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- Abramo, Antonio, et al.
(författare)
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Evaluation of a treatment protocol in distal radius fractures: a prospective study in 581 patients using DASH as outcome.
- 2008
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 79:3, s. 376-385
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Distal radius fractures are most often treated nonoperatively, but sometimes they are treated surgically when deemed unstable. Based on the literature, a consensus protocol for treatment has been developed in southern Sweden to aid clinicians in their decision making. We evaluated the results of this protocol prospectively using a validated outcome instrument (DASH) in a large consecutive and population based series of unselected patients. METHODS: 581 patients were treated according the protocol. Age, sex, fracture side, and type of treatment were registered. The subjective outcome was measured by DASH. 133 patients were operated. RESULTS: 75% of the patients returned the questionnaire. The median DASH score at 3 months was 18.3 and at 12 months it was 7.5. All treatment groups had low DASH scores at the final follow-up. Reduced, nonoperated fractures had a worse score (11.6) than undisplaced (4.2) or operated fractures (6.0). Age was the only other predictor, with older patients having a worse score. A correlation was found between the short-version 11-item QuickDASH questionnaire and the full 30-item DASH, both at 3 months (r = 0.98) and at 1 year (r = 0.97) (p< 0.001 for both). INTERPRETATION: Most patients have residual symptoms at 3 months after the fracture but are normalized at 1 year. Good final subjective result was achieved with the proposed protocol regardless of initial severity and treatment of the fracture, as indicated by a low median DASH score in all groups. There was correlation between QuickDASH and the full DASH, and the former could be used in future studies.
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- Abramo, Antonio
(författare)
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Fracture of the distal radius - outcome, primary surgery and treatment of malunion
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A consensus protocol for treatment of distal radius fractures (DRF) has been developed to aid clinicians in treatment decision making. The protocol was evaluated in Paper I using a validated subjective outcome instrument, DASH in 518 consecutive patients. A good final subjective result was achieved with the proposed protocol, regardless of initial severity with a low median DASH score in all groups at final follow up 1 year after the fracture. No differences were seen for the various operative techniques. In Paper II, 50 patients with an unstable or complex DRF were randomized to either closed reduction and external fixation, or open reduction and internal fixation using the TriMed® system. Pronation/supination and grip strength were better in the internal fixation group at one year compared to the external fixation group. There were no differences in DASH scores or in radiographic parameters. In Paper III we investigated function in patients following an osteotomy due to a malunion after a DRF. Instead of autologous iliac crest bone graft we used a slow resorbing bone substitute (Norian SRS®), consisting of hydroxyapatite, to fill the gap in combination with the TriMed system for fixation. We were able to improve forearm rotation, flexion/extension and radioulnar deviation from. Grip strength increased and DASH scores decreased substantially. The achieved radiographic correction was consistent over the first year but the resorption was slow and the time to remodel was long. In Paper IV a novel bone substitute (Cerament®) was used with a faster resorbing mixture of calcium phosphate and calcium sulphate. 15 consecutive patients with a radiographic and clinically manifesting malunion after a DRF underwent an osteotomy. The same technique was used for fixation of the osteotomy as in Paper III but this time with Cerament® as bone substitute. Grip strength increased and DASH scores decreased. A fast remodelling of the bone was noticed but also an increase of ulnar variance from immediately postoperatively to final follow up. Using a bone substitute, the operation can be performed as an outpatient procedure and donor site pain avoided. Osteotomy of the distal radius is an effective treatment for malunited distal radius fractures, but perhaps a more rigid fixation is needed in fast remodelling bone substitutes.
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- Abramo, Antonio, et al.
(författare)
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Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures A randomized study of 50 patients
- 2009
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 80:4, s. 478-485
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation. Methods 50 patients with an unstable or comminute distal radius fracture were randomized to either closed reduction and bridging external fixation, or open reduction and internal fixation using the TriMed system. The primary outcome parameter was grip strength, but the patients were followed for 1 year with objective clinical assessment, subjective outcome using DASH, and radiographic examination. Results At 1 year postoperatively, grip strength was 90% (SD 16) of the uninjured side in the internal fixation group and 78% (17) in the external fixation group. Pronation/supination was 150 degrees (15) in the internal fixation group and 136 degrees (20) in the external fixation group at 1 year. There were no differences in DASH scores or in radiographic parameters. 5 patients in the external fixation group were reoperated due to malunion, as compared to 1 in the internal fixation group. 7 other cases were classified as radiographic malunion: 5 in the external fixation group and 2 in the internal fixation group. Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year, and tended to have less malunions than external fixation. No difference could be found regarding subjective outcome.
