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Weber DM, Kraus R, Wirth-Welle R, Andreisek G, Gnannt R, Guéro S, Neeser HR, Seiler M. Paediatric fractures of carpal bones other than the scaphoid. HAND SURGERY & REHABILITATION 2023; 42:406-412. [PMID: 37356568 DOI: 10.1016/j.hansur.2023.06.009] [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: 03/24/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Fractures of carpal bones other than the scaphoid are rare in children. The aim of this study was to analyze results and identify risk factors for an unfavorable outcome. MATERIAL AND METHODS Children and adolescents up to the age of 16 years who sustained a carpal fracture other than in the scaphoid between 2004 and 2021 were reviewed in this single-center retrospective study. RESULTS In a series of 209 children and adolescents with carpal fractures, 22 had fractures other than the scaphoid. Mean age was 13 years (range 8-16) years, with a total of 41 fractures, with highest incidences for the capitate (10), trapezium (6), triquetrum (4) and pisiform (4). Twenty-nine of these 41 fractures were missed on initial X-ray. Non-displaced fractures were treated with a short arm spica cast including the thumb. Four patients were operated on for displacement fracture or carpometacarpal subluxation. All fractures united, and patients returned to full activities. At the final consultation at a median 14 months (range 6-89) post-injury, all patients with non-displaced fractures were free of symptoms, with excellent Mayo Wrist Scores (MWS). However, three patients with operated trapezium fractures developed early radiological signs of osteoarthritis, two of them with residual pain and MWS rated only good. CONCLUSION Non-displaced pediatric carpal fractures treated by forearm cast have excellent prognosis. Fractures of the trapezium with displacement or first carpometacarpal subluxation incur a risk of osteoarthritis despite anatomical reduction and internal fixation.
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Affiliation(s)
- Daniel M Weber
- Division of Paediatric Hand Surgery and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Ralf Kraus
- Klinikum Bad Hersfeld, Seilerweg 29, Bad Hersfeld, Germany.
| | - Ruth Wirth-Welle
- Division of Hand Surgery, Kantonsspital, Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland.
| | - Gustav Andreisek
- Department of Radiology, Kantonsspital, Münsterlingen, Spitalcampus 1, 8596 Münsterlingen, Switzerland.
| | - Ralph Gnannt
- Paediatric Department of Radiology and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Stéphane Guéro
- Division of Paediatric Orthopedics, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.
| | - Hannah R Neeser
- Division of Paediatric Hand Surgery and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Michelle Seiler
- Paediatric Emergency Department and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
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Le Hanneur M, Pfister G, Bachy M, Pietton R, Vialle R, Fitoussi F. Magnetically controlled growing rods in severe radial club hand congenital deformities. HAND SURGERY & REHABILITATION 2019; 39:72-74. [PMID: 31730915 DOI: 10.1016/j.hansur.2019.10.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M Le Hanneur
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - G Pfister
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - M Bachy
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - R Pietton
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - R Vialle
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - F Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
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Mulders MAM, Walenkamp MMJ, Slaar A, Ouwehand F, Sosef NL, van Velde R, Goslings JC, Schep NWL. Implementation of the Amsterdam Pediatric Wrist Rules. Pediatr Radiol 2018; 48:1612-1620. [PMID: 29992444 PMCID: PMC6153883 DOI: 10.1007/s00247-018-4186-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/04/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Amsterdam Pediatric Wrist Rules have been developed and validated to reduce wrist radiographs following wrist trauma in pediatric patients. However, the actual impact should be evaluated in an implementation study. OBJECTIVE To evaluate the effect of implementation of the Amsterdam Pediatric Wrist Rules at the emergency department. MATERIALS AND METHODS A before-and-after comparative prospective cohort study was conducted, including all consecutive patients aged 3 to 18 years presenting at the emergency department with acute wrist trauma. The primary outcome was the difference in the number of wrist radiographs before and after implementation. Secondary outcomes were the number of clinically relevant missed fractures of the distal forearm, the difference in length of stay at the emergency department and physician compliance with the Amsterdam Pediatric Wrist Rules. RESULTS A total of 408 patients were included. The absolute reduction in radiographs was 19% compared to before implementation (chi-square test, P<0.001). Non-fracture patients who were discharged without a wrist radiograph had a 26-min shorter stay at the emergency department compared to patients who received a wrist radiograph (68 min vs. 94 min; Mann-Whitney U test, P=0.004). Eight fractures were missed following the recommendation of the Amsterdam Pediatric Wrist Rules. However, only four of them were clinically relevant. CONCLUSION Implementing the Amsterdam Pediatric Wrist Rules resulted in a significant reduction in wrist radiographs and time spent at the emergency department. The Amsterdam Pediatric Wrist Rules were able to correctly identify 98% of all clinically relevant distal forearm fractures.
