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Delamarre M, Leroy M, Barbarin M, Chantelot C, Saab M. Long-term clinical and radiological results after scaphoid non-union treatment: a retrospective study about 60 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:507-515. [PMID: 37635175 DOI: 10.1007/s00590-023-03687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Scaphoid non-union treatment remains nonconsensual and is based on vascularized or non-vascularized bone grafting. This study aimed to evaluate with a long follow-up the functional, clinical, and radiological outcomes, reported complications and reoperations and studied non-union treatment prognostic factors. METHODS Patients who had undergone bone graft surgery for scaphoid non-union were retrospectively reviewed. The evaluated outcomes were pain, qDASH, PRWE and MWS scores, active range of motion, grip strength, union rate, scapholunate angle, carpal height, and presence of arthrosis. Complications and reinterventions were also reported. RESULTS This study included 60 scaphoid non-union treatments with a mean follow-up of 7.7 (1.5-20.3) years. Twenty (33.3%) non-unions were located at the proximal pole, including 6 (10%) with preoperative avascular necrosis (AVN). Union occurred in 51 patients (85%). The functional, clinical, and radiological results were good. The complication rate was 21.3% and the reintervention rate was 16.7%. Subgroup union rate analysis found no difference if the non-union is localized in the proximal pole or if there is AVN. CONCLUSION With a representative sample of the population and a long follow-up, we have found a good union rate, clinical and functional results regardless of the treatment method chosen. Scaphoid non-union treatment is still controversial and more studies are needed to accurate indications of each graft according to the patient and non-union characteristics. LEVEL OF EVIDENCE IV Retrospective cohort study.
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Affiliation(s)
- Morgane Delamarre
- Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France
| | - Maxime Leroy
- Statistics, Economic Evaluation, Data-Management (SEED), CHU Lille, 59037, Lille Cedex, France
| | - Maxime Barbarin
- Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France
| | - Christophe Chantelot
- Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France
| | - Marc Saab
- Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France.
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Bell KR, Oliver WM, White TO, Molyneux SG, Clement ND, Duckworth AD. QuickDASH and PRWE Are Not Optimal Patient-Reported Outcome Measures After Distal Radial Fracture Due to Ceiling Effect: Potential Implications for Future Research. J Bone Joint Surg Am 2023; 105:1270-1279. [PMID: 37399255 DOI: 10.2106/jbjs.22.01213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND The aim of this study was to determine the floor and ceiling effects for both the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) and the PRWE (Patient-Rated Wrist Evaluation) following a distal radial fracture (DRF). Secondary aims were to determine the degree to which patients with a floor or ceiling effect felt that their wrist was "normal" according to the Normal Wrist Score (NWS) and if there were patient factors associated with achieving a floor or ceiling effect. METHODS A retrospective cohort study of patients in whom a DRF was managed at the study center during a single year was undertaken. Outcome measures included the QuickDASH, PRWE, EuroQol-5 Dimensions-3 Levels (EQ-5D-3L), and NWS. RESULTS There were 526 patients with a mean age of 65 years (range, 20 to 95 years), and 421 (80%) were female. Most patients were managed nonsurgically (73%, n = 385). The mean follow-up was 4.8 years (range, 4.3 to 5.5 years). A ceiling effect was observed for both the QuickDASH (22.3% of patients with the best possible score) and the PRWE (28.5%). When defined as a score that differed from the best available score by less than the minimum clinically important difference (MCID) for the scoring system, the ceiling effect increased to 62.8% for the QuickDASH and 60% for the PRWE. Patients who had a ceiling score on the QuickDASH and the PWRE had a median NWS of 96 and 98, respectively, and those who had a score within 1 MCID of the ceiling score reported a median NWS of 91 and 92, respectively. On logistic regression analysis, a dominant-hand injury and better health-related quality of life were the factors associated with both QuickDASH and PRWE ceiling scores (all p < 0.05). CONCLUSIONS The QuickDASH and PRWE demonstrate ceiling effects when used to assess the outcome of DRF management. Some patients achieving ceiling scores did not consider their wrist to be "normal." Future research on patient-reported outcome assessment tools for DRFs should aim to limit the ceiling effect, especially for individuals or groups that are more likely to achieve a ceiling score. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Katrina R Bell
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - William M Oliver
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - Timothy O White
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - Samuel G Molyneux
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - Nicholas D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Moraes VYD, Faria JCV, Fernandes M, Raduan-Neto J, Okamura A, Belloti JC. Questionários Disability of the Arm Shoulder and Hand e Michigan Hand: Explorando a responsividade e performance diagnóstica em amostra de pacientes ambulatoriais com e sem queixas nas mãos e punho. Rev Bras Ortop 2022; 57:449-454. [PMID: 35785113 PMCID: PMC9246537 DOI: 10.1055/s-0041-1724071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/14/2020] [Indexed: 11/08/2022] Open
Abstract
Objective
The present study aimed to verify whether, in an adult population with nontraumatic complaints in the upper limbs, (1) the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) are susceptible to a “ceiling effect” when compared with a sample of healthy subjects; and (2) to determine cutoff points for diagnostic performance and the intercorrelation for DASH and MHQ in both samples.
