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Marxen T, Stewart C, Razavi A, Payne S, Ghareeb P. Impact of Socioeconomic Factors on Time to Surgery for Distal Radius Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5838. [PMID: 38818232 PMCID: PMC11139462 DOI: 10.1097/gox.0000000000005838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/04/2024] [Indexed: 06/01/2024]
Abstract
Background Delay in care secondary to socioeconomic status (SES) and demographic factors represents an area for potential improvement. Reducing time to surgery in distal radius fracture (DRF) fixation may improve outcomes while reducing cost. The purpose of this study is to investigate the effect of SES on time to surgery in our study population. Methods Patients undergoing outpatient DRF surgery within an academic healthcare system during a 4-year period were reviewed. Time to surgery and demographic factors were analyzed. The US Census Bureau was used to determine median household income (MHI) for a patient's ZIP code; patients were stratified into three groups based on MHI. Results A total of 413 patients met inclusion criteria. SES (14.7 d in the low-SES group, 14.0 d in the mid-SES group, and 11.1 d in the high-SES group, P = 0.00063), insurance (11.7 d for insured versus 16.3 d for Medicaid/uninsured, P < 0.0001), race (non-White group: 15.2 d versus White group: 10.9 d, P < 0.0001), and treatment facility (16.2 d at county hospital versus 10.9 d at university hospital, P < 0.0001) were associated with time to surgery in univariate analysis. Multivariate analysis found that only treatment facility was associated with time to surgery. Conclusions Non-White, uninsured/Medicaid individuals residing in low-SES areas may be more likely to receive care at a safety-net facility and are at greatest risk for delay in time to surgery. Measures aimed to reduce barriers to care, increase healthcare coverage, and improve patient education should be initiated to mitigate these disparities.
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Affiliation(s)
- Troy Marxen
- From the Emory University School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Atlanta, Ga
| | - Chris Stewart
- From the Emory University School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Atlanta, Ga
| | - Amir Razavi
- From the Emory University School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Atlanta, Ga
| | - Sam Payne
- From the Emory University School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Atlanta, Ga
| | - Paul Ghareeb
- From the Emory University School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Atlanta, Ga
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Vasdeki D, Barmpitsioti A, De Leo A, Dailiana Z. HOW TO PREVENT HAND INJURIES - REVIEW OF EPIDEMIOLOGICAL DATA IS THE FIRST STEP IN HEALTH CARE MANAGEMENT. Injury 2024; 55:111327. [PMID: 38281348 DOI: 10.1016/j.injury.2024.111327] [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: 04/25/2023] [Revised: 12/22/2023] [Accepted: 01/13/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Hand injuries are common affecting all ages, genders, and geographic regions. They can result in long term disability and mortality, while they place a significant financial burden in society. Although, hand injuries can be prevented. Preventive strategies can be designed, but knowledge of injuries' epidemiological characteristics is required beforehand. METHODS We performed a review of the current literature related to hand injuries to identify their incidence, patients' demographics, type, mode, and time of the injury. RESULTS Hand injuries constitute 6.6% to 28.6% of all injuries presenting to the Emergency Department and 28% of injuries to the musculoskeletal system. They mainly affect young male labourers. Occupational and home accidents are the commonest injury modalities, while traffic road accidents constitute a significant reason for hand injuries as well. Lacerations account for most hand injuries, followed by crush injuries, fractures and amputations. Most occupational injuries occur in the beginning of the week and especially during the morning shift, while there has been identified an increase in the number of hand injuries during the summer months. CONCLUSIONS Hand injuries are an important health problem with impact on patient's life and on the society. Although they can be prevented. Preventive strategies need to be addressed towards many directions and people's activities, since prevention will have an important impact on people's quality of life and society's well-being.
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Affiliation(s)
- Dionysia Vasdeki
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece.
| | - Antonia Barmpitsioti
- 1st Department of Orthopaedic Surgery, KAT General hospital, Kifisia, Athens 14561, Greece
| | - Anna De Leo
- Department of Plastic Surgery, The London Welbeck Hospital, London W1G 8EN, United Kingdom
| | - Zoe Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece; Department of Hand, Upper Extremity Surgery and Microsurgery, Iaso Thessalias, Nikaia, Larissa 41500, Greece
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Clutton JM, Kinghorn AF, Trickett RW. Does Dressing Choice Affect Infection Rate in Percutaneous K-Wiring of the Hand and Wrist? - A Systematic Review. J Hand Surg Asian Pac Vol 2024; 29:3-11. [PMID: 38299244 DOI: 10.1142/s2424835524500012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Background: Percutaneous Kirschner wire (K-wire) fixation of hand and wrist fractures is a common trauma procedure, yet there remains little consensus on the best management of wires postoperatively. If wire's ends are left external to the skin, it remains unknown which dressing regimen best reduces infection risk. We felt that a systematic review was required to assess the current consensus on this question within the published literature. Methods: An electronic search was carried out across multiple databases. Abstracts were screened by two independent reviewers against inclusion criteria and, where necessary, full texts were reviewed. Nine eligible papers were identified, and data regarding type of procedure, dressing choice and infection rate was extracted. Results: The included studies were widely heterogenous, and the standard of the evidence was, in general, poor. In most, dressing choice and infection incidence were not the primary intervention/outcome under study. Conclusions: Based on the available literature, insufficient evidence exists to establish one dressing choice as having a lower infection rate. This highlights the need for further high-quality evidence in this area. Level of Evidence: Level III (Therapeutic).
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Chen K, Duan GY, Wolf JM, Stepan JG. Health Disparities in Hand and Upper Extremity Surgery: A Scoping Review. J Hand Surg Am 2023; 48:1128-1138. [PMID: 37768255 DOI: 10.1016/j.jhsa.2023.08.005] [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: 05/12/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Social determinants of health (SDOH) are linked to poor health care outcomes across the different medical specialties. We conducted a scoping review to understand the existing literature and identify further areas of research to address disparities within hand surgery. METHODS A systematic search of PubMed, Scopus, and Cochrane was conducted. Inclusion criteria were English studies examining health disparities in hand surgery. The following were assessed: the main SDOH, study design/phase/theme, and main disease/injury/procedure. A previously described health disparities research framework was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Studies were categorized according to themes outlined at the National Institute of Health and American College of Surgeons: Summit on Surgical Disparities. RESULTS The initial search yielded 446 articles, with 49 articles included in final analysis. The majority were detecting-type (31/49, 63%) or understanding-type (12/49, 24%) studies, with few reducing-type studies (6/49, 12%). Patient factors (31/49, 63%) and systemic/access factors (16/49, 33%) were the most frequently studied themes, with few investigating clinical care/quality factors (4/49, 8%), clinician factors (3/49, 6%), and postoperative/rehabilitation factors (1/49, 2%). The most commonly studied SDOH include insurance status (13/49, 27%), health literacy (10/49, 20%), and social deprivation (6/49, 12%). Carpal tunnel syndrome (9/49, 18%), upper extremity trauma (9/49, 18%), and amputations (5/49, 10%) were frequently assessed. Most investigations involved retrospective or database designs (29/49, 59%), while few were prospective, cross-sectional, or mixed-methods. CONCLUSIONS Despite an encouraging upward trend in health disparities research, existing studies are in the early phases of investigation. CLINICAL RELEVANCE Most of the literature focuses on patient factors and systemic/access factors in regard to insurance status. Further work with prospective, cross-sectional, and mixed-method studies is needed to better understand health disparities in hand surgery, which will inform future interventions.
