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Plastic and Reconstructive Surgery Aug 2019Older patients are frequently referred to hand therapy after distal radius fracture. Supervised therapy sessions place a transportation burden on patients and are costly... (Comparative Study)
Comparative Study Randomized Controlled Trial
The Relationship between Hand Therapy and Long-Term Outcomes after Distal Radius Fracture in Older Adults: Evidence from the Randomized Wrist and Radius Injury Surgical Trial.
BACKGROUND
Older patients are frequently referred to hand therapy after distal radius fracture. Supervised therapy sessions place a transportation burden on patients and are costly on both the individual and systematic levels. Furthermore, there is little evidence that supervised therapy or home exercises improve long-term outcomes.
METHODS
Data were collected for the Wrist and Radius Injury Surgical Trial, a multicenter, international, pragmatic, randomized trial of distal radius fracture treatment in patients aged 60 years and older. Referral to therapy and therapy protocol were at the discretion of the treating surgeon and therapist. The authors examined outcomes between participants who underwent therapy and those who did not and assessed the duration of therapy. The authors also analyzed the effect of therapy on subgroups at risk for poor outcomes: older participants and those who had more comorbidities or lower baseline activity.
RESULTS
Eighty percent of participants underwent therapy; 70 percent participated in both supervised therapy and home exercises. Participants had a mean 9.2 supervised sessions over 14.2 weeks. There were no differences in patient-reported outcomes between participants who underwent therapy and those who did not. Participants who did not have therapy recovered more grip strength. Participants who engaged in therapy for a shorter time reported greater function, ability to work, and satisfaction. There were no relationships revealed in subgroup analyses.
CONCLUSIONS
Hand therapy after distal radius fracture may not be necessary for older patients. Encouraging participants to resume activities of daily living as soon as possible may be as effective as formal therapy.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, II.
Topics: Age Factors; Aged; Exercise Therapy; Female; Follow-Up Studies; Fracture Fixation, Internal; Hand; Humans; Injury Severity Score; Male; Middle Aged; Postoperative Care; Radius Fractures; Range of Motion, Articular; Risk Assessment; Time Factors; Treatment Outcome; Wrist Injuries
PubMed: 31348349
DOI: 10.1097/PRS.0000000000005829 -
Bulletin of the NYU Hospital For Joint... 2011Perilunate wrist injuries are relatively rare but devastating injuries that can alter the lifestyles of those sustaining them. It is important to recognize the magnitude... (Review)
Review
Perilunate wrist injuries are relatively rare but devastating injuries that can alter the lifestyles of those sustaining them. It is important to recognize the magnitude of the injury and to provide immediate and complete care to the patient. Two of the most important factors affecting outcomes are timing of the care provided and quality of the reduction and carpal alignment following definitive management. This review explores the anatomy, pathoanatomy, and biomechanics, as well as the diagnoses and different treatment options for perilunate wrist injuries available to date and their complications and outcomes.
Topics: Humans; Joint Dislocations; Wrist Injuries; Wrist Joint
PubMed: 21332444
DOI: No ID Found -
Hand Clinics Nov 2017After reviewing this article, readers should have a comprehensive understanding of the indications for diagnostic arthroscopy, technical considerations in performing a... (Review)
Review
After reviewing this article, readers should have a comprehensive understanding of the indications for diagnostic arthroscopy, technical considerations in performing a systematic evaluation of the wrist, and limitations of this technique.
Topics: Arthroscopes; Arthroscopy; Cartilage, Articular; Humans; Ligaments, Articular; Wrist Injuries; Wrist Joint
PubMed: 28991570
DOI: 10.1016/j.hcl.2017.06.004 -
Clinics in Plastic Surgery Jul 2019Hand and wrist fractures are common in the pediatric population. Accurate diagnosis relies on the understanding of the physeal anatomy and carpal ossification. Treatment... (Review)
Review
Hand and wrist fractures are common in the pediatric population. Accurate diagnosis relies on the understanding of the physeal anatomy and carpal ossification. Treatment of these fractures is largely influenced by physeal biology and compliance with treatment. A majority have a favorable outcome with nonoperative treatment. Operative treatment should be considered in patients with clinical deformity, open fractures, and significant fracture displacement. Physeal-friendly surgical approaches and implants should be used to minimize the sequelae of physeal injury.