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Affiliation(s)
- Marjolein A. M. Mulders
- 0000000404654431grid.5650.6Trauma Unit, Department of Surgery, Academic Medical Center, P.O. Box 22660, Meibergdreef, 91105 AZ Amsterdam, The Netherlands
| | - Monique M. J. Walenkamp
- 0000000404654431grid.5650.6Trauma Unit, Department of Surgery, Academic Medical Center, P.O. Box 22660, Meibergdreef, 91105 AZ Amsterdam, The Netherlands
| | - Annelie Slaar
- grid.476832.cDepartment of Radiology, Westfriesgasthuis, P.O. Box 600, 1620 AR Hoorn, The Netherlands
| | - Frank Ouwehand
- 0000000404654431grid.5650.6Emergency Department, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Nico L. Sosef
- 0000 0004 0568 6419grid.416219.9Department of Surgery, Spaarne Gasthuis, P.O. Box 770, 2130 AT Hoofddorp, The Netherlands
| | - Romuald van Velde
- Department of Surgery, Tergooi Hospitals, P.O. Box 10016, 1201 DA Hilversum, The Netherlands
| | - J. Carel Goslings
- grid.440209.bDepartment of Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands
| | - Niels W. L. Schep
- 0000 0004 0460 0556grid.416213.3Department of Trauma and Hand Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
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External validation of clinical decision rules for children with wrist trauma. Pediatr Radiol 2017; 47:590-598. [PMID: 28246898 PMCID: PMC5391386 DOI: 10.1007/s00247-017-3787-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/12/2016] [Accepted: 01/26/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs. OBJECTIVE The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rules in a different cohort of patients. Secondarily, we aimed to compare the performance of these rules with the validated Amsterdam Pediatric Wrist Rules. MATERIALS AND METHODS We included all studies that proposed a clinical prediction or decision rule in children presenting at the emergency department with acute wrist trauma. We performed external validation within a cohort of 379 children. We also calculated the sensitivity, specificity, negative predictive value and positive predictive value of each decision rule. RESULTS We included three clinical decision rules. The sensitivity and specificity of all clinical decision rules after external validation were between 94% and 99%, and 11% and 26%, respectively. After external validation 7% to 17% less radiographs would be ordered and 1.4% to 5.7% of all fractures would be missed. Compared to the Amsterdam Pediatric Wrist Rules only one of the three other rules had a higher sensitivity; however both the specificity and the reduction in requested radiographs were lower in the other three rules. CONCLUSION The sensitivity of the three non-validated clinical decision rules is high. However the specificity and the reduction in number of requested radiographs are low. In contrast, the validated Amsterdam Pediatric Wrist Rules has an acceptable sensitivity and the greatest reduction in radiographs, at 22%, without missing any clinically relevant fractures.
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Trimaille A, Kerfant N, Monnerie C, Le Nen D, Fenoll B, Henry AS, Hu W. La main traumatique de l’enfant. ANN CHIR PLAST ESTH 2016; 61:528-535. [DOI: 10.1016/j.anplas.2016.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
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Slaar A, Walenkamp MMJ, Bentohami A, Maas M, van Rijn RR, Steyerberg EW, Jager LC, Sosef NL, van Velde R, Ultee JM, Goslings JC, Schep NWL. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules. Pediatr Radiol 2016; 46:50-60. [PMID: 26298555 PMCID: PMC4706582 DOI: 10.1007/s00247-015-3436-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/26/2015] [Accepted: 07/09/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND In most hospitals, children with acute wrist trauma are routinely referred for radiography. OBJECTIVE To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. MATERIALS AND METHODS We prospectively developed and validated a clinical decision rule in two study populations. All children who presented in the emergency department of four hospitals with pain following wrist trauma were included and evaluated for 18 clinical variables. The outcome was a wrist fracture diagnosed by plain radiography. RESULTS Included in the study were 787 children. The prediction model consisted of six variables: age, swelling of the distal radius, visible deformation, distal radius tender to palpation, anatomical snuffbox tender to palpation, and painful or abnormal supination. The model showed an area under the receiver operator characteristics curve of 0.79 (95% CI: 0.76-0.83). The sensitivity and specificity were 95.9% and 37.3%, respectively. The use of this model would have resulted in a 22% absolute reduction of radiographic examinations. In a validation study, 7/170 fractures (4.1%, 95% CI: 1.7-8.3%) would have been missed using the decision model. CONCLUSION The decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required.
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Affiliation(s)
- Annelie Slaar
- Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Monique M. J. Walenkamp
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdelali Bentohami
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands
| | - Rick R. van Rijn
- Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands
| | - L. Cara Jager
- Emergency Department, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nico L. Sosef
- Department of Surgery, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Romuald van Velde
- Department of Surgery, Tergooi Hospitals, Hilversum, The Netherlands
| | - Jan M. Ultee
- Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - J. Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels W. L. Schep
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands ,Department of Surgery, Maasstadziekenhuis Rotterdam, Rotterdam, The Netherlands
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