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Mehta SP, Karagiannopoulos C, Pepin ME, Ballantyne BT, Michlovitz S, MacDermid JC, Grewal R, Martin RL. Distal Radius Fracture Rehabilitation. J Orthop Sports Phys Ther 2024; 54:CPG1-CPG78. [PMID: 39213418 DOI: 10.2519/jospt.2024.0301] [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: 09/04/2024]
Abstract
Distal radius fracture (DRF) is arguably the most common upper extremity fracture resulting from a fall accident. These clinical practice guidelines (CPG) were developed to guide all aspects of the management of DRF by physical therapists and other rehabilitation practitioners, such as certified hand therapists. This CPG employed a systematic review methodology to locate, appraise, and synthesize contemporary evidence while developing practice recommendations for determining the prognosis of outcomes, examination, and interventions while managing individuals with DRF. The quality of the primary studies found in the literature search was appraised using standardized tools. The strength of the available evidence for a particular practice domain (e.g., prognosis or intervention) was graded as strong, moderate, weak, or conflicting, where such gradings guided the level of obligation for each practice recommendation. Lastly, the CPG also provided the gaps in the evidence pool for the rehabilitation of DRF that future research efforts can address. J Orthop Sports Phys Ther 2024;54(9):CPG1-CPG78. doi:10.2519/jospt.2024.0301.
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Tutuncu MN, Demiroğlu M. Frykman Type 7-8 Distal Radius Fractures in Elderly Patients: Conservative Treatment vs Volar Plating. Cureus 2024; 16:e63035. [PMID: 39050320 PMCID: PMC11268264 DOI: 10.7759/cureus.63035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION The aim of this study was to determine the clinical outcomes of conservative and surgical treatments in elderly patients with displaced Frykman type 7-8 distal radius fractures. METHODS The clinical outcomes of 50 patients aged 60 and older with displaced Frykman type 7-8 fractures who underwent surgical and conservative treatments between January 2019 and January 2022 were determined. The joint range of motion, pain scores, functional scores, radiological parameters, and any complications that occurred posttreatment were evaluated for each patient who underwent both treatments. RESULTS Descriptive characteristics, excluding sex, were evaluated in 18 patients treated with casting and 32 patients treated with volar plating, and no statistically significant differences were detected between the groups. The functional and radiological assessments of the groups showed no significant differences (p>0.05). The volar tilt of patients who underwent surgical treatment was significantly greater than that of patients who were treated with a cast (p=0.02). The Mayo wrist scores of patients with step-offs greater than 2 mm were significantly lower (p=0.007; p<0.01). The visual analog scale (VAS) scores of patients who met the step-off criterion were significantly greater (p=0.025; p<0.05). The Mayo wrist scores of patients whose radiological parameters were within acceptable limits were significantly greater (p=0.007; p<0.01). The Quick-Quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores of patients whose radiological parameters were within acceptable limits were significantly lower (p=0.007; p<0.01). CONCLUSION In elderly patients with identified Frykman type 7-8 fractures, casting and volar plating treatments produced similar results. Especially in patients with low expectations and multiple comorbidities, satisfactory results can be achieved with plaster treatment.
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Affiliation(s)
- Mehmed Nuri Tutuncu
- Orthopaedics and Traumatology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, TUR
| | - Murat Demiroğlu
- Orthopaedics and Traumatology, Ataşehir Florence Nightingale Hospital, Istanbul, TUR
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Mert S, Stoerzer P, Brauer J, Fuchs B, Haas-Lützenberger EM, Demmer W, Giunta RE, Nuernberger T. Diagnostic power of ChatGPT 4 in distal radius fracture detection through wrist radiographs. Arch Orthop Trauma Surg 2024; 144:2461-2467. [PMID: 38578309 PMCID: PMC11093861 DOI: 10.1007/s00402-024-05298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Distal radius fractures rank among the most prevalent fractures in humans, necessitating accurate radiological imaging and interpretation for optimal diagnosis and treatment. In addition to human radiologists, artificial intelligence systems are increasingly employed for radiological assessments. Since 2023, ChatGPT 4 has offered image analysis capabilities, which can also be used for the analysis of wrist radiographs. This study evaluates the diagnostic power of ChatGPT 4 in identifying distal radius fractures, comparing it with a board-certified radiologist, a hand surgery resident, a medical student, and the well-established AI Gleamer BoneView™. Results demonstrate ChatGPT 4's good diagnostic accuracy (sensitivity 0.88, specificity 0.98, diagnostic power (AUC) 0.93), surpassing the medical student (sensitivity 0.98, specificity 0.72, diagnostic power (AUC) 0.85; p = 0.04) significantly. Nevertheless, the diagnostic power of ChatGPT 4 lags behind the hand surgery resident (sensitivity 0.99, specificity 0.98, diagnostic power (AUC) 0.985; p = 0.014) and Gleamer BoneView™(sensitivity 1.00, specificity 0.98, diagnostic power (AUC) 0.99; p = 0.006). This study highlights the utility and potential applications of artificial intelligence in modern medicine, emphasizing ChatGPT 4 as a valuable tool for enhancing diagnostic capabilities in the field of medical imaging.
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Affiliation(s)
- Sinan Mert
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany.
| | - Patrick Stoerzer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Johannes Brauer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Benedikt Fuchs
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | | | - Wolfram Demmer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Tim Nuernberger
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
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Bhattarai A, Subedi D, Bhandari J, Homagain S, Paudel S, Ghimire J. Neglected volar Barton fracture in adult managed in a rural setting: a case report. Ann Med Surg (Lond) 2024; 86:2330-2334. [PMID: 38576909 PMCID: PMC10990390 DOI: 10.1097/ms9.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Barton fractures are distal radius fractures that extend through the dorsal aspect of the articular surface, with associated dislocation of the radiocarpal joint. They are extremely unstable and require open reduction and internal fixation (ORIF). Delayed presentation is often encountered with difficulty in achieving reduction, and more extensive surgery may be needed. Here, we present a case of a 3-week-old neglected volar Barton fracture of the right wrist treated with the conventional method in a rural setting. Case presentation A 32-year-old gentleman was initially denied surgical intervention for a distal radius fracture he sustained after a motor vehicle accident and was discharged with a long arm slab plus analgesics represented in the outpatient department and agreed upon surgical intervention after his condition did not improve with conservative treatment. The trans-FCR (flexor carpi radialis) approach was used for surgery under the brachial plexus block. The fragment was reduced by applying pressure volarly into the distal radius and was confirmed with imaging. A K-wire (Kirschner) was used to temporarily hold the fragment. A volar distal radius locking plate was used to buttress the distal fragment. Final fixation was made using altogether six screws. The wrist was splinted in a short dorsal slab. Skin sutures were removed after 2 weeks, and an active assisted range of motion of the wrist was begun after 6 postoperative weeks. Discussion Volar Barton is an uncommon subset of intra-articular fractures and typically results from damage sustained at high speeds. The general agreement for neglected fractures is that 'fractures that are not handled or mishandled resulting in treatment delay, worsening of the fracture and even a disability' are to be considered neglected fractures. Rebuilding the damaged anatomy properly and enabling a prompt, problem-free recovery of hand function are the main objectives of treatment. As conservative therapy is often ineffective and rife with side effects, including early osteoarthrosis, deformity, subluxation, and instability, stabilization and anatomic reduction by surgery is the key to managing these fractures. Plating is one of the therapeutic modalities among various therapeutic modalities depicted in the literature that enables shorter time of immobilization and early restoration of wrist function through direct anatomic repair and stable internal fixation. In our case, the callus was relatively immature, and the original fracture site could easily be cleared. Also, there was no significant soft tissue shortening, and the volar fragment had not migrated proximally, in contrast to what is expected in prolonged neglected cases. Hence, the intraoperative reduction was possible, and the fracture was fixed with a volar locking plate as usual. Conclusion Given the modest tissue shortening and young callus, such cases may be treated as conventional Barton's fractures and managed using conventional means of fixation with locking buttress plates. However, it makes sense to prepare for potential malreduction by carrying K wires and wrist distractions. To restore complete function to the injured wrist, adequate physiotherapy and postoperative splinting are essential components of postoperative rehabilitation.
