The aim of this study was to determine the floor and ceiling effects for both the QuickDASH and
This systematic review and meta-analysis aimed to compare the outcome of operative and non-operative management in adults with distal radius fractures, with an additional elderly subgroup analysis. The main outcome was 12-month
Ulnocarpal impaction (UCI) is a common cause of ulnar-sided wrist pain. UCI typically occurs in wrists with positive ulnar variance, which causes altered loading mechanics between the ulnar head, lunate and triquetrum. However, many individuals with positive ulnar variance never develop UCI, and some with neutral or negative ulnar variance do experience UCI. This suggests that other variables contribute to the development of UCI. Suspected culprits include lunate morphology, and dynamic changes with loaded (grip) pronation. If these anatomic variations are contributing to UCI, we expect them to influence functional impairment scores. Therefore, the objective of this study was to evaluate the relationship between radiographic parameters and pre-surgical upper extremity patient-rated outcomes scores (PROS) in patients with a diagnosis of UCI. Retrospective cohort study of patients undergoing ulnar shortening osteotomy or arthroscopic wafer procedure for UCI. Data derived from prospectively collected departmental database that captured demographic, clinical, functional and radiographic information. Radiographic parameters evaluated were: lunate morphology [presence vs. absence of hamate facet; Antuna-Zapico (A-Z) classification], and dynamic changes on grip view [difference in lunate-ulnar head distance (LUD); difference in lunate uncovering index (LUI)]. PROS assessed were QuickDASH and Patient-Rated Wrist Evaluation (PRWE) scores, collected at patient enrolment. ANOVA was used to assess for differences in PROS between A-Z classification groups. Student's t-test was used to assess for differences in PROS based on presence/absence of a hamate facet. Regression analysis evaluated a relationship between change in LUD with grip and PROS, and change in LUI with grip and PROS. Preliminary analysis included 23 wrists, with a mean patient age of 48.9 years [standard deviation (SD) 14.5 years]. Forty-eight percent were male, and the dominant limb was involved in 52.2% of cases. Average QuickDASH and
Thumb Carpometacarpal (CMC) arthritis is a common pathology of the hand. Surgical treatment with thumb reconstruction is well described. Retrospective outcomes have been described for multiple techniques, suggesting patient satisfaction with multiple different techniques. The Thompson technique uses a slip of Abductor Pollicis Longus for suspension and interposition as well as excision of the trapezium. Retrospective outcomes suggest good patient satisfaction. We describe the improvement in Patient rated outcomes scores (PROS) and changes in pinch and grip strength in a prospectively collected cohort of patients treated with a modification of the Thompson technique. To assess changes in Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (QDASH) scores, as well as to determine the percentage of patients that surpassed the Minimal Clinically Important Difference (MCID) figure that has been described in the literature for these tests. In addition, measurements for evaluation of pinch and grip strength prior to surgery, at six, and at twelve months follow-up were done. Between June 2016 and February 2019, a consecutive prospective series of Thirty-seven LRTI procedures with APL suspension arthroplasty (Thompson technique) were performed on 34 patients with osteoarthritis of the thumb CMC joint (24 women / 13 men; age 63±8.553). All surgeries were performed by the senior surgeon. Data was collected as part of a wrist pain database. Patients failing conservative treatment and electing surgical management of thumb arthritis were enrolled into the database. Patients were evaluated pre-operatively with the
Pathologies such as Scapho-Lunate Advanced Collapse (SLAC), Scaphoid Non-union Advanced Collapse (SNAC) and Kienbock's disease can lead to arthritis in the wrist. Depending on the articular surfaces that are involved, motion preserving surgical procedures can be performed. Proximal Row Carpectomy (PRC) and Four Corner Fusion (4CF) are tried and tested surgical options. However, prospective studies comparing the two methods looking at sufficient sample sizes are limited in the literature. The purpose of this study was to prospectively compare the early results of PRC vs 4CF performed in a single centre. Patients with wrist arthritis were prospectively enrolled (2015 to 2021) in a single centre in Vancouver, Canada. Thirty-six patients and a total of 39 wrists underwent either a PRC (n=18) or 4CF (n=21) according to pre-operative clinical, radiographical, and intra-operative assessment. Patient-Rated Wrist Evaluation (PRWE) scores were obtained preoperatively, as well as at six months and one year post operatively. Secondary outcomes were range of motion (ROM) of the wrist, grip strength, reoperation and complication rates. Statistical significance was set at p=0.05. Respectively for PRC and 4CF, the average
