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Jung HS, Lee J, Kang KT, Lee JS. Incidence and predictors of dorsal comminution in older adults with low-energy distal radius fracture. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02559-y. [PMID: 38819680 DOI: 10.1007/s00068-024-02559-y] [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: 10/06/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To identify the incidence of dorsal comminution using computed tomography (CT) images and identify predictors of this phenomenon in older adults with low-energy distal radius fractures (DRFs). METHODS A total of 150 patients aged > 50 years with fall-induced dorsally angulated DRFs were enrolled in this study. Patients were divided into two groups based on the presence of dorsal comminution, defined as a metaphyseal void of greater than one-third of the maximum posterior to anterior depth of the bone on at least three cuts in the sagittal plane on post-reduction CT images. Data on participants' basic demographics, including age, sex, body mass index (BMI), and AO classification of DRFs, were collected. Bone mineral density (BMD) was assessed using T-scores of the femoral neck, and cortical thickness of the distal radius was determined from plain post-reduction radiographs. Radiological parameters and combined ulnar fractures were measured on plain pre-reduction radiographs. RESULTS Among study participants, 91 (61%) had dorsal comminution, whereas 59 (39%) had no dorsal comminution on CT images. Both patient groups were compared based on presence of dorsal comminution, and showed no significant differences in age, sex, BMI, BMD, or cortical thickness on radiographs. However, all radiological parameters were better in the no dorsal comminution group than in the dorsal comminution group, and the proportion of patients with combined ulnar fractures was higher in the dorsal comminution group. In the multivariate analysis, the presence of combined ulnar fractures was the only significant predictor of dorsal comminution (p = 0.029, odds ratio = 2.267, 95% confidence interval: 1.085-4.736). CONCLUSION The incidence of dorsal comminution is relatively high in patients with low-energy DRFs aged > 50 years. In particular, the presence of combined ulnar fractures is closely associated with dorsal comminution of DRFs. Thus, surgeons should exercise caution when evaluating this phenomenon.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Jeuk Lee
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Kyu-Tae Kang
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Jae-Sung Lee
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea.
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Omori NE, Bobitan AD, Vamvakeros A, Beale AM, Jacques SDM. Recent developments in X-ray diffraction/scattering computed tomography for materials science. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2023; 381:20220350. [PMID: 37691470 PMCID: PMC10493554 DOI: 10.1098/rsta.2022.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023]
Abstract
X-ray diffraction/scattering computed tomography (XDS-CT) methods are a non-destructive class of chemical imaging techniques that have the capacity to provide reconstructions of sample cross-sections with spatially resolved chemical information. While X-ray diffraction CT (XRD-CT) is the most well-established method, recent advances in instrumentation and data reconstruction have seen greater use of related techniques like small angle X-ray scattering CT and pair distribution function CT. Additionally, the adoption of machine learning techniques for tomographic reconstruction and data analysis are fundamentally disrupting how XDS-CT data is processed. The following narrative review highlights recent developments and applications of XDS-CT with a focus on studies in the last five years. This article is part of the theme issue 'Exploring the length scales, timescales and chemistry of challenging materials (Part 2)'.
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Affiliation(s)
- Naomi E. Omori
- Finden Limited, Merchant House, 5 East St Helens Street,Abingdon OX14 5EG, UK
| | - Antonia D. Bobitan
- Finden Limited, Merchant House, 5 East St Helens Street,Abingdon OX14 5EG, UK
- Department of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, UK
- Research Complex at Harwell, Rutherford Appleton Laboratory, Harwell Science and Innovation Campus, Didcot, Oxon OX11 0FA, UK
| | - Antonis Vamvakeros
- Finden Limited, Merchant House, 5 East St Helens Street,Abingdon OX14 5EG, UK
- Dyson School of Design Engineering, Imperial College London, London SW7 2DB, UK
| | - Andrew M. Beale
- Finden Limited, Merchant House, 5 East St Helens Street,Abingdon OX14 5EG, UK
- Department of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, UK
- Research Complex at Harwell, Rutherford Appleton Laboratory, Harwell Science and Innovation Campus, Didcot, Oxon OX11 0FA, UK
| | - Simon D. M. Jacques
- Finden Limited, Merchant House, 5 East St Helens Street,Abingdon OX14 5EG, UK
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Foster BK, Boualam B, Shea RP, Udoeyo IF, Luciani AM, Klena JC, Grandizio LC. Trends in the Utilization of Computed Tomography in Operative Treatment of Distal Radius Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:638-642. [PMID: 37790835 PMCID: PMC10543772 DOI: 10.1016/j.jhsg.2023.04.006] [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: 11/05/2022] [Accepted: 04/13/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP). Methods We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020. Baseline demographics, injury, treatment characteristics, and the fellowship training of the 44 included surgeons were recorded. We compared cases with and without a preoperative CT, and an adjusted logistic regression model was generated to determine the odds of having a preoperative CT. Results A total of 1,204 operatively treated DRFs performed by 44 surgeons were included. CT utilization increased during the study period. Intra-articular fractures accounted for 76% of cases, and preoperative CT scans were ordered in 243 of 1240 cases (20%). Overall, isolated VLP was used in 83% of cases. Cases with a preoperative CT were more likely to be treated with an alternative method of fixation (such as dorsal plating). The adjusted logistic regression model demonstrated that male sex (OR 1.62; 95% CI: 1.16, 2.26), intra-articular fractures (OR 3.11; 95% CI: 1.87, 5.81), and associated fractures (OR 2.69; 95% CI: 1.82, 3.98) had a significantly increased odds of having a preoperative CT. Fellowship training was not associated with increased CT utilization overall, but hand surgeons were more likely to use a CT in Orthopaedic Trauma Association-C3 fractures. Conclusions Patient and injury characteristics are associated with CT utilization in operative DRFs. Preoperative CTs are associated with alternative fixation approaches, as cases with a CT were more likely to use fixation methods other than isolated VLP. The costs and benefits of CT scans must be carefully weighed against whether this modality adds value or improves outcomes in treating DRFs. Level of evidence Prognostic II.
