The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures. Data on SSF were retrospectively gathered from virtual fracture clinics (VFCs) across a large Scottish Health Board over a four-year period, from 1 January 2018 to 31 December 2021. The Bluespier Electronic Patient Record System identified any surgical procedure being undertaken in relation to a scaphoid injury over the same time period. Isolating patients who underwent surgical intervention for SSF was performed by cross-referencing the unique patient Community Health Index number for patients who underwent these scaphoid procedures with those seen at VFCs for SSF over this four-year period.Aims
Methods
The benefit of MRI in the preoperative assessment of scaphoid proximal fragment vascularity remains controversial. The purpose of this study is to compare preoperative MRI findings to intraoperative bleeding of the proximal scaphoid. A retrospective review of 102 patients who underwent surgery for scaphoid nonunion between January 2000 and December 2020 at a single institution were identified. Inclusion criteria were: isolated scaphoid nonunion; preoperative MRI assessing the proximal fragment vascularity; and operative details of the vascularity of the proximal fragment with the tourniquet deflated. MRI results and intraoperative findings were dichotomized as either ‘yes’ or ‘no’ for the presence of vascularity. A four-fold contingency table was used to analyze the utility of preoperative MRI with 95% confidence intervals. Relative risk was calculated for subgroups to analyze the association between variables and MRI accuracy.Aims
Methods
The aim of this study was to develop a core outcome set of what to measure in all future clinical research on hand fractures and joint injuries in adults. Phase 1 consisted of steps to identify potential outcome domains through systematic review of published studies, and exploration of the patient perspective through qualitative research, consisting of 25 semi-structured interviews and five focus groups. Phase 2 involved key stakeholder groups (patients, hand surgeons, and hand therapists) prioritizing the outcome domains via a three-round international Delphi survey, with a final consensus meeting to agree the final core outcome set.Aims
Methods
The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury. We report the five-year follow-up of a multicentre, two-arm, parallel-group randomized controlled trial. A total of 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation were recruited from 18 trauma centres in the United Kingdom. Patients were excluded if the surface of the wrist joint was so badly displaced it required open reduction. In all, 448 patients were randomized to receive either K-wire fixation or locking-plate fixation. In the K-wire group, there were 179 female and 38 male patients with a mean age of 59.1 years (19 to 89). In the locking-plate group, there were 194 female and 37 male patients with a mean age of 58.3 years (20 to 89). The primary outcome measure was the patient-rated wrist evaluation (PRWE). Secondary outcomes were health-related quality of life using the EuroQol five-dimension three-level (EQ-5D-3L) assessment, and further surgery related to the index fracture.Aims
Patients and Methods
Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis. A total of 76 patients, including 53 men and 23 women, with a mean age of 50 years (21 to 79) underwent wrist arthrodesis. Complications and re-operations were recorded. At a mean follow-up of 11 years (2 to 18), 63 patients completed questionnaires, and 57 attended for clinical and radiological assessment.Aims
Patients and Methods
The aims of this study were to evaluate the clinical and radiological
outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients
with rheumatoid arthritis. This was a retrospective review of all 95 Universal-2 TWAs which
were performed in our institution between 2003 to 2012 in patients
with rheumatoid arthritis. A total of six patients were lost to
follow-up and two died of unrelated causes. A total of ten patients
had bilateral procedures. Accordingly, 75 patients (85 TWAs) were
included in the study. There were 59 women and 16 men with a mean
age of 59 years (26 to 86). The mean follow-up was 53 months (24
to 120). Clinical assessment involved recording pain on a visual
analogue score, range of movement, grip strength, the Quick Disabilities
of the Arm, Shoulder and Hand (DASH) and Wrightington wrist scores.
Any adverse effects were documented with particular emphasis on
residual pain, limitation of movement, infection, dislocation and
the need for revision surgery. Radiographic assessment was performed pre-operatively and at
three, six and 12 months post-operatively, and annually thereafter.
Arthroplasties were assessed for distal row intercarpal fusion and
loosening. Radiolucent zones around the components were documented
according to a system developed at our institution.Aims
Patients and Methods
Aims. Total wrist arthrodesis (TWA) produces a spectrum of outcomes.
We investigated this by reviewing 77 consecutive TWA performed for
inflammatory and post-traumatic arthropathies, wrist instability
and as a
Arthritis of the wrist is a painful disabling
condition that has various causes and presentations. The traditional treatment
has been a total wrist fusion at a price of the elimination of movement.
However, forms of treatment which allow the preservation of movement
are now preferred. Modern arthroplasties of the wrist are still
not sufficiently robust to meet the demands of many patients, nor
do they restore normal kinematics of the wrist. A preferable compromise
may be selective excision and partial fusion of the wrist using
knowledge of the aetiology and pattern of degenerative change to
identify which joints can be sacrificed and which can be preserved. This article provides an overview of the treatment options available
for patients with arthritis of the wrist and an algorithm for selecting
an appropriate surgical strategy. Cite this article:
In Canada, Dupuytren's contracture is managed
with partial fasciectomy or percutaneous needle aponeurotomy (PNA).
Injectable collagenase will soon be available. The optimal management
of Dupuytren’s contracture is controversial and trade-offs exist
between the different methods. Using a cost-utility analysis approach,
our aim was to identify the most cost-effective form of treatment
for managing Dupuytren’s contracture it and the threshold at which
collagenase is cost-effective. We developed an expected-value decision
analysis model for Dupuytren’s contracture affecting a single finger,
comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase
from a societal perspective. Cost-effectiveness, one-way sensitivity
and variability analyses were performed using standard thresholds
for cost effective treatment ($50 000 to $100 000/QALY gained).
Percutaneous needle aponeurotomy was the preferred strategy for
managing contractures affecting a single finger. The cost-effectiveness
of primary aponeurotomy improved when repeated to treat recurrence.
Fasciectomy was not cost-effective. Collagenase was cost-effective
relative to and preferred over aponeurotomy at $875 and $470 per
course of treatment, respectively. In summary, our model supports the trend towards non-surgical
interventions for managing Dupuytren’s contracture affecting a single
finger. Injectable collagenase will only be feasible in our publicly
funded healthcare system if it costs significantly less than current
United States pricing. Cite this article:
