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Kamal RN, Bronenberg P, Shapiro LM. Volar Intra-articular Extended Window Approach for Intra-articular Distal Radius Fractures. Tech Hand Up Extrem Surg 2024; 28:115-121. [PMID: 37994780 PMCID: PMC11105992 DOI: 10.1097/bth.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Distal radius fractures are one of the most common injuries seen globally with increasing use of use of volar plating for surgical treatment. Although it is common to directly visualize the articular surface for most other periarticular fractures, during volar plating of the distal radius the joint is typically not visualized. This is due to concern for carpal instability from disruption of the volar carpal ligaments. When direct visualization of the articular surface is deemed necessary, either to reduce articular fragments or to confirm the quality of reduction, current options include a separate dorsal arthrotomy or arthroscopic assistance. However, biomechanical evidence supports safely performing a volar capsulotomy to visualize the articular surface. We describe the Volar Intra-Articular Extended Window approach, which allows direct visualization of the articular surface through the volar approach to treat distal radius fractures.
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Affiliation(s)
- Robin N. Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Pedro Bronenberg
- Hand and Upper Extremity Surgery Department, Prof. Dr. “Carlos Ottolenghi Institute”, Hospital Italiano de Buenos Aires
| | - Lauren M. Shapiro
- UC San Francisco Department of Orthopaedic Surgery, San Francisco, CA
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Chen M, Yang J, Hou H, Zheng B, Xia S, Wang Y, Yu J, Wu G, Sun H, Jia X, Ning H, Chang H, Zhang X, Yuan Y, Wang Z. Analysis of factors influencing hospitalization cost of patients with distal radius fractures: an empirical study based on public traditional Chinese medicine hospitals in two cities, China. BMC Health Serv Res 2024; 24:605. [PMID: 38720277 PMCID: PMC11080218 DOI: 10.1186/s12913-024-10953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Distal radius fractures (DRFs) have become a public health problem for all countries, bringing a heavier economic burden of disease globally, with China's disease economic burden being even more acute due to the trend of an aging population. This study aimed to explore the influencing factors of hospitalization cost of patients with DRFs in traditional Chinese medicine (TCMa) hospitals to provide a scientific basis for controlling hospitalization cost. METHODS With 1306 cases of DRFs patients hospitalized in 15 public TCMa hospitals in two cities of Gansu Province in China from January 2017 to 2022 as the study object, the influencing factors of hospitalization cost were studied in depth gradually through univariate analysis, multiple linear regression, and path model. RESULTS Hospitalization cost of patients with DRFs is mainly affected by the length of stay, surgery and operation, hospital levels, payment methods of medical insurance, use of TCMa preparations, complications and comorbidities, and clinical pathways. The length of stay is the most critical factor influencing the hospitalization cost, and the longer the length of stay, the higher the hospitalization cost. CONCLUSIONS TCMa hospitals should actively take advantage of TCMb diagnostic modalities and therapeutic methods to ensure the efficacy of treatment and effectively reduce the length of stay at the same time, to lower hospitalization cost. It is also necessary to further deepen the reform of the medical insurance payment methods and strengthen the construction of the hierarchical diagnosis and treatment system, to make the patients receive reasonable reimbursement for medical expenses, thus effectively alleviating the economic burden of the disease in the patients with DRFs.
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Affiliation(s)
- Mengen Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Jingyu Yang
- School of Health Management, Gansu University of Chinese Medicine, Lanzhou, 730000, China
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Haojia Hou
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Baozhu Zheng
- School of Stomatology, Capital Medical University, Beijing, 100050, China
| | - Shiji Xia
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Yuhan Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Jing Yu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Guoping Wu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Henong Sun
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Xuan Jia
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Hao Ning
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Hui Chang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Xiaoxi Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
- Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, 100053, China
| | - Youshu Yuan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Zhiwei Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China.
- National Institute of Chinese Medicine Development and Strategy, Beijing, 102400, China.
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Ahmed O, Balakrishnan P, Perumal R, Agraharam D, Velmurugesan PS, Jayaramaraju D, Rajasekaran S. A prospective randomized control trial comparing outcomes of casting, pinning, and plating for distal end of radius fractures (AO type A2, A3, C1, or C2) in the elderly population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03949-z. [PMID: 38642122 DOI: 10.1007/s00590-024-03949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly. METHODS A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score. RESULTS Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group. CONCLUSION The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients.