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Affiliation(s)
- Kevin Chen
- University of Chicago, Pritzker School of Medicine, Chicago, IL.
| | - Grace Y Duan
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Jennifer M Wolf
- Department of Orthopaedic Surgery and Rehabilitation Medicine, the University of Chicago Medicine, Chicago, IL
| | - Jeffrey G Stepan
- Department of Orthopaedic Surgery and Rehabilitation Medicine, the University of Chicago Medicine, Chicago, IL
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Wallace DR, Shiver AL, Pulliam SK, Byrd BM, McGee-Lawrence ME, Snoddy MC. Intramedullary Threaded Nail Fixation Versus Plate and Screw Construct in Metacarpal Neck Fractures: A Biomechanical Study. J Am Acad Orthop Surg 2023; 31:e516-e522. [PMID: 37071886 PMCID: PMC10198952 DOI: 10.5435/jaaos-d-22-00595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/16/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Indicated surgical management of metacarpal neck fractures varies with techniques, including Kirschner wire fixation, plate fixation, intramedullary fixation, and headless compression screw fixation, without demonstrated superiority. This study compares intramedullary threaded nail (ITN) fixation with a locking plate construct. METHODS Index through small finger metacarpals were harvested from 10 embalmed cadavers. After application of appropriate exclusion criteria, remaining metacarpals underwent neck fracture creation by a three-point load to failure. Eight samples were randomly allocated to fixation with ITN fixation, and six were stabilized with a 2.3-mm seven-hole locking plate. Samples were then subjected to a second round of biomechanical testing using the same apparatus. Ultimate load between the intact tissue and the subsequently stabilized fracture was analyzed with a paired Student t -test. Percentage change in ultimate load in the intact tissue and stabilized tissue was calculated, and the magnitude of relative difference between the two groups was analyzed using unpaired Student t -tests. Statistical difference was defined by a P value of < 0.05. RESULTS Both groups demonstrated the ability to handle a biomechanical load; however, both were significantly weaker than the intact tissue (paired Student t -test p ITN-fixed versus p ITN-intact = 0.006; p plate-fixed versus p plate-intact = 0.002). ITN samples demonstrated a higher load to failure (unpaired Student t -test p ITN-fixed versus p plate-fixed = 0.039). CONCLUSION ITN provides a biomechanically stronger fixation constructed for vertically oriented metacarpal neck fractures compared with locking plate fixation. Both ITN and locking plate constructs provide stabilization capable of tolerating a biomechanical load; however, both fixation modalities are weaker than the native tissue.
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Affiliation(s)
- Doyle R Wallace
- From Medical College of Georgia at Augusta University, Augusta, GA
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Mousoulis C, Karantana A, Trickett RW, Thomas KS, Leighton P. 'It's just a finger isn't it…': patients' perspectives of recovery following finger fractures and participation in surgical trials - a qualitative interview study. BMJ Open 2023; 13:e065185. [PMID: 37173108 DOI: 10.1136/bmjopen-2022-065185] [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: 05/15/2023] Open
Abstract
OBJECTIVES To (1) generate detailed, person-centred data about the experience of finger injury and treatment and (2) understand the patients' perspectives of research involvement with a view to informing better designed future studies in hand injury. DESIGN Qualitative study using semistructured interviews and framework analysis. PARTICIPANTS 19 participants who were part of the Cohort study of Patients' Outcomes for Finger Fractures and Joint Injuries study in a single secondary care centre in the UK. RESULTS The results of this study showed that although finger injuries are frequently seen as minor by patients and healthcare professionals, their effects on peoples' lives are possibly greater than first anticipated. The relative importance of hand functioning means that the experience of treatment and recovery varies and is shaped by an individual's age, job, lifestyle and hobbies. These factors will also inform an individual's perspective on and willingness to participate in, hand research. Interviewees showed reluctance to accept randomisation in surgical trials. Interviewees would be more likely to participate in a study testing two variants of the same treatment modality (eg, surgery vs surgery), rather than two different modalities, (eg, surgery vs splint). The Patient-Reported Outcome Measure questionnaires that were used in this study were seen as less relevant by these patients. Pain, hand function and cosmetic appearance were considered important, meaningful outcomes. CONCLUSIONS Patients with finger injuries need more support from healthcare professionals as they may experience more problems than first anticipated. Good communication by clinicians and empathy can help patients engage with the treatment pathway. Perceptions of an 'insignificant' injury and/or need for quick functional recovery will influence recruitment to future hand research (both positively and negatively). Accessible information about the functional and clinical consequences of a hand injury will be important in enabling participants to make fully informed decisions about participation.
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Affiliation(s)
- Christos Mousoulis
- Centre for Evidence Based Hand Surgery, University of Nottingham, Nottingham, UK
| | - Alexia Karantana
- Centre for Evidence Based Hand Surgery, University of Nottingham, Nottingham, UK
| | - Ryan W Trickett
- Trauma and Orthopaedics, Cardiff and Vale University Health Board, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Patient Satisfaction with Virtual Clinic Encounters: Analysis of Factors that Impact the Press Ganey Survey in the Hand Surgery Population. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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De Francesco F, Gravina P, Varagona S, Setti S, Gigante A, Riccio M. Biophysical Stimulation in Delayed Fracture Healing of Hand Phalanx: A Radiographic Evaluation. Biomedicines 2022; 10:biomedicines10102519. [PMID: 36289781 PMCID: PMC9599654 DOI: 10.3390/biomedicines10102519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
Phalangeal fractures are common events among the upper limbs accounting for 10% of all human body fractures. Fracture complete healing process may persevere several months or years. Most phalangeal fractures present favorable union within 3 to 6 weeks. In the literature, biophysical stimulation has yielded favorable outcomes in the treatment of hand fractures. A survey involving hospitals in the US reported the use of biophysical stimulation (72%) in relation to nonhealing fractures at three months after trauma. A noninvasive procedure such as biophysical stimulation may be preferential prior to consideration of invasive procedures. In this retrospective study, we analyzed 80 phalangeal fractures, 43 of which did not show any radiographic sign of healing 30 days after surgery; on radiograms, we calculated radiographic data and the total active motion (TAM) for clinical comparison. All radiographic images were evaluated using Adobe Photoshop CS3 (version 10.0, Adobe Systems Inc., San Jose, CA, USA). We calculated the index of relative bone healing each month after surgery starting from 30 days, which was considered as T1, and followed up for a total of 6 months after stimulation (T6) with better results in stimulated groups. We concluded that prompt administration of biophysical stimulation supports fracture healing and yields an important improvement in the union rate compared with nontreatment. Above all, our patients experienced less injury-related distress between the fracture and repair period, which consequently reduced immobilization time, envisaging an early rehabilitation interval, with a better patient hand outcome.
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Affiliation(s)
- Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, Azienda Ospedaliera Universitaria delle Marche, Via Conca, 71, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-071-5963945; Fax: +39-071-5965297
| | - Pasquale Gravina
- Department of Reconstructive Surgery and Hand Surgery, Azienda Ospedaliera Universitaria delle Marche, Via Conca, 71, 60126 Ancona, Italy
- Clinical Orthopedics, Polytechnic University of Marche, Via Conca, 71, 60126 Ancona, Italy
| | - Stefano Varagona
- Clinical Orthopedics, Polytechnic University of Marche, Via Conca, 71, 60126 Ancona, Italy
| | - Stefania Setti
- IGEA SpA, Clinical Biophysics, Via Parmenide, 10/A, 41012 Carpi, Italy
| | - Antonio Gigante
- Clinical Orthopedics, Polytechnic University of Marche, Via Conca, 71, 60126 Ancona, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, Azienda Ospedaliera Universitaria delle Marche, Via Conca, 71, 60126 Ancona, Italy
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Street J, Nessa L, Logan A, Trickett RW. A 4-year study of the use of the short metacarpal cast in the management of metacarpal shaft fractures. J Hand Surg Eur Vol 2021; 46:936-940. [PMID: 34167368 DOI: 10.1177/17531934211024579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report on our experience of using a short, moulded metacarpal cast over a 4-year period in the non-surgical management of metacarpal shaft fractures. Between 6 April 2015 and 6 April 2019, 117 patients were treated using this method. The majority were male, and the mean age was 24.6 years. The most common mechanism of injury was a punch injury (73 patients, 62%). Fifteen patients (13%) were treated for multiple metacarpal fractures. Immediately after cast removal, 68% had a full range of finger movement and 68% were pain free. Few required formal hand therapy. Fifteen patients experienced minor complications, primarily soft tissue irritation from the cast and non-limiting extensor lag. The moulded short metacarpal cast is an effective non-surgical treatment for angulated extra-articular metacarpal fractures of the diaphysis and diametaphyseal junction.Level of evidence: IV.
