due to a distal radius fracture. METHODS Sixty-seven patients undergoing plating for a distal radius fracture rated SE at the first appointment with the physiotherapist. At the three-month follow-up, the following assessments were administered: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip strength, and range of motion. RESULTS The group with a high SE showed significantly better range of motion for flexion (P = .046) and supination (P = .045), hand grip strength (P = .001) and PRWE scores (P = .04). The NRS pain during activity was lower, although not significantly lower (P = .09). Using Spearman's rank correlation coefficient, there was a moderate correlation between SE and pain during activity, wrist flexion, and PRWE score. DISCUSSION SE corresponds to wrist function after combined plating of distal radius fractures. CONCLUSION Measurement of SE could possibly be useful to identify patients in special need of support during the postoperative rehabilitation.
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Affiliation(s)
- Marie Björk
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden
| | - Johan Niklasson
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden
| | - Elisabeth Westerdahl
- Faculty of Medicine and Health, Department of Physiotherapy, Örebro University, Örebro, Sweden
| | - Marcus Sagerfors
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden.
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23
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d'Ailly PN, Koopman JE, Selles CA, Rahimtoola ZO, Schep NW. Patient-Related Outcomes of Arthroscopic Resection of Ganglion Cysts of the Wrist. J Wrist Surg 2021; 10:31-35. [PMID: 33552692 PMCID: PMC7850802 DOI: 10.1055/s-0040-1716509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Background Ganglion cysts of the wrist can cause pain and loss of functionality. No consensus exist on optimal treatment. Arthroscopic resection shows promising results but is poorly studied. Furthermore, only few studies have used patient-related outcomes to evaluate arthroscopic treatment. Purpose The purpose of this study was to assess patient-related outcomes following arthroscopic resection of wrist ganglion cysts. Patients and Methods This was a retrospective study of all consecutive patients that underwent arthroscopic resection of a dorsal or volar wrist ganglion. Minimum follow-up was 6 months. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were recurrence rate and complications. Results A total of 53 patients were included with a mean follow-up of 13 months (interquartile range: 6-23 months). Twenty-six patients (49%) presented with a recurrence following prior treatment. Mean PRWE was 13 (standard deviation [SD] = 1.8), with no difference between patients with dorsal or volar ganglion cysts. There were five recurrences (9%), of which three occurred in the first five patients who were operated. There were three patients with complications (6%), consisting of neuropraxia, extensor carpi ulnaris tendinitis, and painful scar tissue. Conclusion Arthroscopic resection results in good patient-related outcome and low complication and recurrence rates when performed by an experienced surgeon. Recurrence and complication rates are similar to arthroscopic resections described in literature and superior to open resection and needle aspiration. Well-designed randomized clinical trials will be necessary to confirm these findings. Level of Evidence This is a level IV, retrospective study.
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Affiliation(s)
- Philip N. d'Ailly
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jaimy E. Koopman
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Caroline A. Selles
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Zulfiquar O. Rahimtoola
- Department of Orthopaedic and Trauma Surgery, Royal Berkshire Hospital, Reading, United Kingdom
| | - Niels W.L. Schep
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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24
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Stirling PHC, Oliver WM, Ling Tan H, Brown IDM, Oliver CW, McQueen MM, Molyneux SG, Duckworth AD. Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius. Bone Joint J 2020; 102-B:1542-1548. [PMID: 33135431 DOI: 10.1302/0301-620x.102b11.bjj-2020-0848.r3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. METHODS We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. The primary long-term outcome was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the EQ-5D-5L score, complications, and the Net Promoter Score (NPS). Multivariate regression analysis was used to determine factors associated with the PRWE score. RESULTS Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). CONCLUSION We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: III (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542-1548.
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Affiliation(s)
- Paul H C Stirling
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William M Oliver
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Huai Ling Tan
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Iain D M Brown
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christopher W Oliver
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Margaret M McQueen
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Sam G Molyneux
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
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25
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van de Stadt LA, Kroon FPB, Kloppenburg M. Measures of Hand Function. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:321-341. [PMID: 33091260 DOI: 10.1002/acr.24352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023]
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26
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Brouwers D, Decramer A, Cornu P, Le Viet D. Does the DISI matter after distal scaphoidectomy with tendon interposition for STT osteoarthritis? HAND SURGERY & REHABILITATION 2020; 39:284-290. [PMID: 32272185 DOI: 10.1016/j.hansur.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
Abstract
Progression to dorsal extension of the lunate after distal scaphoidectomy was described more than a decade ago. Still, this technique remains a popular choice for surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis (STT OA). This study aimed to investigate short-term postoperative function, patient satisfaction and radiographic outcomes of distal scaphoidectomy with tendon interposition for isolated STT OA in the wrist. Scaphoid resection width, amount of DISI and postoperative complications were also assessed. We evaluated all distal scaphoidectomies done at our hospital from 2012 to 2018. Postoperative clinical analysis consisted of grip and key pinch strength, joint amplitude, pain on visual analog scale (VAS), hand usability (VAS) and functional scores (QuickDASH and PRWHE scores). On follow-up radiographs, we measured the amount of DISI, resection height and scaphoid working length and compared them to functional scores. Eighteen patients with 21 operated wrists were eligible. Average time to postoperative evaluation was 36 (5-78) months. We observed DISI in 95% of the cases (n=19). A mean increase of 13° (±6) in radiolunate angle was noted when comparing pre- and postoperative radiographs. Neither the amount of DISI nor the resection height was significantly correlated with the functional scores. No revision surgery for advanced wrist collapse was reported. Four concomitant surgeries were needed. Distal scaphoid excision with tendon interposition yields good short-term results in isolated STT OA. While 95% of cases developed a DISI deformity, there were no cases of functional impairment. Longitudinal studies with long-term follow-up are required to further evaluate lunate extension and possible clinical implications.
