Database : MEDLINE
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[PMID]: 29519586
[Au] Autor:Herteleer M; Hoekstra H; Nijs S
[Ad] Address:Organ Systems, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Traumatology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium. Electronic address: Michiel.herteleer@kuleuven.be.
[Ti] Title:Diagnosis and treatment of clavicular fractures in Belgium between 2006 and 2015.
[So] Source:J Shoulder Elbow Surg;, 2018 Mar 06.
[Is] ISSN:1532-6500
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Clavicular fractures are common fractures of the shoulder girdle. The debate about whether these fractures should be treated conservatively or surgically is ongoing. This study describes the incidence of clavicular fractures in Belgium between 2006 and 2015 and how the surgical treatment rates have evolved during this time span. METHODS: The study included all patients who were diagnosed with a clavicular fracture or surgically treated in Belgium. The Belgian National Institute for Health and Disability Insurance provided the data, which included the patients' age, sex, location, and time of injury for the entire Belgian population. The fracture incidences and surgical treatment rates for different population groups were assessed. RESULTS: The incidence of clavicular fractures in Belgium increased from 56.5/100,000 persons/year in 2006 to 70.6/100,000 persons/year in 2015. The age-related incidence was U-shaped, with high incidences seen in both men and women younger than 18 and older than 70. The rate of surgically treated clavicular fractures increased by 190% between 2006 and 2015. CONCLUSION: The incidence of clavicular fractures in Belgium increased between 2006 and 2015. In the male population, the fracture incidence increased among all age groups, but in the female population, the increase was most noted in elderly patients. Although the preferred treatment strategy of clavicular fractures continues to be debated, there is a high and increasing rate of surgical treatment in Belgium, with an increasing percentage of patients that are surgically treated as outpatients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

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[PMID]: 29369103
[Au] Autor:Cha SM; Shin HD
[Ad] Address:From the Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
[Ti] Title:Antegrade Intramedullary Pinning in Subacute Fifth Metacarpal Neck Fracture After Failed Conservative Treatment: A Prospective Comparative Study With Acute Fracture.
[So] Source:Ann Plast Surg;80(4):347-352, 2018 Apr.
[Is] ISSN:1536-3708
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purposes of this study were to evaluate the efficacy of antegrade intramedullary pinning performed for neck fractures with angulations of over 30 degrees after failed conservative treatment during the subacute phase and to compare the radiologic and clinical results with those of acute fractures with angulations of over 30 degrees treated via the same procedure. METHODS: Seventy-three patients with a fifth metacarpal neck fracture were admitted to our institute between January 2010 and April 2015. Among them, 26 patients with an acute fracture (group 1) and 27 patients with a subacute fracture after failed conservative treatment who met the inclusion/exclusion criteria were investigated. After surgery, improvements in angulation and shortening, visual analog scale score for postoperative pain, Disabilities of the Arm, Shoulder, and Hand score, active range of motion, and grip strength were evaluated and compared. RESULTS: The mean durations of surgery from injury were 4.92 and 32.74 days in groups 1 and 2, respectively, with a significant difference (P < 0.001). The preoperative amounts of angulation were 44.91 and 45.89 degrees, and the amounts of preoperative shortening were 3.31 and 3.44 mm, respectively, with no significant difference (P > 0.05). At the final follow-up, the angulation had definitively improved compared with before surgery in both groups (P < 0.001, both). However, there was a slight significant difference in terms of the residual angulation of 3.35 and 5.56 degrees in groups 1 and 2, respectively (P = 0.02). Preoperative shortening was restored in both groups (P < 0.001, both) and the final state of residual shortening were similar (P = 0.06). The final visual analog scale scores, Disabilities of the Arm, Shoulder, and Hand scores, range of motion, and grip strength were all satisfactory in both groups without any significant difference. CONCLUSIONS: The failed treatment group, which had been predicted to obtain proper union through the initial use of conservative treatment, provided an adequate indication for noninvasive antegrade pinning. In addition, the current study suggested that closed reduction/immobilization remains a primary recommendation for angulated metacarpal neck fracture as long as careful observation is conducted if progression of the reduced fracture toward dorsal angulation is suspected.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1097/SAP.0000000000001265

