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Héroux J, Bessette PO, Bédard S, Lamarche D, Gagnon A, Échavé P, Loignon MJ, Patenaude N, Baillargeon JP, D'Aragon F. Functional recovery of wrist surgery with regional versus general anesthesia: a prospective observational study. Can J Anaesth 2024; 71:761-772. [PMID: 37932649 DOI: 10.1007/s12630-023-02615-y] [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] [Received: 12/20/2022] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Regional anesthesia may favour postoperative rehabilitation by inhibiting peripheral sensitization and secondary hyperalgesia. The literature on this subject is limited. In the present FUNCTION study, we sought to compare the functional recovery post orthopedic wrist surgery with regional versus general anesthesia. METHODS We conducted a single-centre prospective observational cohort study in adult patients with a distal radial fracture. Functional recovery was assessed with validated psychometrics questionnaires (Quick Disabilities of Arm, Shoulder and Hand [QuickDASH] and Patient-Rated Wrist Evaluation [PRWE]), range of motion, and grip strength. We used a linear mixed regression model to assess the impact of the anesthesia technique on functional recovery. Postoperative pain and patient satisfaction were evaluated using a visual analog scale. RESULTS We recruited 76 patients. At 12 weeks post surgery, there was no difference between the type of anesthesia and functional recovery with the QuickDASH (higher scores worse; regional anesthesia [RA], 22.7 vs general anesthesia [GA], 19.3; adjusted mean difference [aMD], -0.3; 95% confidence interval [CI], -9.6 to 9.0; P = 0.9) and PRWE (higher scores worse; RA group, 21.0 vs GA group, 20.5; aMD, -3.3; 95% CI, -12.1 to 5.6; P = 0.93) questionnaires. Range of motion, satisfaction, and postoperative pain were similar between groups. Right-hand grip strength was higher in the GA group. CONCLUSION Regional anesthesia was not associated with improved functional recovery compared with general anesthesia. The dominance of the operated limb was a confusion factor in all evaluation modalities. Further research taking into account the dominance of the hand is necessary to establish the effects of regional anesthesia on functional recovery. STUDY REGISTRATION ClinicalTrials.gov (NCT04541745); registered 9 September 2020.
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Affiliation(s)
- Jennifer Héroux
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Department of Anesthesiology, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | | | - Sonia Bédard
- Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Daphnée Lamarche
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anthony Gagnon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pablo Échavé
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Josée Loignon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Patenaude
- Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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Rolls C, Van der Windt DA, McCabe C, Babatunde OO, Bradshaw E. Prognostic factors for persistent pain after a distal radius fracture: a systematic review. HAND THERAPY 2022; 27:123-136. [PMID: 37904895 PMCID: PMC10584063 DOI: 10.1177/17589983221124973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/03/2022] [Indexed: 11/01/2023]
Abstract
Introduction The aim of this systematic review was to synthesize the evidence regarding prognostic factors for persistent pain, including Complex Regional Pain Syndrome (CRPS), after a distal radius fracture (DRF), a common condition after which persistent pain can develop. Methods Medline, Pubmed, Embase, Psychinfo, CINAHL, BNI, AMED and the Cochrane Register of Clinical Trials were searched from inception to May 2021 for prospective longitudinal prognostic factor studies investigating persistent pain in adults who had sustained a DRF. The Quality in Prognostic Studies (QUIPS) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were used to assess the strength of evidence. Results A search yielded 440 studies of which 7 studies met full eligibility criteria. From five studies we found low evidence for high baseline pain or an ulnar styloid fracture as prognostic factors for persistent pain, and very low evidence for diabetes or older age. From two studies, investigating an outcome of CRPS, there was low evidence for high baseline pain, slow reaction time, dysynchiria, swelling and catastrophising as prognostic factors, and very low evidence for depression. Sex was found not to be a prognostic factor for CRPS or persistent pain. Conclusions The associations between prognostic factors and persistent pain following a DRF are unclear. The small number of factors investigated in more than one study, along with poor reporting and methodological limitations contributed to an assessment of low to very low strength of evidence. Further prospective studies, investigating psychosocial factors as candidate predictors of multidimensional pain outcomes are recommended.
