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Pintore A, Astone A, Vecchio G, Asparago G, Calabrò G, Migliorini F, Maffulli N. Percutaneous transverse pinning for metacarpal fractures: a clinical trial. Arch Orthop Trauma Surg 2024; 144:3129-3136. [PMID: 38965077 PMCID: PMC11319403 DOI: 10.1007/s00402-024-05422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure. METHODS Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05. RESULTS The mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. CONCLUSION Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Andrea Pintore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Alberto Astone
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giampiero Calabrò
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Nicola Maffulli
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke On Trent, England, UK.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, England, E1 4DG, UK.
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy.
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Suhail D, Ma Y, Chung P, Al-Ani S, Jester A. Management of paediatric fifth metacarpal neck fractures: a systematic review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05393-4. [PMID: 38824459 DOI: 10.1007/s00402-024-05393-4] [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: 05/07/2024] [Accepted: 05/26/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Fifth metacarpal neck fractures (FMCNFs) are common among paediatric patients. Complications include reduced metacarpophalangeal (MCP) range of motion and grip strength, which impede the hand's functional abilities. Various management options are available, but indications are not standardised. This systematic review aims to assimilate all available evidence on the management of paediatric FMCNFs to determine appropriate treatment pathways. METHODS PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures. RESULTS Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9-17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°-33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°-54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°-58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes. CONCLUSIONS This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management.
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Affiliation(s)
| | - Yangmyung Ma
- Hand and Upper Limb Service, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK.
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK.
| | | | - Sami Al-Ani
- Aston Medical School, Birmingham, B4 7ET, UK
| | - Andrea Jester
- Hand and Upper Limb Service, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
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Mert S, Stoerzer P, Brauer J, Fuchs B, Haas-Lützenberger EM, Demmer W, Giunta RE, Nuernberger T. Diagnostic power of ChatGPT 4 in distal radius fracture detection through wrist radiographs. Arch Orthop Trauma Surg 2024; 144:2461-2467. [PMID: 38578309 PMCID: PMC11093861 DOI: 10.1007/s00402-024-05298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Distal radius fractures rank among the most prevalent fractures in humans, necessitating accurate radiological imaging and interpretation for optimal diagnosis and treatment. In addition to human radiologists, artificial intelligence systems are increasingly employed for radiological assessments. Since 2023, ChatGPT 4 has offered image analysis capabilities, which can also be used for the analysis of wrist radiographs. This study evaluates the diagnostic power of ChatGPT 4 in identifying distal radius fractures, comparing it with a board-certified radiologist, a hand surgery resident, a medical student, and the well-established AI Gleamer BoneView™. Results demonstrate ChatGPT 4's good diagnostic accuracy (sensitivity 0.88, specificity 0.98, diagnostic power (AUC) 0.93), surpassing the medical student (sensitivity 0.98, specificity 0.72, diagnostic power (AUC) 0.85; p = 0.04) significantly. Nevertheless, the diagnostic power of ChatGPT 4 lags behind the hand surgery resident (sensitivity 0.99, specificity 0.98, diagnostic power (AUC) 0.985; p = 0.014) and Gleamer BoneView™(sensitivity 1.00, specificity 0.98, diagnostic power (AUC) 0.99; p = 0.006). This study highlights the utility and potential applications of artificial intelligence in modern medicine, emphasizing ChatGPT 4 as a valuable tool for enhancing diagnostic capabilities in the field of medical imaging.
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Affiliation(s)
- Sinan Mert
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany.
| | - Patrick Stoerzer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Johannes Brauer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Benedikt Fuchs
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | | | - Wolfram Demmer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Tim Nuernberger
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
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Brodbeck M, Marks M, Schindele S. Surface replacing arthroplasty of a post-traumatic stiff and deviated proximal interphalangeal joint in an adolescent. Arch Orthop Trauma Surg 2024; 144:1875-1880. [PMID: 38400902 DOI: 10.1007/s00402-024-05221-9] [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: 12/22/2023] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
This case report describes the 4-year outcomes of proximal interphalangeal joint arthroplasty in a 14-year-old girl with a stiff joint after trauma. At follow-up, active range of motion was 35°, she was pain-free and satisfied with the outcome. Implant arthroplasty seems to be a valuable option for young patients with persistent post-traumatic stiff and deviated PIP joints to-at least temporarily-increase quality of life.
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Affiliation(s)
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Stephan Schindele
- Department of Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
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Linhart C, Jägerhuber L, Ehrnthaller C, Schrempf J, Kußmaul AC, Neuerburg C, Böcker W, Lampert C. E-scooter accidents-epidemiology and injury patterns: 3-year results from a level 1 trauma center in Germany. Arch Orthop Trauma Surg 2024; 144:1621-1626. [PMID: 38367063 PMCID: PMC10965700 DOI: 10.1007/s00402-024-05209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/18/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Since the introduction of e-scooters in Germany in 2019, they are becoming more and more popular and associated injuries have increased significantly. The aim of this study was to assess the injury patterns after e-scooter accidents. MATERIALS AND METHODS From May 2019 to October 2022, all consecutive patients who presented at our emergency department (ED) following e-scooter accidents were included in our study and retrospectively analyzed. RESULTS A total of 271 patients were included in our study. The mean age was 33 years. 38% of the patients were female and 62% were male. Most common injuries were traumatic brain injuries in 38% of the patients together with fractures affecting the upper limb (17%). An operative treatment was necessary in 40 patients. Most of the patients presented at night and about 30% were under the influence of alcohol. CONCLUSIONS Our study shows one of the largest cohort of patients suffering e-scooter accidents in Europe. Compulsory helmet use, stricter alcohol controls and locking periods could contribute significantly to safety.
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Affiliation(s)
- Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ludwig Jägerhuber
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Ehrnthaller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Judith Schrempf
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher Lampert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM) University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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