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Affiliation(s)
- Owais Ahmed
- Department of Orthopaedics and Trauma, Ganga Medical Center and Hospital Pvt LTD., 313, Mettupalayam Road, Coimbatore, 641043, India
| | - Pradeep Balakrishnan
- Department of Orthopaedics and Trauma, Ganga Medical Center and Hospital Pvt LTD., 313, Mettupalayam Road, Coimbatore, 641043, India
| | - Ramesh Perumal
- Department of Orthopaedics and Trauma, Ganga Medical Center and Hospital Pvt LTD., 313, Mettupalayam Road, Coimbatore, 641043, India.
| | - Devendra Agraharam
- Department of Orthopaedics and Trauma, Ganga Medical Center and Hospital Pvt LTD., 313, Mettupalayam Road, Coimbatore, 641043, India
| | | | - Dheenadhayalan Jayaramaraju
- Department of Orthopaedics and Trauma, Ganga Medical Center and Hospital Pvt LTD., 313, Mettupalayam Road, Coimbatore, 641043, India
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Jo YH, Lee MK, Lee YS, Choi WS, Kim JH, Kim J, Lee CH. Radiographic and clinical outcomes of muenster and sugar tong splints for distal radius fractures: a comparative study. BMC Musculoskelet Disord 2024; 25:261. [PMID: 38570756 PMCID: PMC10988914 DOI: 10.1186/s12891-024-07362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Non-operative management is typically indicated for extra-articular distal radius fractures. Conservative treatments such as Sugar tong splints (STs) and Muenster splints (MUs) are commonly used. However, there is limited research and outcome data comparing the two splint types. Therefore, this study aimed to investigate and compare the radiographic and clinical outcomes of treatment using STs and MUs. METHODS In this retrospective comparative study, we aimed to evaluate and compare the radiographic and clinical outcomes of STs and MUs for the treatment of distal radius fractures. The study included 64 patients who underwent closed reduction (CR) in the emergency room and were treated with either STs or MUs splints (STs group: n = 38, MUs group: n = 26). Initial X-rays, post-CR X-rays, and last outpatient follow-up X-rays were evaluated. Radial height (RH), ulnar variance (UV), radial inclination (RI), and volar tilt (VT) were measured by a blinded investigator. The Quick DASH form was applied to measure patients' satisfaction after treatments. RESULTS There were no significant differences in baseline characteristics, initial radiographic measurements, or radiographic measurements immediately after CR between the two groups. However, the overall radiological values deteriorated to some degree in both groups compared to the post-CR images. Furthermore, using a paired test, the STs group showed significant differences in RH and RI, and the MUs group showed significant differences in RH and UV between the last follow-up and post-CR images. CONCLUSIONS The study concluded that there was no difference in clinical outcomes between the two splint types. However, both STs and MUs groups showed reduced radiographic parameters, and the MUs group showed a significant reduction of RH and UV in the treatment of distal radius fractures. LEVEL OF EVIDENCE Level IV; Retrospective Comparison; Treatment Study.
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Affiliation(s)
- Young-Hoon Jo
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Myoung Keun Lee
- Department of Orthopaedic Surgery, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Young Seok Lee
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Wan-Sun Choi
- Department of Orthopaedic Surgery, College of Medicine, Ajou University, Suwon, Republic of Korea
| | - Joo-Hak Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Republic of Korea
| | - Jiwhan Kim
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Chang-Hun Lee
- Department of Orthopaedic Surgery, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Liu WC, Hartwich M, Locascio JJ, Regazzoni P, Jupiter JB, Fernandez Dell'Oca A. The association of ICUC trauma score and quick DASH in a distal radius fracture cohort. J Orthop Surg Res 2024; 19:141. [PMID: 38360673 PMCID: PMC10870621 DOI: 10.1186/s13018-024-04623-0] [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: 11/16/2023] [Accepted: 02/11/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND This study evaluates the association between ICUC trauma and short-form Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick DASH) scores among patients who underwent surgery for distal radius fractures. METHODS This research gathered patient-reported outcomes (PROs) from patients registered in the ICUC database at a single trauma center. The study involved 76 adult patients who underwent surgical treatment for distal radius fractures before 2023. These patients received a volar locking plate for their distal radius fracture. The research utilized two different PROs to evaluate the patients' conditions. The ICUC trauma score measures functional impairment and pain through two 5-point scale questions, allowing patients to self-assess these aspects. The Quick DASH, comprising 11 questions, was used to evaluate symptoms and functionality of the upper extremity. RESULTS For patients aged 55.9 ± 15.3 years and 4.6 ± 3.9 years post-op follow-up, the ICUC trauma score was 0.70 ± 0.95, and Quick DASH was 6.07 ± 10.35. A strong correlation between ICUC and Quick DASH was identified (r = 0.71, P < 0.01). The interaction between the ICUC trauma score and age at the surgery to Quick DASH revealed a significant unstandardized partial regression coefficient of 0.19 (95% confidence interval 0.08-0.31; P < 0.01). CONCLUSION This study demonstrated a strong correlation between the ICUC trauma score and the Quick DASH among patients, especially the elderly. It was noted that an elevation in the ICUC trauma score is linked to a more marked increase in the Quick DASH score, particularly in older patients. Given its simplicity and efficacy, the ICUC trauma score may be a viable alternative to the Quick DASH for assessing the patient's clinical outcomes.