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Cha SM, Shin HD, Ga IH, Kim YH. Certain fracture patterns in children/adolescents would be better called 'Barton equivalent' fractures. J Pediatr Orthop B 2024:01202412-990000000-00176. [PMID: 38324634 DOI: 10.1097/bpb.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
We have encountered consecutive children/adolescents with a volar Barton fracture (VBF) pattern without involving the physis. These were managed by buttress plating; thus, we would like to report the radiological and clinical outcomes through retrospective case series and suggest the revisiting of the 'VBF category' in this population. We screened children/adolescents with a diagnosis of trauma to the bony structures in the wrist from 2008 to 2019. Of these patients, 16 who met our inclusion/exclusion criteria were investigated. At the final follow-up performed at least 2 years postoperatively, radiologic and clinical outcomes were evaluated. The mean age at the time of injury was 12.88 years old. At the final follow-up, the volar tiltings, radial inclinations and ulnar variances were 10.13°, 20.88° and -0.50 mm, respectively. None of these radiologic parameters were significantly different from the contralateral values, except the radial inclination. The mean visual analog scale score was 0.38. The mean range of motion arcs were 136.56° and 157.81° in the flexion-extension and pronation-supination arcs, respectively, and the grip strength was 22.00 kg. The mean modified Mayo Wrist Score was 92.8. The radiologic and clinical outcomes compared with the contralateral side were not significantly different from those in a previous report. A VBF pattern without involving the physis in the child/adolescent population was treated satisfactorily by buttress plating. Thus, including the previously reported 'SH-II in sagittal plane' injuries, the current injury pattern would be better called a 'Barton equivalent' fracture. Level of Evidence: Level IV, retrospective case series.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital and Chungnam National University School of Medicine, Daejeon, Korea
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Neijhoft J, Sterz J, Rüsseler M, Britz V, Bepler L, Freund V, Horz C, Henrich D, Marzi I, Janko M. Evaluation of a 3D-printed hands-on radius fracture model during teaching courses. Eur J Trauma Emerg Surg 2024; 50:49-57. [PMID: 37524864 PMCID: PMC10923998 DOI: 10.1007/s00068-023-02327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of a 3D-printed hands-on radius fracture model for teaching courses. The model was designed to enhance understanding and knowledge of radius fractures among medical students during their clinical training. METHODS The 3D models of radius fractures were generated using CT scans and computer-aided design software. The models were then 3D printed using Fused-Filament-Fabrication (FFF) technology. A total of 170 undergraduate medical students participated in the study and were divided into three groups. Each group was assigned one of three learning aids: conventional X-ray, CT data, or a 3D-printed model. After learning about the fractures, students completed a questionnaire to assess their understanding of fracture mechanisms, ability to assign fractures to the AO classification, knowledge of surgical procedures, and perception of the teaching method as well as the influence of such courses on their interest in the specialty of trauma surgery. Additionally, students were tested on their ability to allocate postoperative X-ray images to the correct preoperative image or model and to classify them to the AO classification. RESULTS The 3D models were well received by the students, who rated them as at least equal or better than traditional methods such as X-ray and CT scans. Students felt that the 3D models improved their understanding of fracture mechanisms and their ability to explain surgical procedures. The results of the allocation test showed that the combination of the 3D model and X-ray yielded the highest accuracy in classifying fractures according to the AO classification system, although the results were not statistically significant. CONCLUSION The 3D-printed hands-on radius fracture model proved to be an effective teaching tool for enhancing students' understanding of fracture anatomy. The combination of 3D models with the traditional imaging methods improved students' ability to classify fractures and allocate postoperative images correctly.
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Affiliation(s)
- Jonas Neijhoft
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Jasmina Sterz
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Miriam Rüsseler
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Vanessa Britz
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Lena Bepler
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Verena Freund
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt am Main, Germany
| | - Christian Horz
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Dirk Henrich
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Maren Janko
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Peña-Martínez VM, Villanueva-Guerra E, Tamez-Mata Y, Simental-Mendía M, Gallardo-Madrid A, Blázquez-Saldaña J, Acosta-Olivo C. Distal radius fractures: Classifications concordance among orthopedic residents on a teaching hospital. J Orthop Sci 2024; 29:133-137. [PMID: 36460558 DOI: 10.1016/j.jos.2022.11.010] [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: 07/13/2022] [Revised: 09/20/2022] [Accepted: 11/06/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Several classification systems have been developed to support orthopedic surgeons regarding diagnostic, treatment, or prognostic outcomes of distal radius fracture (DRF). However, the best classification system for this fracture remains controversial. We aimed to identify the reliability of three different DRF classifications among orthopedists in training (medical residents). METHODS Orthopedic residents (n = 22) evaluated thirty cases of DRF in anteroposterior and lateral projections in three different periods (0, 6, 12 months). Each radiography was sorted with three different classifications: Frykman, AO/OTA, and Jupiter-Fernandez. All assessments were blinded to the investigators. The inter- and intra-observer reliability was evaluated using the Cohen's kappa coefficient. An additional analysis was performed for a simpler sub-classification of the AO/OTA (27, 9, or 3 groups). RESULTS Inter-observer agreement for AO/OTA, Frykman, and Jupiter-Fernandez classifications was slight (k = 0.15), fair (k = 0.31), and fair (k = 0.30), respectively. Intra-observer agreement showed similar results: AO/OTA, k = 0.14; Frykman, k = 0.28; and Jupiter-Fernandez, k = 0.28. When the AO/OTA classification was simplified (9 or 3 descriptions), the inter-observer agreement improved from slight (k = 0.16) to fair (k = 0.21 and k = 0.30, respectively). A similar improvement from slight (k = 0.14) to fair (k = 0.32 and k = 0.21) was detected for intra-observer agreement. CONCLUSIONS The more complex the DRF classification system, the more complex is to reach reliable inter- and intra-observer agreements between orthopedic trainees. Senior residents did not necessarily show greater kappa values in DRF classifications.