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Affiliation(s)
- Julia Street
- Department of Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
| | - Luthfun Nessa
- Department of Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
| | - Andrew Logan
- Department of Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
| | - Ryan W Trickett
- Department of Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
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Robinson LS, Brown T, O'Brien L. Cost, profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation. J Hand Ther 2021; 34:29-36. [PMID: 32360062 DOI: 10.1016/j.jht.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/05/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cost-of-illness study. INTRODUCTION Injuries to the hand and wrist are common. Most uncomplicated and stable upper extremity injuries recover with conservative management; however, some require surgical intervention. The economic burden on the health care system from such injuries can be considerable. PURPOSE OF THE STUDY To estimate the economic implications of surgically managed acute hand and wrist injuries at one urban health care network. METHODS Using 33 primary diagnosis ICD-10 codes involving the hand and wrist, 453 consecutive patients from 2014 to 2015 electronic billing records who attended the study setting emergency department and received consequent surgical intervention and outpatient follow-up were identified. Electronic medical records were reviewed to extract demographic data. Costs were calculated from resource use in the emergency department, inpatient, and outpatient settings. Results are presented by demographics, injury type, mechanism of injury, and patient pathway. RESULTS Two hundred and twenty-six individuals (n 1⁄4 264 surgeries) were included. The total cost of all injuries was $1,204,606. The median cost per injury for non-compensable cases (n = 191) was $4508 [IQR $3993-$6172] and $5057 [IQR $3957-$6730] for compensable cases (n = 35). The median number of postoperative appointments with a surgeon was 2.00 (IQR 1.00-3.00) for both compensable and non-compensable cases. The number of hand therapy appointments for non-compensable cases and compensable cases was 4 [IQR 2-6] and 2 [IQR 1-3], respectively. DISCUSSION Findings of this investigation highlight opportunities for health promotion strategies for reducing avoidable injuries and present considerations for reducing cost burden by addressing high fail to attend (FTA) appointment rates. CONCLUSION Surgically managed hand and wrist injuries contribute to a significant financial burden on the health care system. Further research using stringent data collection methods are required to establish epidemiological data and national estimates of cost burden.
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Affiliation(s)
- Luke Steven Robinson
- Department of Occupational Therapy, Monash University, Peninsula Campus, Frankston, Victoria, Australia; Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia.
| | - Ted Brown
- Department of Occupational Therapy, Monash University, Peninsula Campus, Frankston, Victoria, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Monash University, Peninsula Campus, Frankston, Victoria, Australia
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Liu S, Sun B, Wang P, Fu S. Percutaneous pinning with interphalangeal joint locked in phalanx fractures: The surgical technique and the results. Medicine (Baltimore) 2021; 100:e26782. [PMID: 34397826 PMCID: PMC8341342 DOI: 10.1097/md.0000000000026782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of the study was to compare the operation time, the fracture healed time, the postoperative function recovery between the techniques that temporary locking of the interphalangeal joint and traditional manual reduction in the treatment of percutaneous pinning of the phalanx fractures. METHODS Patients with phalanx fractures from January 2015 to January 2018 who were admitted to our hospital were retrospectively reviewed. Patients received surgery with traditional manual or temporary locking of the interphalangeal joint reduction. The information of patients, including age, gender, the length of the operation, the fracture healed time, the postoperative function recovery, complication, and length of postoperative hospital stay, was collected. All of the information were evaluated and compared between the 2 groups. All of the surgery were performed by 2 experienced hand surgeons of our department. The patients in the 2 groups were followed up for an average of 6 months after surgery. RESULTS All patients completed the operation and were followed up completely. There was no significant difference in baseline data between the 2 groups (P > .05). The observation group who received surgery with the interphalangeal joint locked technique had significantly shorter in operative time than the control group (P < .05). And postoperative complications in the observation group were significantly less than those in the control group (P < .05). However, the postoperative functional recovery in both groups was no significant difference between the 2 groups (P > .05). And there were no significant differences in the fracture healed time and length of postoperative hospital stay between the 2 groups (P > .05). CONCLUSION Both surgical techniques can enable patients to achieve good function, but the technique of interphalangeal joint locked is effective in the treatment of the phalanx fractures, as it is characterized by short operations and a quick recovery. However, this technique is only suitable for extra-articular phalanx fractures that the AO/ASIF classification of type A2.3 and less than 2 weeks, not for other phalanx fractures.
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Thomas R, Dyer GSM, Tornetta Iii P, Park H, Gujrathi R, Gosangi B, Lebovic J, Hassan N, Seltzer SE, Rexrode KM, Boland GW, Harris MB, Khurana B. Upper extremity injuries in the victims of intimate partner violence. Eur Radiol 2021; 31:5713-5720. [PMID: 33459857 PMCID: PMC7812562 DOI: 10.1007/s00330-020-07672-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/01/2020] [Accepted: 12/23/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To recognize most common patterns of upper extremity (UE) injuries in victims of Intimate Partner Violence (IPV). METHODS Radiological review of 308 patients who reported physical IPV at our institution from January 2013 to June 2018, identified 55 patients with 88 unique UE injuries. Demographic data and injury patterns and associations were collected from the electronic medical records. RESULTS The cohort included 49 females and 6 males (age 19-63, mean 38). At the time of injury, IPV was reported in 15/88 (17%) and IPV screening was documented for 22/88 (25%) injuries. There were 46 fractures, 8 dislocations or subluxations, and 34 isolated soft tissue injuries, most commonly involving the hand (56/88). Fractures most commonly involved the fingers (21/46, 46%) and the 5th digit (8/27, 30%). Medial UE fractures (5th digit, 4th digit) constituted 44% of hand and finger fractures (12/27) and 26% of all fractures (12/46). Comminuted and displaced fractures were rare (8/46, 17%). Head and face injuries were the most common concomitant injuries (9/22, 41%) and subsequent injuries (21/61, 35%). Of 12 patients with recurrent UE injuries, 6 had recurrent injuries of the same hand. Five of 6 non-acute fractures (83%) were of the hand. CONCLUSIONS Hand and finger injuries are the most common UE injuries in patients with IPV, with finger being the most common site and medial hand the most common region of fracture. Repeated injuries involving the same site and a combination of medial hand and head or face injuries could indicate IPV. KEY POINTS • Upper extremity injuries in victims of intimate partner violence are most commonly seen in the hand and fingers. • Fingers are the most common site of fracture and the medial hand is the most common region of fracture in the upper extremity in victims of intimate partner violence. • In intimate partner violence victims with upper extremity injuries, concomitant injuries and subsequent injuries are most commonly seen in the head and neck region.
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Affiliation(s)
- Richard Thomas
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - George S M Dyer
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Paul Tornetta Iii
- Department of Orthopedic Surgery, Boston Medical Center, 725 Albany St 4th Floor, Suite 4B, Boston, MA, 02118, USA
| | - Hyesun Park
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Rahul Gujrathi
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Babina Gosangi
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jordan Lebovic
- Department of Orthopedic Surgery, Hospital for Joint Diseases, 301 E 17th St, New York, NY, 10003, USA
| | - Najmo Hassan
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Steven E Seltzer
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Giles W Boland
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Mitchel B Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Bharti Khurana
- Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Geada LR, Cochrane S, Schroeder C, Luscia C, Mir H, Daniali L, Pulikkottil BJ. Intramedullary Metacarpal Screw Fracture Fixation: A Retrospective Review of the Rehabilitation Literature and an Illustrative Case Report With a Postoperative Therapy Protocol. Ann Plast Surg 2021; 86:S460-S462. [PMID: 33512820 DOI: 10.1097/sap.0000000000002726] [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: 10/22/2022]
Abstract
ABSTRACT Intramedullary metacarpal screw fixation has shown promising results and quick functional recovery with the proper postoperative rehabilitation. The rehabilitative process after this procedure has not been compared across literature. A retrospective review of literature was used to recommend a therapy timeline, activity and recommendations to allow for proper postoperative rehabilitation for optimal results. An illustrative case report is presented to explain technique and outcomes.
