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Zhang J, Yao X, Song Y, Yin P. Establishment and preliminary evaluation of CT-based classification for distal radius fracture. Sci Rep 2024; 14:9673. [PMID: 38671052 PMCID: PMC11053106 DOI: 10.1038/s41598-024-60416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
Establish a new classification system of distal radius fracture based on computed tomographic (CT), and evaluate its reliability and reproducibility preliminarily, and provide a new theoretical reference for clinicians to use the clinical classification system. The imaging data and clinical data of 204 inpatients with distal radius fracture during 6 years from January 1, 2014 to January 1, 2019 in orthopaedic department were analyzed retrospectively and classified based on CT. Three observers evaluated the image data of 48 randomly selected cases based on CT at different time nodes of T1 and T2. Cohen's kappa was used to calculate the consistency. At the last follow-up, patients' Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE), and VAS scores were collected. Among 204 cases, there were 12 cases of type 1, including 6 cases of type 1-D, 4 cases of type 1-V and 2 cases of type 1-R. There were 6 cases of type 2, including 2 cases of type 2-DV, 2 cases of type 2-DR and 2 cases of type 2-VR. There were 186 cases of type 3, including 32 cases of type 3-0, 127 cases of type 3-1 and 27 cases of type 3-2. There was no significant difference in DASH, PRWE and VAS scores among all types (P > 0.05). The results of interobserver reproducibility were kappa = 0.985, ICC = 0.984 in the first evaluation, kappa = 0.986, ICC = 0.986 in the second evaluation. The results of intraobserver reproducibility were O1 = 0.991, O2 = 0.991, O3 = 0.989 respectively. The new classification system of distal radius fracture based on CT has theoretical and practical significance for incision selection, fracture reduction and internal fixation. 123 classification system is clear, comprehensive, easy to understand and remember. Moreover, it has higher interobserver reliability and intraobserver reproducibility than other systems reported at present.
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Affiliation(s)
- Jun Zhang
- Department of Orthopaedics, The Affiliated Hospital of Innermongolia Medical University, Hohhot, 010010, China.
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, 100038, China.
| | - Xiaoke Yao
- Department of Orthopedics, Chengdu First People's Hospital, Chengdu, 610041, Sichuan, China
| | - Yanan Song
- National Engineering Laboratory for Medical Big Data Application Technology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Peng Yin
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, 100020, China.
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Nogueira CKG, Moraes VYD, Sarmento LP, Nakachima LR, Santos JBGD, Belloti JC. Distal Radial Fractures with Scaphoid Fractures. Rev Bras Ortop 2024; 59:e247-e253. [PMID: 38606120 PMCID: PMC11006516 DOI: 10.1055/s-0044-1785464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/06/2023] [Indexed: 04/13/2024] Open
Abstract
Objective This study evaluated the epidemiological data and functional outcomes from patients with concomitant distal radial and scaphoid fractures treated in a single center specialized in hand surgery. Functional outcomes analysis used validated instruments. Methods Patients diagnosed with distal radial and scaphoid fractures treated from January 2011 to December 2021 underwent assessments using the Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS) for pain, goniometry, radiographic consolidation, and complications six months after surgery. Results The study included 23 patients, 73.9% men and 26.1% women. Most (56.5%) fractures occurred on the right side, and 43.5% happened on the left side. Treatment of most (56%) distal radial fractures used a locked volar plate. Functional assessment by PRWE resulted in a mean score of 35.9 points (range, 14 to 71 points), while DASH showed a mean score of 37.8 points (range, 12 to 78 points). The mean VAS was 2.33 during activities (range, 0.6 to 6.2). Conclusion Distal radial fractures associated with scaphoid fractures resulted from high-energy trauma, and most patients were males. There was a low rate of complications with surgical treatment, and the patients had satisfactory functional evolution with a low level of pain.