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
Distal radius fractures (DRF) are common and the indication for surgical treatment remain controversial in patients higher than 60 years old. The purpose of the study was to review and analyze the current evidence-based literature. We performed a systematic review and meta-analysis according to PRISMA guidelines in order to evaluate the efficacy of volar locking plating (VLP) and conservative treatment in DRF in patients over 60 years old. Electronic databases including MEDLINE, CENTRAL, Embase, Web of science and Clinical Trial.gov were searched from inception to October 2020 for randomized controlled trials. Relevant article reference lists were also passed over. Two reviewers independently screened and extracted the data. Main outcomes included functional status: wrist range of motion, validated scores and grip strength. Secondary outcomes include post-operative complications and radiologic assessment. From 3009 screened citations, 5 trials (539 patients) met the inclusion criteria. All trials of this random effect meta-analysis were at moderate risk of bias due to lack of blinding. Differences in the DASH score (MD −5,91; 95% CI, −8,83; −3,00),
Distal radius fractures (DRF) are common and the indication for surgical treatment remain controversial in patients higher than 60 years old. The purpose of the study was to review and analyze the current evidence-based literature. We performed a systematic review and meta-analysis according to PRISMA guidelines in order to evaluate the efficacy of volar locking plating (VLP) and conservative treatment in DRF in patients over 60 years old. Electronic databases including MEDLINE, CENTRAL, Embase, Web of science and Clinical Trial.gov were searched from inception to October 2020 for randomized controlled trials. Relevant article reference lists were also passed over. Two reviewers independently screened and extracted the data. Main outcomes included functional status: wrist range of motion, validated scores and grip strength. Secondary outcomes include post-operative complications and radiologic assessment. From 3009 screened citations, 5 trials (539 patients) met the inclusion criteria. All trials of this random effect meta-analysis were at moderate risk of bias due to lack of blinding. Differences in the DASH score (MD −5,91; 95% CI, −8,83; −3,00),
Longstanding un-united scaphoid fractures or scapholunate insufficiency can progress to degenerative wrist osteoarthritis (termed scaphoid non-union advanced collapse (SNAC) or scapho-lunate advanced collapse (SLAC) respectively). Scaphoid excision and partial wrist fusion is a well-established procedure for the surgical treatment of this condition. In this study we present a novel technique and mid-term results, where fusion is reserved for the luno-capitate and triquetro-hamate joints, commonly referred to as bicolumnar fusion. The purpose of this study was to report functional and radiological outcomes in a series of patients who underwent this surgical technique. This was a prospective study of 23 consecutive patients (25 wrists) who underwent a bicolumnar carpal fusion from January 2014 to January 2017 due to a stage 2 or 3 SNAC/SLAC wrist, with a minimum follow-up of one year. In all cases two retrograde cannulated headless compression screws were used for inter-carpal fixation. The clinical assessment consisted of range of motion, grip and pinch strength that were compared with the unaffected contralateral side where possible. Patient-reported outcome measures, including the DASH and
Abstract. Background. Scaphoid non-union can result in pain, altered wrist kinematics leading to a Scaphoid Non-union Advance Collapse, ultimately to symptomatic radio-carpal arthritis. Open techniques have their limitations. We describe the rationale, surgical technique and outcomes of our series of arthroscopic bone-grafting (ABG) and fixation of scaphoid non-union. Methods. We performed a prospective single-surgeon series of 22 consecutive patients with clinico-radiologically established scaphoid non-union between March 2015 and April 2019. Data was collected from Electronic Patient Records, Patient Archived Computer system (PACS) and hand therapy assessments. We collected demographic data including age, hand-dominance, occupation and mechanism of injury. The Disabilities of the Arm, Shoulder and Hand Score (Quick DASH), Mayo wrist score, Patient Rated Wrist Evaluation (PRWE) and grip-strength measurements were collected preoperatively and at follow-up appointments. Results. There was an improvement in all outcome measures when comparing preoperative and postoperative results. The Quick DASH score improved by a mean of 24 points, Mayo wrist and