Methods
This was a prospective, comparative, nonrandomized study. In total, 150 subjects were included, with 75 in the case group (with disease) and 75 in the control group (without disease). This was a sample of patients recently admitted to a hand surgery outpatient clinic. Controls were matched to clinical cases according to inclusion. The ceiling effect was determined by a maximum response rate (> 15%); receiver operating characteristic (ROC) curves determined cutoff points for sickness definition, and DASH and MHQ sensitivity and specificity. Statistical significance was set at
p
< 0.05.
Results
The DASH and MHQ questionnaires had no ceiling effect for the case group. In this group, 18 (24%) patients had the maximum DASH score, but none (0%) had the maximum MHQ score. For the control group, 1 (1.33%) subject had the maximum DASH score, but none scored for MHQ. For case determination, DASH scores of 7.1 had 80% sensitivity and 60.3% specificity, whereas MHQ scores of 76.9 had 56.2% sensitivity and 97.3% specificity.
Conclusion
The DASH and MHQ questionnaires are reliable tools to measure the impact of hand and wrist morbidities on daily activities, and they are not susceptible to ceiling effects. The DASH questionnaire is more sensitive for patient identification, whereas the MHQ is more specific. As such, the MHQ seems more appropriate when a more specific functional increase is expected.
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Affiliation(s)
- Vinícius Ynoe de Moraes
- Serviço de Cirurgia da Mão, Hospital Alvorada, Moema, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Marcela Fernandes
- Serviço de Cirurgia da Mão, Hospital Alvorada, Moema, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Jorge Raduan-Neto
- Serviço de Cirurgia da Mão, Hospital Alvorada, Moema, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Aldo Okamura
- Serviço de Cirurgia da Mão, Hospital Alvorada, Moema, São Paulo, SP, Brasil
| | - João Carlos Belloti
- Serviço de Cirurgia da Mão, Hospital Alvorada, Moema, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Effect of the Articular Surface Incongruency on Surgical Outcome of the Distal Radius Fracture. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8357675. [PMID: 35309177 PMCID: PMC8926485 DOI: 10.1155/2022/8357675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 11/18/2022]
Abstract
Purpose The aim of this study was to demonstrate the joint fragment that mostly affects the outcome of the distal radius fracture surgically treated with a volar locking plate (VLP). Methods The outcomes of 69 patients with the distal radius fractures were evaluated at their final follow-up. The articular surface was divided into six specific fragments, and computed tomography (CT) was used to evaluate the degree of mismatch of each fragments. A plain radiograph was also obtained for evaluation of the distal radius alignment. Clinical outcomes were measured by using the Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS). Univariate analyses were performed, with subsequent multiple logistic regression analyses. Results The mean follow-up period was 14.8 (range, 12 to 52) months. The group with a worse DASH score showed significantly greater mismatch in the volar and dorsal lunate facets, as well as the central depression of the distal radius (p = 0.042, 0.031, and 0.023, respectively). There was a significant positive correlation between the DASH score and degree of mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.040 and 0.011, respectively). Groups with worse MMWS showed significantly greater mismatch in the dorsal lunate facet (p = 0.025). There was a significant negative correlation between MMWS and abnormal ulnar variance and mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.041, 0.004, and 0.018, respectively). The result of multiple logistic regression analysis demonstrated that a mismatch of the dorsal lunate facet is a significant predictor for a worse MMWS (odds ratio = 3.072, p = 0.043). Conclusions Articular surface mismatch of the dorsal lunate facet appears to mostly affect the surgical outcomes of the distal radius fractures using VLP. In cases where the dorsal lunate facet is heavily involved, surgeons should be cautious about its reduction and fixation.