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Affiliation(s)
- Victor M Peña-Martínez
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", School of Medicine, Monterrey, Mexico
| | - Enrique Villanueva-Guerra
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", School of Medicine, Monterrey, Mexico
| | - Yadira Tamez-Mata
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", School of Medicine, Monterrey, Mexico
| | - Mario Simental-Mendía
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", School of Medicine, Monterrey, Mexico
| | - Alejandro Gallardo-Madrid
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", School of Medicine, Monterrey, Mexico
| | - Jaime Blázquez-Saldaña
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", School of Medicine, Monterrey, Mexico
| | - Carlos Acosta-Olivo
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", School of Medicine, Monterrey, Mexico.
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Soerensen S, Larsen P, Korup LR, Ceccotti AA, Larsen MB, Filtenborg JT, Weighert KP, Elsoe R. Epidemiology of Distal Forearm Fracture: A Population-Based Study of 5426 Fractures. Hand (N Y) 2024; 19:24-29. [PMID: 35856325 PMCID: PMC10786118 DOI: 10.1177/15589447221109967] [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: 11/17/2022]
Abstract
BACKGROUND Despite intensive research into the epidemiology of adult distal forearm fractures, the literature is limited. This study aimed to provide a full overview of adult distal forearm fracture epidemiology, including incidence, fracture classification, mode of injury, and trauma mechanism in patients sustaining a distal forearm fracture, based on an accurate at-risk population with manually validated data leading to a high quality in data. METHODS This was a population-based cohort study with a manual review of X-rays and charts. The primary outcome measure was the incidence of adult distal forearm fractures. The study was based on an average at-risk population of 522 607 citizens. A total of 5426 adult distal forearm fractures were included during the study period. Females accounted for 4199 (77%) and males accounted for 1227 (23%) of fractures. RESULTS The overall incidence of adult distal forearm fractures was 207.7/100 000/year. Female incidence was 323.4/100 000/year, and male incidence was 93.3/100 000/year. A marked increase in incidence with increasing age was observed for females after 50 years of age. The incidence of distal radius fractures was 203.0/100 000/year, and the incidence of isolated ulna fractures was 3.8/100 000/year. The most common fracture type was an extra-articular AO type 2R3A (69%), and the most common mode of injury was a fall from own height (76%). A small non-trending year-to-year variation was observed during the 5-year study period. CONCLUSION Results show that adult distal forearm fractures are very common in women after the postmenopausal period. The overall incidence of adult distal forearm fractures was 207.8/100 000/year. Female incidence was 323.4/100 000/year.
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Sagerfors M, Jakobsson H, Wretenberg P, Brus O, Möller M. Treatment and outcome of AO/OTA type C distal radius fractures: 12 199 fractures from the Swedish Fracture Register. Acta Orthop Belg 2023; 89:241-247. [PMID: 37924540 DOI: 10.52628/89.2.11473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The aim of this study was to examine the epidemiology, treatment, and patient-reported outcome of AO/OTA type C distal radius fractures (DRF) using data from a large national fracture register. We used prospectively collected data from the Swedish Fracture Register covering all AO/OTA type C DRFs registered between April 2012 and December 2018. Data on fracture type, epidemiology, trauma-mechanism, and treatment had been recorded by the treating physician. Patients had been sent an outcome questionnaire including EQ-VAS, EQ-5D, and the SMFA at the time of injury and 12 months after. A total of 12 199 cases with AO/OTA type C fracture were identified. AO/OTA type C1 fracture was most common, with 5400 cases, followed by AO type C2 with 4304 and AO/OTA type C3 with 2495. Cast treatment and surgical treatment with volar locking plate fixation were the most common treatments. Patient-reported outcome measures worsened significantly one year after the fracture, and 56% reported moderate problems with pain and discomfort one year after the fracture. Patients treated with a volar plate reported a significantly larger deterioration in EQ-5D outcome compared to patients treated with a cast. No treatment method was found to be superior. A good outcome after a type C fracture is possible, but many patients do not recover completely. Our findings indicate a relatively better self-reported outcome for patients treated with a cast, but as treatment was not randomized the clinical relevance is unclear.
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Min H, Rabi Y, Wadhawan A, Bourgeat P, Dowling J, White J, Tchernegovski A, Formanek B, Schuetz M, Mitchell G, Williamson F, Hacking C, Tetsworth K, Schmutz B. Automatic classification of distal radius fracture using a two-stage ensemble deep learning framework. Phys Eng Sci Med 2023; 46:877-886. [PMID: 37103672 DOI: 10.1007/s13246-023-01261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
Distal radius fractures (DRFs) are one of the most common types of wrist fracture and can be subdivided into intra- and extra-articular fractures. Compared with extra-articular DRFs which spare the joint surface, intra-articular DRFs extend to the articular surface and can be more difficult to treat. Identification of articular involvement can provide valuable information about the characteristics of fracture patterns. In this study, a two-stage ensemble deep learning framework was proposed to differentiate intra- and extra-articular DRFs automatically on posteroanterior (PA) view wrist X-rays. The framework firstly detects the distal radius region of interest (ROI) using an ensemble model of YOLOv5 networks, which imitates the clinicians' search pattern of zooming in on relevant regions to assess abnormalities. Secondly, an ensemble model of EfficientNet-B3 networks classifies the fractures in the detected ROIs into intra- and extra-articular. The framework achieved an area under the receiver operating characteristic curve of 0.82, an accuracy of 0.81, a true positive rate of 0.83 and a false positive rate of 0.27 (specificity of 0.73) for differentiating intra- from extra-articular DRFs. This study has demonstrated the potential in automatic DRF characterization using deep learning on clinically acquired wrist radiographs and can serve as a baseline for further research in incorporating multi-view information for fracture classification.
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Affiliation(s)
- Hang Min
- CSIRO Australian e-Health Research Centre, Herston, QLD, Australia.
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
- South Western Clinical School, University of New South Wales, Sydney, Australia.
| | - Yousef Rabi
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ashish Wadhawan
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | | | - Jason Dowling
- CSIRO Australian e-Health Research Centre, Herston, QLD, Australia
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Institute of Medical Physics, The University of Sydney, Sydney, NSW, Australia
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Jordy White
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Medical School, University of Queensland, Brisbane, QLD, Australia
| | | | - Blake Formanek
- Ochsner Clinical School, University of Queensland School of Medicine, Brisbane, QLD, Australia
| | - Michael Schuetz
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre of Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Gary Mitchell
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Medical School, University of Queensland, Brisbane, QLD, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
| | - Frances Williamson
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Medical School, University of Queensland, Brisbane, QLD, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
| | - Craig Hacking
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Medical School, University of Queensland, Brisbane, QLD, Australia
| | - Kevin Tetsworth
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Beat Schmutz
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- Jamieson Trauma Institute, Herston, QLD, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre of Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD, Australia
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Rigney B, Casey C, McDonald C, Pomeroy E, Cleary MS. Distal radius fracture fixation using WALANT versus general and regional anesthesia: A systematic review and meta-analysis. Surgeon 2023; 21:e13-e22. [PMID: 35216922 DOI: 10.1016/j.surge.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/04/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND WALANT (wide-awake local anaesthetic no tourniquet) has become a popular technique in upper limb surgery including distal radius fracture fixation. The purpose of this systematic review and meta-analysis is to assess the effectiveness of the WALANT technique in distal radius fracture fixation, and to compare it to both general and regional anaesthesia. METHODS Pubmed, Embase, and Scopus databases were searched on 26/06/21 according to the PRISMA guidelines with the following search terms: radius, WALANT, "local anesthetic", wide-awake surgery. All studies comparing WALANT with other forms of anaesthesia for distal radius fracture fixation were included. RESULTS 110 articles were identified, six studies (410 patients) were included, 164 of these patients were in the WALANT group. Two patients (1.2%) in the WALANT group and seven (6.5%) in the regional anaesthesia group required conversion to general anaesthesia. There was no statistically significant difference in post-operative complications, intra-operative VAS pain scores, operative times, functional or radiological outcomes. A statistically significant 8.6 mls increase in pooled mean blood loss in the WALANT group was noted (p = 0.02) although the clinical significance of this is doubtful. CONCLUSION The WALANT technique for distal radius fracture fixation is non-inferior to regional and general anaesthesia. It is a safe and effective technique that surgeons may consider utilising, especially for patients not suitable for general anaesthetic or in centres in which there is a lack of access to specialist anaesthetic equipment and care.