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Affiliation(s)
- Wen-Chih Liu
- Kaohsiung Medical University Hospital, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Magdalena Hartwich
- Department of Orthopedics, Hospital Britanico Montevideo, Montevideo, Uruguay
- Orthopedics Specialization, Universidad de Montevideo, Montevideo, Uruguay
| | - Joseph J Locascio
- Biostatistics Center, Division of Clinical Research, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jesse B Jupiter
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Alberto Fernandez Dell'Oca
- Department of Orthopedics, Hospital Britanico Montevideo, Montevideo, Uruguay
- Orthopedics Specialization, Universidad de Montevideo, Montevideo, Uruguay
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Rodriguez-Fontan F, Lauder A. Managing the Extra-Articular Distal Radius Malunion. Hand Clin 2024; 40:63-77. [PMID: 37979991 DOI: 10.1016/j.hcl.2023.06.002] [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: 11/20/2023]
Abstract
Distal radius fractures are common injuries. Satisfactory outcomes are typically achieved with appropriate nonoperative or operative treatment. A proportion of these injuries develop symptomatic malunions, which may be treated surgically with distal radius corrective osteotomy. A thorough understanding of the anatomy, biomechanics, radiographic parameters, and indications is needed to provide appropriate treatment. Factors, including surgical approach, osteotomy type, use of bone graft, fixation construct, management of associated tendon and/or nerve conditions, soft tissue contracture releases, and need for ulnar-sided procedures, should be considered. A comprehensive evaluation is necessary to guide understanding for when salvage procedures may be preferred.
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Affiliation(s)
- Francisco Rodriguez-Fontan
- Department of Orthopedics, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Alexander Lauder
- Department of Orthopedics, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA; Department of Orthopedics, Denver Health Medical Center, Denver, CO, USA.
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Chinta SR, Cassidy MF, Tran DL, Brydges HT, Ceradini DJ, Bass JL, Agrawal NA. Epidemiology of distal radius fractures: Elucidating mechanisms, comorbidities, and fracture classification using the national trauma data bank. Injury 2024; 55:111217. [PMID: 38029683 DOI: 10.1016/j.injury.2023.111217] [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: 09/10/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND An update on the epidemiology of distal radius fractures in the United States is necessary, particularly as the elderly population grows. Additionally, age and frailty have been associated with complications following surgical fixation of DRFs. Herein, we utilize the National Trauma Data Bank, a robust nationwide resource, to investigate the relationship between demographics, comorbidities, injury and fracture characteristics, and admission details. METHODS Patients with isolated distal radius fractures were identified from the National Trauma Data Bank (2016-2019) according to ICD-10 codes. Univariate and multivariate regressions were conducted to determine independent risk factors for bilateral fractures, displaced fractures, open fractures, as well as length of hospital stay and adverse discharge disposition for patients undergoing inpatient surgical fixation. RESULTS The incidence of DRFs was 3.6/1,000 trauma-related emergency department visits and 10.8/1,000 upper extremity traumas. Trauma mechanism was significantly associated with displaced and open fractures. Age (OR 1.01, 95% CI 1.01-1.01), BMI (OR 1.02, 95% CI 1.01-1.02), smoking (OR 1.34, 95% CI 1.15-1.57), and alcohol level (trace: OR 2.18, 95% CI 1.41-3.29; intoxicated: OR 2.20, 95% CI 1.63-2.95) were significantly associated with open fractures. Machinery (β=2.04, 95% CI 1.00-3.08) and MVT (β=0.39, 95% CI 0.08-0.69) mechanisms were independent risk factors for longer length of stay. mFI-5 was an independent risk factor, in a stepwise fashion, for both length of stay and adverse discharge disposition. CONCLUSIONS High-energy mechanisms and risk factors for poor skin quality were significantly associated with open fractures. mFI-5 was an independent risk factor for longer length of stay and non-routine discharges in patients of all ages, despite controlling for other comorbidities, unrelated complications, and mechanism of injury. Trauma mechanism was an independent risk factor for prolonged length of stay only, particularly in patients younger than 65 years of age.
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Affiliation(s)
- Sachin R Chinta
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Michael F Cassidy
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - David L Tran
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Daniel J Ceradini
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Jonathan L Bass
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA
| | - Nikhil A Agrawal
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY 10016, USA.
