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Akahane M, Tada K, Matsuta M, Nakamura Y, Honda S, Mori A, Tsuchiya H. Seasonal variation of surgically treated distal radius fracture in Japan using inpatient database: cross-sectional study. J Bone Miner Metab 2024; 42:207-213. [PMID: 38418699 DOI: 10.1007/s00774-023-01494-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/14/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The purpose of this study was to clarify the relationship between seasonal variation and distal radius fractures using diagnosis procedure combination data in Japan. MATERIALS AND METHODS The participants were hospitalized patients who underwent surgical treatment for distal radius fracture as the primary injury at hospitals that introduced the diagnosis procedure combination system between April 2011 and March 2016. We obtained a summary table of the month of admission, region of residence, age at admission, and sex of the patients from the Ministry of Health, Labour and Welfare and evaluated it by month, region, age group, and sex. RESULTS The total number of patients for the 5 years from 2011 to 2016 was 105,025. There were 29,224 male and 75,801 female participants, with a female-to-male ratio of 2.6. The mean age was 60.2 (standard deviation, 20.8) years. Distal radius fractures occurred more frequently in the winter, especially among female individuals in eastern Japan. Female participants aged ≥ 50 years tended to have a higher incidence of distal radius fracture in winter. The incidence of distal radius fracture among male participants aged 0-19 years was higher from spring to autumn. CONCLUSION Surgically treated distal radius fractures occur frequently during the winter months among female individuals in eastern Japan or those aged ≥ 50 years and increase from school age to adolescence, especially in male individuals from spring to autumn. We should be aware of the high incidence of distal radius fractures in winter, especially in regions with snowfall and cold temperatures.
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Affiliation(s)
- Mika Akahane
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Kaoru Tada
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masashi Matsuta
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuta Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Soichiro Honda
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Akari Mori
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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Ando J, Takahashi T, Ae R, Ajiki T, Matsumura T, Sasao W, Abe M, Takeshita K. Epidemiology of distal radius fracture: a regional population-based study in Japan. BMC Musculoskelet Disord 2023; 24:478. [PMID: 37312071 DOI: 10.1186/s12891-023-06608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Distal radius fracture (DRF) is very common worldwide. In particular, aging countries have numerous patients with DRF, resulting in an urgent need for active preventive measures. As few epidemiological studies have investigated DRF in Japan, we aimed to identify the epidemiological characteristics of patients of all ages with DRF in Japan. METHODS This descriptive epidemiologic study analyzed data obtained from clinical information of patients diagnosed with DRF from January 1, 2011, to December 31, 2020, at a prefectural hospital in Hokkaido, Japan. We calculated the crude and age-adjusted annual incidences of DRF and described the age-specific incidence, injury characteristics (injury location and cause, seasonal differences, and fracture classification), and 1- and 5-year mortality rates. RESULTS A total of 258 patients with DRF were identified, of which 190 (73.6%) were female and the mean age (standard deviation) was 67.0 (21.5) years. The crude annual incidence of DRF ranged from 158.0 to 272.6 per 100,000 population/year, and the age-adjusted incidence among female patients demonstrated a significant decreasing trend during 2011-2020 (Poisson regression analysis; p = 0.043). The age-specific incidence differed by sex, with peaks at 10-14 years for males and 75-79 years for females. The most common cause of injury was a simple fall in patients > 15 year of age and sports injuries in patients ≤ 15 years of age. DRFs were most frequently sustained outdoors and were more common in the winter season. In patients > 15 years of age, the proportions of AO/OTA fracture types A, B, and C were 78.7% (184/234), 1.7% (4/234), and 19.6% (46/234), respectively, and 29.1% (68/234) of patients received surgical treatment for DRF. The 1- and 5-year mortality rates were 2.8% and 11.9%, respectively. CONCLUSIONS Our findings were mostly consistent with previous global studies. Although the crude annual incidence of DRF was relatively high because of recent population aging, the age-adjusted annual incidence among female patients showed a significant decreasing trend during this decade.
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Affiliation(s)
- Jiro Ando
- Department of Orthopedics, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimokoyama 1-15-4, Shimotsuke, Tochigi, 329-0502, Japan.
