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Von Matthey F, Rammensee J, Müller M, Biberthaler P, Abel H. Can elderly patients regain their preoperative functional level after distal radius fracture type A? Results from a fracture register study using PROM. Front Surg 2023; 10:877252. [PMID: 37091269 PMCID: PMC10113482 DOI: 10.3389/fsurg.2023.877252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/08/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionAlthough distal radius fractures (DRFs) are the most common fractures of the human body, there are still ongoing debates concerning the treatment for type A fractures, especially in elderly patients. In spite of good clinical outcomes, it remains unclear whether elderly patients, especially, could regain the preoperative functional level of the wrist. Therefore, we have quantified wrist function within a retrospective study design using patient-reported outcome measures (PROM) and we have analyzed the influence of age between control and patient collective and young vs. old, respectively.Patients and methodsThe retrospective study included all patients with a surgically treated DRF type A and a control group of healthy patients, age and gender matched. The function of the wrist was examined by using a self-assessment questionnaire called the Munich Wrist Questionnaire (MWQ) according to the patient-related outcome measurements PROM.ResultsWe could enroll 110 patients and controls, and the average follow-up was 66 months. Subgroup matching induced similar age group distribution: in both groups, 7 individuals <30 years, 67 between 31 and 64 years, 29 between 65 and 79 years, and 7 individuals >80 years, were enrolled, respectively. In the fracture group, women were significantly older than men (59 ± 15 vs. 47 ± 17 (M ± SD). There was no significant difference between the control and the patient groups (96 ± 6 vs. 95 ± 7). The function was significantly different between controls and patients <30 years (100 ± 1 vs. 98 ± 2). In the control group, there was a functional difference in the age group <30 compared with 65–79 and >80 and in the age group 30–64 compared with 65–79 and >80. In the control group, the function was found to be significantly decreasing with advancing age, whereas in the patient group, this influence was absent. A correlation analysis showed a worse function with increasing age in the control group and therefore a negative correlation. In the fracture group, a similar result could not be obtained.DiscussionAge has a relevant influence on wrist function. Although the wrist function decreases significantly with aging, in the patient group, this influence is absent, and the functional results after surgery are excellent. Even elderly patients can regain their preoperative functional level.
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Mohamad Sabri MQ, Judd J, Ahmad Roslan NF, Che Daud AZ. Hand characteristics and functional abilities in predicting return to work in adult workers with traumatic hand injury. Work 2022; 73:1245-1253. [DOI: 10.3233/wor-205164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Hand injuries affect a person’s functioning, thus impeding their abilities to return to work. There is a limited understanding in return to work of the overall predictors when including hand characteristics and functional abilities. Therefore, it is essential to identify the most relevant predictors in return to work among individuals with a hand injury. OBJECTIVES: (1) To compare hand function characteristics and functional abilities of injured workers who have or have not returned to work. (2) To estimate hand function characteristics and functional abilities as predictors to return to work. METHODS: One hundred and fifteen adult workers with hand injuries aged 18– 59 years old from five general hospitals in Malaysia participated in a cross-sectional study. Predictors were estimated using logistic regression. RESULTS: There was a significant association between occupational sector (p = 0.012), injury duration (p = 0.024), occupational performance (p = 0.009) and satisfaction with performance (p < 0.001), grip strength of injured hand (p = 0.045– 0.002) and the Disability of Arm, Shoulder and Hand (DASH) disability/symptom (p = 0.001) with the person’s return to work status. Significant predictors of return to work were identified using the Canadian Occupational Performance Measure (COPM) satisfaction’s score, DASH disability/symptoms’ score and duration of the injury. CONCLUSION: As two main predictors of return to work were COPM satisfaction and DASH disability/symptoms, occupational therapists working in rehabilitation should focus on achieving functional performance and satisfaction within the optimal time.
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Affiliation(s)
- Mohamad Qayum Mohamad Sabri
- Centre of Occupational Therapy, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), UiTM Kampus Puncak Alam, Bandar Puncak Alam, Selangor, Malaysia
| | - Jenni Judd
- School of Health Medical and Applied Sciences, Division of Higher Education, Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg Campus, Branyan, QLD, Australia
| | - Nor Faridah Ahmad Roslan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Kampus Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | - Ahmad Zamir Che Daud
- Centre of Occupational Therapy, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), UiTM Kampus Puncak Alam, Bandar Puncak Alam, Selangor, Malaysia
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Zwaan E, Cheung E, IJsselmuiden A, Holtzer C, Schreuders T, Kofflard M, Alings M, Coert JH. Predictive Value of the (Quick)DASH Tool for Upper Extremity Dysfunction Following Percutaneous Coronary Intervention. Patient Relat Outcome Meas 2022; 13:145-155. [PMID: 35783347 PMCID: PMC9249092 DOI: 10.2147/prom.s353895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eva Zwaan
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elena Cheung
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
- Correspondence: Elena Cheung, Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands, Tel +31 88 755 6954, Email
| | | | - Carlo Holtzer
- Department of Plastic and Reconstructive Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Ton Schreuders
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marcel Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Hayden CD, Murphy BP, Hardiman O, Murray D. Measurement of upper limb function in ALS: a structure review of current methods and future directions. J Neurol 2022; 269:4089-4101. [PMID: 35612658 PMCID: PMC9293830 DOI: 10.1007/s00415-022-11179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
Measurement of upper limb function is critical for tracking clinical severity in amyotrophic lateral sclerosis (ALS). The Amyotrophic Lateral Sclerosis Rating Scale-revised (ALSFRS-r) is the primary outcome measure utilised in clinical trials and research in ALS. This scale is limited by floor and ceiling effects within subscales, such that clinically meaningful changes for subjects are often missed, impacting upon the evaluation of new drugs and treatments. Technology has the potential to provide sensitive, objective outcome measurement. This paper is a structured review of current methods and future trends in the measurement of upper limb function with a particular focus on ALS. Technologies that have the potential to radically change the upper limb measurement field and explore the limitations of current technological sensors and solutions in terms of costs and user suitability are discussed. The field is expanding but there remains an unmet need for simple, sensitive and clinically meaningful tests of upper limb function in ALS along with identifying consensus on the direction technology must take to meet this need.
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Affiliation(s)
- C D Hayden
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse St, Dublin 2, D02 R590, Ireland.
| | - B P Murphy
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Department of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), Trinity College Dublin, Dublin 2, Ireland
| | - O Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse St, Dublin 2, D02 R590, Ireland.,Neurocent Directorate, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - D Murray
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse St, Dublin 2, D02 R590, Ireland.,Neurocent Directorate, Beaumont Hospital, Beaumont, Dublin 9, Ireland
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Tzimas V, Kotsias C, Galanis C, Panagiotakopoulos G, Tsiampas D, Parnis J, Tilkeridis K, Fiska A. Comparative study of surgical wound closure with nylon interrupted sutures and running subcuticular vicryl rapide suture after open release of the carpal tunnel. Scars Burn Heal 2022; 8:20595131221128951. [PMID: 36200049 PMCID: PMC9528042 DOI: 10.1177/20595131221128951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Surgical decompression of the carpal tunnel is considered the method of choice for its treatment with satisfactory results documented. Various methods and suturing materials have been used for closure of the surgical wound. In the present study, we compared interrupted mattress closure by means of nylon suture to running subcuticular closure with vicryl rapide suture. As far as we know, there is no similar study in the literature. METHODS A total of twenty patients were included in the study. Ten of them had their surgical wound closed with 3.0 nylon suture in an interrupted fashion and for the rest, a running subcuticular 3.0 vicryl rapide was used. All patients filled in a questionnaire about VAS perceived pain and a Quick DASH score sheet, preoperatively, at two and six weeks postoperatively. The cosmesis of the scar was assessed using the POSAS v2.0 system at two and six weeks after surgery and overall incidence of infections was noted as well. RESULTS There was no statistically important difference between the two groups of patients in regards to postoperative VAS pain levels at two and six weeks. Likewise, no statistically significant difference was evident as far as Quick DASH score, POSAS score and infections were concerned. CONCLUSIONS Our results suggest that the use of running subcuticular vicryl rapide suture is an attractive alternative to interrupted nylon sutures for closure after open carpal tunnel decompression, lacking any significant drawbacks. LAY SUMMARY Surgery for carpal tunnel decompression is considered the method of choice for its treatment with documented satisfactory results. Various methods and suturing materials have been used for closure of the surgical wound. In the present study, we compared the use of a non-absorbable suture, placed intermittently to an absorbable continuous intradermal suture. A total of twenty patients were included in the study. Half of them had their wound closed with the absorbable suture and the other half with the non-absorbable suture, as described above. All patients were evaluated as far as pain, scar characteristics, functional outcomes of the operated hand and incidence of infection, at two and six weeks after surgery. After analysis of the data, no significant differences were found between the two groups, suggesting that both of these techniques are equally safe and efficacious.