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Yalin M, Golgelioglu F, Key S. The ageless approach: Nonoperative mastery competes head-on with surgery for elderly distal radius fractures. J Orthop Res 2024; 42:141-147. [PMID: 37609694 DOI: 10.1002/jor.25665] [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: 06/09/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
The aim of the current study is to compare the clinical outcomes of cast immobilization (CI) versus surgical treatment after 1 year for distal radius fractures (DRFs) in the elderly population. The cohort included patients aged 70-89 who suffered an acute, closed, and displaced DRF and who were treated conservatively or surgically at our clinic between August 2018 and January 2022. Those who had pathological fractures, open fractures, concomitant ulna fractures (except ulna styloid fractures), were not between the ages of 70 and 89, or refused to participate were excluded from the study. The study gathered data on patient demographics, initial radiological measurements, clinical measurements after 1 year, treatment models employed, and rates of complications. Of the total number of patients (276), CI was used on 77.2% (213), whereas the other 25 had volar-locked plates (VLP), 25 received external fixators with percutaneous pinning (EFPP), and 13 had isolated percutaneous pinning (IPP). 19 of 276 individuals had complications, with Complex Regional Pain Syndrome and Carpal Tunnel Syndrome being the most often documented. EFPP resulted in significantly higher Disability of the Arm, Shoulder, and Hand (DASH) score values than VLP and IPP at the 1st postoperative year (p < 0.05). No statistically significant difference was found between the DASH score and ROM values at the 1st postoperative year for patients who received CI versus those who underwent surgery (p > 0.05). In the first postoperative year, CI still retains its validity and performs similarly to surgery for DRFs in older individuals. VLPP and IPP methods outperformed EFPP surgeries.
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Affiliation(s)
- Mustafa Yalin
- Department of Orthopedics and Traumatology, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Fatih Golgelioglu
- Department of Orthopedics and Traumatology, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Sefa Key
- Department of Orthopedics and Traumatology, Fırat University Faculty of Medicine, Elazığ, Turkey
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Suna A, Davidson A, Weil Y, Joskowicz L. Automated computation of radiographic parameters of distal radial metaphyseal fractures in forearm X-rays. Int J Comput Assist Radiol Surg 2023; 18:2179-2189. [PMID: 37097517 DOI: 10.1007/s11548-023-02907-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Radiographic parameters (RPs) provide objective support for effective decision making in determining clinical treatment of distal radius fractures (DRFs). This paper presents a novel automatic RP computation pipeline for computing the six anatomical RPs associated with DRFs in anteroposterior (AP) and lateral (LAT) forearm radiographs. METHODS The pipeline consists of: (1) segmentation of the distal radius and ulna bones with six 2D Dynamic U-Net deep learning models; (2) landmark points detection and distal radius axis computation from the segmentations with geometric methods; (3) RP computation and generation of a quantitative DRF report and composite AP and LAT radiograph images. This hybrid approach combines the advantages of deep learning and model-based methods. RESULTS The pipeline was evaluated on 90 AP and 93 LAT radiographs for which ground truth distal radius and ulna segmentations and RP landmarks were manually obtained by expert clinicians. It achieves an accuracy of 94 and 86% on the AP and LAT RPs, within the observer variability, and an RP measurement difference of 1.4 ± 1.2° for the radial angle, 0.5 ± 0.6 mm for the radial length, 0.9 ± 0.7 mm for the radial shift, 0.7 ± 0.5 mm for the ulnar variance, 2.9 ± 3.3° for the palmar tilt and 1.2 ± 1.0 mm for the dorsal shift. CONCLUSION Our pipeline is the first fully automatic method that accurately and robustly computes the RPs for a wide variety of clinical forearm radiographs from different sources, hand orientations, with and without cast. The computed accurate and reliable RF measurements may support fracture severity assessment and clinical management.
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Affiliation(s)
- Avigail Suna
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Israel, Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
| | - Amit Davidson
- Department of Orthopedics, Hadassah University Medical Center, Jerusalem, Israel
| | - Yoram Weil
- Department of Orthopedics, Hadassah University Medical Center, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Israel, Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel.
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Haak SL, Borgstede MG, Stolmeijer R, Bens BW, Boendermaker AE, van der Kolk BBY, Ter Maaten JC, Ter Avest E, Lameijer H. Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial. Emerg Med J 2023; 40:826-831. [PMID: 37748865 DOI: 10.1136/emermed-2023-213178] [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] [Received: 02/21/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. METHODS This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction. The primary outcome was the proportion of patients requiring more than one reduction attempt. The secondary outcomes were time to complete reduction and treatment plan at ED discharge (conservative or operative repair). RESULTS A total of 214 patients were screened, of which 211 patients were included for primary endpoint analysis (87% female, median age 68 years, 94% dorsal angulation, 59% intra-articular and 73% multifragmentary). In total, 105 patients were randomised to standard treatment and 106 patients to PoCUS-guided fracture reduction. In the standard treatment group, 13 patients (12%) required more than one reduction attempt, compared with 6 patients (6%) in the PoCUS group (OR 2.35, 95% CI 0.86 to 6.45). The median reduction time was 5 min in the PoCUS group (IQR 3-6) vs 3 min (IQR 2-4) in the standard reduction group (p<0.001). At ED discharge, operative repair was indicated for 17 (16%) patients in the standard group and 21 (20%) patients in the PoCUS group (OR 0.78, 95% CI 0.39 to 1.58). CONCLUSION This study could not demonstrate that PoCUS-guided reduction of distal radius fractures was associated with a statistically significant decrease in the number of reduction attempts. TRIAL REGISTRATION NUMBER The Netherlands Trial Register (NTR7934).