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Takashi Ajiki
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimokoyama 1-15-4, Shimotsuke, Tochigi, 329-0502, Japan
| | - Tomohiro Matsumura
- Jichi Medical University Hospital Life Saving Emergency Center, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Wataru Sasao
- Hokkaido Prefecture Haboro Hospital, Hokkaido, Sakaemachi 110, Haborochou, Tomamaegun, Hokkaido, 078-4197, Japan
| | - Masahiko Abe
- Hokkaido Prefecture Haboro Hospital, Hokkaido, Sakaemachi 110, Haborochou, Tomamaegun, Hokkaido, 078-4197, Japan
| | - Katsushi Takeshita
- Department of Orthopedics, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
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Zhang XF. The use of phalangeal plate as “hook plate” and external fixation to treat complex distal radius fracture fragments. World J Emerg Med 2022; 13:322-325. [DOI: 10.5847/wjem.j.1920-8642.2022.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
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Constantine RS, Le EL, Gehring MB, Ohmes L, Iorio ML. Risk Factors for Infection After Distal Radius Fracture Fixation: Analysis of Impact on Cost of Care. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:123-127. [PMID: 35601524 PMCID: PMC9120794 DOI: 10.1016/j.jhsg.2021.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Infection after distal radius fracture fixation can be a devastating complication, leading to potential hardware removal, prolonged antibiotic courses, multiple office visits, and increased costs. This study aimed to identify potential risk factors for infectious complications after distal radius fracture fixation and assess the impacts on cost. Methods This study used the PearlDiver national database, encompassing 53 million unique patients from January 1, 2010, to March 31, 2020. The cohort included patients undergoing distal radius fracture fixation. The endpoint was postoperative infection within 180 days of fixation. Two-sample t test was used to compare rates of infection between open and percutaneous fracture fixation techniques. A propensity-matched cohort was created using patient age, gender, and open fracture. Logistic regression analyses defined independent risk factors for developing a postoperative infection among all patients and within the matched cohorts. A Mann-Whitney U test was used to compare costs of care with and without infection. Results The database included 87,169 patients who underwent distal radius fracture fixation. Postoperative infections were identified in 781 patients (0.9%). There was a significant difference in rates of postoperative infection with percutaneous fixation (1.3%) versus open fixation (0.8%). Logistic regression analysis identified male gender, open fracture, lung disease, chronic kidney disease, diabetes, hypertension, liver disease, obesity, and tobacco to be independent risk factors for developing a postoperative infection. Logistic regression analysis of the propensity-matched cohorts identified tobacco use as a significant risk factor. The average cost of care for patients undergoing fracture fixation without an infection was $6,383, versus $23,355 for those with an infection, which was significantly different. Conclusions Multiple risk factors for postoperative infection were identified. Cost is significantly increased after postoperative infection, by almost 4-fold. Attempts to correct or optimize modifiable risk factors may lead to substantial cost savings, and potentially decreased rates of infection. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Ryan S. Constantine
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Elliot L.H. Le
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Michael B. Gehring
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Lucas Ohmes
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Matthew L. Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
- Corresponding author: Matthew L. Iorio, MD, Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 12631 E. 17th Ave, C309 (Room 6414), Aurora, CO 80045.
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Zugasti-Marquínez J, García-Reza A, Domínguez-Prado D, Cela-López M, Oiartzábal-Alberdi I, Castro-Menéndez M. [Translated article] Epidemiological study of distal radius fractures in the sanitary area of Vigo. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chao WQ, Azman MZ, Rosdi SA, Tuan-Mustafa T, Tan YJ, Abdullah S, Aizuddin AN. Epidemiology and Factors Affecting Functional Outcome of Distal Radial Fracture in an Urban Tertiary Medical Centre in Malaysia. Malays Orthop J 2021; 15:84-90. [PMID: 34966500 PMCID: PMC8667256 DOI: 10.5704/moj.2111.013] [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: 11/09/2020] [Accepted: 07/19/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Distal radial fracture is a commonly encountered fracture. This study aims to study the epidemiology of distal radial fracture and factors affecting the patients' functional outcome one to two years after the injury. Materials and methods This is a retrospective cohort study. The records of patients, fulfilling the radiographical diagnosis of distal radial fracture, and aged 18 and above, who presented to our Emergency Department from 1st January 2018 to 31st December 2018 were retrieved. According to AO classification, we grouped our patients into A (extra-articular), B (partial articular) and C (complete articular). Patients with congenital abnormalities were excluded. Epidemiological data and relevant medical history were obtained and tabulated. A Malaysian language translation of Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to assess the functional outcome. Results Out of 168 patients' data retrieved, only 110 patients' data were found complete for purposes of this study. The mean DASH score was 13.7 ± 7.87 approximately one to two years post-injury regardless of treatment method. Increasing age was associated with higher DASH score with r=0.407(p<0.001). Several variables had significantly better functional outcome: male gender (p=0.01), Type A fracture configuration (p=0.007) and non-operational treatment (p=0.03). There was no significant difference between treatment modalities in Type A fracture (p=0.094), but Type B (p=0.043) and Type C (p=0.007) had better outcome without surgery. There was no significant difference between different ethnic groups, open or closed fracture and mechanism of injury. Conclusion Better functional outcome after sustaining distal radial fracture was associated with young age, male gender, type A fracture and treated non-operatively. Interestingly, more complex fracture pattern had better functionality were observed without surgery.
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Affiliation(s)
- W Q Chao
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - M Z Azman
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - S A Rosdi
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Taw Tuan-Mustafa
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Y J Tan
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - S Abdullah
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - A N Aizuddin
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Zugasti-Marquínez J, García-Reza A, Domínguez-Prado DM, Cela-López M, Oiartzábal-Alberdi I, Castro-Menéndez M. Epidemiological study of distal radius fractures in the sanitary area of Vigo. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:38-46. [PMID: 34154968 DOI: 10.1016/j.recot.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Distal radius fractures (DRF) are being a bigger burden for health resources as changes continue to happen in our population demography and in management strategies, so a precise epidemiologic comprehension is mandatory. We present a DRF epidemiology study and we compared it with other sanitary areas of the Iberian Peninsula and Europe. METHOD Every DRF in our sanitary area registered between 2017 and 2018 in patients older than 18 years old were observational and retrospectively recorded and classified using AO-OTA classification. Age, sex, season of the year, mechanism of injury, presence of associated injuries and type of treatment were analysed. RESULTS 1,121 DRF in 1,108 patients, 903 women (81.5%) and 205 men (18.5%), were registered. Left side was affected in 612 cases (54.6%) and right side in 509 cases (45.4%). The average age of our sample was 65.9 years old (CI95%: 65-67.9 years old). The incidence rate of DRF in our population was 158.5 fractures per 100,000 people-year; 49.2% were classified as type A of AO-OTA classification and 19% were treated surgically. CONCLUSION Incidence of DRF had a maximum during males and women sixth decade of age. Type A fractures of AO-OTA classification were the most frequent. Most part of the fractures were treated non-surgically. The usual patient treated surgically was a woman, over 50 years old with a distal radius intraarticular complex fracture.