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Affiliation(s)
- Brian Rigney
- Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland; Discipline of Surgery, National University of Ireland Galway, Galway, Ireland.
| | - Conor Casey
- Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland
| | - Ciaran McDonald
- Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland
| | - Eoghan Pomeroy
- Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland
| | - May S Cleary
- Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland; Department of Surgery, College of Medicine & Health, University College Cork, Cork, Ireland
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12
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Lundqvist E, Fischer P, Wretenberg P, Krauss W, Sagerfors M. Posttraumatic Arthritis After Combined Plating of Distal Radius Fractures AO Type C: A 7-Year Follow-up of 97 Cases. Hand (N Y) 2022; 17:50S-59S. [PMID: 34490825 PMCID: PMC9793614 DOI: 10.1177/15589447211028991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Volar locking plate fixation is the most common method of operative fixation of distal radius fractures (DRFs). For more complex cases, combined plating is an option for stabilizing intra-articular fragments. The prevalence of posttraumatic arthritis (PA) after an intra-articular DRF, and its relation to patient-reported outcome measures (PROMs), remains unclear. The purpose of this study was to study the prevalence of PA and its correlation to clinical outcome measures. METHODS We evaluated 97 consecutive patients with intra-articular DRF, operated with combined plating, 7 years postoperatively. The primary outcome measure was the prevalence of radiographic PA. Secondary outcome measures included visual analog scale (VAS) pain score, hand grip strength, wrist range of motion (ROM), Patient-Rated Wrist Evaluation (PRWE) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographic examination was performed between 1 and 7 years postoperatively. RESULTS The prevalence of PA was 29% at the 7-year follow-up. No correlation was found between PA and ROM, hand grip strength, PRWE, QuickDASH, VAS pain scores, or radiographic reduction. Median wrist ROM and grip strength were significantly inferior compared with the uninjured side. Hardware removal was performed in 51.5% of cases. There were 2 cases of tendon ruptures. CONCLUSIONS Combined plating can yield a good clinical outcome 7 years postoperatively and a low prevalence of PA. The presence of PA did not correlate to clinical outcome measures or to the accuracy of anatomical reduction 1 year postoperatively. The frequency of tendon ruptures was acceptable, but the high frequency of hardware removal is a concern.
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Affiliation(s)
- Eva Lundqvist
- Örebro University, Sweden
- Örebro University Hospital,
Sweden
| | - Per Fischer
- Örebro University, Sweden
- Karlstad Central Hospital, Sweden
| | - Per Wretenberg
- Örebro University, Sweden
- Örebro University Hospital,
Sweden
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13
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Carula BC, Giostri GS, Bebber F, Batista MFDS, Silva FBD, Novak EM. Evaluation of Intra- and Interobserver Reproducibility of the New AO/OTA Classification for Distal Radius Fractures Compared with the Fernandez Classification. Rev Bras Ortop 2022; 57:917-923. [PMID: 36540737 PMCID: PMC9757955 DOI: 10.1055/s-0041-1740471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/13/2021] [Indexed: 10/14/2022] Open
Abstract
Objective To evaluate the inter- and intraobserver reliability and reproducibility of the new AO/OTA 2018 classification for distal radius fractures and to compare it with the Fernandez classification system. Method A questionnaire was applied in the Qualtrics software on 10 specialists in hand surgery who classified 50 radiographs of distal radius fractures according to the Fernandez and AO/OTA 2018 classifications and, subsequently, indicated their treatment. The questionnaire was applied in time T0 and repeated after 4 weeks (t1) . The mean agreement between the answers, and the reliability and inter- and intraobserver reproducibility were analyzed using kappa indexes. Results The mean interobserver agreement in the Fernandez classification was 76.4, and it was 59.2% in the AO/OTA 2018 classification. The intraobserver agreements were 77.3 and 56.6%, respectively. The inter- and intraobserver kappa indexes for the Fernandez classification were 0.57 and 0.55, respectively, and, in the AO/OTA 2018 classification, they were 0.34 and 0.31, respectively. Conclusion The AO/OTA 2018 classification showed a low intra- and interobserver reproducibility when compared with the Fernandez classification. However, both classifications have low intra- and interobserver indexes. Although the Fernandez classification did not obtain excellent results, it remains with better agreement for routine use.
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Affiliation(s)
- Beatriz Canhoto Carula
- Hospital Universitário Cajuru, Curitiba, PR, Brasil,Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brasil,Endereço para correspondência Beatriz Canhoto Carula, MD Rua Desembargador Mota1648, Curitiba, PRBrasil
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14
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Volar Locking Plate Compared With Combined Plating of AO Type C Distal Radius Fractures: A Randomized Controlled Study of 150 Cases. J Hand Surg Am 2022; 47:813-822. [PMID: 35842329 DOI: 10.1016/j.jhsa.2022.04.018] [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: 12/09/2021] [Revised: 03/20/2022] [Accepted: 04/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating. METHODS In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score. RESULTS Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group. CONCLUSIONS In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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15
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Candela V, Di Lucia P, Carnevali C, Milanese A, Spagnoli A, Villani C, Gumina S. Epidemiology of distal radius fractures: a detailed survey on a large sample of patients in a suburban area. J Orthop Traumatol 2022; 23:43. [PMID: 36040542 PMCID: PMC9428104 DOI: 10.1186/s10195-022-00663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Literature lacks data on correlations between epidemiology and clinical data of patients with distal radius fractures (DRFs). Aim The aim of this study was to present a detailed epidemiologic survey of a large consecutive series of patient with DRFs. Materials and Methods This retrospective study included 827 consecutive patients (579 females, 248 men) who sustained a DRFs in the last 5 years. All fractures were radiographically evaluated. DRFs were classified according to Association of Osteosynthesis classification. Data on age, gender, side, period in which fracture occurred, and fracture mechanism were collected. Statistical analysis was performed. Results The patients’ mean age was 60.23 [standard deviation (SD) 16.65] years, with the left side being most frequently involved (56.1%). The mean age of females at the time of fracture was significantly higher than that of males. The most frequent pattern of fracture was the complete articular fracture (64.3%), while the most represented fracture type was 2R3A2.2 (21.5%). Regarding the period in which the fracture occurred, 305 DRFs (37.5%) were observed in the warmer months and 272 (33.4%) in the colder months. Low-energy trauma occurring outside home was found to be the major cause of DRF throughout the year. In both genders, trauma mechanism 2 was more frequent (59.4% F; 31.9% M; p < 0.01). A bimodal distribution of fracture mechanisms was found in males when considering the patient’s age with a high-energy mechanism of fracture (3 and 4), identified in 21% (n = 52) of males aged 18–45 years, and a low-energy mechanism (1 and 2) was observed in 39.9% (n = 99) of males aged > 45 years. A significant correlation between all trauma mechanisms (from 1 to 6) and different fracture patterns (complete, partial, and extraarticular) was found (p value < 0.001). The mean age of patients with extraarticular fractures (mean age 61.75 years; SD 18.18 years) was higher than that of those with complete (mean age 59.84 years; SD 15.67 years) and partial fractures (mean age 55.26 years; SD 18.31 years). Furthermore, considering different fracture patterns and patient age groups, a statistically significant difference was found (p < 0.001). Conclusions DRFs have a higher prevalence in females, an increase in incidence with older age, and no seasonal predisposition. Low-energy trauma occurring at home is the main cause of fracture among younger males sustaining fractures after sports trauma; Complete articular is the most frequent fracture pattern, while 2R3A2.2 is most frequent fracture type. Level of evidence Level IV; case series; descriptive epidemiology study.