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Affiliation(s)
- Svenja L Haak
- Department of Emergency Medicine, Isala, Zwolle, The Netherlands
- Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Marion G Borgstede
- Department of Emergency Medicine, Wilhelmina Hospital Assen, Assen, The Netherlands
| | - Renate Stolmeijer
- Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bas Wj Bens
- Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annemieke E Boendermaker
- Department of Emergency Medicine, Tjongerschans Hospital Heerenveen, Heerenveen, The Netherlands
| | | | - Jan C Ter Maaten
- Department of Emergency Medicine and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewoud Ter Avest
- Department of Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Heleen Lameijer
- Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Kamal RN, Gomez GI, Schultz EA, Shapiro LM. The Safety of the Volar Intraarticular Extended Window (VIEW) Approach for Intra-articular Distal Radius Fractures. Hand (N Y) 2023:15589447231210926. [PMID: 38006231 DOI: 10.1177/15589447231210926] [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: 11/26/2023]
Abstract
BACKGROUND A novel volar approach to intra-articular distal radius fractures has been introduced for treatment of intra-articular distal radius fractures, in which volar extrinsic ligaments are released to create a volar window into the radiocarpal joint (Volar Intraarticular Extended Window [VIEW] approach). Our purpose was to evaluate the safety of VIEW approach for treatment of intra-articular distal radius fractures. METHODS A retrospective chart review was performed for 13 patients with intra-articular distal radius fractures treated operatively with the VIEW surgical technique using an intra-articular window in the volar capsule to aid in reduction and fixation. Postoperative radiographs were reviewed to assess for ulnocarpal translocation by assessing lunate uncovering and radial-carpal distance. RESULTS Thirteen patients were treated with the VIEW approach with mean follow-up of 28 weeks (range, 7-67 weeks; SD, 18 weeks). The mean postoperative lunate uncovering was 34.6% (SD, 7.7%) and mean radial-carpal distance was 4.6 mm (SD, 1.5 mm). Postoperatively, mean intra-articular step-off was 0.9 mm (SD, 1.2 mm) and mean intra-articular gap was 1.2 mm (SD, 1.0 mm). No patients reported clinical symptoms of wrist instability. CONCLUSIONS Using the VIEW approach during a volar approach to intra-articular distal radius fractures is safe and does not lead to carpal instability. Surgeons can consider using the approach when direct visualization of the articular surface may be beneficial for reduction or fixation. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Giselle I Gomez
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Emily A Schultz
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
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Zhuang T, Kamal RN. Strategies for Perioperative Optimization in Upper Extremity Fracture Care. Hand Clin 2023; 39:617-625. [PMID: 37827614 DOI: 10.1016/j.hcl.2023.05.009] [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: 10/14/2023]
Abstract
Perioperative optimization in upper extremity fracture care must balance the need for timely treatment with the benefits of medical optimization. Care pathways directed at optimizing glycemic control, chronic anticoagulation, smoking history, nutrition, and frailty can reduce surgical risk in upper extremity fracture care. The development of multidisciplinary approaches that tie risk modification with risk stratification is needed.
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Affiliation(s)
- Thompson Zhuang
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, 450 Broadway Street MC: 6342, Redwood City, CA 94603, USA
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, 450 Broadway Street MC: 6342, Redwood City, CA 94603, USA.
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13
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Julian KR, Truong NM, Leversedge C, Kwong JW, Rosinski A, Kamal RN, Shapiro LM. Does Time to Surgery for Distal Radius Fractures Impact Clinical and Radiographic Outcomes? A Systematic Literature Review. CURRENT ORTHOPAEDIC PRACTICE 2023; 34:229-235. [PMID: 38264709 PMCID: PMC10802167 DOI: 10.1097/bco.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Distal radius fractures are one of the most common upper extremity fractures across all age groups. Although the American Academy of Orthopaedic Surgery (AAOS) Clinical Practice Guidelines have defined recommendations for the treatment of distal radius fractures, the optimal time to surgery was not included. There remains relatively little guidance or consensus regarding the optimal timing of surgical intervention for distal radius fractures and the impact of time to surgery on outcomes. As such, the purpose of this investigation is to systematically review clinical and radiographic outcomes associated with time to surgical management of distal radius fractures.