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Affiliation(s)
- J Zugasti-Marquínez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España.
| | - A García-Reza
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - D M Domínguez-Prado
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - M Cela-López
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - I Oiartzábal-Alberdi
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - M Castro-Menéndez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
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Ali M, Eiriksdottir A, Murtadha M, Åkesson A, Atroshi I. Incidence of distal radius fracture in a general population in southern Sweden in 2016 compared with 2001. Osteoporos Int 2020; 31:715-720. [PMID: 31930451 PMCID: PMC7075829 DOI: 10.1007/s00198-020-05282-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/06/2020] [Indexed: 11/28/2022]
Abstract
UNLABELLED In this population-based study, we compared the incidence of distal radius fracture in 2016 with that in the same region's adult general population in 2001 using radiographs to identify fracture cases. We showed that the incidence decreased by 24% in 2016 compared with 2001 indicating an important development. INTRODUCTION We conducted an epidemiological study on residents of northeastern Skåne in southern Sweden (population 182,000) to determine the overall incidence of distal radius fracture and the incidence according to age, sex, and fracture characteristics in the region's adult population during 2016, and to study the change in incidence in the same general population between 2001 and 2016 using wrist radiographs to identify fracture cases. METHODS Two orthopedic surgeons examined all wrist radiographs performed at the only two emergency hospitals in the study region to identify individuals, above 18 years of age, who sustained fracture of the distal radius during 2016. We used Poisson regression analysis adjusting for age, sex, and at-risk population to compare the incidence in 2016 with the incidence in 2001, previously estimated using similar methodology. RESULTS The overall incidence in 2016 was 22 (95% CI 20-25) per 10,000; the incidence in women was 34 (95% CI 30-39) and in men was 10 (95% CI 8-12) per 10,000. The overall incidence in 2016 was 0.76 (95% CI 0.70-0.82) of the incidence in 2001 (p < 0.0001). The incidence in the 3 age groups 19-49, 50-79, and ≥ 80 years was 0.91 (95% CI, 0.69-1.20), 0.67 (95% CI, 0.55-0.82), and 0.49 (95% CI, 0.25-0.97) of the incidence in 2001, respectively. CONCLUSION In a general population in Sweden, a statistically significant and clinically important decrease in the incidence of distal radius fracture occurred between 2001 and 2016, driven by lower incidence in individuals 50 years or older.
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Affiliation(s)
- M Ali
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Box 351, 28125, Hässleholm, Sweden.
- Department of Clinical Sciences-Orthopedics, Lund University, Lund, Sweden.
| | - A Eiriksdottir
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Box 351, 28125, Hässleholm, Sweden
| | - M Murtadha
- Department of Radiology, Kristianstad Hospital, Kristianstad, Sweden
| | - A Åkesson
- Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden
| | - I Atroshi
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Box 351, 28125, Hässleholm, Sweden
- Department of Clinical Sciences-Orthopedics, Lund University, Lund, Sweden
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Yoshii Y, Totoki Y, Sashida S, Sakai S, Ishii T. Utility of an image fusion system for 3D preoperative planning and fluoroscopy in the osteosynthesis of distal radius fractures. J Orthop Surg Res 2019; 14:342. [PMID: 31694677 PMCID: PMC6836429 DOI: 10.1186/s13018-019-1370-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Recently, computerized virtual surgery planning has been increasingly applied in various orthopedic procedures. In this study, we developed an image fusion system for 3D preoperative planning and fluoroscopy for the osteosynthesis. To assess the utility of image fusion system, we evaluated the reproducibility of preoperative planning in the osteosynthesis of distal radius fractures with using the image fusion system, and compared with the reproducibility of the patients without using the image fusion system. Methods Forty-two wrists of 42 distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. The patients were divided into two groups. Image fusion group utilized three-dimensional (3D) preoperative planning and image fusion system. Control group utilized only 3D preoperative planning. In both groups, 3D preoperative planning was performed in order to determine reduction, placement, and choice of implants. In the image fusion group, the outline of planned image was displayed on a monitor overlapping with fluoroscopy images during surgery. Reductions were evaluated by volar tilt and radial inclination of 3D images. Plate positions were evaluated with distance to joint surface, plate center axis position, and inclination relative to the radius axis. Screw choices were recorded for the plan and actual choices for each screw hole. Differences in the parameters between pre- and postoperative images were evaluated. Differences in reduction shape, plate positions, and screw choices were compared between groups. Results The differences in the distance from plate to joint surface were significantly smaller in the image fusion group compared to the control group (P < 0.01). The differences in the distal screw choices were significantly smaller in the image fusion group compared to the control group (P < 0.01). Conclusions The image fusion system was useful to reproduce the planned plate position and distal screw choices in the osteosynthesis of distal radius fractures. Trial registration ClinicalTrials.gov, NCT03764501
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Yasukazu Totoki
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | | | - Shinsuke Sakai
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Huetteman HE, Shauver MJ, Malay S, Chung TT, Chung KC. Variation in the Treatment of Distal Radius Fractures in the United States: 2010 to 2015. Plast Reconstr Surg 2019; 143:159-167. [PMID: 30589789 DOI: 10.1097/prs.0000000000005088] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND It remains unknown whether treatment trends for distal radius fracture have changed in light of value-based care initiatives during recent years. The authors aimed to characterize modern practice patterns for distal radius fracture management. METHODS Truven MarketScan databases from 2009 to 2015 were used to extract demographic characteristics, geographic location, and comorbidities for patients receiving treatment for a distal radius fracture. Regression modeling and Joinpoint analysis were used to assess treatment trends and the association of patient factors with treatment provided. RESULTS Among 499,766 eligible encounters, the rate of internal fixation fluctuated around 13 percent. Casting/splinting remained the most frequent treatment across all populations. Treatment trends varied by age; children and adolescents almost exclusively received closed treatment (mean, 97 percent), yet rates of internal fixation increased among adults and elderly patients. Patients aged 55 to 64 years were most likely to undergo internal fixation (OR, 1.89; 95 percent CI, 1.82 to 1.96). Higher median household income also significantly increased odds of receiving internal fixation (p < 0.001). Despite declining rates of external fixation and percutaneous pinning, regional variations among surgical modalities persist. CONCLUSIONS The increased use of internal fixation for distal radius fractures may be slowing. Treatment type continues to differ widely across demographic groups, underscoring the need for standardization. In accordance with value-based care initiatives, treatment decisions should be made to combine patient needs with financial implications on the health system. Comparative effectiveness data to derive optimal management strategies are still warranted.