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Affiliation(s)
- Vasileios Tzimas
- Trauma and Orthopedics Department, General Hospital of Ioannina, Ioannina, Greece
| | - Christos Kotsias
- Trauma and Orthopedics Department, General Hospital of Ioannina, Ioannina, Greece
| | - Charilaos Galanis
- Trauma and Orthopedics Department, General Hospital of Ioannina, Ioannina, Greece
| | | | - Dimitrios Tsiampas
- Trauma and Orthopedics Department, General Hospital of Ioannina, Ioannina, Greece
| | - Juanita Parnis
- Plastic Surgery Department, Mater Dei Hospital, Msida, Malta
| | | | - Aliki Fiska
- Medical School, Anatomy Laboratory, Democritus University of Thrace, Komotini, Greece
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Zeidan M, Stephens AR, Zhang C, Presson AP, Kazmers NH. Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:235-239. [PMID: 34632351 PMCID: PMC8496877 DOI: 10.1016/j.jhsg.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Although baseline biopsychosocial factors are associated with short-term patient-reported outcomes following distal radius fracture open reduction internal fixation (ORIF), their effect on mid-term outcomes is unclear. We aimed to evaluate the effect of social deprivation, previously established as a surrogate for depression, pain interference, and anxiety, on quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores >1 year following distal radius ORIF. Methods Adult patients (≥18 years) with an isolated distal radius fracture treated with ORIF by orthopedic trauma and hand surgeons at a single tertiary academic center over a 3-year period were included. Outcomes at ≥1 year postoperatively were evaluated using QuickDASH. Age, follow-up duration, area deprivation index (ADI; a measure of social deprivation), subspecialty (hand vs trauma), and postoperative alignment were assessed using linear regression with 95% confidence intervals after bootstrapping and a permutation test for P values to test for their association with the final QuickDASH score. Results Follow-up data were obtained for 98 of 220 (44.5%) patients at a mean of 3.1 ± 1.0 years after surgery. Mean age and ADI were 53.2 ± 15.4 years and 26.8 ± 18.7, respectively. Most fractures were intra-articular (67.3%), and 72.4% had acceptable postoperative alignment parameters, as defined by the American Academy of Orthopaedic Surgeons clinical practice guidelines. The mean QuickDASH score was 13.0 ± 16.5. There were no significant associations between the final QuickDASH score and any studied factor, including ADI, as determined using univariable analysis. Multivariable analysis showed no association between ADI and the final QuickDASH score, independent of age, sex, treating service, follow-up duration, and fracture alignment or pattern. Conclusions At mid-term follow up after distal radius ORIF, ADI did not correlate with QuickDASH scores, and the QuickDASH scores of the patients did not differ from those of the general population. However, our cohort mostly comprised patients with levels of deprivation below the national median. Although studies have shown that the short-term outcomes of distal radius ORIF are influenced by biopsychosocial factors, outcomes at the time of final recovery may not be associated with social deprivation. Type of study/level of evidence Prognostic IV.
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Affiliation(s)
- Michelle Zeidan
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | | | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT
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Zhang R, Yin Y, Li S, Hou Z, Jin L, Zhang Y. Intramedullary nailing versus a locking compression plate for humeral shaft fracture (AO/OTA 12-A and B): A retrospective study. Orthop Traumatol Surg Res 2020; 106:1391-1397. [PMID: 32089473 DOI: 10.1016/j.otsr.2019.12.016] [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] [Received: 10/12/2017] [Revised: 08/28/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There has been great progress in surgical techniques for treating humeral shaft fractures over the past few decades. The purpose of this study was to compare the therapeutic effects of intramedullary nailing (IMN) and locking compression plate (LCP) for humeral shaft fractures (AO/OTA 12-A and B). HYPOTHESIS Compared with LCP, better therapeutic effects could be obtained with less invasive IMN. MATERIALS AND METHODS Patients with a humeral shaft fracture who received anterograde IMN or LCP fixation in our institution from December 2011 to June 2016 were reviewed in this study. They were divided into two groups according to the different fixation methods: Group A (IMN) and Group B (LCP). The surgical time, intraoperative blood loss, and complications of the patients were reviewed. Fracture healing was evaluated by radiographs performed at each follow-up. The functional outcome was assessed by the DASH (Disabilities of the Arm, Shoulder and Hand) scoring system at the final follow-up. RESULTS Thirty-four patients in Group A and forty-six patients in Group B were included in this study. Mean incision length and blood loss in Group B were greater than those in Group A (p<0.001). The average surgical times were 118.53minutes in Group A and 128.91minutes in Group B (p=0.114). The mean DASH scores were 23.76±16.78 in Group A and 22.37±15.18 in Group B (p=0.609). The complication rates were 8/34 in Group A and 7/46 in Group B, respectively (p=0.887). DISCUSSION The study hypothesis was partially confirmed. Although IMN was a less invasive technique, similar therapeutic results were obtained for humeral shaft fractures (AO/OTA 12-A and B) fixed with two surgical methods. LEVELS OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Ruipeng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Shilun Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Lin Jin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijazhuang, 050051, China.
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Maurer E, Bahrs C, Kühle L, Ziegler P, Gonser C, Stollhof LE. Comparability of Patient-reported Outcome Measures and Clinical Assessment Tools for Shoulder Function in Patients with Proximal Humeral Fracture. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:638-648. [PMID: 32957148 DOI: 10.1055/a-1200-2797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are gaining increasing importance in the context of quality management. Different PROMs and scoring tools are available to assess shoulder function after proximal humeral fracture (PHFx). In Europe, these include the Constant-Murley Score (CS), Neer Score (NS), Oxford Shoulder Score (OSS), University of California at Los Angeles Score (UCLA) and Disabilities of the Arm, Shoulder and Hands Score (DASH). In addition, the health-related quality of life can be assessed by the PROMs Short Form 36 (SF-36) and EuroQol (EQ-5D). Although all these test instruments assess shoulder function, the components to be answered objectively and subjectively vary and thus the possibility of independent assessment. The aim of the present study is to compare the correlation between the results of the different PROMs and the clinical screening tools in patients with PHFx. METHODS 76 patients who were treated with angular stable plate osteosynthesis for a proximal humeral fracture between 01/2001 and 12/2005 were included in this trial. The outcome was measured with PROMs or clinical scoring tools such as CS, NS, OSS, UCLA, DASH, SF-36 and EQ-5D and a correlation coefficient between those evaluation tools was calculated. In addition, a distinction was made between the two force measurement methods (wrist [HG] vs. deltoid muscle [DM]) for CS. RESULTS The correlation of the results of CS and NS (HG: r = 0.85; p < 0.001/DM: r = 0.93; p < 0.001), CS and UCLA (HG: r = 0.83; p < 0.001/DM: r = 0.86; p < 0.001), NS and UCLA (r = 0.91; p < 0.001) as well as DASH and OSS (r = 0.88; p < 0.001) was strongly expressed. A good comparability of the results was demonstrated between CS and OSS (HG: r = 0.63; p < 0.001/DM: r = 0.66; p < 0.001) and between CS and DASH (HG: r = 0.62; p < 0.001/DM: r = 0.61; p < 0.001). The correlation of CS (HG/DM) and UCLA with the EQ-5D index was also good. Assessment of the physical components of SF-36 with CS, NS, OSS, UCLA and DASH showed a moderate to good association, while the mental components of SF-36 showed a low correlation (p > 0.05). CONCLUSION The assessment of shoulder function after proximal humerus fracture showed a very strong correlation within the clinical questionnaires (CS/NS/UCLA) and the PROMs (OSS/DASH). A strong correlation also exists between the clinical questionnaires and the PROMs. There was only a moderate correlation with the EQ-5D. The moderate to strong correlation between the physical components of SF-36, with almost no correlation between the mental components of SF-36, indicates that the quality of life restriction is based on a physical, but not on a mental impairment.