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[PMID]: 29509625
[Au] Autor:Silvestre J; Upton J; Chang B; Steinberg DR
[Ad] Address:The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
[Ti] Title:The Impact of Specialty on Cases Performed During Hand Surgery Fellowship Training.
[So] Source:J Bone Joint Surg Am;100(5):e29, 2018 Mar 07.
[Is] ISSN:1535-1386
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. METHODS: Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests. An arbitrary 1,000% change between the 90th and 10th percentiles of fellows was used as a threshold to highlight case categories with substantial variability. RESULTS: In this study, 413 orthopaedic hand surgery fellows (87%) and 62 plastic surgery hand surgery fellows (13%) were included. Plastic surgery fellows reported more cases in the following categories: wound closure with graft; wound reconstruction with flap; vascular repair, reconstruction, replantation, or microvascular; closed treatment of fracture or dislocation; nerve injury; and congenital (p < 0.05). Orthopaedic surgery fellows reported more cases in the following categories: wound irrigation and debridement fasciotomy or wound preparation; hand reconstruction or releases; wrist reconstruction, releases, or arthrodesis; forearm, elbow, or shoulder reconstruction or releases; hand fractures, dislocation, or ligament injury; wrist fractures or dislocations; forearm and proximal fractures or dislocations; miscellaneous insertion or removal of devices; shoulder arthroscopy, elbow arthroscopy, and wrist arthroscopy; decompression of tendon sheath, synovectomy, or ganglions; nerve decompression; Dupuytren; and tumor or osteomyelitis (p < 0.05). Plastic surgery fellows reported substantial variability for 12 case categories (range, 1,024% to 2,880%). Orthopaedic surgery fellows reported substantial variability for 9 case categories (range, 1,110% to 9,700%). CONCLUSIONS: Orthopaedic and plastic hand surgery fellowships afford disparate operative experiences. Understanding these differences may help to align prospective trainees with future career goals and to guide discussions to better standardize hand surgery training.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:In-Data-Review
[do] DOI:10.2106/JBJS.17.00176

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[PMID]: 29266635
[Au] Autor:Keighley G; Hermans D; Lawton V; Duckworth D
[Ad] Address:Orthopaedic Department, Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia.
[Ti] Title:Radial nerve palsy in mid/distal humeral fractures: is early exploration effective?
[So] Source:ANZ J Surg;88(3):228-231, 2018 Mar.
[Is] ISSN:1445-2197
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:BACKGROUND: Radial nerve palsies are a common complication with displaced distal humeral fractures. This case series examines the outcomes of early operative exploration and decompression of the nerve with fracture fixation with the view that this provides a solid construct for optimisation of nerve recovery. METHODS: A total of 10 consecutive patients with a displaced distal humeral fracture and an acute radial nerve palsy were treated by the senior author by open reduction and internal fixation of the distal humerus and exploration and decompression of the radial nerve. Motor function and sensation of the radial nerve was assessed in the post-operative period every 2 months or until full recovery of the radial nerve function had occurred. RESULTS: All patients (100%) had recovery of motor and sensation function of their upper limb in the radial nerve distribution over a 12-month period. Recovery times ranged between 4 and 32 weeks, with the median time to recovery occurring at 26 weeks and the average time to full recovery being 22.9 weeks. Wrist extension recovered by an average of 3 months (range 2-26 weeks) and then finger extension started to recover 2-6 weeks after this. Disability of the arm, shoulder and hand scores ranged from 0 to 11.8 at greater than 1 year post-operatively. DISCUSSION: Our study demonstrated that early operative exploration of the radial nerve when performing an open stabilization of displaced distal humeral fractures resulted in a 100% recovery of the radial nerve.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Data-Review
[do] DOI:10.1111/ans.14259

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[PMID]: 29502700
[Au] Autor:Hohmann E
[Ti] Title:Editorial Commentary: Shoulder Subpectoral Biceps Tenodesis Significantly Increases the Humeral Fracture Risk-Is This a Reason to Look for Alternatives?
[So] Source:Arthroscopy;34(3):814-815, 2018 Mar.
[Is] ISSN:1526-3231
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Subpectoral tenodesis is performed at the surgical neck of the humerus. In a cadaveric study, the insertion of a unicortical PEEK (polyether ether ketone) screw decreased the torsional load to failure (fracture) by 30% compared with intact control specimens but was similar to unicortical reaming without screw insertion. Placing the biceps tendon into the tunnel and securing it with a unicortical screw reduced the torsional load to failure by 20%. Whether these facts are significant is currently unknown, but the creation of a stress riser is a concern and may possibly result in surgical neck fractures.
[Pt] Publication type:EDITORIAL
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:In-Data-Review