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Affiliation(s)
- Helen E Huetteman
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; and the Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
| | - Melissa J Shauver
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; and the Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
| | - Sunitha Malay
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; and the Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
| | - Ting-Ting Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; and the Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
| | - Kevin C Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; and the Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital
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Landgren M, Teurneau V, Abramo A, Geijer M, Tägil M. Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year: A Register Study With a 2- to 12-Year Follow-Up. J Hand Surg Am 2019; 44:39-45. [PMID: 30502018 DOI: 10.1016/j.jhsa.2018.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/26/2018] [Accepted: 10/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Most patients recover well from a distal radius fracture (DRF). However, approximately one-fifth have severe disability after 1 year when evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In the present study, we evaluated this subgroup of patients in our register with an inferior outcome. We hypothesized that the patient-reported outcome would improve with time. METHODS Since 2001, patients 18 years and older with a DRF, at the Department of Orthopedics, Skåne University Hospital (Lund, Sweden) are prospectively registered in the Lund Wrist Fracture Register. We have previously defined a DASH score above 35 at the 1-year follow-up as the cutoff of major disability. Between 2003 and 2012, 17% of the patients (445 of 2,571) in the register exceeded this cutoff. Three hundred eighty-eight were women and 57 men and the mean age was 69 years (range, 18-95 years). One-fourth had been surgically treated. In December 2014, 2 to 12 years after the fracture, a follow-up DASH questionnaire was sent to the 346 of 445 patients still alive. RESULTS Seventy-three patients (27%) had initially been treated surgically and 196 (73%) nonsurgically for their DRF. Two hundred sixty-nine of 346 patients (78%) returned the follow-up DASH questionnaire at 2 to 12 years (mean, 5.5 years) after the fracture. The overall median DASH score improved from 50 at 1 year to 36 at the 2- to 12-year follow-up, (P < .05). Forty-seven percent had improved to a score below the cutoff 35, but 53% remained at a high suboptimal level. CONCLUSIONS The subjective outcome after a DRF improves over time for patients with an inferior result at 1 year, but more than half of the patients continue to have major disability. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Marcus Landgren
- Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.
| | - Vendela Teurneau
- Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Antonio Abramo
- Department of Hand Surgery Malmö, Skåne University Hospital, Malmö, Sweden
| | - Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Tägil
- Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
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Solvang HW, Nordheggen RA, Clementsen S, Hammer OL, Randsborg PH. Epidemiology of distal radius fracture in Akershus, Norway, in 2010-2011. J Orthop Surg Res 2018; 13:199. [PMID: 30103788 PMCID: PMC6088403 DOI: 10.1186/s13018-018-0904-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/02/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Several studies published over the last decade indicate an increased incidence of distal radius fractures (DRF). With Norway having one of the highest reported incidence of DRFs, we conducted a study to assess the epidemiology of DRFs and its treatment in the catchment area of Akershus University Hospital (AHUS). METHODS Patients 16 years or older who presented to AHUS with an acute DRF during the years 2010 and 2011 were prospectively recorded and classified according to the AO fracture classification system. The mechanism of injury and treatment modality were noted. RESULTS Overall, 1565 patients with an acute DRF presented to the institution in 2010-2011, of which 1134 (72%) were women. The overall annual incidence was 19.7 per 10,000 inhabitants 16 years or older. Women had an exponential increase in incidence after the age of 50, though the incidence for both genders peaked after the age of 80 years. There was an even distribution between extra- and intra-articular fractures. Falling while walking outside was the most common mechanism of injury. Of the 1565 registered, 418 (26.7%) patients underwent surgery, with a volar locking plate being the preferred surgical option in 77% of the cases. CONCLUSION The overall incidence of distal radius fractures was lower in our study than earlier reports from Norway. Postmenopausal women had a higher risk of fracture than the other groups, and low-energy injuries were most dominant. 26.7% were treated operatively, which is higher than earlier reports, and might reflect an increasing preference for surgical treatment.