There is ongoing debate regarding the optimal management of displaced distal radius fractures in the elderly. The aim of this review was to compare outcomes of operatively versus non-operatively managed displaced extra-articular or undisplaced intra-articular distal radius fractures in patients 65 years and older. All patients over the age of 65 years with displaced extra-articular or undisplaced intra-articular fractures seen in Tauranga Hospital between 1. st. January 2009 and 31st December 2009 were included in the study. Patients from out of town, with incomplete radiographs or who had since passed away were excluded as were patients with comminuted intra-articular or undisplaced/minimally displaced extra-articular fractures. Patients attended follow-up where clinical assessment was carried out by a single Hand Therapist who was blinded to the side of injury and previous management, completed the Patient Rated Wrist Evaluation (PRWE) and DASH questionnaires and a visual analogue satisfaction score. There were 91 distal radius fractures in patients 65 years and older seen in Tauranga Hospital over this 1 year period. 44 were excluded leaving 47 patients. 6 declined follow-up and 5 failed to attend. 36 patients (3 males, 33 females, average age 74.7 years) were included in the study – 23 had been treated non-operatively with casting +/− manipulation while the remaining 13 patients had undergone open reduction and internal fixation. Comparing the injured with the uninjured wrist in the operatively managed group there was an average loss of 5.8 degrees flexion, 1.2 degrees extension, 1.7 degrees ulnar deviation and 3.8 degrees supination with a gain of 0.7 degrees radial deviation, no change in pronation and a loss of 1.2kg in grip strength. These operatively managed patients had an average
Perioperative glucocorticoids have been used as a successful non-opioid analgesic adjunct for various orthopaedic procedures. Here we describe an ongoing randomized control trial assessing the efficacy of a post-operative methylprednisolone taper course on immediate post-operative pain and function following surgical distal radius fixation. We hypothesize that a post-operative methylprednisolone taper course following distal radius fracture fixation will lead to improved patient pain and function. This study is a randomized control trial (NCT03661645) of a group of patients treated surgically for distal radius fractures. Patients were randomly assigned at the time of surgery to receive intraoperative dexamethasone only or intraoperative dexamethasone followed by a 6-day oral methylprednisolone (Medrol) taper course. All patients received the same standardized perioperative pain management protocol. A pain journal was used to record visual analog pain scores (VAS-pain), VAS-nausea, and number of opioid tablets consumed during the first 7 post-operative days (POD). Patients were seen at 2-weeks, 6-weeks, and 12-weeks post-operatively for clinical evaluation and collection of patient reported outcomes (Disabilities of the Arm, Shoulder and Hand Score [qDASH]). Differences in categorical variables were assessed with χ2 or Fischer's exact tests. T-tests or Mann-Whitney-U tests were used to compare continuous data. Forty-three patients were enrolled from October 2018 to October 2019. 20 patients have been assigned to the control group and 23 patients have been assigned to the treatment group. There were no differences in age (p=0.7259), Body Mass Index (p=0.361), race (p=0.5605), smoking status (p=0.0844), or pre-operative narcotic use (p=0.2276) between cohorts. 83.7% (n=36) of patients were female and the median age was 56.9 years. No differences were seen in pre-operative qDASH (p=0.2359) or pre-operative
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 distal radial fracture managed with a radial volar locking plate were identified from hospital audit data systems. Data was collected on all patients from patient notes including radiographs performed pre- and post-operatively and functional scores using the Patient Rated Wrist Evaluation score (PRWE). The study was approved by the Barwon Health Research and Ethics Advisory Committee. In total, there were 153 patients (105 female, 48 male) from all 11 surgeons in the unit. Patients ranged in age from 17 to 91 years, average age of 53.7 years at time of injury (IQR 41-70yr). A quarter had concomitant other injuries, and 60% had type C1-C3 fractures. Most of the patients (n = 147) had the AO Synthes DRVLP, six patients had other volar locking plate systems. Twenty-seven percent of patients (n = 42) had exogenous bone graft insertion for more unstable fracture patterns. The major complication rate was 12% (18/153) with 17 cases requiring further surgery. Post-operative radiographs demonstrated no increase in ulnar variance (median 0.0mm IQR 2.0 to1.0 mm) but an increase in radial inclination by 5 deg (IQR 0-12 deg), radial length by 3.5 mm (IQR 1.0-6.3 mm) and radial tilt by 17 deg (IQR 3-32 deg) (volar angulation) compared to pre-operative radiographs, which was statistically significant (all p<0.001). Ninety percent of patients returned a