  6 / 7876 MEDLINE  
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[PMID]: 29498192
[Au] Autor:Drynan D; McArthur M; Vohora A; Hinton D; Menegon G; Wilkinson MPR
[Ad] Address:Orthopaedic Department, Westmead Hospital, Sydney, New South Wales, Australia.
[Ti] Title:Accuracy of digital radiography: regional scaling factors for trauma.
[So] Source:ANZ J Surg;, 2018 Mar 01.
[Is] ISSN:1445-2197
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:BACKGROUND: Surgical planning in trauma is essential for optimal patient care and best patient outcomes. Digital radiography has improved the availability, convenience and access to radiographs worldwide as used in every trauma centre in Australia. One shortcoming, however, is the variability in magnification error associated with different anatomic regions. Accurate assessment of radiographs is paramount to proper surgical planning. METHODS: A retrospective review of 513 post-operative trauma radiographs of implants at a single centre, collected from January 2015 to August 2016, was measured by the four individual investigators. A comparison of the digital calliper reading with the known implant size, taken from operation reports and company implant data, was conducted. Magnification scales were created for different anatomic regions: femur, tibia, humerus, elbow, wrist and hand, foot and ankle. RESULTS: Precise regional scaling factors increase accuracy of digital radiography. Average magnification for hand, wrist, ankle and forearm is 5% (1-16%). Average magnification for foot, knee, tibia and elbow is 8% (3-11%). Humerus magnification is 10.3% (3-17%) and shoulder and femur approximately 15% (12-18%). Inter-rater Pearson's R reliability testing is 0.985-0.995 and intra-observer reliability is 0.998. DISCUSSION: Applying regional scaling factors improves accuracy of digital imaging, therefore improving clinical decision-making regarding fractures, distance from bony landmarks, component sizing and reduction assessment. Femoral and tibial fracture measurements with appropriate scaling factors allow the accurate estimation of nail diameter required for fixation and screw diameter for fragment fixation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180302
[Lr] Last revision date:180302
[St] Status:Publisher
[do] DOI:10.1111/ans.14446

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[PMID]: 29496333
[Au] Autor:Na KT; Song SW; Lee YM; Choi JH
[Ad] Address:Department of Orthopedic Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
[Ti] Title:Modified triceps fascial tongue approach for primary total elbow arthroplasty.
[So] Source:J Shoulder Elbow Surg;, 2018 Feb 26.
[Is] ISSN:1532-6500
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Triceps weakness is a common complication of total elbow arthroplasty (TEA). Many posterior approaches for TEA have been introduced to maintain triceps function. The present study evaluated the clinical outcomes and extensor strengths of primary TEA with modified triceps fascial tongue approach. METHODS: Twenty-one primary TEAs performed in 20 patients by a single surgeon were reviewed with a mean of 64.2 months (range, 24-127 months) of follow-up. Every TEA was performed using the modified triceps fascial tongue approach, with the Coonrad-Morrey prosthesis. Patient demographics, range of motion, pain visual analog scale, and triceps strength (Medical Research Council [MRC] scale) were compared before and after the operation. The Mayo Elbow Performance Score was evaluated at the latest follow-up. RESULTS: Triceps strength was normal (MRC grade V) in 10 elbows (48%) and good (MRC grade IV) in 11 (52%). Triceps strength after arthroplasty was significantly improved compared with the preoperative strength (P < .001). Mean flexion arc was improved from 78° to 100° after arthroplasty (P = .004). However, mean flexion contracture (preoperative; 29°, postoperative; 26°) was not improved after surgery (P = .377). The mean visual analog scale pain score improved from 7.7 preoperatively to 2.4 postoperatively (P < .001). Postoperative Mayo Elbow Performance Scores were excellent in 13 elbows, good in 6, and fair in 2. The only complications were 3 intraoperative condylar fractures. CONCLUSIONS: Modified triceps fascial tongue approach is an easy and effective approach for primary TEA.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180302
[Lr] Last revision date:180302
[St] Status:Publisher

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[PMID]: 29488343
[Au] Autor:Barai A; Lambie B; Cosgrave C; Baxter J
[Ad] Address:Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
[Ti] Title:Management of distal radius fractures in the emergency department: A long-term functional outcome measure study with the Disabilities of Arm, Shoulder and Hand (DASH) scores.
[So] Source:Emerg Med Australas;, 2018 Feb 28.
[Is] ISSN:1742-6723
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Distal radius fracture (DRF) is a common presentation to the ED. However, little is known about the long-term functional outcome of these patients following their initial management in the ED. METHODS: In order to evaluate the long-term functional outcome of DRF, we collected the Disabilities of Arm, Shoulder and Hand (DASH) scores from the patients who attended our ED with DRF between January 2014 and June 2015. We divided the patients into two groups based on their overall management: (i) conservative group who did not have any surgical interventions; and (ii) open reduction internal fixation (ORIF) group who needed surgical interventions in the theatre. Multiple linear regression models were used to identify the statistically significant predictor variables. RESULTS: Out of the 229 patients whom we contacted, 128 patients responded. The response rate was 56%. The majority of the patients belonged to the conservative group (n = 87, 75%), while one-quarter of the patients were in the ORIF group (n = 29, 25%). DASH score was higher in the ORIF group (median = 12.1, 95% confidence interval 5.6-25) than the conservative group (median = 6, 95% confidence interval 1.7-16.4). This difference between the groups was statistically significant (unadjusted P = 0.017, Wilcoxon test). Multiple linear regression models revealed that the management group and age of the patients were significant predictors for DASH score. CONCLUSION: Conservative management had lower DASH scores signifying better functional outcomes. Further prospective multicentre studies may be suggested to assess the generalisability of the study.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180228
[Lr] Last revision date:180228
[St] Status:Publisher
[do] DOI:10.1111/1742-6723.12946