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Affiliation(s)
- D Brouwers
- AZ Delta, Rodekruisstraat 20, 8800 Roeselare, Belgium.
| | - A Decramer
- AZ Delta, Rodekruisstraat 20, 8800 Roeselare, Belgium
| | - P Cornu
- Research Group Clinical Pharmacology and Clinical Pharmacy, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - D Le Viet
- Institut de la main, clinique Bizet, 21, rue Georges-Bizet, 75016 Paris, France
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27
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Andreasson I, Kjellby-Wendt G, Fagevik-Olsén M, Aurell Y, Ullman M, Karlsson J. Long-term outcomes of corrective osteotomy for malunited fractures of the distal radius. J Plast Surg Hand Surg 2019; 54:94-100. [PMID: 31762349 DOI: 10.1080/2000656x.2019.1693392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim was to investigate the long-term outcome after corrective osteotomy for malunion of distal radius fractures. Radiological findings, function, activity performance, pain, health-related quality of life and self-efficacy were studied. Evaluation of 37 patients 3-10 years after osteotomy fixated with a volar plate. Conventional radiographs were taken. Grip strength and range of motion were evaluated. Scores from the Patient Rated Wrist Evaluation (PRWE) were compared with normative values. The RAND-36 was used for evaluation of health-related quality of life and the General Self-Efficacy scale (S-GSE) for self-efficacy. Radial height, volar tilt, and ulnar variance improved postoperatively. In the long term, the corrections were maintained. Radiographs showed significantly more advanced osteoarthritis. Mean grip strength was 31 kg (SD 13) 89%, and range of motion varied between 80% and 95% compared to the uninjured side. The median PRWE was 12 points (0-99). The study group experienced higher levels of pain than reference values. There was a moderate correlation between the PRWE and volar tilt (rs = 0.453, p = .006) and grip strength (rs = 0.40, p = .014). At long-term follow-up functional outcome after a corrective osteotomy is generally good, but patients may experience some degree of pain. Corrective osteotomy might be considered for patients with a poor functional outcome after a distal radius fracture.
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Affiliation(s)
- Ingrid Andreasson
- Department of Orthopedics, Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Kjellby-Wendt
- Department of Physiotherapy, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik-Olsén
- Department of Physiotherapy, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ylva Aurell
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Ullman
- Department of Orthopedics, Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopedics, Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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28
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Miller L, Ada L, Crosbie J, Wajon A. Pain in the Post-Operative Week Predicts Pain and Hand Use Twelve Weeks after Proximal Phalangeal Fracture Fixation. J Hand Surg Asian Pac Vol 2019; 24:462-468. [PMID: 31690187 DOI: 10.1142/s2424835519500607] [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: 11/18/2022]
Abstract
Background: The purpose of this study was to determine whether baseline characteristics predict outcomes twelve weeks after open reduction and internal fixation of proximal phalangeal fracture. Methods: A cohort of patients (n = 48, mean 35 years; SD 11) commencing outpatient rehabilitation within one week of surgery were reviewed. Outcomes of interest were active PIP extension; active total range of motion; pain at rest; comprehensive pain; strength; and hand use (reported difficulty performing specific activities such as turning a door handle, as well as usual activities including housework and recreation) at twelve weeks. Possible predictors included which finger is injured, whether the fracture is intra or extra-articular, whether the dominant or non-dominant hand is injured and/or how much pain is experienced in the first post-operative week. Multiple linear regression was performed to produce a model of the prediction for each outcome of interest at Week 1 (baseline). Results: Results from multivariate linear regression analyses suggest that pain at rest at baseline was significantly predictive of pain at rest (OR = 1.25, 95% CI = 1.06-1.47), p = 0.01), comprehensive pain (OR = 3.18, 95% CI = 1.47-6.84, p = 0.01), and hand use (OR = 2.38, 95% CI = 1.18-4.80, p = 0.02) twelve weeks after open reduction and internal fixation of proximal phalangeal fracture. The turning point on the receiver-operator characteristic curve of false versus true risk (AUC = 0.94, p = 0.04) indicated that at least a score of 4.5 on the 10 cm visual analogue scale for baseline resting pain was needed for significant likelihood of reduced hand use. Which finger was injured, location of fracture and side of injury were not predictive of any outcomes. Conclusions: Moderate to high levels of resting pain in the week following surgery for proximal phalangeal fracture is predictive of pain and hand use at twelve weeks. Moderate to high levels of resting pain should be recognised as unusual, and could be targeted in rehabilitation. Further prospective studies are needed to determine whether early identification and targeted intervention to reduce pain improves outcomes at 12 weeks.