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Singh HP, Haque A, Taub N, Modi A, Armstrong A, Rangan A, Pandey R. Floor and ceiling effects in the Oxford Shoulder Score : an analysis from the National Joint Registry. Bone Joint J 2021; 103-B:1717-1724. [PMID: 34719266 DOI: 10.1302/0301-620x.103b11.bjj-2021-0668.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The main objective of this study was to examine whether the Oxford Shoulder Score (OSS) demonstrated floor or ceiling effects when used to measure outcomes following shoulder arthroplasty in a large national cohort. Secondary objectives were to assess its pain and function subscales, and to identify independent predictors for patients achieving a postoperative ceiling score following shoulder arthroplasty. METHODS Secondary database analysis of the National Joint Registry (NJR), which included 48,270 patients undergoing shoulder arthroplasty, was conducted. The primary outcome measure was the OSS. Secondary outcome measures were the OSS-Function Component Subscale and OSS-Pain Component Subscale. Floor and ceiling effects were considered to be present if > 15% of patients scored either the lowest or highest possible score. Logistic regression analysis was used to identify independent predictors for scoring the highest possible OSS score postoperatively. RESULTS Preoperatively, 1% of patients achieved the lowest possible OSS score (0) and 0.4% of patients achieved the highest possible score (48). Postoperatively, < 1% of patients achieved the lowest score at all timepoints, but the percentage achieving the highest score at six months was 8.3%, at three years 16.9%, and at five years 17%. Male patients, those aged between 60 and 89 years, and those undergoing an anatomical total shoulder arthroplasty (ATSA) were more likely to contribute to the ceiling effect seen in the OSS questionnaire. Pain and function subscales exhibited greater ceiling effects at three years and five years when compared with the overall OSS questionnaire. Logistic regression analysis showed that sex, procedure type, and preoperative OSS score were independent predictors for scoring the highest possible OSS at years. CONCLUSION Based on NJR patient-reported outcome measures data, the OSS does not exhibit a ceiling effect at six months, but does at three years and five years, in part due to outcome scores of ATSA. Preoperative OSS, age, male sex, and ATSA are independent predictors of achieving a ceiling score. Cite this article: Bone Joint J 2021;103-B(11):1717-1724.
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Affiliation(s)
| | - Aziz Haque
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nick Taub
- University of Leicester, Leicester, UK
| | - Amit Modi
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Amar Rangan
- James Cook University Hospital, Middlesbrough, UK
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Shoulder outcome scoring systems have substantial ceiling effects 2 years after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:2070-2076. [PMID: 32440715 DOI: 10.1007/s00167-020-06036-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Previous studies show no difference in clinical outcomes between patients with healed and structurally failed rotator cuff repairs. The objective of this study was to assess ceiling effects when reporting surgical outcomes of arthroscopic rotator cuff repair using four of the currently most popular clinical shoulder outcome scoring systems. METHODS Ninety-two patients who underwent arthroscopic rotator cuff repair were examined. The simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder rating scale, and Constant-Murley shoulder score were completed 2 years postoperatively. Demographic data of the subjects were analysed using descriptive statistics. The ceiling effects in the outcome data assessed for each scale were estimated based on two previously reported definitions. RESULTS The number of patients with the maximum possible score was 31 (33.7%) with the SST, 26 (28.3%) with the ASES score, 28 (30.4%) with the UCLA scale, and 18 (19.6%) with the Constant-Murley score. The standardised distance of the outcome data assessed by the SST, ASES score, UCLA scale, and Constant-Murley scores were 0.92, 0.97, 0.96, and 1.18, respectively. CONCLUSION The SST, ASES score, and UCLA scale evaluated at 2 years postoperatively have substantial ceiling effects showing that the proportion of patients with the maximum possible score is > 20%, and the standardised distance is < 1.0. Researchers should be aware of possible biases due to ceiling effects when interpreting the results of studies investigating the surgical outcomes of arthroscopic rotator cuff repair. It could increase the likelihood of a type II error. LEVEL OF EVIDENCE IV.