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Affiliation(s)
- V Candela
- Dept. of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - P Di Lucia
- Dept. of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - C Carnevali
- Dept. of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - A Milanese
- Dept. of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - A Spagnoli
- Dept. of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Villani
- Dept. of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Stefano Gumina
- Dept. of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy.
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16
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Zhang L, Wang M, Liu Z, Wang Y, Sun Y, Zhu Z, Wang X, Liu F, Cui Y. Open Reduction and Internal Fixation by Volar Locking Plates and the "Poking Reduction" Technique in Distal Radius Fractures with Displaced Dorsal Ulnar Fragments: A Retrospective Study. Orthop Surg 2022; 14:2489-2498. [PMID: 36017756 PMCID: PMC9531059 DOI: 10.1111/os.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
Objective To investigate the clinical and radiological outcomes of distal radius fractures (DRFs) with displaced dorsal ulnar fragments treated with volar locking plate (VLP) and the “poking reduction” technique. Methods Between January 2014 and January 2019, 78 unilateral DRFs with displaced dorsal ulnar fragment (AO type C3) treated with VLP were conducted. According to the reduction technique of the dorsal ulnar fragment, the patients were divided into the conventional reduction (CRG) group (33 patients, 14 males and 19 females, mean age 57.2 ± 12.1 years old) and the “poking reduction” (PRG) group (45 patients, 11 males and 34 females, mean age 60.1 ± 12.4 years old). According to the AO classification, there were 21 cases of C3.1 and 12 of C3.2 in the CPG group, 27 cases of C3.1 and 18 of C3.2 in the PRG group. Clinical and radiographic data were extracted from the electronic medical record system. These data were reviewed for clinical outcomes (range of motion, grip strength), radiological outcomes (volar tilt, radial inclination, radial height, step of articular surface), and postoperative complications. The final functional recovery was evaluated by the disabilities of the arm, shoulder, and hand (DASH) score. Results The mean duration of follow‐up was 27 months (range from 12 to 56). The average operation time and intraoperative blood loss did not significantly differ between groups (p > 0.05). Postoperative CT examination showed that the step of articular surface in CPG group (0.8 ± 0.3 mm) was larger than that in PRG group (0.5 ± 0.2 mm) (p < 0.001). The DASH score did not significantly differ between groups (26.1 ± 4.6 in CRG and 24.7 ± 4.0 in PRG, p > 0.05) at 3 months postoperatively. At 6 months and 12 months postoperatively, the DASH score was better in PRG group (11.8 ± 2.5 and 10.4 ± 2.0) than in CRG group (13.6 ± 2.7 and 12.2 ± 2.5) (p = 0.004, p = 0.001, respectively). At 12 months postoperatively, wrist range of motion did not significantly differ between groups (p > 0.05). There was no significant difference in radiological parameters between the two groups (p > 0.05). The incidence of complications was higher in the CRG group (7/33) than in the PRG group (2/45) (p = 0.009). Conclusion The “poking reduction” technique is a wise option for reduction of dorsal ulnar fragment in DRFs. This innovative technique could restore smoothness of the radiocarpal joint effectively, and the dorsal ulnar fragment could be fixed effectively combined with the volar plate.
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Affiliation(s)
- Linyuan Zhang
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Mengran Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiqing Liu
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yueting Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen'an Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuhui Wang
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Fengxiang Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yin Cui
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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17
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Sagerfors M, Jakobsson H, Thórdardóttir Á, Wretenberg P, Möller M. Distal radius fractures in the superelderly: an observational study of 8486 cases from the Swedish fracture register. BMC Geriatr 2022; 22:140. [PMID: 35183121 PMCID: PMC8857784 DOI: 10.1186/s12877-022-02825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The distal radius fracture (DRF) is the most common fracture in adults. With an ageing population, the number of wrist fractures in the superelderly (≥ 80 years) is expected to rise. Optimal treatment for displaced DRFs remains controversial, especially in the superelderly group. In addition, basic knowledge of the outcome after a DRF in this heterogenic group is lacking. The aim of this study was to study injury characteristics, treatment and outcome of DRFs in superelderly patients using data from a large national register. Methods We used prospectively collected data from the Swedish Fracture Register. All distal radius fractures registered between April 2012 and December 2018 in patients ≥ 80 years of age were included. Data on epidemiology, fracture type, trauma mechanism and treatment are registered by the physician treating the patient. Patients are also sent a subjective outcome questionnaire including EQ-5D, EQ-VAS and Short Musculoskeletal Function Assessment questionnaire (SMFA-score) at the time of injury and after 12 months. The 12-month questionnaire was sent to those who had completed the questionnaire at the time of injury. A Mann–Whitney U-test was used to assess differences between treatment methods. Results Mean age for this population was 86 years (80–105 years), a majority of the patients were female (86.7%). The dominating injury mechanism was a simple fall (74.6%) in the patient’s residence. The majority of fractures were AO type A (70%) followed by AO type C (20.9%) and type B (8.6%). The incidence of open fractures was significantly higher in females (2.6%) compared to males (1.5%). A majority of the fractures were treated with a cast (87.5%) with volar locking plate as the second most common treatment method (6.6%). Patient-reported outcome measures (PROMs) EQ-5D, EQ-VAS and the Arm Hand Function Index of the SMFA-score deteriorated somewhat one year after injury compared to pre-injury. PROMs did not correlate to treatment with cast or a volar plate. Conclusions This nationwide register study provides detailed data on DRFs in the superelderly regarding epidemiology, treatment and self-reported outcome. A good self-reported outcome is possible, but many patients do not recover completely. PROMs did not correlate to type of treatment. The frequency of open fractures was significantly higher in females. The reason for this is unclear but different skin thickness in older males versus females may be one explanation.