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Affiliation(s)
- Lauren Miller
- Hand Therapy Unit, Sydney Hospital, Sydney, Australia
| | - Louise Ada
- The University of Sydney, Faculty of Health Sciences, Sydney, Australia
| | - Jack Crosbie
- University of Western Sydney, School of Physiotherapy, Campbelltown, Australia
| | - Anne Wajon
- Macquarie University, Faculty of Medicine and Health Sciences, North Ryde, Australia
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29
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Cöster MC, Rosengren BE, Karlsson MK, Carlsson Å. Age- and Gender-Specific Normative Values for the Self-Reported Foot and Ankle Score (SEFAS). Foot Ankle Int 2018; 39:1328-1334. [PMID: 30035614 DOI: 10.1177/1071100718788499] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Self-Reported Foot and Ankle Score (SEFAS) is a foot- and ankle-specific patient-reported outcome measurement (PROM) score that has been validated with good results for a variety of foot and ankle disorders. SEFAS is sensitive detecting improvement or deterioration after surgery. However, normative values, required to put a specific patient's summary score into perspective, are lacking. METHODS In this report, we included 396 population-based men and 383 women (43% of the invited individuals), age 20-89 years, who had completed the SEFAS questionnaire and questions regarding anthropometrics and health. We used Mann-Whitney U test to test gender differences and Spearman correlation coefficients to determine any association between SEFAS score and age. We present gender-specific median SEFAS scores with range and 5th to 95th percentiles and mean with standard deviation. RESULTS The SEFAS normative values were median 48 in men (range 11-48), 5th to 95th percentiles 31 to 48 and mean 45 ± 6, and in women, median 47 (range 6-48), 5th to 95th percentiles 23 to 48 and mean 43 ± 8 (gender comparison P < .001). SEFAS normative values correlated inversely with age (r = -0.12, P < .001). CONCLUSION In the general population, older age was associated with lower SEFAS value, and men had higher values than women. The population-based normative SEFAS values provided in this study can facilitate quantification of disability related to foot and ankle with and without surgery in the foot and ankle. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Maria C Cöster
- 1 Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital in Malmö, Sweden
| | - Björn E Rosengren
- 1 Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital in Malmö, Sweden
| | - Magnus K Karlsson
- 1 Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital in Malmö, Sweden
| | - Åke Carlsson
- 1 Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital in Malmö, Sweden
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30
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Kirkeby L, Frost P, Hansen TB, Svendsen SW. Disability and return to work after MRI on suspicion of scaphoid fracture: Influence of MRI pathology and occupational mechanical exposures. PLoS One 2018; 13:e0197978. [PMID: 29864121 PMCID: PMC5986122 DOI: 10.1371/journal.pone.0197978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/12/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives We aimed to determine the prognosis after early MRI on clinical suspicion of scaphoid fracture, hypothesising that MRI pathology is associated with more disability and that MRI pathology and high occupational mechanical hand-arm exposures are associated with slower return to work (RTW). Methods We conducted a follow-up study of a cohort of 469 patients, who were scanned in the period 2006 to 2010. The respondents constituted our cohort for disability analysis and the subset that was in the labour market at the time of the trauma constituted our sub-cohort for RTW analysis. Questionnaires included disability scores, job title, and lifestyle factors. Job titles were linked with a job exposure matrix to estimate occupational exposures. Register information was obtained on time until RTW. We used logistic regression analysis of disability and Cox regression analysis of time until RTW. Results The proportion that responded was 53% (249/469) for the disability analysis and 59% (125/212) for the RTW analysis. The mean age at follow up was 43.5 years, the mean time since trauma was 4.8 years, 53% had injury of the dominant hand, and 54% had MRI pathology. Men constituted 43% of the cohort and 56% of the sub-cohort. MRI pathology was not associated with more disability [e.g., for a 'Disabilities of the Arm Shoulder and Hand'-score ≥20 the odds ratio was 0.58 (95% confidence interval 0.26–1.17)]. Patients without MRI pathology and with low occupational exposures were off work for an average of four weeks. Patients with MRI pathology or high occupational exposures were off work for twice as long time. Conclusion MRI pathology was not associated with more disability. For patients, who were in the labour market at the time of the trauma, MRI pathology and high occupational mechanical hand-arm exposures were associated with slower RTW.
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Affiliation(s)
- Lone Kirkeby
- University Clinic of Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Holstebro, Denmark
- * E-mail:
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Bæk Hansen
- University Clinic of Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Holstebro, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland–University Research Clinic, Herning, Denmark
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