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Affiliation(s)
- Caio Kzan Geyer Nogueira
- Disciplina de Cirurgia da Mão e Membro Superior, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Vinícius Ynoe de Moraes
- Disciplina de Cirurgia da Mão e Membro Superior, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Lucas Pereira Sarmento
- Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Luís Renato Nakachima
- Disciplina de Cirurgia da Mão e Membro Superior, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Baptista Gomes dos Santos
- Disciplina de Cirurgia da Mão e Membro Superior, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Carlos Belloti
- Disciplina de Cirurgia da Mão e Membro Superior, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Abstract
BACKGROUND Traditionally, distal radius fractures (DRFs) have been described using eponyms, e.g. Colles, Smith, Barton, Chauffeur. During the last half of the 20th century several classification systems for DRF have emerged. We evaluated the inter- and intra-observer agreement of the AO/OTA, Frykman and Older classification systems. METHODS Four observers, an intern, an orthopaedic registrar, an orthopaedic consultant and a radiology consultant, independently evaluated DRF radiograms and classified the fractures according to the AO/OTA, Frykman and Older classification systems. After an interval of 6 months, radiograms of 30 randomly chosen patients were re-evaluated by the same observers. RESULTS Radiograms of 573 DRF patients were evaluated in the study. The inter-observer reliability of the AO/OTA fracture types (A, B and C) was 'weak' (kappa = 0.45). The agreement dropped to 'minimal' (kappa = 0.24) regarding the AO/OTA groups (A2, A3, B1, B2, B3, C1, C2 and C3). The reliability of the Frykman classification system was 'weak' (kappa = 0.41), and we observed the lowest inter-observer reliability for the Older classification system (kappa = 0.10). The kappa values for the intra-observer reproducibility of the AO/OTA fracture types (A, B and C) ranged from 0.58 to 0.87. For the AO/OTA groups (A2, A3, B1, B2, B3, C1, C2 and C3) the reproducibility was lower ranging from 'minimal' to 'weak'. The intra-observer reproducibility of the Frykman system was 'weak' to 'moderate' and even worse for the Older classification system. CONCLUSION Based on these findings the AO/OTA classification system seems to be most reliable for routine use, however, with lower kappa values concerning the agreement for the groups. The Frykman and Older classification systems cannot be recommended because of less convincing results.
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Thorninger R, Madsen ML, Wæver D, Borris LC, Rölfing JHD. Complications of volar locking plating of distal radius fractures in 576 patients with 3.2 years follow-up. Injury 2017; 48:1104-1109. [PMID: 28336098 DOI: 10.1016/j.injury.2017.03.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Volar plating of unstable distal radius fractures (DRF) has become the favoured treatment. The complication rates vary from 3 to 36%. The purpose of the study was to estimate the complication rate of volar plating of DRF and its association with AO/OTA fracture type, surgeon experience and type of volar plate. METHODS Retrospectively, all patients treated with volar plating of a DRF between February 2009 and June 2013 at Aarhus University Hospital, Denmark were included. AO/OTA fracture type, surgeon experience (1st year, 2nd-5th year resident or consultant), type of plate (VariAx®, Acu-Loc®) and complications were extracted from the electronic medical records. Complications were categorized as carpal tunnel syndrome, other sensibility issues, tendon complications including irritation and rupture, deep infections, complex regional pain syndrome and unidentified DRUJ or scapholunar problems. Reoperations including hardware removal were also charted. RESULTS 576 patients with a median age of 63 years (min: 15; max: 87) were included. 78% were female and the mean observation time was 3.2 years (min: 2.0; max: 5.4). 78% (n=451) of the patients were treated with VariAx® and 22% (n=125) with Acu-Loc®. The overall complication rate was 14.6% (95% CI 11.8-17.7) including carpal tunnel syndrome or change in sensibility in 5.2% and tendon complications in 4.7%. Five flexor tendon ruptures and 12 extensor tendon ruptures were observed. The reoperation rate was 10.4% including 41 cases of hardware removal. A statistically significant association between AO/OTA fracture type C and complications was found. No statistically significant association between complication rate and surgeon experience and type of plate was observed. CONCLUSION The majority of DRF patients treated with a volar plate suffer no complications. However, the overall complication rate of 14.6% is substantial. Intra-articular fractures, e.g. AO/OTA-type 23C1-3, had significantly higher complication rates. Neither surgeon experience, nor type of volar plate was able to predict complications.