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Affiliation(s)
- Luis R Geada
- From the Department of General Surgery, Kendall Regional Medical Hospital, Miami, FL
| | - Shannon Cochrane
- Program in Occupational Therapy, Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Carol Schroeder
- Burn and Reconstructive Centers of Colorado, Swedish Medical Center, Englewood, CO
| | - Chris Luscia
- Burn and Reconstructive Centers of Colorado, Swedish Medical Center, Englewood, CO
| | - Haaris Mir
- Department of Plastics and Reconstructive Surgery, Kendall Regional Medical Hospital, Miami, FL
| | - Lily Daniali
- Burn and Reconstructive Centers of Colorado, Swedish Medical Center, Englewood, CO
| | - Benson J Pulikkottil
- Burn and Reconstructive Centers of Colorado, Swedish Medical Center, Englewood, CO
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The Impact of Social Deprivation on Orthopaedic Outpatient Satisfaction Using the Press Ganey Outpatient Medical Practice Survey. J Am Acad Orthop Surg 2020; 28:e1111-e1120. [PMID: 32235241 DOI: 10.5435/jaaos-d-19-00852] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In orthopaedics, multiple factors (patient age, wait time, and depression) have been associated with lower Press Ganey Outpatient Medical Practice Survey (PGOMPS) patient satisfaction scores. We hypothesized that increased social deprivation is an independent predictor of lower patient satisfaction, as measured by the PGOMPS. METHODS We retrospectively reviewed unique new outpatient orthopaedic surgery visits between January 1, 2014, and December 31, 2016, at a single tertiary academic institution. Given the high ceiling effects, satisfaction was defined a priori as achieving a score above the 33rd percentile. Social deprivation was determined using the 2015 Area Deprivation Index (ADI). Univariate and multivariable binary logistic regressions were used to detect factors associated with patient satisfaction for both the PGOMPS Total Score and Provider Sub-Score. RESULTS Of the 4,881 included patients, the mean age was 53.3 ± 15.9 years, 59.3% were women, and mean ADI was 30.1 ± 19.2. Univariate analysis revealed a significantly decreased odds of achieving satisfaction on the Total Score for each decile increase in ADI (odds ratio [OR] 0.94; P < 0.001). Compared with the least deprived quartile, patients of the most deprived quartile were significantly less likely to report satisfaction for both the Total Score (OR 0.56; P = 0.001) and Provider Sub-Score (OR 0.63; P = 0.011). Multivariable analysis revealed that the odds of achieving satisfaction for each decile increase in ADI were 0.96 for the Total Score (P = 0.014) and 0.95 for the Provider Sub-Score (P = 0.004), independent of age, wait time, race, subspecialty, provider type, and the clinic setting. CONCLUSIONS Increased social deprivation was an independent predictor of orthopaedic outpatient dissatisfaction on the PGOMPS. These findings should be considered when interpreting patient satisfaction scores and lend further support in an effort to improve healthcare inequalities. LEVEL OF EVIDENCE Level III.
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Faccioli N, Santi E, Foti G, Mansueto G, Corain M. Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation. Musculoskelet Surg 2020; 106:169-177. [PMID: 33211300 PMCID: PMC9130154 DOI: 10.1007/s12306-020-00687-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement. Methods We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit. Results Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020). Conclusion CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.
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Affiliation(s)
- N Faccioli
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy.
| | - E Santi
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy
| | - G Foti
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - G Mansueto
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy
| | - M Corain
- Hand Surgery Department, G.B. Rossi University Hospital, Piazzale L.A.Scuro 10, 37134, Verona, Italy
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16
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Abstract
Hand fractures are the most common fractures of the upper extremity, with a reported incidence of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Understanding the diagnosis and management of these injuries is vital for any clinician working in the emergency department, plastic or orthopaedic surgery or providing community care. This review identifies the most common presentations and outlines how to assess and manage such fractures appropriately, with an emphasis on clinical and radiographic examination. The majority of hand fractures are managed conservatively and operative management should be carefully considered on a case-by-case basis with analysis of patient and fracture-related factors, in order to achieve optimal hand function following treatment.
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Affiliation(s)
- Dardan Popova
- Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Ted Welman
- Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Sarita V Vamadeva
- Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Foundation Trust, London, UK
| | - Gurjinderpal S Pahal
- Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Foundation Trust, London, UK
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17
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Meza BC, Iacone D, Talwar D, Sankar WN, Shah AS. Socioeconomic Deprivation and Its Adverse Association with Adolescent Fracture Care Compliance. JB JS Open Access 2020; 5:e0064. [PMID: 33123665 PMCID: PMC7418910 DOI: 10.2106/jbjs.oa.19.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Socioeconomic deprivation increases fracture incidence in adolescents, but
its impact on fracture care is unknown. The area deprivation index (ADI),
which incorporates 17 factors from the U.S. Census, measures socioeconomic
deprivation in neighborhoods. This investigation aimed to determine the
impact of socioeconomic deprivation and other socioeconomic factors on
fracture care compliance in adolescents. Methods: This study included patients who were 11 to 18 years of age and received
fracture care at a single urban children’s hospital system between
2015 and 2017. Demographic information (sex, race, caregiver status,
insurance type) and clinical information (mechanism of injury, type of
treatment) were obtained. The ADI, which has a mean score of 100 points and
a standard deviation of 20 points, was used to quantify socioeconomic
deprivation for each patient’s neighborhood. The outcome variables
related to compliance included the quantity of no-show visits at the
orthopaedic clinic and delays in follow-up care of >1 week. Risk
factors for suboptimal compliance were evaluated by bivariate analysis and
multivariate logistic regression. Results: The cohort included 457 adolescents; 75.9% of the patients were male, and the
median age was 16.1 years. The median ADI was 101.5 points (interquartile
range, 86.3 to 114.9 points). Bivariate analyses demonstrated that higher
ADI, black race, single-parent caregiver status, Medicaid insurance,
non-sports mechanisms of injury, and surgical management are associated with
suboptimal fracture care compliance. Adolescents from the most socially
deprived regions were significantly more likely to have delays in care
(33.8% compared with 20.1%; p = 0.037) and miss scheduled orthopaedic
visits (29.9% compared with 7.1%; p < 0.001) compared with adolescents
from the least deprived regions. ADI, Medicaid insurance, and initial
presentation to the emergency department were independent predictors of
suboptimal care compliance, when controlling for other variables. Conclusions: Socioeconomic deprivation is associated with an increased risk of suboptimal
fracture care compliance in adolescents. Clinicians can utilize caregiver
and insurance status to better understand the likelihood of fracture care
compliance. These findings highlight the importance of understanding
differences in each family’s ability to adhere to the recommended
follow-up and of implementing measures to enhance compliance.
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Affiliation(s)
- Blake C Meza
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dina Iacone
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Divya Talwar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wudbhav N Sankar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Apurva S Shah
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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18
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Wormald JCR, Claireaux HA, Gardiner MD, Jain A, Furniss D, Costa ML. Management of extra-articular fractures of the fifth metacarpal: Operative vs. Non-opeRaTive TrEatment (FORTE) - A systematic review and meta-analysis. JPRAS Open 2020; 20:59-71. [PMID: 32158872 PMCID: PMC7061598 DOI: 10.1016/j.jpra.2019.02.001] [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] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/04/2019] [Indexed: 11/25/2022] Open
Abstract
Aims Extra-articular fifth metacarpal fractures are treated operatively and non-operatively without consensus. We aim to establish whether there are differences in patient-reported outcome, objective clinical outcome and adverse events for skeletally mature patients with closed extra-articular fractures of the 5th metacarpal that are treated operatively versus non-operatively. Patients Skeletally mature patients with closed, extra-articular 5th metacarpal fractures. Methods A systematic review and meta-analysis of randomised controlled trials using methodology adapted from the Cochrane Handbook for Systematic Review of Interventions and compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PROSPERO CRD42018091633) Results Two trials of 5th metacarpal neck fractures met the inclusion criteria and were included in the final pooled analysis (n = 125). There were no significant differences in patient-reported, objective clinical or radiographic outcomes between the operative and non-operative groups at 12 months. Operatively managed patients reported greater time off work and were more likely to suffer an adverse event. Conclusion Existing trial data is limited and inconclusive in terms of patient-reported outcome measures. Given that there remains wide variation in the treatment of these common injuries around the world, there is a need for further high-quality evidence to guide clinical practice.