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| 6. |
- Abramo, Antonio, et al.
(författare)
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Osteotomy of distal radius fracture malunion using a fast remodeling bone substitute consisting of calcium sulphate and calcium phosphate.
- 2010
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Ingår i: Journal of biomedical materials research. Part B, Applied biomaterials. - : Wiley. - 1552-4981 .- 1552-4973. ; 92:1, s. 281-6
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Tidskriftsartikel (refereegranskat)abstract
- Malunion after a distal radius fracture can be treated with an osteotomy of the distal radius. Autologous iliac crest bone graft is often used to fill the gap, but the procedure is associated with donor site morbidity. In this study a novel fast resorbing biphasic bone substitute consisting of a mixture of calcium sulphate and calcium phosphate is used (Cerament BoneSupport AB, Sweden). Fifteen consecutive patients, with a mean age of 52 (27-71) years were included. All had a malunion after a distal radius fracture and underwent an osteotomy. A fragment specific fixation system, TriMed (TriMed, Valencia, CA), consisting of a Buttress Pin and a Radial Pin Plate were used for fixation and a calcium sulphate and calcium phosphate mixture as bone substitute. The patients were followed for 1 year. Grip strength increased from 61 (28-93)% of the contralateral hand to 85 (58-109)%, p < 0.001. DASH scores decreased from 37 (22-61) to 24 (2-49) p = 0.003. Radiographically all osteotomies healed. An increase of ulnar variance was noted during healing from 1.8 mm immediately postoperatively to 2.6 mm at final follow up. Osteotomy can increase grip strength and decease disability after a malunited fracture. In the present series the bone substitute was replaced by bone, but a minor loss of the achieved radiographic correction was noted in some patients during osteotomy healing. A more rigid fixation may improve the radiographic outcome with this kind of bone substitute.
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- Abramo, Antonio, et al.
(författare)
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Osteotomy of dorsally displaced malunited fractures of the distal radius: no loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute.
- 2008
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 79:2, s. 262-268
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Malunion after a distal radius fracture can be treated with an osteotomy of the distal radius. Often autologous iliac crest bone graft is used to fill the gap, but this is associated with donor site morbidity. Instead of bone graft, we have used a slow-resorbing bone substitute in combination with a minimally invasive fixation technique. PATIENTS AND METHODS: 25 consecutive patients with a dorsal malunion after a distal radius fracture underwent an osteotomy. A TriMed buttress pin and a radial pin plate were used for fixation, and Norian SRS as bone substitute. The patients were followed for a minimum of 1 year and range of motion, grip strength, DASH scores, and the radiographic correction were measured. RESULTS: Forearm rotation improved from 137 degrees to 155 degrees , flexion/extension from 102 degrees to 120 degrees , and radioul-nar deviation from 32 degrees to 43 degrees . Grip strength increased from 62% of the contralateral hand to 82%. DASH scores decreased from 36 to 23. Radiographically, all osteotomies but 1 healed and the radiographic correction achieved was consistent over the first year. INTERPRETATION: Osteotomy of the distal radius is effective in increasing motion and grip strength after a malunited distal radial fracture. Patient satisfaction is high and subjective results measured with DASH are good. Using a bone substitute, the operation can be performed as an outpatient procedure and donor-site pain avoided. No loss of the radiographic correction achieved was noted during osteotomy healing.
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| 8. |
- Afendras, G, et al.
(författare)
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Hemi-hamate osteochondral transplantation in proximal interphalangeal dorsal fracture dislocations: a minimum 4 year follow-up in eight patients.
- 2010
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 35:8, s. 627-631
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Tidskriftsartikel (refereegranskat)abstract
- Fracture dislocations of the PIP joint are challenging to treat. In hemi-hamate arthroplasty, the palmar lip joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. In the long term, collapse of non-vascularized osteochondral grafts might lead to degenerative arthritis. We examined the radiographic result after a minimum of 4 years with special reference to the development of osteoarthritis and its relation to clinical symptoms in eight patients, mean age 49 (25-66) years. After a mean of 60 (48-69) months, the arc of motion was 67 degrees (45 degrees -95 degrees ) at the PIP joint and grip strength was 91% of the uninjured side. The visual analogue score for pain (0-100) was 10 (0-70) mm. Severe arthritis (grade IV) was found in two and mild arthritis (grade II) in another two patients, but only one of these four cases had troublesome pain. The hemi-hamate technique is an attractive alternative to other treatment options, but some cases develop osteoarthritis in the medium term.