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Affiliation(s)
- Kaitlyn R Julian
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Nicole M Truong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Chelsea Leversedge
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street Redwood City, CA
| | - Jeffrey W Kwong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Alexander Rosinski
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program 450 Stanyan Street San Francisco, CA 94117
| | - Robin N Kamal
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street MC: 6342 Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
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14
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Kamal RN, Ostergaard PJ, Shapiro LM. Response to "Letter Regarding 'The Volar Intra-Articular Extended Window Approach for Intra-Articular Distal Radius Fractures'". J Hand Surg Am 2023; 48:e7. [PMID: 37536879 DOI: 10.1016/j.jhsa.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Peter J Ostergaard
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Lauren M Shapiro
- University of California San Francisco Department of Orthopaedic Surgery, San Francisco, CA
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15
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Lemos J, Xiao M, Castro Appiani LM, Katz P, Kamal RN, Shapiro LM. Are Patient-Reported Outcome Measures for Distal Radius Fractures Validated for Spanish and Culture? A Systematic Review. J Hand Surg Am 2023; 48:673-682. [PMID: 37191603 PMCID: PMC10330065 DOI: 10.1016/j.jhsa.2023.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are used commonly to assess function to direct treatment and evaluate outcomes for patients with distal radius fractures. Most PROMs have been developed and validated in English with minimal report of the demographics of patients studied. The validity of applying these PROMs among Spanish-speaking patients is unknown. The purpose of this study was to evaluate the quality and psychometric properties of Spanish-language adaptations of PROMs for distal radius fractures. METHODS We conducted a systematic review to identify published studies of adaptations of Spanish-language PROMs evaluating patients with distal radius fractures. We evaluated the methodologic quality of the adaptation and validation using Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures, Quality Criteria for Psychometric Properties of Health Status Questionnaire, and the Consensus-based Standards for the Selection of Health Measurement Instruments Checklist for Cross-Cultural Validity. The level of evidence was evaluated based upon prior methodology. RESULTS Five instruments reported in eight studies were included: the Patient-Rated Wrist Evaluation (PRWE), Disability of Arm Shoulder and Hand, Upper Limb Functional Index, Lawton Instrumental Activities of Daily Living Scale, and Short Musculoskeletal Function Assessment. The PRWE was the most frequently included PROM. No study followed all six processes for adaptation or assessed all measurement properties. No study demonstrated the completion of more than eight of the 14 aspects of cross-cultural validity. The PRWE had moderate evidence to support half of the domains of measurement properties evaluating the level of evidence. CONCLUSIONS None of the five instruments identified received a good rating on all three checklists. Only the PWRE demonstrated moderate evidence on half of the measurement domains. CLINICAL RELEVANCE Given the lack of strong evidence to support the quality of these instruments, we recommend adaptation and testing of PROMs for this population before use. Currently, PROMs in Spanish-speaking patients should be used with caution so as not to perpetuate health care disparities.
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Affiliation(s)
- Jacie Lemos
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Michelle Xiao
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | | | - Patricia Katz
- Department of Medicine, University of California - San Francisco, San Francisco CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, CA.
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16
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Shen O, Chen CT, Jupiter JB, Chen NC, Liu WC. Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis. Injury 2023:S0020-1383(23)00396-0. [PMID: 37188586 DOI: 10.1016/j.injury.2023.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/17/2023]
Abstract
AIM This network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. METHODS We searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes. RESULTS Fourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups. CONCLUSION Evidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.
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Affiliation(s)
- Oscar Shen
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Chih-Ting Chen
- Department of Clinical Education, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Jesse B Jupiter
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Neal C Chen
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Wen-Chih Liu
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Orthopedics, Kaohsiung Medical University Hospital, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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17
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Stein A, Lalka A, Scott F, Rodriguez Fontan F. Is the Repair of Acute Scapholunate Injuries Associated With Distal Radius Fractures Necessary at the Time of Osteosynthesis? A Systematic Review and Meta-Analysis. Hand (N Y) 2023:15589447231151259. [PMID: 36802849 DOI: 10.1177/15589447231151259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Acute scapholunate ligament injuries (SLIs) can occur in distal radial fractures (DRFs). This systematic review compares patient-reported outcomes and range of motion (ROM) between operative and nonoperative treatment of acute SLIs in association with surgical fixation of DRFs. We hypothesize that there is no clinical difference. METHODS A meta-analysis was used to evaluate the effectiveness of SLI repair versus no repair occurring with DRF with Disabilities of the Arm, Shoulder, and Hand (DASH) scores. We identified 154 articles of which 14 were eligible for review. Only 7 studies reported sufficient radiographic or clinical outcomes data and were included: 3 for meta-analysis and 4 underwent narrative analysis due to lack of homogeneity. We analyzed the patients in 2 groups: operative SLI (O-SLI) versus nonoperative SLI (NO-SLI). The primary outcomes were ROM and DASH scores with 1-year follow-up, where a pooled effect size was generated to determine a difference between groups. RESULTS A total of 128 patients were included (71 O-SLI and 57 NO-SLI), with a mean follow-up of 70.2 months (SD: 23.5). The overall effect size for ROM for flexion was 1.74 (95% confidence interval [CI], -3.48 to 6.95; P = .51) and for extension was 0.79 (95% CI, -3.41 to 4.99; P = .71), while the overall effect size for DASH scores was -0.28 (95% CI, -0.66 to 0.10; P = .14). Although NO-SLI led to better ROM and O-SLI led to lower DASH scores, these were not significantly different. CONCLUSION The acute surgical intervention of a scapholunate interosseous ligament injury is no different from conservative management in the setting of acute DRFs undergoing osteosynthesis. But the sample size for pooed analyses was small, hence the evidence to date is low to recommend either way.