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Affiliation(s)
- Håkon With Solvang
- The Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Robin Andre Nordheggen
- The Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Ståle Clementsen
- The Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway
- The Faculty of Medicine, The University of Oslo, Oslo, Norway
| | - Ola-Lars Hammer
- The Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway
- The Faculty of Medicine, The University of Oslo, Oslo, Norway
| | - Per-Henrik Randsborg
- The Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway
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Matsuura Y, Rokkaku T, Kuniyoshi K, Takahashi K, Suzuki T, Kanazuka A, Akasaka T, Hirosawa N, Iwase M, Yamazaki A, Orita S, Ohtori S. Smith's fracture generally occurs after falling on the palm of the hand. J Orthop Res 2017; 35:2435-2441. [PMID: 28262985 DOI: 10.1002/jor.23556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/26/2017] [Indexed: 02/04/2023]
Abstract
Orthopedic trauma surgeons often encounter Smith's fracture in patients who report that they have fallen on the palms of their hands. The aim of this study was to clarify the pathogenesis of Smith's fracture in basic clinical aspects. First, a survey was conducted for investigating the mechanism of injury and arm position at the time of injury among patients with Smith's fractures who consulted at our outpatient clinic. Second, we created three-dimensional finite element models (FEMs) to predict the influence of arm position on the type of injury resulting from a fall. These predictions were then used in ten freshly frozen cadavers to provide experimental proof of Smith's fractures resulting from the impact on the palmar side. Twenty-six patients (5 males and 21 females) with Smith's fractures were enrolled in this study. Injury resulting from a fall on the palm of the hand, the dorsum, or ulno-dorsum of the hand, and fisting handle was observed in 16 cases (61%), 3 cases (12%), and 1 case (4%), respectively. Six patients were uncertain of their arm position at the time of injury. FEM analysis showed that Smith's fractures occurred when the angle between the long axis of the forearm and the ground was 30°-45° in the sagittal plane and 75°-90° in the coronal plane. Smith's fractures occurred in 7 of 10 wrists in the experimental study, whereas no Colles' fractures were observed. This study demonstrated that Smith's fracture results from falling on the palm of the hand. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2435-2441, 2017.
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Affiliation(s)
- Yusuke Matsuura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Tomoyuki Rokkaku
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Kazuki Kuniyoshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Kazuhisa Takahashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Takane Suzuki
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, 1273-2 Aoba-cho Cyuou-ku, Chiba 260-0852, Japan
| | - Aya Kanazuka
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Tomoyo Akasaka
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Naoya Hirosawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Maki Iwase
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Atsuro Yamazaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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14
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Raittio L, Launonen A, Hevonkorpi T, Luokkala T, Kukkonen J, Reito A, Sumrein B, Laitinen M, Mattila VM. Comparison of volar-flexion, ulnar-deviation and functional position cast immobilization in the non-operative treatment of distal radius fracture in elderly patients: a pragmatic randomized controlled trial study protocol. BMC Musculoskelet Disord 2017; 18:401. [PMID: 28923035 PMCID: PMC5604291 DOI: 10.1186/s12891-017-1759-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/11/2017] [Indexed: 11/19/2022] Open
Abstract
Background Distal radius fractures (DRFs) are the second most common fractures, after hip fractures, seen in clinical practice. The high incidence of low-energy trauma DRFs in elderly patients raises questions about the best treatment method in terms of function, pain, and quality of life. Although the majority of these fractures are treated non-operatively with cast immobilization, valid scientific evidence of the optimal cast immobilization is lacking. In addition, several publications, including Cochrane review have outlined the need for more evidence to determine the most appropriate method of cast immobilization. Methods This study is a pragmatic, prospective, randomized, multi-centre trial. The trial is designed to compare two widely used cast positions (volar flexion-ulnar deviation position and functional position) for the non-operative treatment of DRF in patients over 64 years of age. The main hypothesis of the trial is that function position yields corresponding functional outcome, pain relief and quality of life when compared to the volar flexion-ulnar deviation position. The primary outcome measure is Patient Rated Wrist Evaluation (PRWE) score and the secondary outcome measures will be the Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS), 15-dimensional (15D) value and rate of surgical interventions. The results of the trial will be analysed after 1 and 2-years. Discussion This publication presents a prospective, pragmatic, randomized, national multi-centre trial study protocol. It provides details of patient flow, randomization, follow-up and methods of analysis of the material as well as publication plan. Trial registration ClinicalTrials.gov identifier: NCT02894983 22 August 2016. Electronic supplementary material The online version of this article (10.1186/s12891-017-1759-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauri Raittio
- University of Tampere, School of Medicine, 33014, Tampere, Finland.
| | - Antti Launonen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Teemu Hevonkorpi
- University of Tampere, School of Medicine, 33014, Tampere, Finland
| | - Toni Luokkala
- Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Juha Kukkonen
- Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
| | - Aleksi Reito
- Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Bakir Sumrein
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Minna Laitinen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Ville M Mattila
- University of Tampere, School of Medicine, 33014, Tampere, Finland.,Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
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15
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Jerrhag D, Englund M, Karlsson MK, Rosengren BE. Epidemiology and time trends of distal forearm fractures in adults - a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord 2017; 18:240. [PMID: 28576135 PMCID: PMC5457562 DOI: 10.1186/s12891-017-1596-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022] Open
Abstract
Background A distal forearm fracture is a very common injury causing both suffering and substantial health care costs. The incidence of this fracture type seemed to increase worldwide until the middle 1980’s, but thereafter most reports have shown stable or decreasing rates. As few large studies have been presented lately we aimed to describe recent epidemiology and time trends of distal forearm fractures in adults. We paid special attention to fractures in working ages as they present challenges in terms of treatment and costs for sick-leave, and have not previously been thoroughly investigated. Methods By use of population data from Statistics Sweden and official in- and out-patient register data of men and women (≥17 years) in Sweden (Skåne region), we ascertained distal forearm fractures and estimated age- and sex-specific rates and time-trends from year 1999 to 2010 (11.2 million person-years (py)). Results The total incidence rate was 278 per 100,000 py (31,233 fractures) with 23% higher annual numbers 2010 compared with 1999. An increase in the annual age standardized incidence was found in men, +0.7% per annum (95% confidence interval (CI) 0.1, 1.4), and women, +0.9% (95% CI 0.5, 1.3), driven mainly by an increasing incidence in working ages (17–64 years). Also, expected demographic changes including a 25% population increase may result in 38% more fractures until 2050, compared to 2017. Conclusions The incidence of distal forearm fractures in adults in southern Sweden is increasing, mainly driven by an increase in working ages. In combination with expected demographic changes these findings may present substantial challenges for the future.