Trapeziometacarpal arthritis is a common condition, causing symptoms in up to ten percent of women and one percent of men¹. LRTI is the most commonly used surgical technique for this condition however, long-term studies have shown persistent weakness of pinch strength² after surgery. The Ascension® PyroDisk is a pyrocarbon disk shaped implant designed to articulate against the trapezium and metacarpal, preserving the height of the articulation. The objective of this study was to determine whether treatment with a pyrocarbon implant resulted in comparable pain relief and range of motion, whilst providing superior gains in pinch strength when compared to LRTI. This is a prospective randomized control trial comparing pyrocarbon implant to LRTI. Surgeries were accomplished by a single surgeon in a standardized fashion. Patients were evaluated at six weeks, three, six and 12 months following surgery. Data on pain (VAS), function (Patient Rated Wrist Evaluation (PRWE)), mobility and strength (grip, key and lateral pinch) were obtained as well as radiographic assessment of the height of the arthroplasty space. A total of 80 patients had surgery between July 2008 and November 2016. Forty patients were allocated to the PyroDisk group and 40 to the LRTI group. Seventy-four patients (92,5%) completed the one year follow-up. Mean age was slightly older in the PyroDisk group (64 vs 60,8 y.o., p=0,03). Surgical and tourniquet times were longer in the PyroDisk group. There was no difference between the groups in strength, pain or functional outcome at one year. However, VAS was significantly higher in the PyroDisk group at three and six months (4,5 vs 2,4, p < 0,001, 2,6 vs 1,7, p=0,02) and
Volar Locking Plates (VLP) have revolutionised the treatment of distal radius fractures allowing the anatomic reduction and stable fixation of the more comminuted and unstable of fractures. The benefits of this in terms of range of movement (ROM), pain and earlier return to work and daily activities is documented. However we were interested in was what improvements in wrist function patients made from 6 to 12 months after injury?. Methods. We retrospectively looked at a series of 34 consecutive patients that had undergone VLP fixation through a standard anterior approach followed by early physiotherapy. We documented standard demographics and assessed function in terms of Range of Movement, Grip strength (GS), Modified Gartland and Werley score (MGWS), Patient Rated Wrist Evaluation (PRWE) and the quick DASH questionnaire at six and twelve months. Results. Two patients were excluded from analysis as they failed to make both assessments. Of the 32 remaining (26 female:6 male) the mean age was 53.2yrs; range (26–78). On average GS, PGS, VAS function and pain did not improve. There was a modest improvement in Movement; Wrist Flexon-13 deg, Wrist Extension-14deg, Radial Deviation-7deg, Ulnar Deviation-9deg. There was no improvement in pronation and supination. There was little improvement in qDASH,
Introduction. The management of chronic wrist pain is a challenging clinical problem. Wrist denervation aims to achieve an improvement in pain through selective neurotomy, irrespective of cause. Numerous authors have reported their experience and demonstrated a range of clinical outcomes. No studies to date have reliably identified patient populations in whom denervation surgery is most likely to succeed. We aimed to establish and investigate a new approach, combining local anaesthetic injections with a uniquely tailored functional assessment by a hand therapist, to act as a tool to identify individuals in whom surgical denervation is more likely to yield benefit. Methods. We conducted a retrospective review of 17 patients who had undergone wrist denervation procedures following our method of pre-operative assessment and selection. Patients in whom denervation was combined with other diagnostic or therapeutic surgical procedures were excluded. Each patient underwent an initial assessment by a hand therapist in which pain and functional scores were recorded using the Patient Rated Wrist Evaluation (PRWE). Further unique assessments of function were made, tailored to the functional goals and requirements of each patient. Pain scores were measured for each task. Local anaesthetic injections were then administered around the nerves considered for neurotomy and the assessments were repeated. Patients who demonstrated clear improvements in pain and function underwent surgery. Post-operative assessments of pain and function were repeated. Results. Results were analysed using the Wilcoxon signed ranks test. There was a statistically significant improvement in pain following wrist denervation surgery (p=0.06) as well as an improvement in function as measured on
