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Suen K, Zhang R, Kutaiba N. Accuracy of wrist fracture detection on radiographs by artificial intelligence compared to human clinicians. A systematic review and meta-analysis. Eur J Radiol 2024; 178:111593. [PMID: 38981178 DOI: 10.1016/j.ejrad.2024.111593] [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: 02/08/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE The aim of the study is to perform a systematic review and meta-analysis comparing the diagnostic performance of artificial intelligence (AI) and human readers in the detection of wrist fractures. METHOD This study conducted a systematic review following PRISMA guidelines. Medline and Embase databases were searched for relevant articles published up to August 14, 2023. All included studies reported the diagnostic performance of AI to detect wrist fractures, with or without comparison to human readers. A meta-analysis was performed to calculate the pooled sensitivity and specificity of AI and human experts in detecting distal radius, and scaphoid fractures respectively. RESULTS Of 213 identified records, 20 studies were included after abstract screening and full-text review. Nine articles examined distal radius fractures, while eight studies examined scaphoid fractures. One study included distal radius and scaphoid fractures, and two studies examined paediatric distal radius fractures. The pooled sensitivity and specificity for AI in detecting distal radius fractures were 0.92 (95% CI 0.88-0.95) and 0.89 (0.84-0.92), respectively. The corresponding values for human readers were 0.95 (0.91-0.97) and 0.94 (0.91-0.96). For scaphoid fractures, pooled sensitivity and specificity for AI were 0.85 (0.73-0.92) and 0.83 (0.76-0.89), while human experts exhibited 0.71 (0.66-0.76) and 0.93 (0.90-0.95), respectively. CONCLUSION The results indicate comparable diagnostic accuracy between AI and human readers, especially for distal radius fractures. For the detection of scaphoid fractures, the human readers were similarly sensitive but more specific. These findings underscore the potential of AI to enhance fracture detection accuracy and improve clinical workflow, rather than to replace human intelligence.
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Affiliation(s)
- Kary Suen
- Department of Radiology, Austin Health, Victoria, Australia.
| | - Richard Zhang
- Department of Radiology, Austin Health, Victoria, Australia
| | - Numan Kutaiba
- Department of Radiology, Austin Health, Victoria, Australia
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Mehta SP, Karagiannopoulos C, Pepin ME, Ballantyne BT, Michlovitz S, MacDermid JC, Grewal R, Martin RL. Distal Radius Fracture Rehabilitation. J Orthop Sports Phys Ther 2024; 54:CPG1-CPG78. [PMID: 39213418 DOI: 10.2519/jospt.2024.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Distal radius fracture (DRF) is arguably the most common upper extremity fracture resulting from a fall accident. These clinical practice guidelines (CPG) were developed to guide all aspects of the management of DRF by physical therapists and other rehabilitation practitioners, such as certified hand therapists. This CPG employed a systematic review methodology to locate, appraise, and synthesize contemporary evidence while developing practice recommendations for determining the prognosis of outcomes, examination, and interventions while managing individuals with DRF. The quality of the primary studies found in the literature search was appraised using standardized tools. The strength of the available evidence for a particular practice domain (e.g., prognosis or intervention) was graded as strong, moderate, weak, or conflicting, where such gradings guided the level of obligation for each practice recommendation. Lastly, the CPG also provided the gaps in the evidence pool for the rehabilitation of DRF that future research efforts can address. J Orthop Sports Phys Ther 2024;54(9):CPG1-CPG78. doi:10.2519/jospt.2024.0301.
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Quax MLJ, Krijnen P, Schipper IB, Termaat MF. Managing patient expectations about recovery after a distal radius fracture based on patient reported outcomes. J Hand Ther 2023; 36:903-912. [PMID: 36914490 DOI: 10.1016/j.jht.2022.11.002] [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: 01/31/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 03/16/2023]
Abstract
INTRODUCTION PROMs are increasingly used by clinicians to evaluate recovery after distal radius fractures, but can also be used as benchmark data to help patients managing their expectations about recovery after DRF. PURPOSE OF THE STUDY The study aimed to determine the general course of patient-reported functional recovery and complaints during 1 year after a DRF, depending on fracture type and age. The study aimed to determine the general course of patient-reported functional recovery and complaints during one year after a DRF, depending on fracture type and age. METHODS Retrospectively analyzed PROMs of 326 patients with DRF from a prospective cohort at baseline and at 6, 12, 26 and 52 weeks included PRWHE questionnaire for measuring functional outcome, VAS for pain during movement, and items of the DASH for measuring complaints (tingling, weakness, stiffness) and limitations in work and daily activities. The effect of age and fracture type on outcomes were assessed using repeated measures analysis. RESULTS PRWHE scores after one year were on average 5.4 points higher compared to the patients' pre-fracture scores. Patients with type B DRF had significantly better function and less pain than those with types A or C at every time point. After six months, more than 80% of the patients reported mild or no pain. Tingling, weakness or stiffness were reported by 55-60% of the overall cohort after six weeks, while 10-15% had persisting complaints at one year. Older patients reported worse function and more pain, complaints and limitations. CONCLUSIONS Functional recovery after a DRF is predictable in time with functional outcome scores after one-year follow-up that are similar to pre-fracture values. Some outcomes after DRF differ between age and fracture type groups.