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Affiliation(s)
- Elke Maurer
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen
| | - Christian Bahrs
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen
| | - Luise Kühle
- Department of Orthopedics and Trauma Surgery, St Josefs Hospital, Wiesbaden
| | - Patrick Ziegler
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen
| | - Christoph Gonser
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen
| | - Laura Emine Stollhof
- Department for Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen
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Gabbe BJ, Stewart I, Veitch W, Beck B, Cameron P, Russ M, Bucknill A, Steiger RD, Esser M. Long-term outcomes of major trauma with unstable open pelvic fractures: A population-based cohort study. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620933203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims The aims of this study were to describe the profile and longer-term outcomes of major trauma patients with unstable open pelvic fractures. Patients and methods An observational study was performed using data from the population-based Victorian State Trauma Registry. Adult (≥16 years) major trauma patients who had sustained an unstable open pelvic fracture between 1 July 2010 and 30 June 2017 in Victoria (Australia) were included. Patient demographics, injury event, severity and management data were extracted. Patients were followed up at 6, 12 and 24 months post-injury to collect information about health status, function and return to work. Results There were 67 patients. The mean (SD) age was 41.4 (18.3) years, and 66% were male. Seventy-six per cent were road traffic injuries, 96% were managed at Level 1 trauma centres and all were multi-trauma patients. A third were Tile C fractures and 80% underwent surgical stabilisation of the pelvic injury. Eighty per cent were admitted to intensive care. The in-hospital mortality rate was 9%. Most (89%) survivors were discharged to an inpatient rehabilitation facility. The proportion classified as ‘severe disability’ on the Glasgow Outcome-Scale Extended declined from 38% at 6 months to 19% at 24 months. The overall three-level EuroQoL five-dimensional instrument score increased with time indicating better health status, and 50% of patients returned to work by 24 months. Conclusions Major trauma with unstable, open pelvic fracture is rare. Low in-hospital mortality was observed. Most survived to hospital discharge and outcomes improved with time post-injury, but 75% of patients experienced persistent pain and ongoing mobility and activity restrictions.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Ian Stewart
- Department of Orthopaedic Surgery, The Alfred, Prahran, Australia
| | - William Veitch
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Faculty of Medicine, Laval University, Quebec City, Canada
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, Australia
| | - Matthias Russ
- Department of Orthopaedic Surgery, The Alfred, Prahran, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia
- Department of Surgery, University of Melbourne, Parkville, Australia
| | - Richard de Steiger
- Department of Surgery, University of Melbourne, Parkville, Australia
- Department of Surgery, Epworth Healthcare, Richmond, Australia
| | - Max Esser
- Department of Orthopaedic Surgery, The Alfred, Prahran, Australia
- Department of Surgery, Monash University, Melbourne, Australia
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Schmidt I. Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion, Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature. Open Orthop J 2019. [DOI: 10.2174/1874325001913010217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Background:
Several salvage procedures for the arthritically destroyed wrist exist. Each of these has advantages as well as disadvantages.
Aims:
The aim of this article is to give practical insights for the clinician on: (1) biomechanical and clinical fundamentals of normal and impaired wrist motion; (2) difficulties in assessment of postoperative outcome between measured motion by the surgeon and self-reported outcome by the patient; (3) indications for each procedure; and (4) differences in functional outcome between partial and complete motion-preserving as well as complete motion-restricting salvage procedures.
Methods:
In trend, Proximal Row Carpectomy (PRC) is slightly superior over four-corner fusion (4CF) in terms of functional outcome, but the methodology-related postoperative motion is decreased for both procedures. Furthermore, PRC is easier to perform, needs lower costs, and has fewer complications than 4CF. Total Wrist Arthroplasty (TWA) has the advantage compared to PRC and 4CF that the preoperative motion values are preserved, but it is limited by decreased load-bearing capacity for the wrist. Total Wrist Fusion (TWF) is associated with a higher load-bearing capacity for the wrist than TWA, but it is limited for carrying out essential activities of daily living. Both PRC and 4CF can be combined primarily by wrist denervation. Wrist denervation alone does not impair the movement of the wrist.
Results and Conclusion:
Salvage procedures for the arthritically destroyed wrist should be detected regarding patients age- and gender-related claims in work and leisure. Not all of them can be successfully re-employed in their original occupations associated with high load-bearing conditions.
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Sanz DR, Solano FU, López DL, Corbalan IS, Morales CR, Lobo CC. Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment in subjects who suffer from cervicobrachial pain: a randomized clinical trial. Arch Med Sci 2018; 14:871-879. [PMID: 30002707 PMCID: PMC6040136 DOI: 10.5114/aoms.2017.70328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Oral ibuprofen (OI) and median nerve neural mobilization (MNNM) are first line treatments for patients who suffer cervicobrachial pain (CP). OI may produce side effects which are not tolerated by all subjects who suffer CP, whereas MNNM has no known side effects. Therefore, the aim of this study was to assess the effectiveness of both treatments (OI vs. MNNM) in CP. MATERIAL AND METHODS This investigation was a blinded parallel randomized clinical trial (NCT02593721). Sixty-two participants diagnosed with CP were recruited and randomly assigned to 2 groups (n = 31), which received MNNM or 1200 mg/day OI treatment for 6 weeks. The numeric rating scale for pain intensity was the primary outcome. The cervical rotation range of motion (CROM) and the upper limb function were the secondary outcomes. RESULTS The results showed that OI treatment (η2 = 0.612-0.755) was clearly superior to MNNM (η2 = 0.816-0.821) in all assessments (p < 0.05) except for the CROM device results, which were equivalent to those of the MNNM group (p > 0.05). Three subjects were discharged because of OI side effects. CONCLUSIONS Oral ibuprofen may be superior to MNNM for pain reduction and upper limb function increase of subjects with CP. Nevertheless, both treatments were effective. Median nerve neural mobilization may be considered an effective non-pharmaceutical treatment option in subjects with CP. Regarding OI adverse effects, our findings challenge the role of pharmacologic versus manual therapy as possible treatments that may improve pain intensity and upper limb functionality in subjects with CP.
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Affiliation(s)
- David Rodriguez Sanz
- Department of Physical Therapy and Podiatry, Physical Therapy and Health Sciences Research Group Universidad Europea de Madrid, Madrid, Spain
| | - Francisco Unda Solano
- Interuniversity Degree in Physiotherapy UB-UdG/Grau en Fisioteràpia EUSES-UdG, Barcelona, Spain
| | - Daniel López López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
| | - Irene Sanz Corbalan
- Department of Nursing, Physical Therapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Romero Morales
- Department of Physical Therapy and Podiatry, Physical Therapy and Health Sciences Research Group Universidad Europea de Madrid, Madrid, Spain
| | - Cesar Calvo Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de Leon, Leon, Spain
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Resnik L, Borgia M, Silver B, Cancio J. Systematic Review of Measures of Impairment and Activity Limitation for Persons With Upper Limb Trauma and Amputation. Arch Phys Med Rehabil 2017; 98:1863-1892.e14. [DOI: 10.1016/j.apmr.2017.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 01/04/2023]
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Seebach C, Henrich D, Meier S, Nau C, Bonig H, Marzi I. Safety and feasibility of cell-based therapy of autologous bone marrow-derived mononuclear cells in plate-stabilized proximal humeral fractures in humans. J Transl Med 2016; 14:314. [PMID: 27846890 PMCID: PMC5111224 DOI: 10.1186/s12967-016-1066-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/20/2016] [Indexed: 02/06/2023] Open
Abstract
Background Local implantation of ex vivo concentrated, washed and filtrated human bone marrow-derived mononuclear cells (BMC) seeded onto β-tricalciumphosphate (TCP) significantly enhanced bone healing in a preclinical segmental defect model. Based on these results, we evaluated in a first clinical phase-I trial safety and feasibility of augmentation with preoperatively isolated autologous BMC seeded onto β-TCP in combination with angle stable plate fixation for the therapy of proximal humeral fractures as a potential alternative to autologous bone graft from the iliac crest. Methods 10 patients were enrolled to assess whether cell therapy with 1.3 × 106 autologous BMC/ml/ml β-TCP, collected on the day preceding the definitive surgery, is safe and feasible when seeded onto β-TCP in patients with a proximal humeral fracture. 5 follow-up visits for clinical and radiological controls up to 12 weeks were performed. Results β-tricalciumphosphate fortification with BMC was feasible and safe; specifically, neither morbidity at the harvest site nor at the surgical wound site were observed. Neither local nor systemic inflammation was noted. All fractures healed within the observation time without secondary dislocation. Three adverse events were reported: one case each of abdominal wall shingles, tendon loosening and initial screw perforation, none of which presumed related to the IND. Conclusions Cell therapy with autologous BMC for bone regeneration appeared to be safe and feasible with no drug-related adverse reactions being described to date. The impression of efficacy was given, although the study was not powered nor controlled to detect such. A clinical trial phase-II will be forthcoming in order to formally test the clinical benefit of BMC-laden β-TCP for PHF patients. Trial registration The study was registered in the European Clinical Trial Register as EudraCT No. 2012-004037-17. Date of registration 30th of August 2012. Informed consent was signed from all patients enrolled.