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Affiliation(s)
- Catherine Rolls
- Therapy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Candy McCabe
- School for Health and Social Wellbeing, University West of England, Bristol, UK
| | | | - Elizabeth Bradshaw
- Therapy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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DeGeorge BR, Van Houten HK, Mwangi R, R Sangaralingham L, Kakar S. Outcomes and complications of operative versus non-operative management of distal radius fractures in adults under 65 years of age. J Hand Surg Eur Vol 2021; 46:159-166. [PMID: 32752977 DOI: 10.1177/1753193420941310] [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
To compare the outcomes of non-operative versus operative treatment for distal radius fractures in patients aged from 18 to 64 years, we performed a retrospective analysis using the OptumLabs® Data Warehouse using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes of distal radius fracture. Of the 34,184 distal radius fractures analysed, 11,731 (34%) underwent operative management. Short-term complications within 90 days of fracture identified an overall complication rate of 16.6 per 1000 fractures and the 1-year upper extremity-specific complication rate was 287 per 1000 fractures. Overall, post-injury stiffness was the most common 1-year upper extremity-specific complication and was associated with operative management (202.8 vs. 123.4 per 1000 fractures, operative vs. non-operative, p < 0.01). Secondary procedures were significantly more common following non-operative management (8.7% vs. 43%, operative vs. non-operative, p < 0.01) with carpal tunnel release representing the most common secondary procedure. Operative management of distal radius fractures resulted in significantly fewer secondary procedures at the expense of increased overall 1-year complication rates, specifically stiffness.Level of evidence: III.
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Affiliation(s)
- Brent R DeGeorge
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Holly K Van Houten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,OptumLabs, Cambridge, MA, USA
| | - Raphael Mwangi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,OptumLabs, Cambridge, MA, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Combined Conventional and Transulnar Percutaneous Pinning of the Displaced Distal Radius Fracture. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lameijer CM, Ten Duis HJ, Haag CMSC, El Moumni M, van der Sluis CK. The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant? Disabil Rehabil 2020; 43:3777-3788. [PMID: 32356451 DOI: 10.1080/09638288.2020.1753247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Following distal radius fractures in young non-osteoporotic patients, clinical relevancy of outcome has been scarcely reported. Outcome can be put in perspective by using measurement errors of radiological measurements and Minimal Important Change when reporting on clinician and patient reported outcome. Aim of this study was to assess the clinical relevance of radiological measurements, clinician and patient reported outcomes following distal radius fractures in young non-osteoporotic patients.Methods: Retrospective cohort study. Non-osteoporotic patients following a distal radius fracture were selected. Radiographs of both wrists were obtained at baseline, 6 weeks and at follow-up. Active range of motion and grip strength measurements were obtained at the follow-up visit and 4 questionnaires were answered to assess pain, upper extremity functioning, and health status.Results: Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years at the time of injury were included. Median follow up was 62 months (IQR 53.0-84.5). Several radiological measurements evolved statistically significantly over time, however none exceeded measurement errors. Flexion/extension difference of injured compared to uninjured wrist (mean difference 11.2°, t = -7.5, df = 72, p < 0.001), exceeded Minimal Important Change, while grip strength differences did not. When comparing patients with DRFs to healthy controls, only the differences on Patient Reported Wrist Evaluation subscales "pain", "function" and total scores exceeded minimal important change (8, 10 and 13 points, respectively). Multivariable regression analysis revealed statistically significant relationships between residual step-off and respectively diminished flexion/extension (B = -36.8, 95% CI -62; -11.1, p = 0.006), diminished radial/ulnar deviation (B = -17.9, 95% CI -32.0; -3.9, p = 0.013) and worse ShortForm-36 "mental component score" (B = -15.4, 95% CI -26.6; -4.2, p < 0.001).Conclusion: Radiological measurements following distal radius fractures seem to evolve over time, but differences were small and were probably not clinically relevant. Range of motion, in particular flexion/extension, was impaired to such extend that it was noticeable for a patient, whereas grip strength was not impaired. The Patient Reported Wrist Evaluation was clinically relevantly diminished. Residual articular incongruency seems to influence range of motion.Implications for rehabilitationReporting Minimal Important Change regarding clinician and patient reported outcome following distal radius fractures is of more clinical value than reporting on statistical significance.Following distal radius fractures, the changes in radiological measurements do not seem to reflect a clinical relevant change.Range of motion, in particular flexion/extension, should be measured following distal radius fractures, as this might be impaired in a clinically relevant way.Measuring grip strength is of less importance following distal radius fractures, because grip strength does not seem to be affected.Residual articular incongruency seems to influence range of motion and therefore should be reduced to a minimum when treating non-osteoporotic patients.