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Affiliation(s)
- Marcus Sagerfors
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden.
| | - Hugo Jakobsson
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden
| | - Ásgerdur Thórdardóttir
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden
| | - Per Wretenberg
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Suzuki T, Maki S, Yamazaki T, Wakita H, Toguchi Y, Horii M, Yamauchi T, Kawamura K, Aramomi M, Sugiyama H, Matsuura Y, Yamashita T, Orita S, Ohtori S. Detecting Distal Radial Fractures from Wrist Radiographs Using a Deep Convolutional Neural Network with an Accuracy Comparable to Hand Orthopedic Surgeons. J Digit Imaging 2022; 35:39-46. [PMID: 34913132 PMCID: PMC8854542 DOI: 10.1007/s10278-021-00519-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 02/03/2023] Open
Abstract
In recent years, fracture image diagnosis using a convolutional neural network (CNN) has been reported. The purpose of the present study was to evaluate the ability of CNN to diagnose distal radius fractures (DRFs) using frontal and lateral wrist radiographs. We included 503 cases of DRF diagnosed by plain radiographs and 289 cases without fracture. We implemented the CNN model using Keras and Tensorflow. Frontal and lateral views of wrist radiographs were manually cropped and trained separately. Fine-tuning was performed using EfficientNets. The diagnostic ability of CNN was evaluated using 150 images with and without fractures from anteroposterior and lateral radiographs. The CNN model diagnosed DRF based on three views: frontal view, lateral view, and both frontal and lateral view. We determined the sensitivity, specificity, and accuracy of the CNN model, plotted a receiver operating characteristic (ROC) curve, and calculated the area under the ROC curve (AUC). We further compared performances between the CNN and three hand orthopedic surgeons. EfficientNet-B2 in the frontal view and EfficientNet-B4 in the lateral view showed highest accuracy on the validation dataset, and these models were used for combined views. The accuracy, sensitivity, and specificity of the CNN based on both anteroposterior and lateral radiographs were 99.3, 98.7, and 100, respectively. The accuracy of the CNN was equal to or better than that of three orthopedic surgeons. The AUC of the CNN on the combined views was 0.993. The CNN model exhibited high accuracy in the diagnosis of distal radius fracture with a plain radiograph.
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Affiliation(s)
- Takeshi Suzuki
- Department of Orthopedic Surgery, Tonosho Hospital, Chiba, Japan
| | - Satoshi Maki
- grid.136304.30000 0004 0370 1101Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670 Japan ,grid.136304.30000 0004 0370 1101Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Takahiro Yamazaki
- grid.136304.30000 0004 0370 1101Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670 Japan
| | - Hiromasa Wakita
- grid.136304.30000 0004 0370 1101Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670 Japan
| | - Yasunari Toguchi
- grid.136304.30000 0004 0370 1101Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670 Japan
| | - Manato Horii
- grid.136304.30000 0004 0370 1101Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670 Japan
| | - Tomonori Yamauchi
- grid.413946.dDepartment of Orthopedic Surgery, Asahi General Hospital, Chiba, Japan
| | - Koui Kawamura
- grid.413946.dDepartment of Orthopedic Surgery, Asahi General Hospital, Chiba, Japan
| | - Masaaki Aramomi
- grid.413946.dDepartment of Orthopedic Surgery, Asahi General Hospital, Chiba, Japan
| | - Hiroshi Sugiyama
- grid.413946.dDepartment of Orthopedic Surgery, Asahi General Hospital, Chiba, Japan
| | - Yusuke Matsuura
- grid.136304.30000 0004 0370 1101Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670 Japan
| | - Takeshi Yamashita
- Department of Orthopaedic Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Sumihisa Orita
- grid.136304.30000 0004 0370 1101Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670 Japan ,grid.136304.30000 0004 0370 1101Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- grid.136304.30000 0004 0370 1101Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670 Japan
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Hruby LA, Haider T, Laggner R, Gahleitner C, Erhart J, Stoik W, Hajdu S, Thalhammer G. Standard radiographic assessments of distal radius fractures miss involvement of the distal radioulnar joint: a diagnostic study. Arch Orthop Trauma Surg 2022; 142:1075-1082. [PMID: 33558991 PMCID: PMC9110479 DOI: 10.1007/s00402-021-03801-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/20/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Distal radius fractures account for one-fifth of all fractures in the emergency department. Their classification based on standard radiographs is common practice although low inter-observer reliabilities and superiority of computer tomography (CT) scanning in evaluation of joint congruency have been reported. MATERIALS AND METHODS We retrospectively analyzed 96 displaced distal radius fractures scheduled for open reduction and internal fixation using standard radiographic assessment. The radiographs were classified with the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA), Fernandez and Frykman classifications by three observers and inter-rater reliabilities were calculated. Additional CT scanning was performed in all cases and the following parameters were assessed: radiocarpal joint involvement, fracture extent into the radial sigmoid notch, i.e. the distal radio-ulnar joint, comminution of the metaphysis, and concomitant ulnar styloid fracture. The CT scans were used as a reference standard to determine sensitivity and accuracy of standard radiographic assessment in evaluation of distal radius fractures. RESULTS The inter-rater agreement for the AO classification was 35.4%, 68.8% for the Fernandez and 38.5% for the Frykman classification. Fracture extension into the radiocarpal joint was present in 81 cases (84.4%). Sigmoid notch involvement was found in 81 fractures (84.4%). Involvement of both joints was present in 72 cases (75%). The sensitivity of standard radiographs regarding radiocarpal joint involvement was 93.8%. Considering involvement of the distal radio-ulnar joint the false-negative rate using standard radiographs was 61.7% and the test's accuracy for sigmoid notch involvement was 45.8%. CONCLUSION This study demonstrates that involvement of the sigmoid notch is frequently missed in standard radiographs. The presented data support the frequent use of CT imaging to allow the holistic illustration of a fracture's complexion and to ensure optimal pre-operative planning.
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Affiliation(s)
- Laura A. Hruby
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria ,Department of Orthopedics and Traumatology, Hospital of the St. John of God Brothers Eisenstadt, Johannes von Gott-Platz 1, 7000 Eisenstadt, Austria
| | - Roberta Laggner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Claudia Gahleitner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Jochen Erhart
- Department of Orthopedics and Traumatology, Hospital of the St. John of God Brothers Eisenstadt, Johannes von Gott-Platz 1, 7000 Eisenstadt, Austria
| | - Walter Stoik
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Gerhild Thalhammer
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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20
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De Jonge MC, Assink J, Vanhoenacker FM. Acute Bony Injuries of Hand and Wrist. Semin Musculoskelet Radiol 2021; 25:277-293. [PMID: 34374063 DOI: 10.1055/s-0041-1729151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. At the carpal level, scaphoid fractures are the most common followed by fractures of the dorsal side of the triquetrum. The metacarpals often fracture, most commonly the base of the thumb and the subcapital region of the fifth metacarpal. In the fingers, we encounter many different types of fractures, often avulsions reflecting underlying soft tissue pathology (e.g., mallet finger). Dislocations are common in the fingers, predominantly in the distal interphalangeal joints. From an imaging standpoint, conventional radiography is always the initial examination. Complex (intra-articular) fractures, fracture-dislocation injuries, and a strong clinical suspicion of radiographically occult fractures need to be further evaluated for decision making regarding treatment. Computed tomography is the primary imaging modality of choice for the first two. In the latter, magnetic resonance imaging can be preferable, depending on clinical suspicion and the local situation in the associated hospital.