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Affiliation(s)
- Caroline Seebach
- Department of Trauma Surgery, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, Main, 60590, Frankfurt, Germany.
| | - Dirk Henrich
- Department of Trauma Surgery, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, Main, 60590, Frankfurt, Germany
| | - Simon Meier
- Department of Trauma Surgery, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, Main, 60590, Frankfurt, Germany
| | - Christoph Nau
- Department of Trauma Surgery, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, Main, 60590, Frankfurt, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immune Hematology, Johann-Wolfgang-Goethe University, and DRK-Blutspendedienst Baden-Württemberg-Hessen, Main, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma Surgery, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, Main, 60590, Frankfurt, Germany
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Clement ND, Duckworth AD, Jenkins PJ, McEachan JE. Interpretation of the QuickDASH score after open carpal tunnel decompression: threshold values associated with patient satisfaction. J Hand Surg Eur Vol 2016; 41:624-31. [PMID: 26744508 DOI: 10.1177/1753193415622341] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/16/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We studied the correlation between change in the QuickDASH score and the absolute post-operative QuickDASH score with patient satisfaction after open carpal tunnel decompression. Threshold values in the QuickDASH score, the point at which the sensitivity and specificity are maximal in predicting patient satisfaction, were identified. During the study period, outcome data were compiled for 937 carpal tunnel decompressions, which included 219 (23%) male and 718 (77%) female patients with a mean age of 58 years (standard deviation (SD) 14). There was a significant improvement (mean difference 32, 95% confidence interval (CI) 30 to 34) in the QuickDASH from a mean of 54 (SD 20) to 22 (SD 23) at 1 year after surgery. There were 808 (86%) patients who defined their outcome as satisfactory at 1 year. The identified threshold values for the post-operative QuickDASH score (⩽34 points) and the change (⩾20 points) in the score were highly predictive of patient satisfaction. However, these threshold values varied significantly according to the baseline pre-operative score. The threshold values identified in the QuickDASH can be used to interpret the score. However, the influence of the pre-operative baseline score should be taken into account when comparing different cohorts of patients or using the values to power future studies. LEVEL OF EVIDENCE IV Prognosis, observational cohort study.
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Affiliation(s)
- N D Clement
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK
| | - A D Duckworth
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK
| | - P J Jenkins
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK
| | - J E McEachan
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK
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Lil NA, Makkar DS, Aleem A A. Results of Closed Intramedullary Nailing using Talwarkar Square Nail in Adult Forearm Fractures. Malays Orthop J 2014; 6:7-12. [PMID: 25279048 DOI: 10.5704/moj.1207.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT The aim of the study was to evaluate results of closed intramedullary nailing using Talwarkar square nails in adult forearm fractures. We prospectively evaluated 34 patients with both bone forearm fractures. The average time to union was 12.8 (SD +3.2) weeks with cast support for a mean of 8.2 weeks. Union was achieved in 31 out of 34 patients. Using the Grace and Eversmann rating system, 17 patients were excellent, 10 were good, and 4 had an acceptable result. Three patients had non-unions, 2 for the radius and one for the ulna. There were two cases of superficial infection, one subject had olecranon bursitis, and one case of radio-ulnar synostosis. Complication rates associated with the use of square nails were lower compared to plate osteosynthesis and locked intramedullary nails. To control rotation postoperatively, there is a need for application of an above-elbow cast after nailing. KEY WORDS Adult radius-ulna fractures, square nail, closed intramedullary nailing, radius-ulna nailing.
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Affiliation(s)
- Nadeem A Lil
- Department of Orthopaedic Surgery, AMC - MET Medical College, Gujarat, India
| | - Damandeep S Makkar
- Department of Orthopaedic Surgery, AMC - MET Medical College, Gujarat, India
| | - Adatia Aleem A
- Department of Orthopaedic Surgery, AMC - MET Medical College, Gujarat, India
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Stone OD, Clement ND, Duckworth AD, Jenkins PJ, Annan JD, McEachan JE. Carpal tunnel decompression in the super-elderly. Bone Joint J 2014; 96-B:1234-8. [DOI: 10.1302/0301-620x.96b9.34279] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is conflicting evidence about the functional outcome and rate of satisfaction of super-elderly patients (≥ 80 years of age) after carpal tunnel decompression. We compiled outcome data for 756 patients who underwent a carpal tunnel decompression over an eight-year study period, 97 of whom were super-elderly, and 659 patients who formed a younger control group (< 80 years old). There was no significant difference between the super-elderly patients and the younger control group in terms of functional outcome according to the mean (0 to 100) QuickDASH score (adjusted mean difference at one year 1.8; 95% confidence interval (CI) -3.4 to 7.0) and satisfaction rate (odds ratio (OR) 0.78; 95% CI 0.34 to 1.58). Super-elderly patients were, however, more likely to have thenar muscle atrophy at presentation (OR 9.2, 95% CI 5.8 to 14.6). When nerve conduction studies were obtained, super-elderly patients were more likely to have a severe conduction deficit (OR 12.4, 95% CI 3.0 to 51.3). Super-elderly patients report functional outcome and satisfaction rates equal to those of their younger counterparts. They are more likely to have thenar muscle atrophy and a severe nerve conduction deficit at presentation, and may therefore warrant earlier decompression. Cite this article: Bone Joint J 2014; 96-B:1234–8.