Topics: Adolescent; Age Factors; Child; Child, Preschool; Hand Bones; Hand Injuries; Humans; Infant; Intra-Articular Fractures; Wrist Injuries
PubMed: 31103087
DOI: 10.1016/j.cps.2019.02.012 -
BMC Musculoskeletal Disorders Feb 2020Distal radius fractures are the most common of all fractures. Optimal treatment is still debated. Previous studies report substantial changes in treatment trends in... (Observational Study)
Observational Study
Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register.
BACKGROUND
Distal radius fractures are the most common of all fractures. Optimal treatment is still debated. Previous studies report substantial changes in treatment trends in recent decades. Few nation-wide studies on distal radius fracture epidemiology and treatment exist, none of which provide detailed data on patient and injury characteristics, fracture pattern and mortality. The aim of this study was to describe the epidemiology, fracture classification, current treatment regimens and mortality of distal radius fractures in adults within the context of a large national register study.
METHODS
We performed a descriptive study using prospectively registered data from the Swedish fracture register. Included were all non-pathological distal radius fractures registered between January 1st 2015 and December 31st 2017 in patients aged 18 years and above. Nominal variables were presented as proportions of all registered fractures.
RESULTS
A total of 23,394 distal radius fractures in 22,962 patients were identified. The mean age was 62.7 ± 17.6 years for all, 65.4 ± 16.0 for women and 53.6 ± 20.0 for men. A simple fall was the most common cause of injury (75%, n = 17,643/23,394). One third (33%, n = 7783/21,723) of all fractures occurred at the patients' residence. 65% (n = 15,178/23,394) of all fractures were classified as extra-articular AO-23-A, 12% (n = 2770/23,394) as partially intra-articular AO-23-B and 23% (n = 5446/23,394) as intra-articular AO-23-C. The primary treatment was non-surgical for 74% (n = 17,358/23,369) and surgical for 26% (n = 6011/23,369) of all fractures. Only 18% of the AO-23-A fractures were treated surgically, compared to 48% of the AO-23-C fractures. The most frequently used surgical method was plate fixation (82%, n = 4954/5972), followed by pin/wire fixation (8.2%, n = 490/5972), external fixation (4.8%, n = 289/5972) and other methods (4.0%, n = 239/5972). The overall 30-day mortality was 0.4% (n = 98/23,394) and the 1-year mortality 2.9% (n = 679/23,394).
CONCLUSION
This nation-wide observational study provides comprehensive data on the epidemiology, fracture classification and current treatment regimens of distal radius fractures in a western European setting. The most common patient was an eldery woman who sustained a distal radius fracture through a simple fall in her own residence, and whose fracture was extra-articluar and treated non-surgically.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Radius Fractures; Registries; Sweden; Wrist Injuries; Young Adult
PubMed: 32035488
DOI: 10.1186/s12891-020-3097-8 -
Hand (New York, N.Y.) Mar 2019Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by... (Review)
Review
BACKGROUND
Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury.
METHODS
A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms "Galeazzi" and "fracture." Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found.
RESULTS
The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted.
CONCLUSIONS
In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.
Topics: Fracture Dislocation; Humans; Joint Instability; Missed Diagnosis; Radius Fractures; Tendon Entrapment; Time-to-Treatment; Wrist Injuries
PubMed: 29185351
DOI: 10.1177/1558944717744334 -
BMJ Case Reports Jan 2021A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from...
A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from case reports. In this case, we present a 51-year-old right-hand dominant male who sustained the injury after a fall. He attended the emergency department on the same day and a closed reduction was able to be performed under a haematoma block. On review in follow-up clinic the patient's symptoms had completely resolved.
Topics: Accidental Falls; Casts, Surgical; Closed Fracture Reduction; Humans; Joint Dislocations; Male; Middle Aged; Pisiform Bone; Treatment Outcome; Wrist Injuries
PubMed: 33408102
DOI: 10.1136/bcr-2020-237482 -
Orthopaedics & Traumatology, Surgery &... Feb 2016High-energy injuries to the wrist gather complex fractures of the distal radius, radiocarpal dislocations, perilunate dislocations, and other intracarpal dislocations.... (Review)
Review
High-energy injuries to the wrist gather complex fractures of the distal radius, radiocarpal dislocations, perilunate dislocations, and other intracarpal dislocations. Depending on the energy of the injury and the position of the wrist at the time of impact, the patient, often a young male with a high functional demand, presents one of these injuries associating fracture(s) and ligament injury. The trauma is often bilateral, with proximal lesions (elbow) very often associated with contusion or compression of the median nerve. Diagnosis is confirmed by wrist X-rays, which are sufficient to determine treatment for radiocarpal and perilunate dislocations. In cases of distal radius fractures or other intracarpal dislocations, a preoperative CT is necessary. Reduction of the dislocation and relief of neurovascular compression are performed immediately. The final treatment of each lesion (bone fixation, ligament repair) can be undertaken simultaneously or delayed, depending on the patient and the lesions. Cartilage lesions, resulting from the high-energy injury, can be estimated using arthroscopy but cannot be repaired and determine the prognosis. The surgeon's objective is to restore joint congruence, which does not prevent stiffness, the main complication of these rare injuries, which the surgeon must know how to recognize and treat.
