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Tahir A, Naji O, Khawar H, Iqbal MJ. Torus fractures - diagnosis and management. Br J Hosp Med (Lond) 2024; 85:1-8. [PMID: 38815969 DOI: 10.12968/hmed.2023.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Torus fractures are a common paediatric injury involving the distal radius. Patients typically present following a fall onto the outstretched hand, with wrist pain as their primary complaint. The principal investigation of choice is a plain radiograph of the wrist joint. These fractures should be managed with a soft-bandage and immediate discharge approach and do not require specialist follow-up. Clinicians have historically had differing views regarding optimal management of torus fractures. It is therefore important for hospital clinicians to uniformly understand the most up-to-date management of this condition. This review provides an overview of the epidemiology, anatomy, diagnosis and management, with an aim to improve outcomes.
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Affiliation(s)
- Abdullah Tahir
- Department of Trauma & Orthopaedics, John Radcliffe Hospital, Oxford, UK
| | - Omar Naji
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - Haseeb Khawar
- Department of Trauma & Orthopaedics, Royal Cornwall Hospital, Truro, UK
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Minonzio JG, Ramiandrisoa D, Schneider J, Kohut E, Streichhahn M, Stervbo U, Wirth R, Westhoff TH, Raum K, Babel N. Bi-Directional Axial Transmission measurements applied in a clinical environment. PLoS One 2022; 17:e0277831. [PMID: 36584002 PMCID: PMC9803229 DOI: 10.1371/journal.pone.0277831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/03/2022] [Indexed: 12/31/2022] Open
Abstract
Accurate measurement of cortical bone parameters may improve fracture risk assessment and help clinicians on the best treatment strategy. Patients at risk of fracture are currently detected using the current X-Ray gold standard DXA (Dual XRay Absorptiometry). Different alternatives, such as 3D X-Rays, Magnetic Resonance Imaging or Quantitative Ultrasound (QUS) devices, have been proposed, the latter having advantages of being portable and sensitive to mechanical and geometrical properties. The objective of this cross-sectional study was to evaluate the performance of a Bi-Directional Axial Transmission (BDAT) device used by trained operators in a clinical environment with older subjects. The device, positioned at one-third distal radius, provides two velocities: VFAS (first arriving signal) and VA0 (first anti-symmetrical guided mode). Moreover, two parameters are obtained from an inverse approach: Ct.Th (cortical thickness) and Ct.Po (cortical porosity), along with their ratio Ct.Po/Ct.Th. The areal bone mineral density (aBMD) was obtained using DXA at the femur and spine. One hundred and six patients (81 women, 25 men) from Marien Hospital and St. Anna Hospital (Herne, Germany) were included in this study. Age ranged from 41 to 95 years, while body mass index (BMI) ranged from 16 to 47 kg.m-2. Three groups were considered: 79 non-fractured patients (NF, 75±13years), 27 with non-traumatic fractures (F, 80±9years) including 14 patients with non-vertebral fractures (NVF, 84±7years). Weak to moderate significant Spearman correlations (R ranging from 0.23 to 0.53, p < 0.05) were found between ultrasound parameters and age, BMI. Using multivariate Partial Least Square discrimination analyses with Leave-One-Out Cross-Validation (PLS-LOOCV), we found the combination of VFAS and the ratio Ct.Po/Ct.Th to be predictive for all non traumatic fractures (F) with the odds ratio (OR) equals to 2.5 [1.6-3.4] and the area under the ROC curve (AUC) equal to 0.63 [0.62-0.65]. For the group NVF, combination of four parameters VA0. Ct.Th, Ct.Po and Ct.Po/Ct.Po, along with age provides a discrimination model with OR and AUC equals to 7.5 [6.0-9.1] and 0.75 [0.73-0.76]. When restricted to a smaller population (87 patients) common to both BDAT and DXA, BDAT ORs and AUCs are comparable or slightly higher to values obtained with DXA. The fracture risk assessment by BDAT method in older patients, in a clinical setting, suggests the benefit of the affordable and transportable device for the routine use.
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Affiliation(s)
- Jean-Gabriel Minonzio
- Sorbonne Université, INSERM UMR S 1146, CNRS UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, France
- Escuela de Ingeniería Informática, Universidad de Valparaíso, Valparaíso, Chile
- Centro de Investigación y Desarrollo en Ingeniería en Salud, Universidad de Valparaíso, Valparaíso, Chile
- * E-mail:
| | | | - Johannes Schneider
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
| | - Eva Kohut
- Medical Clinic I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
| | - Melanie Streichhahn
- Medical Clinic I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
| | - Ulrik Stervbo
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
| | - Rainer Wirth
- Department for Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Timm Henning Westhoff
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
| | - Kay Raum
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
| | - Nina Babel
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
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