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Affiliation(s)
- Rikke Thorninger
- Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark.
| | - Mette Lund Madsen
- Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark
| | - Daniel Wæver
- Department of Orthopaedics, Regionshospital Randers, Skovbrynet 15, 8930 Randers, Denmark; Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - Lars Carl Borris
- Department of Orthopaedics, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
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Machado DG, da Cruz Cerqueira SA, de Lima AF, de Mathias MB, Aramburu JPG, Rodarte RRP. Statistical analysis on the concordance of the radiological evaluation of fractures of the distal radius subjected to traction. Rev Bras Ortop 2016; 51:11-5. [PMID: 26962498 PMCID: PMC4767842 DOI: 10.1016/j.rboe.2014.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/29/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the current classifications for fractures of the distal extremity of the radius, since the classifications made using traditional radiographs in anteroposterior and lateral views have been questioned regarding their reproducibility. In the literature, it has been suggested that other options are needed, such as use of preoperative radiographs on fractures of the distal radius subjected to traction, with stratification by the evaluators. The aim was to demonstrate which classification systems present better statistical reliability. RESULTS In the Universal classification, the results from the third-year resident group (R3) and from the group of more experienced evaluators (Staff) presented excellent correlation, with a statistically significant p-value (p < 0.05). Neither of the groups presented a statistically significant result through the Frykman classification. In the AO classification, there were high correlations in the R3 and Staff groups (respectively 0.950 and 0.800), with p-values lower than 0.05 (respectively <0.001 and 0.003). CONCLUSION It can be concluded that radiographs performed under traction showed good concordance in the Staff group and in the R3 group, and that this is a good tactic for radiographic evaluations of fractures of the distal extremity of the radius.
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Machado DG, Cerqueira SADC, Lima AFD, Mathias MBD, Aramburu JPG, Rodarte RRP. Análise estatística da concordância na avaliação radiológica das fraturas de rádio distal submetidas a tração. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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das Graças Nascimento V, da Costa AC, Falcochio DF, Lanzarin LD, Checchia SL, Chakkour I. Computed tomography's influence on the classifications and treatment of the distal radius fractures. Hand (N Y) 2015; 10:663-9. [PMID: 26568720 PMCID: PMC4641105 DOI: 10.1007/s11552-015-9773-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Distal radius fractures are common in emergency centers. The radiographic routine includes at least two radiographic projections used for diagnosing most of these fractures. Computed tomography (CT) is indicated for evaluating complex fractures that affect the articular surface, as well as the fragments' size and position. There are not enough comparative studies on choosing classification and treatment by means of the four radiographic projections and computed tomography (CT) and the association of these with the levels of expertise. METHODS We conducted a randomized cross-sectional study by observing images from 61 patients with distal radius fractures organized in two phases: the first phase comprising radiographic images alone and the second one with those same images associated with tomograms. Seventeen evaluators with different levels of training and expertise classified the fractures according to the AO and Universal classification systems and proposed treatment guidelines. RESULTS The agreement between the AO and Universal classification ratings was poor (worse for the former), with smaller Fleiss' kappa resulting from data obtained by orthopedics residents and non-specialist orthopedists. CT influenced the classification choice, with a higher change frequency for more complex patterns in the AO classification system and intra-articular and irreducible fractures in the Universal classification system, especially in the group comprised of orthopedic residents and orthopedic physicians. CT did not influence the treatment choice made by the group comprised of hand surgery residents and hand surgeons. CONCLUSION The less experienced in hand surgery the observer was, the more important computed tomography was for determining the fracture pattern.