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Affiliation(s)
- O. D. Stone
- Queen Margaret Hospital, Department
of Orthopaedic Surgery, Whitefield Road, Dunfermline, Fife, UK
| | - N. D. Clement
- Queen Margaret Hospital, Department
of Orthopaedic Surgery, Whitefield Road, Dunfermline, Fife, UK
| | - A. D. Duckworth
- Queen Margaret Hospital, Department
of Orthopaedic Surgery, Whitefield Road, Dunfermline, Fife, UK
| | - P. J. Jenkins
- Glasgow Royal Infirmary, Department
of Orthopaedic Surgery, Castle Street, Glasgow, G4
0SF, UK
| | - J. D. Annan
- Queen Margaret Hospital, Department
of Orthopaedic Surgery, Whitefield Road, Dunfermline, Fife, UK
| | - J. E. McEachan
- Queen Margaret Hospital, Department
of Orthopaedic Surgery, Whitefield Road, Dunfermline, Fife, UK
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Gabbe BJ, Hofstee DJ, Esser M, Bucknill A, Russ MK, Cameron PA, Handley C, de Steiger RN. Functional and return to work outcomes following major trauma involving severe pelvic ring fracture. ANZ J Surg 2014; 85:749-54. [DOI: 10.1111/ans.12700] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- College of Medicine; Swansea University; Swansea UK
| | - Dirk-Jan Hofstee
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Max Esser
- Department of Orthopaedic Surgery; The Alfred Hospital; Melbourne Victoria Australia
| | - Andrew Bucknill
- Department of Orthopaedics; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Matthias K. Russ
- Department of Orthopaedic Surgery; The Alfred Hospital; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - Peter A. Cameron
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Victoria Australia
| | - Christopher Handley
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Richard N. de Steiger
- Department of Surgery; Epworth Healthcare; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
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Usefulness of QuickDASH in patients with cervical laminoplasty. J Orthop Sci 2014; 19:218-222. [PMID: 24390596 DOI: 10.1007/s00776-013-0515-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 11/27/2013] [Indexed: 02/09/2023]
Abstract
PURPOSE Clumsiness and numbness of the upper extremity is one of the most common complaints of patients with cervical myelopathy. However, most previous evaluations after cervical laminoplasty have only been based on physicians' points of view. We used Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) self-report questionnaire, which was designed to measure physical function and symptoms in people with upper-limb disorders to evaluate functional outcomes after laminoplasty. METHODS Ninety-four patients who underwent laminoplasty for cervical myelopathy and replied to the questionnaire were included in this study. The average age was 62 years, and mean follow-up period was 61 months. The Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI), Short-Form Health Questionnaire of 36 questions (physical component score, PCS), upper-extremity pain (Numerical Rating Scale), and QuickDASH (0-100, 0 being least severe) were used to evaluate surgical outcomes. Satisfaction with treatment was also investigated, and internal consistency and criterion-related validity were evaluated. The QuickDASH cutoff value for patient satisfaction was determined by receiver operating characteristic curve (ROC) analysis. RESULTS The mean total JOA scores were 10 before and 13 after surgery, and average postoperative QuickDASH score was 30. Cronbach α of the QuickDASH was 0.94. QuickDASH was significantly correlated with JOA score for upper-extremity motor and sensation, NDI, PCS, and pain. Cutoff value of the QuickDASH was 34.0 by ROC analysis. Significantly better QuickDASH scores were found for patients who were satisfied with treatment than for those who were not, whereas JOA score for upper-extremity motor function did not show a significant difference. DISCUSSION QuickDASH had significant correlations with disease-specific JOA scores and other generic outcome measures. Moreover, QuickDASH significantly reflected patients' satisfaction with treatment, whereas the JOA score for upper-extremity motor function did not. CONCLUSION QuickDASH was useful in evaluating upper-extremity functional outcomes after cervical laminoplasty.
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Jerosch-Herold C, Shepstone L, Wilson ECF, Dyer T, Blake J. Clinical course, costs and predictive factors for response to treatment in carpal tunnel syndrome: the PALMS study protocol. BMC Musculoskelet Disord 2014; 15:35. [PMID: 24507749 PMCID: PMC3921988 DOI: 10.1186/1471-2474-15-35] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/06/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb and a significant contributor to hand functional impairment and disability. Effective treatment options include conservative and surgical interventions, however it is not possible at present to predict the outcome of treatment. The primary aim of this study is to identify which baseline clinical factors predict a good outcome from conservative treatment (by injection) or surgery in patients diagnosed with carpal tunnel syndrome. Secondary aims are to describe the clinical course and progression of CTS, and to describe and predict the UK cost of CTS to the individual, National Health Service (NHS) and society over a two year period. METHODS/DESIGN In this prospective observational cohort study patients presenting with clinical signs and symptoms typical of CTS and in whom the diagnosis is confirmed by nerve conduction studies are invited to participate. Data on putative predictive factors are collected at baseline and follow-up through patient questionnaires and include standardised measures of symptom severity, hand function, psychological and physical health, comorbidity and quality of life. Resource use and cost over the 2 year period such as prescribed medications, NHS and private healthcare contacts are also collected through patient self-report at 6, 12, 18 and 24 months. The primary outcome used to classify treatment success or failures will be a 5-point global assessment of change. Secondary outcomes include changes in clinical symptoms, functioning, psychological health, quality of life and resource use. A multivariable model of factors which predict outcome and cost will be developed. DISCUSSION This prospective cohort study will provide important data on the clinical course and UK costs of CTS over a two-year period and begin to identify predictive factors for treatment success from conservative and surgical interventions.
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Affiliation(s)
| | - Lee Shepstone
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Edward CF Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
| | - Tony Dyer
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Julian Blake
- Department of Neurophysiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Abstract
There is no outcome measure designated as the gold standard when assessing the treatment results following fractures of the hand. Numerous measures have been described in the literature, but only a limited number have been validated to specifically evaluate functional recovery with respect to hand fractures. Of the outcome measures validated for use with hand fractures, few have been studied in comparative trials designed to analyze their ability to predict functional recovery. This review article provides an evidence-based description of the validated scales and scores frequently used in assessing the functional outcomes and their ability to predict recovery.
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Affiliation(s)
- Paul C Baldwin
- Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
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21
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Gavaskar AS, Muthukumar S, Chowdary N. Fragment-specific fixation for complex intra-articular fractures of the distal radius: results of a prospective single-centre trial. J Hand Surg Eur Vol 2012; 37:765-71. [PMID: 22403437 DOI: 10.1177/1753193412439677] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The goal was to evaluate the efficacy of 2.4 mm column-specific plating for intra-articular distal radius fractures. In total, 105 patients with AO type C distal radius fractures were operated on using the locking distal radius system, Synthes. Follow-up assessments including clinical (wrist and forearm range of motion, grip strength), radiological (articular step, radial length and inclination, volar tilt, and ulnar variance), and functional scores (Disabilities of the Arm, Shoulder, and Hand; Patient Rated Wrist Evaluation) were made at regular intervals until 1 year. Union was obtained in all patients. Articular surface was anatomically reconstructed in 74 patients (70.5%). Clinical and functional evaluation showed significant continuous improvements over the first year. C1 fractures had a better chance of anatomical reduction compared with C2 and C3 fractures. Fracture type, quality of reduction, and presence of degenerative changes did not show a significant effect on functional outcome scores. Column-specific fixation of the distal radius can achieve satisfactory results in complex intra-articular fractures.
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Balogh ZJ, Reumann MK, Gruen RL, Mayer-Kuckuk P, Schuetz MA, Harris IA, Gabbe BJ, Bhandari M. Advances and future directions for management of trauma patients with musculoskeletal injuries. Lancet 2012; 380:1109-19. [PMID: 22998720 DOI: 10.1016/s0140-6736(12)60991-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Musculoskeletal injuries are the most common reason for operative procedures in severely injured patients and are major determinants of functional outcomes. In this paper, we summarise advances and future directions for management of multiply injured patients with major musculoskeletal trauma. Improved understanding of fracture healing has created new possibilities for management of particularly challenging problems, such as delayed union and non union of fractures and large bone defects. Optimum timing of major orthopaedic interventions is guided by increased knowledge about the immune response after injury. Individual treatment should be guided by trading off the benefits of early definitive skeletal stabilisation, and the potentially life-threatening risks of systemic complications such as fat embolism, acute lung injury, and multiple organ failure. New methods for measurement of fracture healing and function and quality of life outcomes pave the way for landmark trials that will guide the future management of musculoskeletal injuries.
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Affiliation(s)
- Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
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Vos DI, Verhofstad MHJ, Hanson B, van der Graaf Y, van der Werken C. Clinical outcome of implant removal after fracture healing. Design of a prospective multicentre clinical cohort study. BMC Musculoskelet Disord 2012; 13:147. [PMID: 22894749 PMCID: PMC3493388 DOI: 10.1186/1471-2474-13-147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/07/2012] [Indexed: 11/21/2022] Open
Abstract
Background The clinical results of removal of metal implants after fracture healing are unknown and the question whether to remove or to leave them in is part of discussion worldwide. We present the design of a prospective clinical multicentre cohort study to determine the main indications for and expectations of implant removal, the influence on complaints, the incidence of surgery related complications and the socio-economic consequences of implant removal. Methods/Design In a prospective multicentre clinical cohort study at least 200 patients with a healed fracture after osteosynthesis with a metal implant are included for analyzing the outcome after removal. Six hospitals in the Netherlands are participating. Special questionnaires are designed. The follow up after surgery will be at least six months. The primary endpoint is the incidence of surgery related complications. Secondary endpoints are the influence of removal on preoperative symptoms and complaints and the socio-economic consequences. Discussion By performing this study we hope to find profound arguments to remove or not to remove metal implants after fracture healing that can help to develop clear guidelines for daily practice. Trial registration NTR1297, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1297
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Affiliation(s)
- Dagmar I Vos
- Department of Surgery, Amphia Hospital Breda, Breda, the Netherlands.