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Affiliation(s)
| | - Andy Lalka
- Department of Orhopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Frank Scott
- Department of Orhopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
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18
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Muacevic A, Adler JR, Federer A, Lindeque B. Giant Cell Tumor of the Wrist After Fracture Osteosynthesis: A Case Report. Cureus 2023; 15:e34110. [PMID: 36843756 PMCID: PMC9946760 DOI: 10.7759/cureus.34110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
A 60-year-old female sustained a distal radius fracture and underwent open reduction internal fixation with a volar locking plate. The patient had an uneventful recovery until four months postoperatively when the patient clinically regressed, and an expansile, radiolucent metaepiphyseal lesion was found. Further workup revealed this was a giant cell tumor of bone (GCTB). Definitive management consisted of extensive curettage, cryoablation, and cementation of the lesion, and the hardware was left intact. The current case presents an uncommon presentation of GCTB. The case illuminates the importance of thorough scrutiny of postoperative radiographs when clinical improvement plateaus or regresses and the need to pursue additional workup when the clinical course is atypical. The authors query the possibility of a sub-radiological presentation of GCTB.
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Affiliation(s)
- Alexander Muacevic
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - John R Adler
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
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19
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Thomas TL, Henry TW, Kistler JM, Seigerman DA, Tulipan JE, Beredjiklian PK. Reliability of Routine Radiographs for Conservatively Treated Metacarpal Shaft and Neck Fractures. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:1026-1029. [PMID: 36721658 PMCID: PMC9846730 DOI: 10.22038/abjs.2022.66036.3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/02/2022] [Indexed: 02/02/2023]
Abstract
Background To investigate the reliability of orthopedic hand surgeons to evaluate radiographic healing in initial and follow-up radiographs of the conservatively treated metacarpal shaft and neck fractures. The rationale for this study was to reduce the rate of unnecessary, routine radiographs when treating metacarpal fractures. Methods Forty sets of digital x-rays, twenty at the initial visit and twenty at the 4-week follow-up, were randomly selected and reviewed. Three hand surgeons evaluated the x-rays for (1) fracture location, (2) radiograph timing, (3) healing status, (4) percentage healed, (5) angulation, and (6) confidence in healing status. Observers reviewed studies in random order and evaluated the same set of radiographs one month after the initial review. Intra- and interobserver agreements were analyzed using Fleiss' kappa (κ) for all parameters and all possible observer pairings. Results Interobserver and intraobserver reliability was highest when evaluating fracture location and lowest when assessing the percentage healed. The interobserver reliability was fair for radiograph timing and healing status and fair-to-moderate for angulation. The intraobserver reliability was moderate for radiograph timing and healing status and moderate-to-substantial for angulation. Observers correctly differentiated initial vs. follow-up images 62% of the time and reported to feel somewhat certain in their evaluation of healing status. Conclusion When evaluating initial and 4-week follow-up radiographs, hand surgeons were somewhat confident in their assessment of healing but had less than substantial intra- and interobserver reliability following radiographic evaluation. Due to their poor reproducibility, routine radiographs may be unnecessary when evaluating conservatively treated metacarpal fractures. Further studies and guidelines that identify clear indications for the use of routine imaging in metacarpal fracture care are warranted.