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Affiliation(s)
- Brian K. Foster
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Benchaa Boualam
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - R. Parker Shea
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Idorenyin F. Udoeyo
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - A. Michael Luciani
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Joel C. Klena
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Louis C. Grandizio
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
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Grinčuk A, Petryla G, Masionis P, Sveikata T, Uvarovas V, Makulavičius A. Short-term results and complications of the operative treatment of the distal radius fracture AO2R3 C type, planned by using 3D-printed models. Prospective randomized control study. J Orthop Surg (Hong Kong) 2023; 31:10225536231195127. [PMID: 37620284 DOI: 10.1177/10225536231195127] [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] [Indexed: 08/26/2023] Open
Abstract
PURPOSE 3D-printed models rapidly evolving in orthopaedic. Studies show that 3D-printed models used for preoperative planning improve a better understanding of fracture morphology and reduce operative time, blood loss and frequency of fluoroscopy, but there are no studies that investigated possible advantages in the outcomes and complications for the treatment of distal radius fracture (DRF). Our study aims to evaluate short-term functional results and complications between two groups treated DRF using 3D-printed models for preoperative planning and without. We hypothesize that the addition of 3D-printed models would improve functional outcomes and reduce complication rates. METHODS 66 randomized cases of DRF AO/OTA C type were enrolled and divided into "Control group" (n = 33) and "3D-printed model group" (n = 33). Personalized 3D-printed models were created. The primary outcomes were: Patient-Rated Wrist Evaluation questionnaire, Quick Disabilities of the Arm, Shoulder and Hand Score questionnaire, and complications. The secondary outcomes were: measurement of the range of motions, grip strength, radiological evaluation, and the visual analogue scale. Assessments were measured at 6 weeks, 3 months, and 6 months intervals. RESULTS We found that the integration of the 3D-printed model in preoperative planning decreased complication incidence significantly - from 30.3% in the "Control group" to 6.1% in the "3D-printed model group", p = .022. But we did not find a difference in functional and radiological outcomes. CONCLUSION The 3D-printed models for preoperative planning surgically treating DRF AO/OTA C type can help minimize the complication rate, however, they can't improve functional outcomes in the short-term results. LEVEL OF EVIDENCE Level I randomized controlled study.
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Affiliation(s)
- Aleksandr Grinčuk
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrius Petryla
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Povilas Masionis
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Sveikata
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Valentinas Uvarovas
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aleksas Makulavičius
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Pulos N, Shin AY. Strategies for Specific Reduction in High-Energy Distal Radius Fractures. Hand Clin 2021; 37:267-278. [PMID: 33892880 DOI: 10.1016/j.hcl.2021.02.009] [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] [Indexed: 02/02/2023]
Abstract
High-energy distal radius fractures frequently result in comminution with intra-articular fragmentation. Knowledge of predictable patterns of injury allows the surgeon to develop a preoperative plan for anatomic reduction and stable fixation of individual fragments that are too small or too distal to be fixed with standard volar locked plating. We review the column model, which organizes the distal radius into an intermediate column, radial column, and pedestal as the basis of a reconstructive algorithm and emphasize the importance of the volar ulnar fragment. Specific reduction and fixation techniques are described to assist the surgeon in treating these injuries.
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Affiliation(s)
- Nicholas Pulos
- 200 1st Street Southwest, Rochester, MN 55905, USA. https://twitter.com/NickPulosMD
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