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Affiliation(s)
- JCR Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, United Kingdom
- Department of Plastic, Reconstructive and Burns Surgery, Stoke Mandeville Hospital, Aylesbury HP21 8AL, United Kingdom
- Corresponding author at: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, United Kingdom.
| | - HA Claireaux
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, United Kingdom
- Oxford Trauma, NDORMS, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom
| | - MD Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, United Kingdom
- Department of Plastic, Reconstructive and Hand Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford OX3 7LD, United Kingdom
| | - A Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, United Kingdom
- Department of Plastic, Reconstructive and Hand Surgery, Imperial College Healthcare Trust, London W2 1NY, United Kingdom
| | - D Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, OX3 7LD, United Kingdom
- Department of Plastic, Reconstructive and Hand Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford OX3 7LD, United Kingdom
| | - ML Costa
- Oxford Trauma, NDORMS, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom
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19
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Birks ME, Sharma K, Steele K, Jones G, Miller JG. Understanding the patient profile and health-related quality of life in patients presenting for hand surgery. J Hand Surg Eur Vol 2020; 45:140-146. [PMID: 31619128 DOI: 10.1177/1753193419880792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this descriptive epidemiological study of patients, referred to and selected for surgery at a UK tertiary hand centre, was to investigate patterns of common hand disorders and their impact on those individuals. A prospective collection of patient-reported outcome scores was carried out in patients before operation using the Patient Outcomes of Surgery Hand/Arm and the Euro-Qol 5 dimension three-level measures. Patient participation was voluntary and data collected over a 4-year period are discussed. Patient-reported outcome scores were calculated using appropriate algorithms. The results show correlation between the number of comorbidities and both symptoms and activity domains of the Patient Outcomes of Surgery Hand/Arm; higher symptom scores were seen in women. There was no increase in scores for older patients or those from more deprived areas. Population-based research using recognized patient-reported outcome measurement tools could aid future health service planning. Level of evidence: IV.
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Affiliation(s)
| | | | - Kathryn Steele
- Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
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20
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Wolfstadt JI, Pincus D, Kreder HJ, Wasserstein D. Association between socioeconomic deprivation and surgical complications in adults undergoing ankle fracture fixation: a population-based analysis. Can J Surg 2019; 62:320-327. [PMID: 31550093 DOI: 10.1503/cjs.012018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Few studies have investigated the outcomes of surgical fracture care among socially deprived patients despite the increased incidence of fractures and the inequality of care received in this group. We evaluated whether socioeconomic deprivation affected the complications and subsequent management of marginalized/homeless patients following surgery for ankle fracture. Methods In this retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, we evaluated 45 444 patients who underwent open reduction and internal fixation (ORIF) for ankle fracture performed by 710 different surgeons between Jan. 1, 1994, and Dec. 31, 2011. Multivariable logistic regression models were used to assess the association between deprivation and shorter-term outcomes within 1 year (implant removal, repeat ORIF, irrigation and débridement owing to infection, and amputation). Multivariable Cox proportional hazards models were used to assess longer-term outcomes up to 20 years (ankle fusion and ankle arthroplasty). Results A higher level of deprivation was associated with an increased risk of irrigation and débridement (quintile 5 v. quintile 1: odds ratio [OR] 2.14, 95% confidence interval [CI] 1.25–3.67, p = 0.0054) and amputation (quintile 4 v. quintile 1: OR 3.56, 95% CI 1.01–12.4, p = 0.0466). It was more common for less deprived patients to have their hardware removed (quintile 5 v. quintile 1: OR 0.822, 95% CI 0.76–0.888, p < 0.0001). There was no correlation between marginalization and subsequent revision ORIF, ankle fusion, or ankle arthroplasty. Conclusion Marginalized patients are at a significantly increased risk of infection and amputation following surgical treatment of ankle fractures. However, these complications are still extremely uncommon among this group. Socioeconomic deprivation should not prohibit marginalized patients from receiving surgery for unstable ankle fractures.
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Affiliation(s)
- Jesse Isaac Wolfstadt
- From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder)
| | - Daniel Pincus
- From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder)
| | - Hans J. Kreder
- From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder)
| | - David Wasserstein
- From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder)
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Alieyan K, Almomani A, Anbar M, Alauthman M, Abdullah R, Gupta BB. DNS rule-based schema to botnet detection. ENTERP INF SYST-UK 2019. [DOI: 10.1080/17517575.2019.1644673] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kamal Alieyan
- National Advanced IPv6 Centre (NAv6), Universiti Sains Malaysia, Gelugor, Penang, Malaysia
| | - Ammar Almomani
- Department of Information Technology, Al-Huson University College, Al-Balqa Applied University, Irbid, Jordan
| | - Mohammed Anbar
- National Advanced IPv6 Centre (NAv6), Universiti Sains Malaysia, Gelugor, Penang, Malaysia
| | - Mohammad Alauthman
- Department of Computer Science, Faculty of information technology, Zarqa university, Zarqa, Jordan
| | - Rosni Abdullah
- National Advanced IPv6 Centre (NAv6), Universiti Sains Malaysia, Gelugor, Penang, Malaysia
| | - B. B. Gupta
- Department of Computer Engineering, National Institute of Technology Kurukshtra, Kurukshetra, India
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22
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Manley OWG, Wormald JCR, Furniss D. The changing shape of hand trauma: an analysis of Hospital Episode Statistics in England. J Hand Surg Eur Vol 2019; 44:532-536. [PMID: 30764703 DOI: 10.1177/1753193419828986] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hospital Episode Statistics (HES) include freely accessible records of all hospital episodes in England. We analysed HES from 1998-1999 to 2014-2015 for diagnoses of hand fractures, tendon injuries, nerve injuries, blood vessel injuries, traumatic amputations and nail bed injuries. Population data were used to calculate the incidence. The overall incidence of the injuries increased from 70 to 110 per 100,000. There were especially large increases in the incidence of fractures in the over 75 years age group and nail bed injuries in the 0-14 years age group. The incidence of nerve injuries also increased. We conclude from this study that HES is a useful tool. The information from HES may help plan service provision and also highlight important clinical problems that may benefit from further research.
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Affiliation(s)
- Oliver W G Manley
- 1 Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - Justin C R Wormald
- 1 Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK.,2 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Dominic Furniss
- 2 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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Hoffmeyer P, Miozzari H, Holzer N. Non-hip/non-vertebral fractures - How to treat best? Best Pract Res Clin Rheumatol 2019; 33:236-263. [PMID: 31547981 DOI: 10.1016/j.berh.2019.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fractures of the extremities in the elderly constitute more than two-thirds of all fragility fractures befalling frail, osteoporotic and sarcopenic patients. Although treatment controversies abound, consensus exists. Upper extremity fractures hinder activities of daily living and are debilitating. Open fractures or displaced fractures will need surgical intervention. Wrist fractures treated operatively allow early use of the hand. Most pelvic fractures are treated conservatively. In the lower extremities, fractures of the long bones, tibia and femur need surgical intervention. Non-displaced fractures around the foot may be treated with immobilisation and avoidance of full weight-bearing. As a rule, fractures take four months for consolidation. Individually tailored solutions are needed for frail patients with comorbidities. Maintaining joint mobility and muscle strength preserves mobility and autonomy. Caring for extremities trauma is team work, involving family and health care providers. Prevention efforts are mandatory.