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- Arvidsson, Linnea, et al.
(författare)
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Patients Aged 80 or More With Distal Radius Fractures Have a Lower One-Year Mortality Rate Than Age- and Gender-Matched Controls : A Register-Based Study
- 2024
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Ingår i: Geriatric Orthopaedic Surgery and Rehabilitation. - 2151-4585. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: With a rapidly ageing population, the number of distal radius fractures (DRFs) in the elderly will increase dramatically. The aim of this retrospective register study was to examine the 1- and 5-year mortality in DRF patients aged 80 years or more and correlate the overall survival to factors not related to the fracture itself. Material and Methods: Patients aged ≥80 diagnosed with DRFs in Lund University Hospital in Sweden in the period 2010-2012 were extracted from the prospective Lund Distal Radius Fracture register. One- and 5-year standardised mortality rates (SMRs) were calculated using the Swedish standard population as a reference. Medical records were searched for non-fracture-related factors including comorbidity, medications, cognitive impairment and type of living. Cox proportional hazard regression models were used to identify prognostic factors for all-cause mortality. Results: The study cohort included 240 patients, with a mean age of 86. The overall 1-year mortality was 5% (n = 11/240) and the 5-year mortality was 44% (n = 105/240). The 1-year SMR was.44 (CI.18-.69, P <.01) when indirectly adjusted for age and gender and compared to the Swedish standard population. The 5-year SMR was.96 (CI.78-1.14). The patients’ ability to live independently in their own home had the highest impact on survival. Discussion: The 1-year mortality rate among the super-elderly DRF patients was only 44% of that expected. Possibly, a DRF at this age could be a sign of a healthier and more active patient. Conclusions: The DRF patients aged 80 or more had a substantially lower mortality rate 1 year after fracture compared to the age- and gender-matched standard population. Patients living independently in their own homes had the longest life expectancy. Treatment should not be limited solely because of old age, but individualised according to the patient’s ability and activity level.
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| 10. |
- Clementson, Martin, et al.
(författare)
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Clinical and Patient-Reported Outcomes After Total Wrist Arthroplasty and Total Wrist Fusion : A Prospective Cohort Study with 2-Year Follow-up
- 2024
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Ingår i: Journal of Bone and Joint Surgery. - 1535-1386. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The functional benefits of total wrist arthroplasty (TWA) over total wrist fusion (TWF) are unknown. The purpose of this prospective cohort study was to compare TWA and TWF with respect to functional outcomes and activitylimitations at up to 2 years postoperatively.Methods: Between 2015 and 2020, we enrolled all adult patients undergoing TWA or TWF for the management of symptomatic end-stage wrist arthritis at 1 hand surgery department. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE). The secondary outcomes were the visual analog scale (VAS) for pain at rest, on motion, and on loading; grip strength; Disabilities of the Arm, Shoulder and Hand (DASH); and range of motion. Patients completed questionnairesand were examined by the same physiotherapist at baseline and at 3, 6, 12, and 24 months postoperatively. Mixed-model analyses adjusting for age, diagnosis, the preoperative value of the dependent variable, and time since surgery wereperformed to compare differences in PRWE scores, VAS pain scores, and grip strength between TWA and TWF.Results: Of the 51 patients who had been included at baseline, 47 (18 in the TWA group and 29 in the TWF group) responded to questionnaires and underwent examinations at up to 2 years postoperatively. At baseline, the 2 groups did not differ in terms of age, sex, diagnosis (inflammatory or noninflammatory arthritis), PRWE score, VAS pain score, grip strength, DASH score, or range of motion. No differences between the groups were found for the PRWE (b, 20.1; 95% confidence interval [CI], 214 to 13; p = 0.99), VAS pain at rest (b, 23.3; 95% CI, 215 to 9; p = 0.58), VAS pain on loading (b, 25.3; 95% CI, 222 to 11; p = 0.52), or grip strength (b, 20.02; 95% CI, 20.18 to 0.14; p = 0.80) on the adjusted mixed-model analyses.Conclusions: Among patients with symptomatic end-stage wrist arthritis, those who underwent TWA did not demonstrate short-term outcomes, including patient-reported disability, pain, and grip strength, superior to those of patients who underwent TWF. These findings call into question the widespread use of TWA.Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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