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Affiliation(s)
- M L J Quax
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - P Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - M F Termaat
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Wu C, Liu T, Shi Z, Fang L, Jin H, Tong P. Novel nomograms for predicting the risk of low distal bone strength: development and validation in a Chinese population-based observational study. J Orthop Surg Res 2023; 18:70. [PMID: 36717927 PMCID: PMC9885689 DOI: 10.1186/s13018-023-03546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study aims to develop nomogram models based on the speed of sound (SOS) measurements results along with demographic information to predict the risk of low bone strength (LBS) of radius appropriate to the Chinese population of a broad age spectrum. METHODS A population-based cross-sectional study was conducted in 5 outpatient clinics located in Zhejiang, the southern part of China. A total of 38,699 participants from 2013 to 2017 were included. Baseline measurements included SOS of the distal radius and clinical risk factor evaluation. Logistic regression models were used to evaluate prognosis and identify independent predictive factors, which were then utilized to establish nomograms for predicting the low bone strength of radius. The discrimination and calibration of nomograms were validated using the calibration plots, the decision curve analysis (DCA), and the receiver operating characteristics curve (ROC). RESULTS A total of 19,845 of the 38,904 participants ranged in age from 10 to 88 years were selected in this process. LBP nomogram model 1 was constructed based on age, weight, height, BMI, and gender. LBP nomogram model 2 was constructed based on age, height, BMI, and gender. The AUCs for model 1 and model 2 were 0.838 (95% CI: 0.832-0.844) and 0.837 (95% CI: 0.831-0.843), respectively. High-quality calibration plots and DCA in nomogram models were noticed, indicated that the constructed nomogram models were clinically useful. CONCLUSIONS Our study demonstrates that the nomograms established in this study could effectively evaluate the high-risk population groups of distal radius fracture in China.
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Affiliation(s)
- Congzi Wu
- grid.417400.60000 0004 1799 0055Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.268505.c0000 0000 8744 8924The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China
| | - Ting Liu
- grid.268505.c0000 0000 8744 8924School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053 China
| | - Zhenyu Shi
- grid.417400.60000 0004 1799 0055Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.417400.60000 0004 1799 0055Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, 310003 Zhejiang Province People’s Republic of China
| | - Liang Fang
- grid.417400.60000 0004 1799 0055Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.268505.c0000 0000 8744 8924The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China
| | - Hongting Jin
- grid.417400.60000 0004 1799 0055Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.417400.60000 0004 1799 0055Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, 310003 Zhejiang Province People’s Republic of China
| | - Peijian Tong
- grid.417400.60000 0004 1799 0055Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang Province People’s Republic of China ,grid.417400.60000 0004 1799 0055Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, 310003 Zhejiang Province People’s Republic of China
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Kaya O, Gulabi D, Buyukdogan H, Baris AC, Kilic B, Caliskan M. Clinical Results of Distal Radius Intraarticular Comminuted Fractures in the Elderly: A Retrospective Comparative Analysis of Different Fixation Methods. Cureus 2022; 14:e28077. [PMID: 36134071 PMCID: PMC9481218 DOI: 10.7759/cureus.28077] [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] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Distal radius intraarticular fractures in the elderly population are likely to cause impaired clinical outcomes. Intraarticular fracture treatment in the literature is a debatable issue with mixed results. Here, we aimed to present a tertiary trauma center experience with plate fixation and K wire-assisted external fixator in elderlies over 60 years old. Material and methods Patients who were diagnosed with an unstable intraarticular distal radius fracture and received surgical treatment with plate fixation or K wire-assisted external fixator between 2016 January and 2020 January were included in the study. Patients were evaluated retrospectively in terms of radiologic stability criteria and clinical outcomes. Results There were 27 patients; 14 in the volar plate group (group 1) and 13 (group 2) in the external fixator group. The mean age was 64.2 (60-72) in group 1 and 67.7 (60-76) in group 2. The mean follow-up time was 31.6 (12-63) in group 1 and 28.8 (12-59) in group 2. The mean quick disabilities of the arm, shoulder, and hand (Q-DASH) score was 25.7 (5-75) in group 1 and 24.4 (10-87) in group 2. The mean patient-reported wrist evaluation (PRWE) was 27.1 (6-87) in group 1 and 31.4 (10-87) in group 2. There was no statistical difference between groups in terms of clinical scores, hospital stay, follow-up, and complications. (p>0.05). Conclusion Although open reduction and plate fixation and K wire-assisted external fixator are viable options for providing radiologic union, unsatisfactory clinical outcomes were maintained independently of the fixation method in elderly patients.
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Babatunde OO, Bucknall M, Burton C, Forsyth JJ, Corp N, Gwilym S, Paskins Z, van der Windt DA. Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis. Osteoporos Int 2022; 33:753-782. [PMID: 34766193 DOI: 10.1007/s00198-021-06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning. PURPOSE To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over. METHODS Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes. RESULTS 78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5-78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10-20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes. CONCLUSION Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further. PROSPERO CRD42018116478.
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Affiliation(s)
- O O Babatunde
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK.
| | - M Bucknall
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - C Burton
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - J J Forsyth
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, UK
| | - N Corp
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - S Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Z Paskins
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK
| | - D A van der Windt
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
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