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Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J. Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S174-88. [PMID: 22588743 DOI: 10.1002/acr.20630] [Citation(s) in RCA: 385] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Felix Angst
- RehaClinic Zurzach, Bad Zurzach, and Schulthess Klinik, Zurich, Switzerland.
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Duckworth AD, Clement ND, Jenkins PJ, Will EM, Court-Brown CM, McQueen MM. Socioeconomic deprivation predicts outcome following radial head and neck fractures. Injury 2012; 43:1102-6. [PMID: 22440531 DOI: 10.1016/j.injury.2012.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/05/2012] [Accepted: 02/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is increasing evidence demonstrating an association between fracture epidemiology and socioeconomic status. However, the influence of socioeconomic deprivation on fracture outcome has not been documented before. The aim of this study was to determine if socioeconomic deprivation influenced the short-term outcome following a fracture of the radial head or neck. METHODS We identified from a prospective database all patients who sustained a radial head or neck fracture over an 18-month period. The primary outcome measure for this study was the patient-reported short musculoskeletal function assessment (SMFA). The Index of Multiple Deprivation (IMD) was used to quantify deprivation, and any correlation with functional outcome was determined. Multivariate regression analysis was used to determine the influence of deprivation on outcome once other significant demographic and fracture characteristics had been accounted for. RESULTS There were 200 patients in the study cohort, of which 107 (53.5%) were female and the mean age was 44 years (16-83). At a mean follow-up of 6 months the median SMFA score was 0.54 (0-55.4). The SMFA was found to be influenced by the IMD, with increasing deprivation associated with a poorer outcome (p=0.006). On multivariate analysis, the AO fracture classification, compensation and increasing deprivation were the only independent predictors of outcome (all p<0.05). CONCLUSIONS We have a shown a clear correlation between functional outcome and socioeconomic status, with the most deprived patients reporting a poorer outcome. Future work should be aimed at determining which aspects of deprivation influence patient outcome, with modifiable factors targeted in future health-care planning.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
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Abstract
There is no established outcome measure designated as the superior measure when evaluating the results of distal radius fracture management. Although there are many used in the literature, there are only a few that have been validated to specifically predict recovery after a distal radius fracture. Additionally, there are few comparative trials that attempt to directly measure the predictive abilities of specific outcome measures. This article discusses the common scales and scores used to measure the functional recovery after distal radius fracture management and provides evidence-based literature to assess the reliability of these measures to predict outcomes.
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Affiliation(s)
- Andrew W Ritting
- Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
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An assessment of patient satisfaction with nonoperative management of clavicular fractures using the disabilities of the arm, shoulder and hand outcome measure. ACTA ACUST UNITED AC 2011; 71:1126-9. [PMID: 22071918 DOI: 10.1097/ta.0b013e3182396541] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clavicle fractures historically have been managed without internal fixation. Current literature is raising questions regarding this management as opposed to offering operative fixation in some instances. This study addresses the use of the Disabilities of the Arm, Shoulder and Hand (DASH) outcomes measure to identify those that have the least satisfaction with nonoperative care of the clavicle fracture based upon clavicular deformity and variation in fracture location based upon Allman Classification. METHODS Patients having suffered clavicle fractures were mailed the DASH Outcomes Questionnaire to be completed and returned. A total of 113 surveys were returned completed with 92 being of value for evaluation. Patient chest or clavicle radiographs were evaluated, and measurements were made of the clavicle fractures for amount of separation or shortening and grade according to Allman Classification. Statistical evaluation compared DASH Scores (patient satisfaction as outcome measure) to the Allman Classification and the degree of separation or shortening. Comparison of categorical variables was performed using Fisher's exact test. Comparison of continuous variables was preformed using Student's t test. Statistical significance was demonstrated by a p value of less than 0.05. RESULTS Patients with clavicular shortening of greater than 2 cm were found to have the highest DASH score indicating dissatisfaction and disability with their outcome postinjury (p = 0.0001). Separation or lengthening seemed to be associated with lower DASH Scores. Patients with Allmen Classification I (midshaft clavicle) fractures had higher DASH score than other fracture locations (p = 0.0001). CONCLUSIONS Patients with midshaft clavicle fractures with shortening of greater than 2 cm may be good candidates for operative repair given the degree of dissatisfaction with nonoperative management of these fractures as assessed by long-term outcome measures of disability.
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Hill BE, Williams G, Bialocerkowski AE. Clinimetric evaluation of questionnaires used to assess activity after traumatic brachial plexus injury in adults: a systematic review. Arch Phys Med Rehabil 2011; 92:2082-9. [PMID: 22133257 DOI: 10.1016/j.apmr.2011.07.188] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 07/08/2011] [Accepted: 07/09/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To identify upper limb questionnaires used in the brachial plexus injury (BPI) literature to assess activities and to evaluate their clinimetric properties. DATA SOURCES; STUDY SELECTION; DATA EXTRACTION This systematic review was undertaken in 2 stages. In stage 1, 10 electronic databases and 1 Internet journal were searched for quantitative studies (ie, randomized controlled trials, comparative studies, case series, and case studies) that evaluated outcome after BPI, irrespective of language or date of publication, from date of database inception to September 2010. All outcome instruments used were extracted and classified using the International Classification of Functioning, Disability and Health framework. Questionnaires were identified that apportioned >50% of the total score to the assessment of upper limb activity. In stage 2, 4 electronic databases were searched for papers that evaluated the clinimetric properties of all identified activity questionnaires with respect to peripheral nerve injuries of the upper limb. Two independent reviewers assessed the clinimetric properties of identified questionnaires according to standardized criteria. DATA SYNTHESIS Stage 1 identified 4324 papers, of which 265 met the inclusion criteria. One hundred and three outcome measures were identified, the majority of which assess body function or body structure. Twenty-nine questionnaires assessed upper limb activity. Two questionnaires, the ABILHAND and Disability of the Arm, Shoulder and Hand (DASH), attributed >50% of the overall score to activity of the upper limb. The DASH had some published evidence of clinimetric properties in individuals with peripheral nerve injuries. Neither had been clinimetrically evaluated for BPI, nor met all quality criteria. CONCLUSIONS Day-to-day activities of the upper limb are infrequently evaluated after BPI. While attempts have been made to measure activity, there is a paucity of clinimetric evidence on activity questionnaires for individuals with BPI. We recommend that a core set of items be developed which evaluate activity, as well a body structure, body function, and participation.
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Jezukaitis P, Kapur D. Management of occupation-related musculoskeletal disorders. Best Pract Res Clin Rheumatol 2011; 25:117-29. [DOI: 10.1016/j.berh.2011.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 12/16/2010] [Indexed: 12/13/2022]
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Beloosesky Y, Weiss A, Manasian M, Salai M. Handgrip strength of the elderly after hip fracture repair correlates with functional outcome. Disabil Rehabil 2010; 32:367-73. [PMID: 20025431 DOI: 10.3109/09638280903168499] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the relationship between handgrip strength (HG) and upper limb functioning of hip fracture operated elderly patients and their functional outcome 6 months post-op. METHODS Retrospectively, data on 105 post-operative hip fracture patients was analyzed. Functional level was measured by the Functional Independence Measure (FIM) and HG by hand dynamometer, 7-10 days, 1, 3 and 6 months post-op. FIM1 up-to FIM4 (FIM1-FIM4) and HG1 up-to HG4 (HG1-HG4) were determined. Pre-fracture upper limb function was evaluated using the disabilities of the arm, shoulder and hand (DASH) questionnaire. The Mini-Mental-State Examination evaluated cognition. RESULTS FIM1-FIM4 scores increased during the 6-month follow-up; HG1-HG4 scores remained unchanged. No differences were found in FIM1-FIM4 and DASH scores between genders. HG1-HG4 scores were significantly higher in men (p = 0.04-0.005). FIM1-FIM4, HG1-HG4 and DASH scores were higher in the cognitively normal patients (p < 0.001). A fair correlation was found between all HG and FIM scores (R = 0.36-0.71, p < 0.001), and between DASH and FIM scores (R = 0.5-0.7, p < 0.001). Log HG1 and FIM4 scores were highly correlated (R(2) = 0.54, p < 0.001). Regression analysis found that only, and in the following order were Log HG1, FIM1, DASH and age significant factors affect FIM4 score (R(2) = 0.69). CONCLUSIONS HG and FIM scores, a week post-op., combined with upper limb functioning and age, can have a 69% prediction accuracy for motor functioning 6 months post-fracture. HG measurement, a week post-hip fracture repair, might be considered in estimating functional motor outcome, and eventually additional interventions should be employed to increase muscle strength and, thus, improve functional outcome.