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[PMID]: 29486672
[Au] Autor:Torrens C; Alentorn-Geli E; Mingo F; Gamba C; Santana F
[Ad] Address:1 Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar - Hospital del Mar & Hospital de l'Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain.
[Ti] Title:Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes.
[So] Source:J Orthop Surg (Hong Kong);26(1):2309499018760132, 2018 Jan-Apr.
[Is] ISSN:2309-4990
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:PURPOSE: To investigate the influence of greater tuberosity healing on the functional outcomes of reverse shoulder arthroplasty (RSA) for the treatment of acute complex proximal humeral fractures (PHFs), and to investigate the influence of patient- and surgery-related factors in the healing of the greater tuberosity. METHODS: Retrospective study including 41 consecutive PHFs treated using RSA with minimum 2-year follow-up. In all the cases, tuberosities were reattached with a standardized technique. All the patients were assessed at the last follow-up with constant score. Body mass index, surgery delay, comorbidities, polyethylene size, glenosphere size, overhanging of glenosphere, and scapular notch were recorded, and their influence in final constant score and in greater tuberosity healing was analyzed. RESULTS: Mean final constant score was of 60.7 points (standard deviation (SD) = 9.9). Greater tuberosity healed in proper position in 68% of the cases. There were no significant differences in constant score between patients with (mean = 61; SD = 9.5) and without (mean = 61; SD = 11.3) the healing of greater tuberosity. All patients scored above 90° in forward elevation. Scapular notch was reported in 14.6% of the cases. Age significantly affected the constant score ( p = 0.008). Comorbidities significantly interfered with greater tuberosity healing ( p = 0.03). There was one reoperation after dislocation. CONCLUSION: In spite of expecting good functional outcome with low complication rate after RSA for acute PHFs, the influence of greater tuberosity healing on shoulder function could not be demonstrated. The presence of comorbidities, but not age or gender, negatively influenced the healing of the greater tuberosity.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180228
[Lr] Last revision date:180228
[St] Status:In-Data-Review
[do] DOI:10.1177/2309499018760132

  10 / 7876 MEDLINE  
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[PMID]: 29484901
[Au] Autor:Galle SE; Harness NG; Hacquebord JH; Burchette RJ; Peterson B
[Ad] Address:1 Columbia University, New York, NY, USA.
[Ti] Title:Complications of Radial Column Plating of the Distal Radius.
[So] Source:Hand (N Y);:1558944718760861, 2018 Feb 01.
[Is] ISSN:1558-9455
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Distal radius fractures treated with open reduction and internal fixation are commonly stabilized with a volar locking plate; however, more complex fracture patterns may require supplemental fixation with fragment-specific implants. The objective of this study was to evaluate the outcomes of distal radius fractures treated with radial column plates. METHODS: A consecutive series of 61 patients who sustained distal radius fractures underwent radial column plating alone or in conjunction with other implants between August 2006 and January 2014. Thirty-one patients returned for follow-up or returned a mailed questionnaire at an average of 4.1 years. The outcomes measures included Visual Analog Scale (VAS); Disabilities of the Arm, Shoulder and Hand (DASH); and Patient-Rated Wrist Evaluation (PRWE) scores. RESULTS: Sixty-one patients with a mean age of 55 years (range, 20-87) met inclusion criteria and were available for follow-up or chart review at an average of 5.2 years (range, 1.6-9.0 years). Seventeen of 61 (28%) underwent radial column plate removal. Twenty patients returned for final follow-up examination, and 11 completed questionnaires via mail. Subjective scores included a mean postoperative VAS of 0.72, DASH score of 17.2, and PRWE score of 15.7. Hardware sensitivity and wrist stiffness were the most common complications at final follow-up. CONCLUSIONS: Radial column plating of the distal radius is a safe treatment modality and a valuable adjunct in the setting of complex distal radius fractures, but patients should be counseled that there is a 28% chance that hardware removal may be required. Our retrospective review found evidence of few complications and objective scores consistent with return to normal function.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:Publisher
[do] DOI:10.1177/1558944718760861


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