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Affiliation(s)
- Charlotte M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Jan Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Charlotte M S C Haag
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Persistent Pain After Wrist or Hand Fracture: Development and Validation of a Prognostic Model. J Orthop Sports Phys Ther 2019; 49:28-35. [PMID: 30208793 DOI: 10.2519/jospt.2019.8342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Worldwide, the incidence of wrist fracture is increasing. There are currently no externally validated prognostic models to inform early decision making for these patients. OBJECTIVES To develop and validate a prognostic model from a comprehensive range of candidate prognostic factors that can identify patients who are at risk of developing persistent pain following wrist or hand fracture. METHODS We developed and validated a prognostic model using secondary data derived from a prospective cohort study (n = 715), with recruitment sites in 3 metropolitan hospitals in Sydney, Australia. The primary outcome was persistent pain 4 months following the injury. The current study used a backward stepwise regression analysis to develop the model in 2 hospitals (n = 408) and externally validate it in a third hospital (n = 307). To determine the accuracy of the model, we assessed calibration and discrimination in accordance with the PROGnosis RESearch Strategy framework. RESULTS Complete data were available for 95% of the cohort. Of 14 candidate variables, the final model contained 2 prognostic factors: patient age and pain intensity reported at initial presentation. The area under the receiver operating characteristic curve was 0.63 (95% confidence interval: 0.56, 0.69) in the development sample and 0.61 (95% confidence interval: 0.51, 0.70) in the validation sample. The model systematically overestimated risk (intercept, -1.13; slope, 0.73). CONCLUSION We developed and externally validated a prognostic model to predict persistent pain 4 months after a wrist or hand fracture. Future studies are needed to assess whether the accuracy of this model can be improved by updating and validating it in local settings. LEVEL OF EVIDENCE Prognosis, level 1b. J Orthop Sports Phys Ther 2019;49(1):28-35. Epub 12 Sep 2018. doi:10.2519/jospt.2019.8342.
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Gauci MO, Lenoir H, Waitzenegger T, Andrin J, Lazerges C, Coulet B, Chammas M. [Extra-articular distal radius fractures in young adults]. HAND SURGERY & REHABILITATION 2016; 35S:S44-S50. [PMID: 27890211 DOI: 10.1016/j.hansur.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/23/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
Extra-articular distal radius fractures in young active patients are typically the result of sport injuries or traffic accidents. Displaced fractures are less well tolerated in young patients than in older people, especially in terms of dorsal tilt and radial shortening. Non-surgical treatment is only indicated when the fracture is minimally or not displaced. No fracture fixation method is superior to another, however, the treatment goal is a rapid return to previous activities.
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Affiliation(s)
- M-O Gauci
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - H Lenoir
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - T Waitzenegger
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J Andrin
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Lazerges
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - B Coulet
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - M Chammas
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Fontaine C, Bry R, Laronde P, Guerre E, Aumar A. [Descriptive, radiographic, topographic and functional anatomy applied to distal radius fractures]. HAND SURGERY & REHABILITATION 2016; 35S:S3-S14. [PMID: 27890208 DOI: 10.1016/j.hansur.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/17/2016] [Accepted: 07/04/2016] [Indexed: 10/20/2022]
Abstract
Extensive anatomical knowledge is needed in order to correctly treat distal radius fractures: normal and pathological osteology of the distal radius, distal radio-ulnar joint and radiocarpal joint-both on the descriptive and functional level-the neurovascular and muscular environments of the distal radius-which are essential to the surgical approaches-and the angles that need to be restored during the reduction. All of these concepts are broached in this article.
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Affiliation(s)
- C Fontaine
- Service d'orthopédie B, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France; Laboratoire d'automatique, de mécanique et d'informatique industrielle et humaine (LAMIH), université de Valenciennes et du Hainaut-Cambrésis, Le-Mont-Houy, 59313 Valenciennes cedex, France.
| | - R Bry
- Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France; Laboratoire d'automatique, de mécanique et d'informatique industrielle et humaine (LAMIH), université de Valenciennes et du Hainaut-Cambrésis, Le-Mont-Houy, 59313 Valenciennes cedex, France
| | - P Laronde
- Service d'orthopédie B, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France
| | - E Guerre
- Service d'orthopédie B, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France
| | - A Aumar
- Service d'orthopédie B, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France
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Lechler P, Börsch M, Timmesfeld N, Schwarting T, Boese CK, Frink M. The relationship between initial closed reduction and the surgical reconstruction of the radiocarpal joint line in distal radial fractures. Injury 2016; 47:925-9. [PMID: 26686595 DOI: 10.1016/j.injury.2015.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Whilst initial closed reduction followed by definitive open fixation is widely applied in the treatment of distal radial fractures, the effect of the closed reduction on the reconstruction of the articular surface remains unclear. Our research questions were: METHODS Palmar tilt and radiocarpal inclination of 425 patients were measured at admission, following initial closed reduction and after surgical reconstruction. RESULTS Closed reduction increased palmar tilt by 12.1° and radial inclination by 2.7°. Open surgical reduction further corrected palmar tilt by 17.88° and radial inclination by 3.5°. Whilst there was no association between postoperative palmar tilt and initially achieved closed reduction, a significant association between radial inclination following closed reduction and surgical fixation was found. CONCLUSION Our retrospective study challenges the existence of a relationship between the initial closed reduction and the reconstruction of the anatomic joint line in surgically treated distal radial fractures.