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Affiliation(s)
- Daniel Jerrhag
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University, SE 20502, Malmo, Sweden.
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Faculty of Medicine, Lund, Sweden.,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University, SE 20502, Malmo, Sweden
| | - Bjorn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University, SE 20502, Malmo, Sweden
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16
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MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 2017; 29:136-45. [PMID: 27264899 DOI: 10.1016/j.jht.2016.03.003] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Literature Review. INTRODUCTION For optimal Distal Radius Fracture (DRF) rehabilitation and fracture prevention, it is important to understand the epidemiology and factors predictive of injury, chronic pain, chronic disability, and subsequent fracture. PURPOSE To summarize the literature reporting on DRF epidemiology, risk factors, and prognostic factors. METHODS Literature synthesis. RESULTS Although incidence varies globally, DRFs are common across the lifespan and appear to be on the rise. Risk of DRF is determined by personal factors (age, sex/gender, lifestyle, health condition) and environmental factors (population density, climate). For example, age and sex influence risk such that DRF is most common in boys/young men and older women. The most common causes of DRF in the pediatric and young adult age groups include playing/sporting activities and motor vehicle accidents. In contrast, the most common mechanism of injury in older adults is a low-energy trauma because of a fall from a standing height. Poorer health outcomes are associated with older age, being female, poor bone healing (or having an associated fracture of the ulnar styloid), having a compensated injury, and a lower socioeconomic status. CONCLUSIONS Risk stratification according to predictors of chronic pain and disability enable therapists to identify those patients who will benefit from advocacy for more comprehensive assessment, targeted interventions, and tailored educational strategies. The unique opportunity for secondary prevention of osteoporotic fracture after DRF has yet to be realized by treating therapists in the orthopedic community. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Norma J MacIntyre
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| | - Neha Dewan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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17
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Esakki S, MacDermid J, Vajravelu S. Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions. Hand (N Y) 2016; 11:314-321. [PMID: 27698634 PMCID: PMC5030861 DOI: 10.1177/1558944715627305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: American Academy of Orthopaedic Surgeons (AAOS) distal radius fracture (DRF) clinical practice guidelines (CPG) are readily available to clinicians, patients, and policymakers. International Classification of Functioning, Disability, and Health (ICF) provides a framework for describing the impact of health conditions. The International Classification of Diseases-10th Revision (ICD-10) is a classification system to classify health conditions as specific disease or disorders. The aim of this study is to analyze and describe the scope and focus of the AAOS DRF CPG using the ICF and ICD-10 as a basis for content analysis, and to compare the content of the CPG with the ICF hand core sets as the reference standard. Methods: Established linking rules were used by 2 independent raters to analyze the 29 recommendations of the AAOS DRF CPG. ICD-10 codes were assigned in the same process. Summary linkage statistics were used to describe the results for ICF and the hand core sets. Results: Among the 29 recommendations of the AAOS DRF CPG, 5 meaningful concepts were linked to the ICF codes. Of these, 5 codes appeared on the comprehensive ICF core set and only 3 codes appeared in the brief ICF core set, and 7 conditions were covered in ICD-10 codes. Conclusions: The AAOS DRF CPG focuses on surgical interventions and has minimal linkage to the constructs of the ICD-10 and ICF. It does not address activity or participation (disability), and is not well linked to key concepts relevant to hand conditions.
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Affiliation(s)
- Saravanan Esakki
- McMaster University, Hamilton, ON, Canada,Saravanan Esakki, School Of Rehabilitation Sciences, McMaster University, 1280, Main St West, Hamilton, ON L8S 4L8, Canada.
| | - Joy MacDermid
- McMaster University, Hamilton, ON, Canada,St. Joseph’s Hospital, London, ON, Canada
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18
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Iselin LD, Massy-Budmiger AS, Droeser RA, Mett TR, Babst R, Rikli DA. Ten Years' Follow-Up on Combined Palmar and Dorsal Internal Fixation of Complex Distal Radius Fractures. Medicine (Baltimore) 2016; 95:e3509. [PMID: 27149450 PMCID: PMC4863767 DOI: 10.1097/md.0000000000003509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Complex distal intra-articular radial fractures (AO Type C3) are rare, but are life-changing injuries. They are usually related to high-velocity trauma mechanisms in a working male population.We surveyed a cohort of these fractures treated in our institution to assess the functional long-term outcome.Twelve consecutive patients with comminuted intra-articular distal radial fractures were treated at our institution. Osteosynthesis was performed by a single senior surgeon with volar and dorsal extended approaches. The intermediate and final control included conventional X-ray, range of motion (ROM), grip strength, and the Disabilities of the Arm, Shoulder, and Hand index (DASH), as well as the Patient-rated Wrist Evaluation (PRWE) score for functional outcome at 1 and 10 years' of follow-up.At 10 years' follow-up, anatomic reconstruction with a step or gap of <1 mm was achieved in 10 of the 12 above-mentioned patients, whereas 2 patients were lost to follow-up. ROM was good to excellent in 8 patients. Median grip strength was 107% of the contralateral side. Median DASH-Index and PRWE were 2.3 and 6 respectively, at 10 years. Eight patients returned to premorbid heavy labor. One patient was retired at the time of injury.Combined volar and dorsal approaches allow achieving anatomical reconstruction in comminuted intra-articular distal radius fractures and reveal good functional outcomes at intermediate and long-time follow-up.