Aims. To study the outcomes of DVR plating for distal radius fractures. Methods. We prospectively studied all patients managed with a DVR plate, over a twelve-month period in 2006/07. All patients were seen in our dedicated research clinic at 2, 6, 12 and 26 weeks post-operatively. Physiotherapy started at 2 weeks post-operatively. Active range of motion (ROM) of the injured wrist was recorded at 6, 12 and 26 weeks and compared with the normal side. Standardised radiographs were taken at 2 and 6 weeks and compared with pre- and post-operative films for radial and volar angulations, relative radial length, ulnar variance and implant position. Patient satisfaction was measured with the Patient Rated Wrist Evaluation score (PRWE) at 6, 12 and 26 weeks. Results. 129 patients (male:female 1:3) with a median age of 59 years (92-17 years) were seen. Mean measurements of pre-operative films were of 16 degrees dorsal angulation, 15 degrees radial inclination, 7 mm relative radial length and +2mm ulnar variance. In comparison post-operative results were -6 degrees, +22 degrees, 11mm and 0mm respectively, which remained unchanged at 2 and 6 weeks. The mean comparative active ROM was 70%, 88% and 98% at 6, 12 and 26 weeks respectively. The
BACKGROUND. In our institution we use the Winklestabile volar locking plate for operative fixation of distal radius fractures. This study aims to assess subjective and objective outcomes using this method of treatment. METHODS. A total of 21 patients who underwent ORIF of distal radius fractures with the Winklestable plate in 2005 with a minimum follow up of 12 months were assessed using the Patient Rated Wrist Evaluation (PRWE) questionnaire and the Disabilities of the Arm Shoulder and Hand (DASH) score. Range of wrist movement (ROM), grip strength and pinchgrip strength were assessed by comparison with the unaffected wrist. RESULTS. Mean age was 64.34yrs (median 65.74, interquartile range (IQR) 59.11 – 71.80). The mean time from presentation to surgery was 2.0 days (median 1.0, IQR 1.0 - 2.0). Radiological union was confirmed after a mean of 83.3 days (median 83.0, IQR 83.0 – 90.0). Twenty fractures followed low energy trauma and 19 were closed. Eleven fractures were extra-articular. None, minimal or mild
Increased use of locking volar plates for distal radius fractures led to a number of reports in literature of flexor tendon injuries from impingement and attrition against hardware. Repair of the pronator quadratus is critical in preventing tendon injury. We present a pronator quadratus sparing approach to the distal radius. The senior author has used a pronator quadratus sparing lateral pillar approach for for the past five years. A lateral incision is used over the radial styloid. The first dorsal compartment is released and APL and EPB tendons retracted. The underlying brachio-radialis tendon and insertion fascia is split and the palmar portion elevated off the distal radius with the pronator quadratus as a single contiguous sheet. The distal edge of the pronator quadratus is elevated from the wrist capsule by sharp dissection. The radial artery is protected by the retracted tissue. Repair of the brachio-radialis tendon and insertion fascia is much more robust than that of the pronator quadratus covering the entire plate. Since 2004, the senior author has used the pronator quadratus sparing approach for volar plating of the distal radius, in 183 cases. At last follow-up there were no instances of flexor tendon injury, which was considered to be one of the outcome measures and end-points. There was no impingement in the first dorsal compartment, except in two cases of lateral pillar hardware impingement from additional lateral pillar plate fixation through the same approach. Nine cases had minor persistent superficial radial nerve parasthesia. One case had a superficial wound infection requiring drainage. The repaired pronator quadratus formed a barrier protecting the plate. The infection was aggressively treated and the plate left in situ for three months till fracture union. Cultures from the retrieved plate showed no organisms. Another implant had two of the locking screws back out. The pronator quadratus fascia was tented with an underlying haematoma. The fascia however only showed minimum screw penetration and no flexor tendon injury. Average wrist dorsiflexion was 72 deg and palmar flexion 65 deg. Average pronation was 81 deg and average supination 69 deg. Supination range was slow to recover in younger patients. One explanation could be the tight pronator quadratus repair. Average