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Affiliation(s)
- Pierre Hoffmeyer
- Swiss Foundation for Innovation and Training in Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
| | - Hermes Miozzari
- Department of Orthopaedics, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
| | - Nicolas Holzer
- Department of Orthopaedics, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
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Johnson NA, Jeffery J, Stirling E, Thompson J, Dias JJ. Effects of deprivation, ethnicity, gender and age on distal radius fracture incidence and surgical intervention rate. Bone 2019; 121:1-8. [PMID: 30599298 DOI: 10.1016/j.bone.2018.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/28/2018] [Accepted: 12/24/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Social deprivation has been shown to be associated with increased incidence of many types of fracture but the causes for this have not been established. The aim of this study was to establish if distal radius fracture was associated with deprivation and investigate reasons for this. METHOD Data was reviewed of 4463 adult patients who attended our Emergency Department over a four year period. The Index of Multiple Deprivation was used to measure deprivation for each patient. Modelling techniques were used to investigate the relationship between fracture rate and deprivation, gender, ethnicity and age. RESULTS Distal radius fracture rate was higher for patients in more deprived quintiles. Mean age in the most deprived two quintiles was 54.4 years compared to 60.1 years in the least deprived three quintiles. Modelling showed important differences between ethnic groups. Deprivation was an independent risk factor for distal radius fracture only in white patients. Deprived white women had a lower second metacarpal cortical index than women of other ethnicities suggesting increased bone fragility. Being male is a risk factor for fracture when deprivation, ethnicity and age are taken into account. Incidence rate ratio of the least deprived quintile compared to the most deprived was 0.33 (95% CI: 0.30-0.37) for white men and 0.47 (95% CI: 0.44-0.49) for white women. CONCLUSION Effective interventions exist to prevent further fragility fracture and this work allows geographical areas at risk to be identified. Presentation with a distal radius fracture provides an opportunity to implement interventions. In the current economic climate resources are scarce and must be used prudently. Resources should be targeted to those at risk patients from deprived areas and preventative strategies put in place.
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Affiliation(s)
- Nick A Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
| | - John Jeffery
- Nuffield Orthopaedic Centre, Windmill road, Oxford OX3 7HE, UK
| | - Euan Stirling
- Nuffield Orthopaedic Centre, Windmill road, Oxford OX3 7HE, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Joseph J Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK
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25
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Ghazala C, Choudhry N, Rajeev A. Closed Intramedullary Locking Nailing for Metacarpal Fractures: A Retrospective Study of Sixty-Six Fractures. Malays Orthop J 2018; 12:7-14. [PMID: 30112122 PMCID: PMC6092540 DOI: 10.5704/moj.1807.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Metacarpal fractures are frequent injuries in the young male working population and the majority are treated non-operatively. There is a growing trend to surgically treat these fractures, with the aim of reducing the deformity and shortening the rehabilitation period. The aim of this retrospective case series is to report on our experience and clinical outcomes of using percutaneous flexible locking nails for the management of displaced metacarpal fractures. This study is a retrospective review of 66 fractures that were managed at our centre over a 7-year period. Materials and Methods: Records of 60 patients were retrospectively reviewed. Indications for surgery were a displaced metacarpal shaft or neck fracture with associated rotational deformity, or multiple metacarpal fractures. The fracture was reduced by closed manipulation, and a flexible pre-bent locked intramedullary nail (1.6mm diameter) was inserted through a percutaneous dorsal antegrade approach, facilitated by a specially designed pre-fabricated awl. The implant was removed at union. Patients were followed-up in clinic until the fracture had united. Results: The mean union time was seven weeks (range 2 to 22 weeks) and there were nine (14%) delayed unions (>3 months) and no non-unions. The nail had migrated in three cases (5%) and caused skin impingement in two cases (3%). There was one infected case (2%). Rotational clinical deformity was evident for two (3%) cases. Conclusion: The use of a minimally-invasive locked intramedullary nailing for unstable metacarpal fractures has a significantly low complication rate, with predictable union times and good functional outcomes.
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Affiliation(s)
- C Ghazala
- Department of Orthopaedics, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - N Choudhry
- Department of Orthopaedics, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - A Rajeev
- Department of Orthopaedics, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
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Buried Versus Exposed Kirschner Wires Following Fixation of Hand Fractures: l Clinician and Patient Surveys. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1747. [PMID: 29876183 PMCID: PMC5977964 DOI: 10.1097/gox.0000000000001747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/13/2018] [Indexed: 02/03/2023]
Abstract
Background: Fractures of the metacarpals and phalanges are common. Placement of Kirschner wires (K-wires) is the most common form of surgical fixation. After placement, a key decision is whether to bury the end of a K-wire or leave it protruding from the skin (exposed). A recent systematic review found no evidence to support either approach. The aim of study was to investigate current clinical practice, understand the key factors influencing clinician decision-making, and explore patient preferences to inform the design of a randomized clinical trial. Methods: The steering group developed surveys for hand surgeons, hand therapists, and patients. Following piloting, they were distributed across the United Kingdom hand surgery units using the Reconstructive Surgery Trials Network. Results: A total of 423 hand surgeons, 187 hand therapists, and 187 patients completed the surveys. Plastic surgeons and junior surgical trainees preferred to leave K-wires not buried. Ease of removal correlated with a decision to leave wires exposed, whereas perceived risk of infection correlated with burying wires. Cost did not affect the decision. Hand therapists were primarily concerned about infection and patient-related outcomes. Patients were most concerned about wire-related problems and pain. Conclusion: This national survey provides a new understanding of the use of K-wires to manage hand fractures in the United Kingdom. A number of nonevidence-based factors seem to influence the decision to bury or leave K-wires exposed. The choice has important clinical and health economic implications that justify a randomized controlled trial.
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Treatment of proximal phalanx fractures: transarticular pinning the metacarpophalangeal joint or cross pinning from the base of the proximal phalanx-a prospective study. Eur J Trauma Emerg Surg 2018; 45:737-743. [PMID: 29487957 DOI: 10.1007/s00068-018-0927-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION For extraarticular proximal phalanx fractures, two methods are employed, transarticular fixation in which the metacarpophalangeal joint is crossed and the extraarticular method in which the pins are introduced through the base of the proximal Phalanx. MATERIALS AND METHODS This study was a prospective one on patients with proximal phalanx transverse or short oblique fractures. In one of the groups we used parallel pins from metacarpal head through MCP joint to proximal phalanx. In the second, we used two cross pins from proximal phalanx the base of the proximal phalanx to fix the fracture. We evaluated metacarpophalangeal, proximal and distal interphalangeal joints active range of motion and how long it took the patient to resume their daily activities and work without difficulty, as well as post-operative complications such as wound infection, malunion, and nonunion in 3 and 6 months follow-up. RESULTS Ultimately, 61 people entered the study, 29 in the parallel pins and 31 in the cross pins group. There was no significant difference between the two groups, but the improvement in all of the joints range of motion showed a statistically significant difference (P < 0.0001) from the 3 to 6 months follow-up. The final range of motion showed an inverse correlation with age of the patient (P < 0.05). Most of the patients were in the excellent grade of range of motion class and no serious complication was observed in any of them. CONCLUSION The results of treatment in proximal phalangeal fractures with both methods were comparable and so the surgeon may select each based on the experience and training.
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Does socioeconomic status influence the epidemiology and outcome of distal radial fractures in adults? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017. [PMID: 28638948 DOI: 10.1007/s00590-017-2003-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study in adult patients with a distal radial fracture was to determine whether socioeconomic status influenced the epidemiology, mechanism of injury, fracture severity, or the outcome according to function, radiographic assessment, and rate of associated complications. METHODS We identified 3983 distal radial fractures over a 7-year period. Socioeconomic status was assigned using the Carstairs score, and the population was divided into quintiles depending on deprivation. Patient demographics, mechanism of injury, fracture severity, and radiographic assessment at time of injury were assessed for epidemiological differences according to social quintile. Functional outcome was assessed using grip strength, Moberg pickup test, return to normal use of the hand, and range of movement. Radiographs were assessed at 1 week, 6 weeks, and 1 year. Complications were defined as malunion, carpal tunnel syndrome, complex regional pain syndrome (CRPS), persistent pain, and subjective cosmetic deformity of the wrist. RESULTS Socioeconomically deprived patients were significantly younger (p < 0.001) and more likely to be male (p = 0.017); after adjusting for confounding factors, deprived patients were 3.1 (95% CI 1.4-4.7) years younger than the most affluent patients (p < 0.001). Deprived patients were more likely to sustain their fracture by a high-energy mechanism (p = 0.004). There were no significant differences between quintiles in outcome. There was a significantly greater prevalence of CRPS in more affluent patients (p = 0.004). CONCLUSIONS Socioeconomically deprived patients sustaining a distal radial fracture are more likely to be younger and male. Outcome is not influenced by socioeconomic status, but the prevalence of CRPS is greater in more affluent patients.