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Affiliation(s)
- Lukas Daniel Iselin
- From the Department of Orthopaedic Surgery and Traumatology (LDI, A-SM-B, TRM, RB), Kantonsspital Lucerne, Lucerne; Department of Surgery (RAD); and Department of Surgery (DAR), Trauma Unit, University Hospital of Basel, Basel, Switzerland
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19
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Röding F, Lindkvist M, Bergström U, Lysholm J. Epidemiologic patterns of injuries treated at the emergency department of a Swedish medical center. Inj Epidemiol 2015; 2:3. [PMID: 27747735 PMCID: PMC5005584 DOI: 10.1186/s40621-014-0033-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background The injury spectrum published in the literature has mainly been presented for a certain age group, as elderly or for a certain type of injury, as fracture and often restricted to in-hospital care cases. Our objective was to give an overview of the major types of injuries for all age groups and trends in the adult population. Methods We analyzed 68,159 adult injury events, which occurred between 1999 and 2008 and was treated at the Emergency Department of Umea University Hospital. All these injuries are registered in a database. The injuries were analyzed depending on frequency, type of injury, and activity at the time of injury. Incidence rates were calculated using population data from Statistics Sweden. Results Injury event incidence varied between 614 (2004) and 669 (2007) per 10,000 persons. The most common injury was a fracture, although contusions and wounds were also frequent. Fractures were responsible for almost three quarters of hospital days related to injury. The risk for fractures increased with age, as did contusions and concussions, whereas sprains decreased with age. Fracture incidence increased among the 50- to 59-year age group for both women and men. Fall-related injuries increased significantly for middle-aged adults. Sports-related and work injuries decreased, while injuries occurring during leisure time increased the most. Conclusion A fracture is the most frequent type of injury for adults and accounts for the largest proportion of the trauma care burden. Contusions are also common and responsible for a significant proportion of the in-hospital days. Injuries caused by a fall increased among middle-age adults imply a need for an extension of fall prevention programs.
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Affiliation(s)
- Fredrik Röding
- Division of Surgery and Perioperative Sciences, Department of Orthopaedics, Umea University, 90187, Umea, Sweden.
| | - Marie Lindkvist
- Department of Public health and Clinical Medicine, Epidemiology and Global Health, Umea University, 90187, Umea, Sweden.,Umea school of business and economics, Department of Statistics, Umea University, Umea, 90187, Sweden
| | - Ulrica Bergström
- Division of Surgery and Perioperative Sciences, Department of Orthopaedics, Umea University, 90187, Umea, Sweden
| | - Jack Lysholm
- Division of Surgery and Perioperative Sciences, Department of Orthopaedics and Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Centre of Quality Registries North Sweden, Umea University, 90187, Umea, Sweden
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20
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Mellstrand-Navarro C, Pettersson HJ, Tornqvist H, Ponzer S. The operative treatment of fractures of the distal radius is increasing: results from a nationwide Swedish study. Bone Joint J 2014; 96-B:963-9. [PMID: 24986952 DOI: 10.1302/0301-620x.96b7.33149] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of this study was to investigate the epidemiology of fractures of the distal radius in the Swedish population and to review the methods used to treat them between 2005 and 2010. The study population consisted of every patient in Sweden who was diagnosed with a fracture of the wrist between 1 January 2005 and 31 December 2010. There were 177 893 fractures of the distal radius. The incidence rate in the total population was 32 per 10 000 person-years. The mean age of the patients was 44 years (0 to 104). The proportion of fractures treated operatively increased from 16% in 2005 to 20% in 2010. The incidence rate for plate fixation in the adult population increased 3.61 fold. The incidence rate for external fixation decreased by 67%. The change was greatest in the 50 years to 74 years age group. In Sweden, there is an increasing tendency to operate on fractures of the distal radius. The previously reported increase in the use of plating is confirmed: it has increased more than threefold over a five-year period.