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Affiliation(s)
- Yichayaou Beloosesky
- Department of Geriatrics Surgery, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel.
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The Disabilities of the Arm, Shoulder, and Hand questionnaire in intercollegiate athletes: validity limited by ceiling effect. J Shoulder Elbow Surg 2010; 19:349-54. [PMID: 20303460 DOI: 10.1016/j.jse.2009.11.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Accepted: 11/06/2009] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has been validated as an effective upper extremity specific outcome measure. Normative scores have not been established for young athletes. This study was conducted to establish normative DASH scores for intercollegiate athletes. We hypothesized that DASH scores in intercollegiate athletes differ from published values obtained from the general population. MATERIALS AND METHODS The DASH questionnaire was administered to 321 athletes cleared for full participation in intercollegiate sports. Their scores were compared with normative values in the general population and 2 other age-matched cohorts. RESULTS Intercollegiate athletes had significantly better upper extremity function compared with the general population (1.37 +/- 2.96 vs 10.10 +/- 14.68, P < .001) and an age-matched cohort of employed adults (1.37 +/- 2.96 vs 5.40 +/- 7.57, P < .0001). The DASH was 0 for 65.1%. Within this cohort, men reported better upper extremity function than women (0.98 vs 1.82, P = .010). Athletes participating in overhead sports reported worse upper extremity function than nonoverhead athletes (1.81 vs 0.98, P = .042). DISCUSSION We report normative DASH values for a group of intercollegiate athletes and show a significant difference between the scores of these athletes and the general population. Within our cohort of competitive athletes, overhead sports and female gender are associated with significantly lower DASH scores and sports module scores. The utility of using these results are limited by a substantial ceiling effect in this population of competitive athletes. Differences within our cohort and differences between our cohort and other populations are minimized by this ceiling effect. Various upper extremity outcome measures may be similarly limited by a ceiling effect and should be examined for appropriateness before use. CONCLUSION Intercollegiate athletes report significantly greater upper extremity function than the general population; however, validity of the DASH in these athletes is limited and population differences may be minimized by a substantial ceiling effect.
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Calderón SAL, Zurakowski D, Davis JS, Ring D. Quantitative Adjustment of the Influence of Depression on the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire. Hand (N Y) 2010; 5:49-55. [PMID: 19495887 PMCID: PMC2820631 DOI: 10.1007/s11552-009-9205-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 05/19/2009] [Indexed: 11/29/2022]
Abstract
Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) with an average of 58 years of age (range, 18-100) were asked to simultaneously complete the DASH and Center for Epidemiologic Studies Depression Scale (CES-D) scores at their initial visit to a hand surgeon. Pearson's correlations between each of the DASH items and the CES-D score were obtained. The DASH score was then adjusted for the influence of Depression for women and men using ordinary least-squares regression and subtracting the product of the regression coefficient and the CES-D score from the raw DASH score. The average DASH score was 24 points (SD, 19; range, 0-91), and the average CES-D score was 10 points (SD, 8; range, 0-42). Thirteen of the 30 items of the DASH demonstrated correlation greater than r = 0.20. Adjustment of these DASH items for the depression effect led to significant reductions in the mean (5.5 points; p < 0.01) and standard deviation (0.8 points; p < 0.01) of DASH scores. Adjustment for depression alone had a significant but perhaps clinically marginal effect on the variance of DASH scores. Additional research is merited to determine if DASH score adjustments for the most important subjective and psychosocial aspects of illness behavior can improve correlation between DASH scores and objective impairment.
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Affiliation(s)
| | - David Zurakowski
- Harvard Medical School, Boston, MA USA ,Department of Surgery, Children’s Hospital Boston, Boston Children’s Hospital, Boston, MA USA
| | - James S. Davis
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA USA
| | - David Ring
- Harvard Medical School, Boston, MA USA ,Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Abstract
BACKGROUND Devastating brachial plexus injury with multiple root avulsions results in wrist instability, imbalance, and inability of patients to control the placement of their hand in space. In this study, results of wrist arthrodesis were analyzed in relation to factors such as age, severity score, and additional hand reanimation procedures. Indices of patient satisfaction were also measured using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires. METHODS Between January of 1978 and January of 2006, 97 patients with posttraumatic plexopathies underwent secondary procedures for hand reanimation. Sixty-one of these patients had wrist fusion. Arthrodesis was performed between the radius and third metacarpal using mainly a rigid plate; iliac bone graft was used in the majority of patients. Thirty-one patients underwent muscle transfers (45 free muscles) and 11 had tendon transfers in the wrist fusion group to enhance finger function. Patient self-assessment was carried out using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires. RESULTS All patients' wrists fused. Patients with free-muscle transfer for finger flexion and extension achieved superior muscle grading compared with patients without wrist fusion, but this was not significant. A total of 35 patients (57.37 percent) answered the questionnaires; 97.14 percent were satisfied with wrist stability and 88.57 percent reported that the procedure enhanced the overall upper limb function. The Disabilities of the Arm, Shoulder and Hand score was 59.14 +/- 12.9, which means moderate ability in daily activities. CONCLUSIONS Wrist fusion in patients with brachial plexus palsy is recommended as a complementary procedure, offering a stable, painless carpus, with improvement of overall upper limb function and appearance.
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Khan WS, Dillon B, Agarwal M, Fehily M, Ravenscroft M. The validity, reliability, responsiveness, and bias of the Manchester-Modified Disability of the Arm, Shoulder, and Hand score in hand injuries. Hand (N Y) 2009; 4:362-7. [PMID: 19381726 PMCID: PMC2787220 DOI: 10.1007/s11552-009-9191-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 03/19/2009] [Indexed: 11/24/2022]
Abstract
The Manchester-Modified Disability of Arm, Shoulder and Hand questionnaire (M(2) DASH) was developed by the authors as a modification to the original DASH questionnaire. In this study, we assessed the validity, reliability, responsiveness, and bias of the M(2) DASH questionnaire for hand injuries using completed M(2) DASH, Patient Evaluation Measure, and Michigan Hand Outcome questionnaires from 40 patients. The M(2) DASH scores showed significant positive correlations with the Patient Evaluation Measure and Michigan Hand Outcome scores suggesting validity. There was also no evidence of a statistical difference in the M(2) DASH scores when the condition had stabilized suggesting good test-retest reproducibility and reliability. The effect size and the standardized response mean for the M(2) DASH score were greater than those for the Patient Evaluation Measure and Michigan Hand Outcome scores establishing that the M(2) DASH is highly responsive. There was no gender, hand dominance, or dominant side injured bias for the M(2) DASH score. There was, however, a relatively weak association between age and the M(2) DASH score at presentation. We conclude that the M(2) DASH questionnaire is a robust region-specific outcome measure. It is a valid and responsive questionnaire with test-retest reliability proven for hand injuries in this study. Gender, handedness, and side injured did not cause bias in the responses.