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20
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Davidson A, Feldman G, Mosheiff R, Suna A, Joskowicz L, Weil YA. Computer-Generated Radiographic Measurements of Distal Radius Fractures: Does It Help With Decision Making? J Hand Surg Am 2022:S0363-5023(22)00574-3. [PMID: 36336570 DOI: 10.1016/j.jhsa.2022.09.015] [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: 01/02/2022] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Operative management of distal radius fractures (DRFs) has become increasingly common. Age, activity levels, and comorbid conditions are major factors influencing the treatment decision, although operative indications are still controversial. Radiographic parameters (RPs), such as radial inclination, dorsal tilt, and articular step-off, can provide objective support for effective decision making. However, manual measurement of RPs may be imprecise and subject to inconsistency. To address this problem, we developed custom software of an algorithm to automatically detect and compute 6 common RPs associated with DRF in anteroposterior and lateral radiographs. The aim in this study was to assess the effect of this software on radiographic interobserver variability among orthopedic surgeons. Our hypothesis was that precise and consistent measurement of RPs will improve radiographic interpretation variability among surgeons and, consequently, may aid in clinical decision making. METHODS Thirty-five radiograph series of DRFs were presented to 9 fellowship-trained hand and orthopedic trauma surgeons. Each case was presented with basic clinical information, together with plain anteroposterior and lateral radiographs. One of the 2 possible treatment options was selected: casting or open reduction with a locking plate. The survey was repeated 3 weeks later, this time with computer-generated RP measurements. Data were analyzed for interobserver and intraobserver variability for both surveys, and the interclass coefficient, kappa value, was calculated. RESULTS The interobserver reliability (interclass coefficient value) improved from poor to moderate, 0.35 to 0.50, with the provided RP. The average intraobserver interclass coefficient was 0.68. When participants were assessed separately according to their subspecialties (trauma and hand), improved interobserver variability was found as well. CONCLUSIONS Providing computed RPs to orthopedic surgeons may improve the consistency of the radiographic judgment and influence their clinical decision for the treatment of DRFs. CLINICAL RELEVANCE Orthopedic surgeons' consistency in the radiographic judgment of DRFs slightly improved by providing automatically calculated radiographic measurements to them.
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Affiliation(s)
- Amit Davidson
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel; Orthopedic Department, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Guy Feldman
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel; Orthopedic Department, Emek Medical Center, Afula, Israel
| | - Rami Mosheiff
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Avigail Suna
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoram A Weil
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel
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21
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Eraslan U, Usta H, Demirkan AF, Kitis A, Baskoc A. Association between perceived and objective hand-wrist function in distal radius fracture. HAND SURGERY & REHABILITATION 2022; 41:582-588. [PMID: 35970440 DOI: 10.1016/j.hansur.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/18/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
The relationship between patient-reported outcome measures and objective measures is important for understanding patient expectations. The aim of this study was to investigate the relationship of each section of the Michigan Hand Outcomes Questionnaire (MHQ) to objective measurements in patients with distal radius fracture (DRF). Eighty-four patients who were treated operatively or non-operatively for DRF were included. Injury severity was assessed by the Modified Hand Injury Severity Score. Joint motion was assessed at 6 and 12 weeks and grip strength at 12 weeks after non-operative treatment or surgery. The MHQ was used to assess hand functionality. The relationships between measurements were analyzed by Spearman correlation analysis. Statistical significance was set at p < 0.05. Fifty-one patients (60.7%) were women and 33 (39.3%) men. Mean age was 48.17 ± 12.26 (range, 20-64) years. Fifty-two (61.9%) patients were treated surgically and 32 (38.1%) non-operatively. Forearm pronation-supination and wrist flexion and ulnar deviation at week 6 and forearm pronation-supination, wrist extension and radial deviation at week 12 correlated with MHQ scores, unlike wrist extension and radial deviation at week 6 and flexion and ulnar deviation at week 12. Gross and fine grip strength at week 12 correlated with MHQ, except for the overall hand function, work performance and pain subsections. The MHQ subsections correlated with joint motion and grip strength in the early period after DRF. These findings clarified patient expectations in the early period.
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Affiliation(s)
- U Eraslan
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
| | - H Usta
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
| | - A F Demirkan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
| | - A Kitis
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
| | - A Baskoc
- Institute of Health Sciences, Pamukkale University, University Street, No: 11, 20160, Denizli, Turkey.
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Cooper AM, Wood TR, Scholten II DJ, Carroll EA. Nonsurgical Management of Distal Radius Fractures in the Elderly: Approaches, Risks and Limitations. Orthop Res Rev 2022; 14:287-292. [PMID: 35996621 PMCID: PMC9391939 DOI: 10.2147/orr.s348656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
The elderly have conventionally been defined as individuals over the age of 65 and are projected to represent about 21% of the United States (US) population by the year 2030. Distal radius fractures (DRF) in particular are one of the most common fractures among elderly patients and their incidence continues to rise in part due to increased activity levels among the elderly, increased life expectancy, rising rates of obesity, changes to dietary habits, and the prevalence of osteoporosis. Although various treatment options exist for these injuries, nonsurgical treatment of distal radius fractures remains a mainstay among elderly patients with mounting evidence of its non-inferiority to surgical fixation in the literature. Here, we summarize the overall approach to nonsurgical treatment of distal radius fractures in the elderly population while examining its supporting data and highlighting potential risks and limitations to it.
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Affiliation(s)
- Alexus M Cooper
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Taylor R Wood
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Donald J Scholten II
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Eben A Carroll
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
- Correspondence: Eben A Carroll, Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA, Email
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