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Headless Compression Screw Versus Kirschner Wire Fixation for Metacarpal Neck Fractures: A Biomechanical Study. J Hand Surg Am 2017; 42:392.e1-392.e6. [PMID: 28359640 DOI: 10.1016/j.jhsa.2017.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 01/24/2017] [Accepted: 02/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to determine the biomechanical stability of headless compression screws in the fixation of metacarpal neck fractures and to compare them with another common, less invasive form of fixation, K-wires. The hypothesis was that headless compression screws would show higher stiffness and peak load to failure than K-wire fixation. METHODS Eight matched-paired hands (n = 31), using the ring and little finger metacarpals, had metacarpal fractures simulated at the physeal scar. Each group was stabilized with either a 3.5-mm headless compression screw or 2 0.045-in (1.1-mm) K-wires. Nineteen metacarpals were tested in 3-point bending and 12 in axial loading. Peak load to failure and stiffness were calculated from the load displacement curve. Bone mineral density was recorded for each specimen. RESULTS Bone mineral density was similar in the 2 groups tested for 3-point bending and axial loading. Stiffness was not significantly different in 3-point bending for headless compression screws and K-wires (means, 141.3 vs 194.5 N/mm) but it was significant in axial loading (means, 178.0 vs 111.6 N/mm). Peak load to failure was significantly higher in headless compression screws in 3-point bending (means, 401.2 vs 205.3 N) and axial loading (means, 467.5 vs 198.3 N). CONCLUSIONS Compared with K-wires, headless compression screws for metacarpal neck fractures are biomechanically superior in load to failure, 3-point bending, and axial loading. CLINICAL RELEVANCE Headless compression screws demonstrate excellent biomechanical stability in metacarpal neck fractures. In conjunction with promising clinical studies, these data suggest that headless compression screws may be an option for treating metacarpal neck fractures.
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Impact of Safety Net Hospitals in the Care of the Hand-Injured Patient: A National Perspective. Plast Reconstr Surg 2017; 138:429-434. [PMID: 27465165 DOI: 10.1097/prs.0000000000002373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A clear disparity in the pattern and provision of surgical care exists, particularly for patients with vulnerable socioeconomic backgrounds. For hand-injured patients in particular, this discrepancy has been frequently shown in their receiving appropriate care. With the advent of the Affordable Care Act and with Medicaid expansion on the horizon, more patients will be requiring access to care. Safety net programs have been shown to provide equivalent levels of care for patients compared with non-safety net providers, and the survival of these hospitals for the disadvantaged is essential to providing quality care for this growing patient population. In this article, the authors review the factors that affect the barriers to care, the importance of safety net hospitals, the epidemiology of the hand-injured patient, and how the Affordable Care Act will impact these safety net programs.
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Anakwe RE, Middleton SD, Bugler KE, Duckworth AD, McQueen MM, Brown CMC. Open Finger Fractures: Incidence, Patterns of Injury and the Influence of Social Deprivation. J Hand Surg Asian Pac Vol 2016; 21:352-6. [PMID: 27595953 DOI: 10.1142/s2424835516500338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study investigates the patterns and epidemiology of open finger fractures. There is little good data about these injuries. METHODS Data were collected prospectively in a single trauma unit serving a well-defined population. RESULTS Over a 15 year period 1090 open finger fractures were treated in 1014 patients. These made up the vast majority of open fractures treated in the trauma unit during this period. The incidence of open finger fractures was 14.0 per 100,000 patients per year. Deprivation did not influence the incidence of open finger fractures but did affect treatment choices for women. Most open finger fractures resulted from crush injuries or falls and required only simple operative treatments: debridement, lavage and early mobilization. CONCLUSIONS Open finger fractures formed the majority of the workload of open fractures at our trauma centre but usually required simple treatments only. Social deprivation was not shown to influence the patterns or epidemiology of these injuries but did affect treatment choices for women.
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Affiliation(s)
- Raymond E Anakwe
- † Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Scott D Middleton
- * Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Kate E Bugler
- * Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- * Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Margaret M McQueen
- * Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Kocaoğlu S, Özhasenekler A, İçme F, Pamukçu Günaydın G, Şener A, Gökhan Ş. The role of ultrasonography in the diagnosis of metacarpal fractures. Am J Emerg Med 2016; 34:1868-71. [PMID: 27396537 DOI: 10.1016/j.ajem.2016.06.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the efficiency of ultrasonography (USG) in identifying metacarpal bone fractures in patients admitted to the emergency department (ED) with hand injury. MATERIALS AND METHODS Patients who were admitted to a training and research hospital's ED during the study period with hand trauma and had suspected metacarpal fractures were included in the study. They were examined for metacarpal fracture by USG and x-ray. Hand radiographs reviewed by an emergency physician were considered to be the criterion standard diagnostic tool. Ultrasonography results were compared to x-ray results. RESULTS Ninety-eight ultrasound examinations were performed on 96 adult patients who were enrolled in the study. The mean age of the patients was 30.1±11.8 years; 79.2% of the patients were male. Right hand injury was observed in 69.4% of the cases. Forty metacarpal fractures were detected in 38 patients on x-ray. We found a sensitivity of 92.5% (95% confidence interval [CI], 78.5-98), a specificity of 98.28% (95% CI, 89.5-99.9), a positive predictive value of 97.37% (95% CI, 84.5-99.8), and a negative predictive value of 95% (95% CI, 85-98) for USG to detect metacarpal fractures when compared to x-ray imaging. CONCLUSIONS Under the light of these results, we suggest that USG may be an option for detecting metacarpal fractures and prevent unnecessary x-ray imaging examinations in patients presenting to the ED with hand trauma.
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Affiliation(s)
- Salih Kocaoğlu
- Department of Emergency Medicine, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ayhan Özhasenekler
- Department of Emergency Medicine, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Ferhat İçme
- Department of Emergency Medicine, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Gül Pamukçu Günaydın
- Department of Emergency Medicine, Atatürk Training and Research Hospital, Ankara, Turkey.
| | - Alp Şener
- Department of Emergency Medicine, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Şervan Gökhan
- Department of Emergency Medicine, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
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Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid. Bone Joint J 2016; 98-B:654-9. [PMID: 27143737 DOI: 10.1302/0301-620x.98b5.36938] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/13/2015] [Indexed: 11/05/2022]
Abstract
Aims This study explores the epidemiology of patients with a fracture of the scaphoid presenting to a regional teaching hospital. Patients and Methods All patients with a confirmed fracture of the scaphoid over a retrospective period between January 2010 and May 2013 were included. Their demographics, deprivation status and when the fracture occurred was noted and assessed. There were 415 fractures in 365 males and 50 females. Results The incidence of fracture of the scaphoid was 12.4 in 100 000 each year in the general population. The mean age of the patients was 22 years (nine to 35); the highest incidence was in males aged between 15 and 19 years. We calculate the annual incidence in the United Kingdom to be 7265 each year. Patients with the lowest socioeconomic status had an incidence of 18.57 in 100 000 whereas the least deprived patients had an incidence of 9.98 (p < 0.001). There was evidence of a seasonal trend (p = 0.022) with the highest monthly rate found in June (16.96 in 100 000 each year) and the lowest was in December (7.61 in 100 000 each year). There were significantly fewer presentations of fracture at the weekend (p < 0.001), and the highest incidence was on Mondays. Most fractures occurred at the waist (64%) and tubercle (18.1%). Take home message: In this large-scale epidemiological study, we confirmed that young men are most at risk of sustaining a fracture of the scaphoid, and report new factors in relation to social deprivation and seasonality that influence scaphoid fractures. Cite this article: Bone Joint J 2016;98-B:654–9.