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Cheema AS, O’Brien PJ, Broekhuyse HM, Lefaivre KA. Measuring Outcomes Over Time in Distal Radius Fractures: A Comparison of Generic, Upper Extremity-Specific and Wrist-Specific Outcome Measures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:272-276. [PMID: 35415515 PMCID: PMC8991422 DOI: 10.1016/j.jhsg.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/25/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose This study compared the responsiveness of a generic (Short Form-36 [SF-36]), an upper extremity-specific (Disabilities of the Arm, Shoulder, and Hand [DASH]) and a wrist-specific (Patient-Rated Wrist Evaluation [PRWE]) outcome score when evaluating distal radius fractures over time. Methods We observed 235 patients who met the inclusion criteria of an isolated distal radius fracture treated surgically or nonsurgically and greater than age 50 years for 12 months in this prospective study. Standardized assessments were performed at baseline and at 6 and 12 months. Exclusion criteria included subjects with concomitant injuries in the ipsilateral limb and follow-up of less than 1 year. Responsiveness was evaluated through the standardized response mean and the proportion who met a minimal clinically important difference. Floor and ceiling effects were also calculated. Results The standardized response mean was significantly greatest for the DASH between baseline and 6 months (P < .001), and the PRWE between both baseline and 6 months (P < .01) and 6 and 12 months (P < .01) compared with the SF-36. The proportion of patients who met a minimal clinically important difference between baseline and 6 months was greater in the PRWE, but it did not meet statistical significance (P = .12). The PRWE demonstrated a high ceiling effect at baseline (76.6%) but less so at 12 months (16.9%). The DASH demonstrated similar ceiling effects at baseline (62.9%) and 12 months (18.6%). The SF-36 had no ceiling effect. Conclusions In the first 6 months, both the DASH and PRWE have greater responsiveness in assessing change over the SF-36 in distal radius fractures. From 6 to 12 months, the wrist-specific PRWE has greater responsiveness over both the DASH and SF-36. This supports the use of the anatomy- and injury-specific outcome measures over the generic outcome measure in detecting change over a patient's early recovery. However, as the time from injury increases, the absence of a ceiling effect from the generic outcome measure may become more useful. Clinical relevance This study demonstrates the responsiveness of the DASH, PRWE, and SF36 in assessing distal radius fractures treated in patients greater than age 50 in the first year. In establishing the most responsive measure, respondent burden can be decreased in future research.
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Affiliation(s)
- Amarpal S. Cheema
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J. O’Brien
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Henry M. Broekhuyse
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly A. Lefaivre
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
- Corresponding author: Kelly A. Lefaivre, MD, MSc, FRCSC, Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, VGH Research Pavilion, 110-828 West 10th Avenue, Vancouver, BC, Canada V5Z 1M9.
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Nagura N, Naito K, Sugiyama Y, Obata H, Goto K, Kaneko A, Kawakita S, Kaneko K. Evaluation of Patient-Reported and Clinician-Reported Outcomes of Volar Locking Plate Fixation for Distal Radius Fractures. J Hand Surg Asian Pac Vol 2020; 25:359-363. [PMID: 32723039 DOI: 10.1142/s2424835520500411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Postoperative evaluation of wrist joint trauma is divided into patient-reported outcomes (PROs) and clinician-reported outcomes (CROs). We investigated the association of the Q-DASH score as the postoperative PROs and the Mayo wrist score as the postoperative CROs with clinical evaluation in patients with distal radius fractures surgically treated using a volar locking plate (VLP). Moreover, whether PROs and CROs are correlated to the clinical evaluation was investigated. Methods: The subjects were 109 patients surgically treated for distal radius fractures at our hospital between June 2013 and May 2017. Forty-one patients were male, 68 patients were female, and the mean age was 61.4 (19-86) years old. The fracture type was AO classification A type in 30 patients (A2: 25, A3: 5), B type in 5 (B2: 1, B3: 4), and C type in 74 (C1: 50, C2: 11, C3: 13). All patients were surgically treated using VLP. The range of motion of the wrist, grip strength the Visual Analog Scale (VAS), the Q-DASH score (PROs), and the Mayo wrist score (CROs) were investigated. Each evaluation was compared as the clinical outcome between at 3 months after surgery and the final follow-up. In addition, the correlations of the postoperative PROs and CROs with the clinical evaluation were analyzed. Results: Each evaluation was significantly improved compared with that at 3 months after surgery. There was a significant correlation between PROs and CROs at 3 months after surgery and the final follow-up. However, the range of motion of the wrists was not significantly correlated with PROs or CROs at 3 months after surgery or at the final follow-up. Conclusions: On evaluation after surgery for distal radius fractures, PROs and CROs improved early after surgery (3 months after surgery) before the final follow-up, and an inverse correlation was present between these scores.