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Affiliation(s)
- Valdênia das Graças Nascimento
- Hand Surgery and Microsurgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 112, CEP 01221-020 São Paulo, SP Brazil
| | - Antonio Carlos da Costa
- Hand Surgery and Microsurgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 112, CEP 01221-020 São Paulo, SP Brazil
| | - Diego Figueira Falcochio
- Hand Surgery and Microsurgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 112, CEP 01221-020 São Paulo, SP Brazil
| | - Leonardo Depiere Lanzarin
- Hand Surgery and Microsurgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 112, CEP 01221-020 São Paulo, SP Brazil
| | - Sérgio Luiz Checchia
- Hand Surgery and Microsurgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 112, CEP 01221-020 São Paulo, SP Brazil
| | - Ivan Chakkour
- Hand Surgery and Microsurgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 112, CEP 01221-020 São Paulo, SP Brazil
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Raduan Neto J, de Moraes VY, Gomes dos Santos JB, Faloppa F, Belloti JC. Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol. BMC Musculoskelet Disord 2014; 15:65. [PMID: 24597699 PMCID: PMC3996038 DOI: 10.1186/1471-2474-15-65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/29/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Various treatments are available for reducible unstable fractures of the distal radius, such as closed reduction combined with fixation by external fixator (EF), and rigid internal fixation using a locked volar plate (VP). Although there are studies comparing these methods, there is no conclusive evidence indicating which treatment is best. The hypothesis of this study is that surgical treatment with a VP is more effective than EF from the standpoint of functional outcome (patient-reported). METHODS/DESIGN The study is randomized clinical trial with parallel groups and a blinded evaluator and involves the surgical interventions EF and VP. Patients will be randomly assigned (assignment ratio 1:1) using sealed opaque envelopes. This trial will include consecutive adult patients with an acute (up to 15 days) displaced, unstable fracture of the distal end of the radius of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen-Association for the Study of Internal Fixation classification and type II or type III by the IDEAL32 classification, without previous surgical treatments of the wrist. The surgical intervention assigned will be performed by three surgical specialists familiar with the techniques described. Evaluations will be performed at 2, and 8 weeks, 3, 6 and 12 months, with the primary outcomes being measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Pain Scale and digital algometer). Secondary outcomes will include radiographic parameters, objective functional evaluation (goniometry and dynamometry), and the rate of complications and method failure according to the intention-to-treat principle. Final postoperative evaluations (6 and 12 months) will be performed by independent blinded evaluators. For the Student's t-test, a difference of 10 points in the DASH score, with a 95% confidence interval, a statistical power of 80%, and 20% sampling error results in 36 patients per group. DISCUSSION Results from this study protocol will improve the current evidence regarding to the surgical treatment these fractures. TRIAL REGISTRATION ISCRTN09599740.
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Affiliation(s)
- Jorge Raduan Neto
- Hand, Arm and Shoulder Surgery Unit, Department of Orthopedics and Traumatology, Federal University of São Paulo, UNIFESP/EPM, São Paulo, SP, Brazil
- Hand, Arm and Shoulder Surgery Unit, Rua Borges Lagoa, 778 Vila Clementino, São Paulo, SP, Brazil
| | - Vinicius Ynoe de Moraes
- Hand, Arm and Shoulder Surgery Unit, Department of Orthopedics and Traumatology, Federal University of São Paulo, UNIFESP/EPM, São Paulo, SP, Brazil
| | - João B Gomes dos Santos
- Hand, Arm and Shoulder Surgery Unit, Department of Orthopedics and Traumatology, Federal University of São Paulo, UNIFESP/EPM, São Paulo, SP, Brazil
| | - Flávio Faloppa
- Hand, Arm and Shoulder Surgery Unit, Department of Orthopedics and Traumatology, Federal University of São Paulo, UNIFESP/EPM, São Paulo, SP, Brazil
| | - João Carlos Belloti
- Hand, Arm and Shoulder Surgery Unit, Department of Orthopedics and Traumatology, Federal University of São Paulo, UNIFESP/EPM, São Paulo, SP, Brazil
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