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Affiliation(s)
- Wasim S. Khan
- Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT UK ,Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP UK
| | - Bernice Dillon
- Department of Medical Statistics, South Manchester University Teaching Hospital NHS Trust, Wythenshawe Hospital, Wythenshawe, Manchester, M23 9LT UK
| | - Manish Agarwal
- Department of Trauma and Orthopaedics, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Crumpsall, Manchester, M8 5RB UK
| | - Max Fehily
- Department of Trauma and Orthopaedics, Royal Bolton Hospitals NHS Trust, Royal Bolton Hospital, Bolton, Lancashire BL4 3FY UK
| | - Matthew Ravenscroft
- Department of Trauma and Orthopaedics, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, Cheshire SK7 2PE UK
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Methodological properties of six shoulder disability measures in patients with rheumatic diseases referred for shoulder surgery. J Shoulder Elbow Surg 2009; 18:89-95. [PMID: 19095181 DOI: 10.1016/j.jse.2008.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 06/18/2008] [Accepted: 07/09/2008] [Indexed: 02/01/2023]
Abstract
The aim of this study was to explore the methodological properties in 6 commonly used shoulder disability measures (Dash, Spadi, Oxford, the Constant score, Shoulder Function Assessment Scale, Bostrom's shoulder movement impairment scale) in patients with inflammatory or degenerative diseases referred for shoulder surgery. One-hundred and six patients completed the measures preoperatively. Fifty-five (51.9%) were not able to carry out the assessment of the strength component of the Constant score. Pearson correlation coefficients between the measures varied between 0.22 and 0.87. The lowest correlation coefficients were found between performance-based and self-report measures. All measures, except the Dash, were able to differentiate significantly between patients who were more and less severely affected. Performance-based measures differentiated better (effect size, 0.68- 0.87) than self-report measures (effect size, 0.21-0.61) between the 2 patient groups. Performance-based and self-report assessments provide complementary information about shoulder status and should not be used interchangeably.
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Simmen BR, Angst F, Schwyzer HK, Herren DB, Pap G, Aeschlimann A, Goldhahn J. A concept for comprehensively measuring health, function and quality of life following orthopaedic interventions of the upper extremity. Arch Orthop Trauma Surg 2009; 129:113-8. [PMID: 18784930 DOI: 10.1007/s00402-008-0718-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Indexed: 11/27/2022]
Abstract
The view that subjective complaints rather than "objective" measurements decide on whether to consult the doctor or allow for an intervention to be carried out, should contribute to the decision-making process. This is especially true in diseases with multiple joint impairments. Although a variety of patient self-assessment scores exists, no gold standard is available to measure function and quality of life (QoL) after interventions at the upper extremity. The goal of our concept is to establish a comprehensive score set where patients should rate their generic health resp. quality of life (QoL), function of the upper extremity and specific joint function including activities of daily living, function and pain. A comparison with normative data should be possible in order to estimate how the subjective results of the patient when compared to "healthy" people in the general population. Score sets for measuring intervention effect at the shoulder, elbow and the hand were established after previous methodological testing within an interdisciplinary research project. The provisional sets were defined following a systematic literature search. Each set received a score of measuring the quality of life (SF-36), the whole function of the arm (DASH) and the specific joint function (SPADI/ASES for shoulder, PREE/mASES for the elbow and PRWE/custom for the hand). Individual scores were translated, if necessary according to AAOS-guidelines, and tested for reliability and construct validity. All three score sets were then systematically tested in cross-sectional studies. In addition, characteristic values such as minimal detectable difference and effect size could already be determined in the shoulder set in a long-term study. Definite score sets were defined, which allow quantification of the intervention effect at the upper extremity on function and quality of life after.
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Affiliation(s)
- Beat R Simmen
- Upper Extremity/Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
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Bengtson KA, Spinner RJ, Bishop AT, Kaufman KR, Coleman-Wood K, Kircher MF, Shin AY. Measuring outcomes in adult brachial plexus reconstruction. Hand Clin 2008; 24:401-15, vi. [PMID: 18928889 DOI: 10.1016/j.hcl.2008.04.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The focus of this article is on evaluating the various outcome measures of surgical interventions for adult brachial plexus injuries. From a surgeon's perspective, the goals of surgery have largely focused on the return of motor function and restoration of protective sensation. From a patient's perspective, alleviation of pain, cosmesis, return to work, and emotional state are also important. The ideal outcome measure should be valid, reliable, responsive, unbiased, appropriate, and easy. The author outlines pitfalls and benefits of current outcome measures and offers thoughts on possible future measures.
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Affiliation(s)
- Keith A Bengtson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA
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Khan WS, Jain R, Dillon B, Clarke L, Fehily M, Ravenscroft M. The 'M2 DASH'-Manchester-modified Disabilities of Arm Shoulder and Hand score. Hand (N Y) 2008; 3:240-4. [PMID: 18780103 PMCID: PMC2525880 DOI: 10.1007/s11552-008-9090-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 02/22/2008] [Indexed: 12/01/2022]
Abstract
The Disability of the Arm, Shoulder, and Hand (DASH) questionnaire was originally designed as a measure of disability in patients with disorders of the upper limb, but the DASH score is also affected by disability because of lower limb disorders. The aim of this study was to investigate the construct validity of the DASH questionnaire and to create a revised DASH questionnaire, the Manchester-modified or M2 DASH, with fewer questions that is more specific to the upper limb. Patients were asked to fill in the DASH questionnaire in a fracture clinic after ethical approval. This included 79 patients with upper limb injuries, 61 patients with lower limb injuries, and 52 control subjects. The mean DASH scores for the three groups varied significantly, and the lower limb group had a mean score of 16. The M2 DASH questionnaire was developed using questions more specific to the upper limb and included questions 1-4, 6, 13-17, 21-23, and 26-30 from the original questionnaire. The mean M2 DASH score for the lower limb group was 9 and, unlike the original DASH score, was not statistically different from the control group. The M2 DASH scores were then calculated for the upper limb group and a correlation study showed highly significant correlation between the original DASH scores and the M(2) DASH scores. Our study shows that the original DASH questionnaire is not specific for the upper limb. The M2 DASH questionnaire has the advantage of being more specific for the upper limb than the DASH questionnaire, and it correlates well with the original DASH questionnaire when looking at isolated upper limb injuries.
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Affiliation(s)
- Wasim S. Khan
- Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT UK ,Academic Clinical Fellow, University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London HA7 4LP UK
| | - Rohit Jain
- Department of Trauma and Orthopaedics, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, Lancashire PR2 9HT UK
| | - Bernice Dillon
- Department of Medical Statistics, South Manchester University Teaching Hospital NHS Trust, Wythenshawe Hospital, Wythenshawe, Manchester, M23 9LT UK
| | - Lawrence Clarke
- Department of Trauma and Orthopaedics, Pennine Acute Hospitals NHS Trust, Rochdale Infirmary, Rochdale, Lancashire OL12 0NB UK
| | - Max Fehily
- Department of Trauma and Orthopaedics, Royal Bolton Hospitals NHS Trust, Royal Bolton Hospital, Bolton, Lancashire BL4 3FY UK
| | - Mark Ravenscroft
- Department of Trauma and Orthopaedics, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, SK7 2PE UK
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Current utilization, interpretation, and recommendations: the musculoskeletal function assessments (MFA/SMFA). J Orthop Trauma 2007; 21:738-42. [PMID: 17986893 DOI: 10.1097/bot.0b013e31815bb30f] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The development of patient-oriented health status measurements has resulted in the emergence of several generic condition-specific and anatomic-specific instruments. These instruments are generally designed to measure the function of the individual as a whole from the individual's own point of view. They are not intended to replace traditional physician-oriented clinical outcome measures, such as complication rates, ranges of motion, or time to fracture union; instead, they are an attempt to measure the results of a treatment or condition from the patient's perspective. Over the past decade, the Musculoskeletal Function Assessment (MFA) instrument has been developed and used as one of the primary generic musculoskeletal functional assessment tools, in part because of its validity, reliability, and responsiveness. Despite the numerous publications reporting the MFA/SMFA, we are unaware of any publications that have used those results to subsequently affect patient care. We hope that this special interest article highlights the current underutilization of the available data and encourages the orthopedic community to maximize the clinical and research potential of the MFA/SMFA (Short Musculoskeletal Function Assessment).
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Pinedo Otaola S. Afección de la extremidad superior y calidad de vida. Med Clin (Barc) 2006; 127:454-5. [PMID: 17040631 DOI: 10.1157/13093066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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