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Affiliation(s)
- Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Ayaka Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - So Kawakita
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
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Cost-Effectiveness of Operative Versus Non-Operative Treatment for Clavicle Fracture: a Systematic Literature Review. Curr Rev Musculoskelet Med 2020; 13:391-399. [PMID: 32383036 PMCID: PMC7340703 DOI: 10.1007/s12178-020-09640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Operative and non-operative treatment of midshaft clavicle fractures seems to yield comparative functional results. Furthermore, it has been suggested that surgery is more expensive compared with non-operative treatment of clavicle fracture. Cost-effectiveness seems to be more important in trends of treatment decisions. The purpose of this study is to investigate the cost-effectiveness of clavicle fracture treatment. RECENT FINDINGS Seven publications were selected, and 5 studies showed that operative treatment is more expensive than non-operative treatment. The mean overall cost per person in discounted prices was 10,230 USD for operative and 7923 USD for non-operative treatment. The mean absence from work ranged 8-193 and 24-69 days for operative and non-operative treatment, respectively. Studies varied in methods of assessing the cost-effectiveness of treatment modalities. Based on this literature review, routine operative treatment seems to be more expensive. In some cases, operative treatment might be more cost-effective. In all studies, direct and indirect costs of health care were calculated, but a great heterogeneity exists in the sources of cost data between countries. The cost-effectiveness of the treatment of clavicle fracture depends strongly on the cost of operative treatment and length of absence from work. Cost-effectiveness analysis could be a routine in RCT studies in the future.
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Early Results of Surgical Treatment of Triangular Fibrocartilage Complex Tears in Children and Adolescents. J Hand Surg Am 2020; 45:449.e1-449.e9. [PMID: 31519316 DOI: 10.1016/j.jhsa.2019.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 03/24/2019] [Accepted: 06/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the clinical results and patient-reported outcomes following surgical treatment for triangular fibrocartilage complex (TFCC) tears in the pediatric and adolescent population. METHODS We reviewed 149 patients with 153 arthroscopy-confirmed TFCC tears. Mean age at surgery was 15.5 years (range, 7-19 years). There were 86 females. Plain radiographs and magnetic resonance imaging were used to characterize bony and soft tissue pathology. Mayo Modified Wrist Score (MMWS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Short Form assessed functional outcomes. Median patient follow-up was 21.8 months (IQR:5.9-55.4). RESULTS Pre-operatively, all patients had wrist pain or instability with activities. The median pre-operative MMWS was 80 (interquartile range [IQR], 65-90). Fifty-six (35%) presented with positive ulnar variance. Concomitant pathology included distal radioulnar joint (DRUJ) instability (14%), ulnocarpal impaction (20%), ulnar styloid nonunion (33%), and distal radius growth arrest (30%). On arthroscopy, there were 15 (10%) isolated 1A, 79 (52%) 1B, 1 (1%) 1C, 30 (20%) 1D tears, and 25 (16%) cases of multiple tears. Twenty-six percent of wrists underwent TFCC debridement, 68% arthroscopy-assisted repair, 6% both for combined tears. Fifty-one percent of wrists underwent bony procedures-most commonly ulnar-shortening osteotomy to achieve neutral ulnar variance (40%) and symptomatic ulnar styloid nonunion excision with concomitant TFCC repair (39%). At final follow-up, pain, wrist range of motion, DRUJ stability, ulnar variance, and MMWS (median, 95 [IQR, 86.5-100]) improved significantly. The median PROMIS T-score at final follow-up was 57 (IQR, 45-57). The MMWS was better in those with concomitant bony procedures at index surgery than those with only repair or debridement of TFCC tears. CONCLUSIONS Most pediatric TFCC tears are posttraumatic and peripheral. Surgical treatment of TFCC tears and concomitant pathology in the pediatric and adolescent population results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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