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Affiliation(s)
- K. Garala
- University Hospitals Coventry and Warwickshire, Coventry, CV2
2DX, UK
| | - N. A. Taub
- University of Leicester, 22-28
Princess Road West, Leicester LE1 6TP, UK
| | - J. J. Dias
- Leicester General Hospital, Gwendolen
Road, Leicester, LE5 4PW, UK
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Weum S, Millerjord S, de Weerd L. The distribution of hand fractures at the university hospital of north Norway. J Plast Surg Hand Surg 2016; 50:146-50. [DOI: 10.3109/2000656x.2015.1137923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Epidemiology and patterns of the hand and distal forearm fractures at King Abdul-Aziz Medical City, Riyadh, KSA. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Malasitt P, Owen JR, Tremblay MA, Wayne JS, Isaacs JE. Fixation for metacarpal neck fracture: a biomechanical study. Hand (N Y) 2015; 10:438-43. [PMID: 26330775 PMCID: PMC4551637 DOI: 10.1007/s11552-015-9744-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is no robust evidence of the best operative treatment for displaced unstable metacarpal neck fractures. Numerous constructs are used in the fixation of metacarpal neck fractures. Currently, two common methods are dorsal locking plate and K-wire fixation. A new metacarpal sled fixation system for metacarpal neck fracture was designed to provide fracture stability but limit dissection and avoid exposed hardware. The purpose of this study was to compare the biomechanical integrity of the metacarpal sled versus standard locking plate fixation and retrograde K-wire fixation in a simulated porcine metacarpal fracture model. METHODS Transverse metacarpal neck fractures were created in 30 porcine second metacarpals. The specimens were randomly fixed with locking plates, metacarpal sleds, or retrograde K-wires. Constructs were then loaded to failure in three-point bending. Stiffness and peak load were measured from the load-to-failure deflection curve. Data were analyzed via ANOVA, followed by Tukey-Kramer's post hoc pairwise comparison. RESULTS The K-wire group had the highest initial stiffness followed by the sled group and then the plate group. Statistical difference was only found between K-wires and plate. Peak load for the K-wire group was lowest, followed by sled, and then by plate. A statistically significant difference was observed between the peak loads of the K-wires and plate, as well as the sled and plate. However, a difference in peak load was not detected between the K-wires and sled. CONCLUSIONS For transverse metacarpal neck fractures, a metacarpal sled construct provides similar fixation to K-wires with limited dissection and without exposed hardware or the potential for soft tissue tethering. The new low profile construct using a minimally invasive technique would be suitable for unstable metacarpal neck fractures.
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Affiliation(s)
- Pramote Malasitt
- />Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, P.O. Box 980153, Richmond, VA 23298-0153 USA
| | - John R. Owen
- />Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA 23298-0153 USA
| | - Marc-Antoine Tremblay
- />Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA 23298-0153 USA
| | - Jennifer S. Wayne
- />Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA 23298-0153 USA
| | - Jonathan E. Isaacs
- />Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, P.O. Box 980153, Richmond, VA 23298-0153 USA
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Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM. Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am 2014; 96:1716-23. [PMID: 25320198 DOI: 10.2106/jbjs.m.01354] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is evidence to support primary nonoperative management of isolated stable fractures of the radial head, although minimal data exist regarding long-term outcomes. The aim of this study was to report subjective long-term outcomes of isolated stable fractures of the radial head and neck following primary nonoperative management. METHODS From a prospective database of proximal radial fractures, we identified all skeletally mature patients who sustained an isolated stable Mason type-1 or type-2 fracture of the radial head or neck during an eighteen-month period. Inclusion criteria were a confirmed isolated stable fracture of the proximal aspect of the radius, primarily managed nonoperatively. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS The study cohort comprised 100 patients with a mean age of forty-six years (range, seventeen to seventy-nine years). A fall from a standing height accounted for 69% of all injuries. Thirty-five percent of the patients had one or more comorbidities. There were fifty-seven Mason type-1 fractures and forty-three Mason type-2 fractures. At a mean of ten years post injury (range, 8.8 to 10.2 years), the mean DASH score was 5.8 (range, 0 to 67.2) and the mean Oxford Elbow Score (OES) was 46 (range, 14 to 48). Fourteen (14%) of the patients reported stiffness and twenty-four (24%) reported some degree of pain. A worse DASH score was associated with older age (p = 0.002), one or more comorbidities (p = 0.008), increasing socioeconomic deprivation by Index of Multiple Deprivation quintile (p = 0.026), increasing amount of fracture displacement (p = 0.041), and involvement in compensation proceedings (p = 0.006). CONCLUSIONS Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. We suggest that routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients in our study requiring further intervention for persisting complaints. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Neil R Wickramasinghe
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Nicholas D Clement
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
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Clement ND, McQueen MM, Court-Brown CM. Social deprivation influences the epidemiology and outcome of proximal humeral fractures in adults for a defined urban population of Scotland. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1039-46. [DOI: 10.1007/s00590-013-1301-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/17/2013] [Indexed: 11/28/2022]
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Şahin F, Akca H, Akkaya N, Zincir ÖD, Işik A. Cost analysis and related factors in patients with traumatic hand injury. J Hand Surg Eur Vol 2013. [PMID: 23204134 DOI: 10.1177/1753193412469012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to measure the direct and indirect costs and factors influencing these costs in patients presenting following traumatic hand injury. We assessed patients aged 18-65 years who were in work. Hand injury severity and functional status were assessed. Direct costs, including medical care expenses, and indirect costs, including lost productivity, were calculated. Seventy-nine patients of a mean age of 32 years were included. The mean direct cost for each patient was $1772 (47% of total cost), and the indirect cost was $1891 (53% of total cost). Injury severity, time to return to work, and hospitalization time were the main parameters of increased total cost in a linear regression analysis.
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Affiliation(s)
- F Şahin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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Laugharne E, Bhavsar D, Rajaratnam V. The distribution of hand fractures: a British perspective. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0775-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hand education for emergency medicine residents: results of a pilot program. J Hand Surg Am 2012; 37:1245-8.e12. [PMID: 22554611 DOI: 10.1016/j.jhsa.2012.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 03/10/2012] [Accepted: 03/13/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Multiple studies have demonstrated the lack of knowledge of hand anatomy and pathology among those who first see patients with hand disorders. The goal of this study was to determine whether a hand surgery rotation for emergency medicine residents would improve this group's knowledge of the hand and its disorders as assessed at the end of their residency training. METHODS Seven postgraduate year (PGY) 2 emergency medicine residents completed a 4-week hand surgery rotation. Hand knowledge was assessed at the start, at the end, and 1 year after this rotation (end of PGY 3). Knowledge of a control group of 7 PGY 3 emergency medicine residents who did not have this rotation was also assessed. RESULTS Hand knowledge in the residents who completed the rotation was significantly improved. This was true for overall test performance (88% vs 70% correct responses), as well as for each of the anatomy and function (89% vs 57%), diagnosis (96% vs 86%), and treatment (79% vs 51%) categories. Overall test performance (78% vs 66%) and anatomy and function category performance (75% vs 43%) were significantly better at the end of PGY 3 for the residents who completed the rotation as compared to the control residents. CONCLUSIONS A hand surgery rotation during an emergency medicine residency program improved the knowledge of hand anatomy and disorders. This knowledge was retained 1 year later and was greater than the knowledge of matched emergency medicine residents who did not have this rotation. Better knowledge of hand anatomy and disorders among emergency physicians might improve their ability to initially evaluate and treat patients with these conditions. Such knowledge might allow emergency department physicians to play a more important role in the management of hand emergencies. A hand surgery rotation has been incorporated into the PGY 2 curriculum for all emergency medicine residents at my institution.
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ten Berg PWL, Ring D. Patients lost to follow-up after metacarpal fractures. J Hand Surg Am 2012; 37:42-6. [PMID: 22015075 DOI: 10.1016/j.jhsa.2011.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 08/04/2011] [Accepted: 08/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine factors associated with non-attendance at scheduled follow-up visits for treatment of metacarpal fractures, to improve subject retention in prospective investigations. METHODS This study included adult patients with metacarpal fractures seen in an outpatient hand clinic between 2004 and 2009. We assessed a number of variables (demographic, social, and injury-specific) that might be associated with failure to return for follow-up. The statistical analysis included both bivariate and multivariable models. RESULTS In a cohort of 335 patients (228 men and 107 women) with a mean age of 40 years (range, 18-88 y), independent factors associated with non-attendance were unmarried status (single or divorced), having no insurance, having an unemployed or disabled status, having an unknown work status, and having a small finger metacarpal neck fracture. CONCLUSIONS Patients who do not attend a scheduled 1-month follow-up after a single isolated metacarpal fracture are sociologically distinct from those who do attend. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Paul W L ten Berg
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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