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Affiliation(s)
- P Lechler
- Department of Trauma, Hand and Reconstructive Surgery, University Medical center Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - M Börsch
- Department of Trauma, Hand and Reconstructive Surgery, University Medical center Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - N Timmesfeld
- Institute for Medical Biometry and Epidemiology, Philipps-University, Marburg, Germany
| | - T Schwarting
- Department of Trauma, Hand and Reconstructive Surgery, University Medical center Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - C K Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - M Frink
- Department of Trauma, Hand and Reconstructive Surgery, University Medical center Marburg, Baldingerstraße, 35043 Marburg, Germany.
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Machado DG, da Cruz Cerqueira SA, de Lima AF, de Mathias MB, Aramburu JPG, Rodarte RRP. Statistical analysis on the concordance of the radiological evaluation of fractures of the distal radius subjected to traction. Rev Bras Ortop 2016; 51:11-5. [PMID: 26962498 PMCID: PMC4767842 DOI: 10.1016/j.rboe.2014.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/29/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the current classifications for fractures of the distal extremity of the radius, since the classifications made using traditional radiographs in anteroposterior and lateral views have been questioned regarding their reproducibility. In the literature, it has been suggested that other options are needed, such as use of preoperative radiographs on fractures of the distal radius subjected to traction, with stratification by the evaluators. The aim was to demonstrate which classification systems present better statistical reliability. RESULTS In the Universal classification, the results from the third-year resident group (R3) and from the group of more experienced evaluators (Staff) presented excellent correlation, with a statistically significant p-value (p < 0.05). Neither of the groups presented a statistically significant result through the Frykman classification. In the AO classification, there were high correlations in the R3 and Staff groups (respectively 0.950 and 0.800), with p-values lower than 0.05 (respectively <0.001 and 0.003). CONCLUSION It can be concluded that radiographs performed under traction showed good concordance in the Staff group and in the R3 group, and that this is a good tactic for radiographic evaluations of fractures of the distal extremity of the radius.
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Machado DG, Cerqueira SADC, Lima AFD, Mathias MBD, Aramburu JPG, Rodarte RRP. Análise estatística da concordância na avaliação radiológica das fraturas de rádio distal submetidas a tração. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kim JY, Tae SK. Percutaneous distal radius-ulna pinning of distal radius fractures to prevent settling. J Hand Surg Am 2014; 39:1921-5. [PMID: 25194770 DOI: 10.1016/j.jhsa.2014.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/05/2014] [Accepted: 07/11/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and radiological outcomes of distal radius fractures treated by percutaneous fixation using distal radius-ulna pinning and to assess its effectiveness especially for preventing fracture settling. METHODS We retrospectively reviewed 18 distal radius fractures (15 AO type A2 and 3 AO type C1). Range of motion and Disabilities of the Arm, Shoulder, and Hand scores were evaluated. We measured radiographic parameters at the final follow-up and compared them with those on immediate postoperative x-rays. RESULTS All fractures united and average time to initial healing was 6.9 weeks (range, 6-7 wk). Average follow-up was 29 months (range, 26-43 mo). Average wrist flexion and extension were 70° and 65°, respectively. Average forearm supination and pronation were 82° and 83°, respectively. Average pain score was 1.2 and average Disabilities of the Arm, Shoulder, and Hand score was 13. Mean difference of ulnar variance, volar tilt, and radial inclination between immediate and final follow-up x-rays was 0.7 mm, 1°, and less than 1°, respectively. CONCLUSIONS Percutaneous fixation of distal radius fractures using distal radius-ulna pinning had favorable radiologic and functional outcomes and was effective in preventing fracture settling during initial healing in unstable extra-articular fractures and some simple sagittal split intra-articular fractures. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Jin Young Kim
- Department of Orthopedic Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Donggu, Ilsan, Goyang, Republic of Korea.
| | - Suk Kee Tae
- Department of Orthopedic Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Donggu, Ilsan, Goyang, Republic of Korea
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