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Affiliation(s)
- Milko C De Jonge
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Joeri Assink
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium.,Department of Radiology, Ghent University Hospital, Ghent, Belgium
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21
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Bergvall M, Bergdahl C, Ekholm C, Wennergren D. Validity of classification of distal radial fractures in the Swedish fracture register. BMC Musculoskelet Disord 2021; 22:587. [PMID: 34174861 PMCID: PMC8235642 DOI: 10.1186/s12891-021-04473-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background Distal radial fractures (DRF) are one of the most common fractures with a small peak in incidence among young males and an increasing incidence with age among women. The reliable classification of fractures is important, as classification provides a framework for communicating effectively on clinical cases. Fracture classification is also a prerequisite for data collection in national quality registers and for clinical research. Since its inception in 2011, the Swedish Fracture Register (SFR) has collected data on more than 490,000 fractures. The attending physician classifies the fracture according to the AO/OTA classification upon registration in the SFR. Previous studies regarding the classification of distal radial fractures (DRF) have shown difficulties in inter- and intra-observer agreement. This study aims to assess the accuracy of the registration of DRF in adults in the SFR as it is carried out in clinical practice. Methods A reference group of three experienced orthopaedic trauma surgeons classified 128 DRFs, randomly retrieved from the SFR, at two classification sessions 6 weeks apart. The classification the reference group agreed on was regarded as the gold standard classification for each fracture. The accuracy of the classification in the SFR was defined as the agreement between the gold standard classification and the classification in the SFR. Inter- and intra-observer agreement was evaluated and the degree of agreement was calculated as Cohen’s kappa. Results The accuracy of the classification of DRF in the SFR was kappa = 0.41 (0.31–0.51) for the AO/OTA subgroup/group and kappa = 0.48 (0.36–0.61) for the AO/OTA type. This corresponds to moderate agreement. Inter-observer agreement ranged from kappa 0.22–0.48 for the AO/OTA subgroup/group and kappa 0.48–0.76 for the AO/OTA type. Intra-observer agreement ranged from kappa 0.52–0.70 for the AO/OTA subgroup/group and kappa 0.71–0.76 for the AO/OTA type. Conclusions The study shows moderate accuracy in the classification of DRF in the SFR. Although the degree of accuracy for DRF appears to be lower than for other fracture locations, the accuracy shown in the current study is similar to that in previous studies of DRF.
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Affiliation(s)
- Malena Bergvall
- Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45 Göteborg, Gothenburg/Mölndal, Sweden
| | - Carl Bergdahl
- Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45 Göteborg, Gothenburg/Mölndal, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Ekholm
- Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45 Göteborg, Gothenburg/Mölndal, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Wennergren
- Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45 Göteborg, Gothenburg/Mölndal, Sweden. .,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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22
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Desiree RM, Kabir R. Wrist fracture management and the role of surgical care practitioner through the patient's journey. J Perioper Pract 2021; 32:115-122. [PMID: 34112025 DOI: 10.1177/1750458920976070] [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: 11/16/2022]
Abstract
The presentation of this case study involves an exploration of the patient's journey in detail after having a traumatic wrist fracture, which is recognised as one of the most common fractures encountered daily in emergency services by junior doctors and practitioners. However, this article not only analyses the medical guidance for this type of case, but also the importance of the surgical care practitioner role in trauma and orthopaedics. All practitioners attending patients in emergency services are required to develop a good knowledge of anatomy, physiology, patient's examination technique, classifications and consequently being aware of the possible surgical options for treatment of the fracture. They will also need to fully understand the legal implications of consent to ensure safe practice.
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Affiliation(s)
- Rojas Moya Desiree
- School of Allied Health, Faculty of HEMS, Anglia Ruskin University, Essex, UK
| | - Russell Kabir
- School of Allied Health, Faculty of HEMS, Anglia Ruskin University, Essex, UK
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23
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Pulos N, Shin AY. Strategies for Specific Reduction in High-Energy Distal Radius Fractures. Hand Clin 2021; 37:267-278. [PMID: 33892880 DOI: 10.1016/j.hcl.2021.02.009] [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: 02/02/2023]
Abstract
High-energy distal radius fractures frequently result in comminution with intra-articular fragmentation. Knowledge of predictable patterns of injury allows the surgeon to develop a preoperative plan for anatomic reduction and stable fixation of individual fragments that are too small or too distal to be fixed with standard volar locked plating. We review the column model, which organizes the distal radius into an intermediate column, radial column, and pedestal as the basis of a reconstructive algorithm and emphasize the importance of the volar ulnar fragment. Specific reduction and fixation techniques are described to assist the surgeon in treating these injuries.
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Affiliation(s)
- Nicholas Pulos
- 200 1st Street Southwest, Rochester, MN 55905, USA. https://twitter.com/NickPulosMD
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24
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Association of secondary displacement of distal radius fractures with cortical bone quality at the distal radius. Arch Orthop Trauma Surg 2021; 141:1909-1918. [PMID: 33128608 PMCID: PMC8497288 DOI: 10.1007/s00402-020-03658-2] [Citation(s) in RCA: 1] [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: 03/18/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the associations of patient characteristics, bone mineral density (BMD), bone microarchitecture and calculated bone strength with secondary displacement of a DRF based on radiographic alignment parameters. MATERIALS AND METHODS Dorsal angulation, radial inclination and ulnar variance were assessed on conventional radiographs of a cohort of 251 patients, 38 men and 213 women, to determine the anatomic position of the DRF at presentation (primary position) and during follow-up. Secondary fracture displacement was assessed in the non-operatively treated patients (N = 154) with an acceptable position, preceded (N = 97) or not preceded (N = 57) by primary reduction (baseline position). Additionally, bone microarchitecture and calculated bone strength at the contralateral distal radius and tibia were assessed by HR-pQCT in a subset of, respectively, 63 and 71 patients. OUTCOME Characteristics of patients with and without secondary fracture displacement did not differ. In the model with adjustment for primary reduction [OR 22.00 (2.27-212.86), p = 0.008], total [OR 0.16 (95% CI 0.04-0.68), p = 0.013] and cortical [OR 0.19 (95% CI 0.05-0.80], p = 0.024] volumetric BMD (vBMD) and cortical thickness [OR 0.13 (95% CI 0.02-0.74), p = 0.021] at the distal radius were associated with secondary DRF displacement. No associations were found for other patient characteristics, such as age gender, BMD or prevalent vertebral fractures. CONCLUSIONS In conclusion, our study indicates that besides primary reduction, cortical bone quality may be important for the risk of secondary displacement of DRFs.