Topics: Arthroscopy; Carpal Joints; Elbow Joint; Humans; Joint Dislocations; Radiography; Radius Fractures; Wrist Injuries; Wrist Joint
PubMed: 26782706
DOI: 10.1016/j.otsr.2015.05.009 -
Cartilage Dec 2021Focal cartilage injuries, and posttraumatic osteoarthritis (OA) in the wrist are likely common and a cause of wrist pain. To estimate the incidence of cartilage lesions... (Review)
Review
OBJECTIVE
Focal cartilage injuries, and posttraumatic osteoarthritis (OA) in the wrist are likely common and a cause of wrist pain. To estimate the incidence of cartilage lesions and to understand the pathomechanisms leading to wrist cartilage injuries and OA, a literature review on the subject was performed combined with a presentation of one of the authors' own experience.
DESIGN
This study includes a literature review of the topic. As a comparison to the review findings, the observations of one of the authors' consecutive 48 wrist arthroscopies, were assessed. PubMed, Scholar, and Cochrane databases were searched using the keywords "cartilage injury AND wrist AND treatment" and "wrist AND cartilage AND chondral AND osteochondral AND degenerative OA."
:RESULT
A total of 11 articles, including 9 concerning chondral and osteochondral repair and treatment and 2 regarding posttraumatic OA, were retrieved. The cartilage repair treatments used in these articles were drilling, osteochondral autograft, juvenile articular cartilage allograft, and chondrocyte implantation. One article displayed concomitant cartilage injuries in displaced distal radius fractures in 32% of the patients. The review of our findings from a 1-year cohort of wrist arthroscopies showed 17% cartilage injuries.
CONCLUSION
There is a lack of knowledge in current literature on cartilage injuries and treatment, as well as posttraumatic OA in the wrist. Cartilage injuries appear to be common, being found in 17% to 32% of all wrist arthroscopies after trauma, but no guidelines regarding conservative or surgical treatment can be recommended at the moment. Larger prospective comparative studies are needed.
Topics: Arthroscopy; Cartilage Diseases; Cartilage, Articular; Humans; Osteoarthritis; Prospective Studies; Wrist; Wrist Injuries
PubMed: 34128415
DOI: 10.1177/19476035211021909 -
European Journal of Trauma and... Dec 2022The purpose of this study was to describe the epidemiology, treatment and costs of hand and wrist injuries presenting to the Dutch ED. With increasing medical costs and...
PURPOSE
The purpose of this study was to describe the epidemiology, treatment and costs of hand and wrist injuries presenting to the Dutch ED. With increasing medical costs and crowding of emergency departments (ED), a more detailed description of emergency department attendance of hand and wrist injuries and their treatment may help to facilitate more adequate allocation of health care services.
METHODS
The Dutch Injury Surveillance System obtained a total of 160,250 hand and wrist injuries. Patient characteristics, incidence rates, type of injury, treatment, and costs were described.
RESULTS
The incidence of hand and wrist injuries in the Netherlands in 2016 was 11 per 1000 in males and 8 per 1000 in females. This is about 25% of all injuries presented at the ED. Of all hand injuries, only 3% was directly admitted to the hospital or received emergency surgery. Thirty percent did not need further treatment in the hospital.
CONCLUSION
The current data suggest that a substantial proportion of the hand and wrist injuries needed no subsequent specialized treatment. Although the severity of the injury could not be deduced from our data, the data suggest a ground for a more extensive role of primary health care (general) practitioners in the primary triage and treatment of hand and wrist injuries. This may reduce health care cost and help decongest the ED departments. Prospective studies are needed to confirm these preliminary conclusions.
LEVEL OF EVIDENCE
III.
Topics: Male; Female; Humans; Wrist Injuries; Incidence; Hand Injuries; Emergency Service, Hospital; Health Care Costs
PubMed: 34196727
DOI: 10.1007/s00068-021-01732-x