Introduction. The distal radius is the most frequently fractured bone in the forearm with an annual fracture incidence in the UK of about 9–37 in 10,000. Restoration of normal anatomy is an important factor that dictates the final functional outcome. A number of operative options are available, including Kirschner wiring, bridging or non-bridging external fixation and open reduction and internal fixation by means of dorsal, radial or volar plates. We designed this study to analyse the clinical and radiological outcome of
Purpose.
Long term outcomes of distal radius fractures have rarely been studied prospectively and do not traditionally extend past 1–2 years following treatment. The purpose of this study was to describe the long term patient-rated pain and disability of patients after a distal radius fracture and to also determine the differences in patient reported pain and disability after one year following injury and at the long term follow-up. Patients who had previously participated in a prospective study, where baseline and standardised one year follow-up were performed following a distal radius fracture were contact to participate in this long term follow-up (LTFU) study. Eligible cases that consented agreed to evaluation which included being sent a package in the mail contain a letter of information and questionnaire. Baseline demographic data including age and sex, as well as date of fracture, mechanism of fall and attending physician information was obtained for all participating subjects. Patient rated pain and disability was measured at baseline, one year and at long-term follow-up using the Patient Rated Wrist Evaluation (PRWE). Patients were categorised as having had a worse outcome (compared to one year follow-up PRWE scores) if their LTFU PRWE score increased by 5 points, having no change in status (if their score changed by four or less points) or improved if their LTFU PRWE score decreased by 5 or more points. Sixty-five patients (17 male, 48 female) with an average age of 57 years at the time of injury and 67 years at follow-up were included in the study. The mean length of follow-up was 10.7 (± 5.8) years (range: 3–19 years). Overall, 85% of patients reported having no change or had less patient-reported pain and disability (PRWE) at their long-term follow-up compared to their one year PRWE scores. As well, one year PRWE scores were found to be predictive (20.2%) of the variability in long term PRWE score (p=0.001). This study provided data on a cohort of prospectively followed patients with a distal radius fracture, approximately 10 years after injury. This data may be useful to clinicians and therapists who are interested in determining the long term effects of this frequently occurring upper extremity fracture. The results of this study indicate that after 10 years following a distal radius fracture, 85% of patients will have good outcomes. The results of this study also indicate that majority of cases, if patients have a low amount of pain and disability at one year, then these outcomes will also be true approximately 10 years later.
Displaced
The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized controlled trial (RCT) and to study patterns of change between subspecialties and nationalities. Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of
Aims. The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized contolled trial (RCT) and to study patterns of change between subspecialties and nationalities. Methods. Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of
Despite the variety of implants or techniques that exist to treat displaced
Introduction. Fractures of the distal radius are one of the most common extremity fractures encountered in A&E departments and general adult fracture clinics. Over the last 10 years the rate of operation for
The ITS volar radial plate (Implant Technology Systems, Graz/Austria) is a fixation device that allows for the distal locking screws to be fixed at variable angles (70°-110°). This occurs by the different material properties, with the screws (titanium alloy) cutting a thread through the plate holes (titanium). We present our experience with the ITS plate. We retrospectively studied 26 patients who underwent ITS plate fixation for unstable multifragmentary
The use of percutaneous Kirschner wires [K-wires] and plaster is a popular method of treatment for displaced distal radius fracture. However, multi-database electronic literature review reveals unsurprisingly different views regarding their use. From August 2002 till June 2004, 280
Paediatric wrist fractures are routinely managed with closed reduction and a molded cast. Gap(GI) and Cast indices(CI) are useful in predicting re-displacement following application of cast. Over 6 months we audited the efficacy of molded cast application following closed reduction of
Distal radius fractures are the most common fracture of the upper extremity. Malunion of the distal radius is a common clinical problem after these injuries and frequently leads to pain, stiffness loss of strength and functional impairments. Currently, there is no consensus as to whether not the mal-aligned distal radius has an effect on carpal kinematics of the wrist. The purpose of this study was to examine the effect of dorsal angulation (DA) of the distal radius on midcarpal and radiocarpal joint kinematics, and their contributions to total wrist motion. A passive wrist motion simulator was used to test six fresh-frozen cadaveric upper extremities (age: 67 ± 17yrs). The specimens were amputated at mid humerus, leaving all wrist flexor and extensor tendons and ligamentous structures intact. Tone loads were applied to the wrist flexor and extensor tendons by pneumatic actuators via stainless steel cables. A previously developed distal radius implant was used to simulate native alignment and three DA deformity scenarios (DA 10 deg, 20 deg, and 30 deg). Specimens were rigidly mounted into the simulator with the elbow at 90 degrees of flexion, and guided through a full range of flexion and extension passive motion trials (∼5deg/sec). Carpal motion was captured using optical tracking; radiolunate and capitolunate joint motion was measured and evaluated. For the normally aligned radius, radiolunate joint motion predominated in flexion, contributing on average 65.4% (±3.4). While the capitolunate joint motion predominated in extension, contributing on 63.8% (±14.0). Increasing DA resulted in significant alterations in radiolunate and capitolunate joint kinematics (p<0.001). There was a reduction of contribution from the capitolunate joint to total wrist motion throughout flexion-extension, significant from 5 degrees of wrist extension to full extension (p = 0.024). Conversely, the radiolunate joint increased its contribution to motion with increasing DA; significant from 5 degrees of wrist extension to full extension as the radiolunate and capitolunate joint kinematics mirrored each other. A DA of 30 degrees resulted in an average radiolunate contribution of 72.6% ± 7.7, across the range of motion of 40 degrees of flexion to 25 degrees of extension. The results of our study for the radius in a normal anatomic alignment are consistent with prior investigators, showing the radiocarpal joint dominated flexion, and the midcarpal joint dominated extension; with an average 60/40 division in contributions for the radiocarpal in flexion and the midcarpal in extension, respectfully. As DA increased, the radiocarpal joint provided a larger contribution of motion throughout flexion and extension. This alteration in carpal kinematics with increased distal radius dorsal angulation may increase localised stresses and perhaps lead to accelerated joint wear and wrist pain in patients with malunited