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25
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Shirzadi A, Farzad M, Farhoud A, Shafiee E. Application of continuous passive motion in patients with distal radius fractures: A randomized clinical trial. HAND SURGERY & REHABILITATION 2020; 39:522-527. [DOI: 10.1016/j.hansur.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
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26
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丁 海, 陆 芸. [Research progress in the treatment of distal radius fractures assisted by wrist arthroscopy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1341-1345. [PMID: 33063502 PMCID: PMC8171884 DOI: 10.7507/1002-1892.201912041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/18/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To review the research progress of wrist arthroscopy assisted treatment of distal radius fractures. METHODS To summarize and describe the anatomical characteristics and fracture classification of the distal radius, indications and contraindications of wrist arthroscopy-assisted treatment, surgical methods, and associated soft tissue injuries, and summarize the advantages and disadvantages of the operation through a large number of literature at home and abroad on the treatment of distal radius fractures assisted by wrist arthroscopy. RESULTS Wrist arthroscopy as a minimally invasive technique for the treatment of distal radius fractures, compared with traditional surgery, can accurately observe intra-articular damage and perform operations under the microscope to avoid secondary damage to blood vessels, nerve, and tendon, etc., and can achieve one-stage repair and reconstruction by repairing the ligament, trigonal fibrocartilage complex, and carpal dislocation. It has the advantages of less trauma, fast postoperative recovery, extensive indications, fewer complications, and satisfactory effectiveness. CONCLUSION Wrist arthroscopy has advantages that traditional X-ray film, CT, MRI, and arthrography examinations do not have. Moreover, wrist arthroscopy has achieved satisfactory effectiveness in the adjuvant treatment of intra-articular distal radius fractures.
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Affiliation(s)
- 海波 丁
- 天津医科大学(天津 300070)Tianjin Medical University, Tianjin, 300070, P.R.China
| | - 芸 陆
- 天津医科大学(天津 300070)Tianjin Medical University, Tianjin, 300070, P.R.China
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27
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Li S, Zhang YQ, Wang GH, Li K, Wang J, Ni M. Melone's concept revisited in comminuted distal radius fractures: the three-dimensional CT mapping. J Orthop Surg Res 2020; 15:222. [PMID: 32546176 PMCID: PMC7298813 DOI: 10.1186/s13018-020-01739-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background There is no consensus in the literature about the ideal classification of the distal radius fracture for the clinical practice. The traditional Melone classification system divides the distal radius into four basic components, the shaft, radial styloid, dorsal medial fragment, and volar medial fragment. The aim of this study was to identify fracture lines in comminuted distal radius fractures using three-dimensional mapping of computed tomography (CT) images to test the hypothesis that fracture fragments can be divided according to the Melone classification. Methods Fifty-nine consecutive OTA/AO 23C3 fractures presented at the hospital between January 2018 and October 2019 were retrospectively reviewed. The fracture lines were characterized in the axial, sagittal, and coronal CT planes. After reducing the fractures in a three-dimensional (3D) model, the fracture lines were plotted from the CT images and were then superimposed on one another and oriented to fit a standard template. The area of articular surfaces was measured and compared to quantify the differences between the radial bone fragments. Results Thirty-five cases (59.3%) in this study fit the Melone classification and 24 cases (40.7%) did not. On the radiocarpal surface, there was a greater concentration of fracture lines in the dorsal area of the radius than in the volar area. On the distal radioulnar joint (DRUJ), the fracture lines were focused around two specific concentrated regions. For the articular surface area, the mean area of the radial styloid, volar medial fragment, and dorsal medial fragment was 141.13 ± 90.16 mm2, 147.79 ± 75.94 mm2, and 79.05 ± 70.73 mm2, respectively. There was a significant difference in articular surface area for the Melone fragments (P = 0.002). Conclusions The Melone classification system is not suitable for characterizing all C3 fractures. The findings of this study confirm that the dorsal medial fragments are relatively comminuted and small. Extra care should be given to these small fragments when reducing the fracture.
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Affiliation(s)
- Shuang Li
- Department of Orthopaedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine and Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai, 201299, People's Republic of China
| | - Ying-Qi Zhang
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University, 389 Xincun Road, Putuo District, Shanghai, 200065, People's Republic of China
| | - Gu-Heng Wang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226001, Jiangsu Province, People's Republic of China
| | - Kai Li
- Department of Orthopaedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine and Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai, 201299, People's Republic of China
| | - Jian Wang
- Department of Orthopaedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine and Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai, 201299, People's Republic of China
| | - Ming Ni
- Department of Orthopaedic Surgery, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine and Health Sciences, No. 490 Chuanhuan South Road, Pudong New Area, Shanghai, 201299, People's Republic of China.
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28
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Gan K, Xu D, Lin Y, Shen Y, Zhang T, Hu K, Zhou K, Bi M, Pan L, Wu W, Liu Y. Artificial intelligence detection of distal radius fractures: a comparison between the convolutional neural network and professional assessments. Acta Orthop 2019; 90:394-400. [PMID: 30942136 PMCID: PMC6718190 DOI: 10.1080/17453674.2019.1600125] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Artificial intelligence has rapidly become a powerful method in image analysis with the use of convolutional neural networks (CNNs). We assessed the ability of a CNN, with a fast object detection algorithm previously identifying the regions of interest, to detect distal radius fractures (DRFs) on anterior-posterior (AP) wrist radiographs. Patients and methods - 2,340 AP wrist radiographs from 2,340 patients were enrolled in this study. We trained the CNN to analyze wrist radiographs in the dataset. Feasibility of the object detection algorithm was evaluated by intersection of the union (IOU). The diagnostic performance of the network was measured by area under the receiver operating characteristics curve (AUC), accuracy, sensitivity, specificity, and Youden Index; the results were compared with those of medical professional groups. Results - The object detection model achieved a high average IOU, and none of the IOUs had a value less than 0.5. The AUC of the CNN for this test was 0.96. The network had better performance in distinguishing images with DRFs from normal images compared with a group of radiologists in terms of the accuracy, sensitivity, specificity, and Youden Index. The network presented a similar diagnostic performance to that of the orthopedists in terms of these variables. Interpretation - The network exhibited a diagnostic ability similar to that of the orthopedists and a performance superior to that of the radiologists in distinguishing AP wrist radiographs with DRFs from normal images under limited conditions. Further studies are required to determine the feasibility of applying our method as an auxiliary in clinical practice under extended conditions.
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Affiliation(s)
- Kaifeng Gan
- Department of Orthopaedics, Ningbo Medical Center, Lihuili Hospital, Ningbo, 315000, China;; ,School of Medicine, Ningbo University, Ningbo, 315000, China;;
| | - Dingli Xu
- School of Medicine, Ningbo University, Ningbo, 315000, China;;
| | - Yimu Lin
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China;;
| | - Yandong Shen
- Department of Orthopaedics, Ningbo Medical Center, Lihuili Hospital, Ningbo, 315000, China;; ,School of Medicine, Ningbo University, Ningbo, 315000, China;;
| | - Ting Zhang
- Department of Orthopaedics, Ningbo Medical Center, Lihuili Hospital, Ningbo, 315000, China;;
| | - Keqi Hu
- Department of Orthopaedics, Ningbo Medical Center, Lihuili Hospital, Ningbo, 315000, China;;
| | - Ke Zhou
- Department of Orthopaedics, Ningbo Medical Center, Lihuili Hospital, Ningbo, 315000, China;;
| | - Mingguang Bi
- Department of Orthopaedics, Ningbo Medical Center, Lihuili Hospital, Ningbo, 315000, China;;
| | - Lingxiao Pan
- Department of Orthopaedics, Ningbo Medical Center, Lihuili Hospital, Ningbo, 315000, China;;
| | - Wei Wu
- Department of Orthopaedics, Second Hospital of Ningbo, Ningbo, 315000, China;;
| | - Yunpeng Liu
- Faculty of Electronics & Computer, Zhejiang Wanli University, Ningbo, 315000, China,Correspondence:
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