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Affiliation(s)
- C Mellstrand-Navarro
- Karolinska Institute, Södersjukhuset, Department of Orthopaedics, Stockholm, 118 83, Sweden
| | - H J Pettersson
- Karolinska Institute, Södersjukhuset, Department of Orthopaedics, Stockholm, 118 83, Sweden
| | - H Tornqvist
- Karolinska Institute, Södersjukhuset, Department of Orthopaedics, Stockholm, 118 83, Sweden
| | - S Ponzer
- Karolinska Institute, Södersjukhuset, Department of Orthopaedics, Stockholm, 118 83, Sweden
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21
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Ekrol I, Duckworth AD, Ralston SH, Court-Brown CM, McQueen MM. The influence of vitamin C on the outcome of distal radial fractures: a double-blind, randomized controlled trial. J Bone Joint Surg Am 2014; 96:1451-9. [PMID: 25187584 DOI: 10.2106/jbjs.m.00268] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitamin C has been proposed to improve outcomes after a distal radial fracture by promotion of bone and soft-tissue healing and reduction of the prevalence of complex regional pain syndrome (CRPS). Our primary aim was to examine the effect of vitamin C on functional outcome after a distal radial fracture. METHODS A total of 336 adult patients with an acute fracture of the distal aspect of the radius were recruited over a one-year period and randomized to receive 500 mg of vitamin C or placebo daily for fifty days after the fracture. The primary outcomes were the DASH (Disabilities of the Arm, Shoulder and Hand) score at six weeks and at one year. Secondary variables included complications, wrist and finger motion, grip and pinch strength, pain, and a CRPS score. RESULTS There were no significant differences in patient or fracture characteristics between the treatment groups. There was no significant effect of vitamin C on the DASH score throughout the study period. At six weeks, patients in the vitamin C group with a nondisplaced fracture had a significantly greater wrist flexion deficit (p = 0.008) and pinch strength deficit (p = 0.020) and a greater rate of CRPS (p = 0.022), but there was no difference in the CRPS rate at any other time point. At twenty-six weeks, there was a higher rate of complications (p = 0.043) and greater pain with use (p = 0.045) in the patients with a displaced fracture treated with vitamin C. There was no significant difference in the time to fracture-healing. CONCLUSIONS This study demonstrated no significant difference at one year in the DASH score, other functional outcomes, the rate of CRPS, or osseous healing of nondisplaced or displaced distal radial fractures treated with vitamin C compared with placebo. We conclude that administration of vitamin C confers no benefit to patients with a displaced or nondisplaced fracture of the distal aspect of the radius. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ingri Ekrol
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Stuart H Ralston
- Rheumatic Disease Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, United Kingdom. E-mail address for A.D. Duckworth:
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22
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Jariwala AC, Phillips AR, Storey PA, Nuttall D, Watts AC. Internal fixation versus other surgical methods for treating distal radius fractures in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Arpit C Jariwala
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
| | - Alistair R Phillips
- Plymouth Hospitals NHS Trust; Department of Orthopaedics; Derriford Hospital Derriford Plymouth Devon UK PL6 8DH
| | - Philip A Storey
- Sheffield NHS Teaching Hospitals Trust; Department of Trauma and Orthopaedics, Northern General Hospital; Herries Road Sheffield South Yorkshire UK S7 5AU
| | - David Nuttall
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
| | - Adam C Watts
- Wrightington, Wigan and Leigh NHS Trust; Upper Limb Unit; Wrightington Hospital, Hall Lane Appley Bridge Wigan Lancashire UK WN6 9EP
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Wilcke MKT, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop 2013; 84:292-6. [PMID: 23594225 PMCID: PMC3715813 DOI: 10.3109/17453674.2013.792035] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The incidence of fractures of the distal radius may have changed over the last decade, and operative treatment has been commoner during that time. We investigated the incidence of fractures of the distal radius and changing trends in surgical treatment during the period 2004-2010. PATIENTS AND METHODS Registry data on 42,583 patients with a fracture of the distal radius from 2004 to 2010 were evaluated regarding diagnosis, age, sex, and surgical treatment. RESULTS The crude incidence rate was 31 per 10(4) person-years with a bimodal distribution. After the age of 45 years, the incidence rate in women increased rapidly and leveled off first at a very high age. The incidence rate in postmenopausal women was lower than previously reported. In men, the incidence was low and it increased slowly until the age of 80 years, when it amounted to 31 per 10(4) person-years. The number of surgical procedures increased by more than 40% despite the fact that there was reduced incidence during the study period. In patients ≥ 18 years of age, the proportion of fractures treated with plating increased from 16% to 70% while the use of external fixation decreased by about the same amount. INTERPRETATION The incidence rate of distal radius fractures in postmenopausal women appears to have decreased over the last few decades. There has been a shift in surgical treatment from external fixation to open reduction and plating.
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Affiliation(s)
- Maria K T Wilcke
- Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital
| | - Henrik Hammarberg
- Section of Hand Surgery, Department of Clinical Sciences and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
| | - Per Y Adolphson
- Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital
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Reichel LM, Bell BR, Michnick SM, Reitman CA. Radial styloid fractures. J Hand Surg Am 2012; 37:1726-41. [PMID: 22835591 DOI: 10.1016/j.jhsa.2012.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 02/02/2023]
Abstract
Radial styloid fractures can occur in isolation or in association with other injuries, including complex intra-articular distal radius fractures, carpal fractures, carpal dislocations, and radiocarpal dislocations. The anatomy surrounding the radial styloid is complex, and complications related to surgical approach, treatments, and symptomatic hardware can occur. Operative treatments vary according to the injury pattern present, and pattern recognition is the key to optimizing treatment of these injuries. Outcomes are related to the precision of the reconstruction as well as the magnitude of the injury; better results are associated with lower-energy patterns.
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Affiliation(s)
- Lee M Reichel
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX, USA.
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Abstract
Distal radius fractures are one of the most common types of fractures. Although the pediatric and elderly populations are at greatest risk for this injury, distal radius fractures still have a significant impact on the health and well-being of young adults. Data from the past 40 years have documented a trend toward an overall increase in the prevalence of this injury in both the pediatric and elderly populations. Understanding the epidemiology of this fracture is an important step toward the improvement of treatment strategies and the development of preventive measures with which to target this debilitating injury.
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Affiliation(s)
- Kate W. Nellans
- Hand Fellow, University of Michigan Health System, Section of Plastic Surgery
| | - Evan Kowalski
- Research Associate, University of Michigan Health System, Section of Plastic Surgery
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, The University of Michigan Medical School
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