Aim. Fixation of
Outcome following wrist fractures is difficult to assess. There are many methods used to assess outcome following distal radius fractures, but may be that simply asking the patient for their level of satisfaction may be enough. We looked at 50 wrist fractures at 12 weeks post injury and compared their level of satisfaction with various respected outcome measures (Gartland and Verley, Sarmiento, Cooney, Patient-Rated Wrist Evaluation, Hand Function Score, and Disability of Arm Shoulder and Hand Score) to determine whether there was a correlation with their level of satisfaction. The aim was to determine which wrist scoring system best correlates with patient satisfaction and functional outcome and which individual variables predict a good outcome. Forty-five females and 5 males with a mean age of 66 years (range 19 to 93 years) were included in the study. Multivariate regression analysis was carried out using SPSS 17. Patient satisfaction correlated best with the MacDermid, Watts and DASH scores. The variables in these scoring systems that best accounted for hand function were pain, ability to perform household chores or usual occupation, open packets and cut meat. The McDermid, Watts and DASH scores provide a better measure of patient satisfaction than the Gartland and Verley, Sarmiento and Cooney scores, however they are all time consuming, complicated and may indeed not be necessary. The four most important questions to ask in the clinic following wrist fractures are about severity of pain, ability to open packets, cut meat and perform household chores or usual occupation. This may provide a simple and more concise means of assessing outcome after
Aim. With the current wave of enthusiasm for internal fixation with volar locking plates in the treatment of
The Royal Marines regularly deploy to Norway to conduct Cold Weather, Arctic and Mountain Warfare training. A total of 1200 personnel deployed to Norway in 2010 over a 14-week period. Patients, whose injuries prevented them from continuing training, were returned to the UK via AEROMED. The aim of this investigation was to describe the epidemiology of musculoskeletal injuries during cold weather training. All data on personnel returned to the UK was prospectively collected and basic epidemiology recorded. 53 patients (incidence 44/1,000 personnel) were returned to the UK via AEROMED. 20/53 (38%) of cases were musculoskeletal injuries (incidence 17/1000 personnel). 15/20 musculoskeletal injuries were sustained while conducting ski training (incidence 13/1,000): 4/20 were non-alcohol related injuries, 1/20 was related to alcohol consumption off duty. Injuries sustained whilst skiing: 5/15 sustained anterior shoulders dislocation, 5/15 Grade 1-3 MCL/LCL tears, 2/15 sustained ACJ injuries, 1/15 crush fracture T11/T12, 1/15 tibial plateau fracture and 1/15 significant ankle sprain. Non-Training injuries: 1 anterior shoulder dislocation, 1
In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery. A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through EMBASE, Medline, and PubMed libraries using two domains of terms: “orthopaedic surgery” and “environmental sustainability”.Aims
Methods
Distal radial volar locking plating systems (DRVLP) are increasingly used for complex fractures of the distal radius. There have been limited studies on volar locking plating systems focusing on functional outcome and complications data. The aim of this study is to assess whether the surgeon can predict which fractures will have a good or poor outcome in terms of clinical, radiological and functional outcome assessment. Patients who sustained a
Purpose. To determine, in skeletally immature children with acceptably angulated (< = 15 degrees deformity at presentation) distal radius fractures, if a pre-fabricated wrist splint is at least as effective as a cast. Methods. A randomised controlled, non-inferiority, single blinded, single-centre trial was performed. The primary outcome was physical function at six weeks. Secondary outcomes included angulation, wrist range of motion, strength, pain, and patient preferences. Results. 93 of 97 randomised patients completed full follow-up. ASK scores at six weeks were 92.8 in the splint group and 91.4 in the cast group. Among patients treated in a cast, the average angular deformity at follow-up was 11.0 degrees, compared with an average of 6.6 degrees angulation among patients treated in a splint (p=0.02, t-test). Complications did not differ between groups, nor did range of motion. Conclusion. Splinting was not inferior to casting, and in fact may be superior to casting, for maintaining the position of a minimally displaced
Fresh-frozen allograft bone is frequently used
in orthopaedic surgery. We investigated the incidence of allograft-related
infection and analysed the outcomes of recipients of bacterial culture-positive
allografts from our single-institute bone bank during bone transplantation.
The fresh-frozen allografts were harvested in a strict sterile environment
during total joint arthroplasty surgery and immediately stored in
a freezer at -78º to -68º C after packing. Between January 2007
and December 2012, 2024 patients received 2083 allografts with a
minimum of 12 months of follow-up. The overall allograft-associated
infection rate was 1.2% (24/2024). Swab cultures of 2083 allografts
taken before implantation revealed 21 (1.0%) positive findings.
The 21 recipients were given various antibiotics at the individual
orthopaedic surgeon’s discretion. At the latest follow-up, none
of these 21 recipients displayed clinical signs of infection following
treatment. Based on these findings, we conclude that an incidental positive
culture finding for allografts does not correlate with subsequent
surgical site infection. Additional prolonged post-operative antibiotic
therapy may not be necessary for recipients of fresh-frozen bone
allograft with positive culture findings. Cite this article: