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- Ali, Muhanned, et al.
(author)
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Assessment of a novel computer software in diagnosing radiocarpal osteoarthritis on plain radiographs of patients with previous distal radius fracture
- 2020
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In: Osteoarthritis and Cartilage Open. - : Elsevier BV. - 2665-9131. ; 2:4
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Journal article (peer-reviewed)abstract
- Objective: Osteoarthritis (OA) has primarily been diagnosed with plain radiographs assessed visually by examiners with regard to joint space width and presence of subchondral sclerosis, cysts and osteophytes. The increasing use of artificial intelligence has seen software developed to examine plain radiographs for diagnosing OA, based on observed OA-associated subchondral bone microarchitecture changes. A software for computerized texture analysis has been developed to identify knee OA. The aim of this study was to assess the software's ability to identify radiocarpal OA.Design: Presence of radiocarpal OA on 63 wrist radiographs of patients with a previous distal radius fracture was assessed independently by two surgeons experienced in assessing radiographs, and classified according to Kellgren-Lawrence (38 OA, 25 no OA). First, the computer software, not previously trained to identify wrist OA, assessed presence of radiocarpal OA on the 63 radiographs. In a second step, 144 labeled wrist radiographs with and without radiocarpal OA was used to train the computer software. Presence of OA on the original 63 radiographs were then reassessed by the software. Sensitivity, specificity and area under the curve (AUC) were calculated to determine the software's ability to discriminate between cases with and without OA.Results: Before training, sensitivity was 76% (95% CI 59–88), specificity 25% (10–47), and AUC 0.50 (0.35–0.65). After training, sensitivity was 46% (29–63), specificity 70% (47–87), and AUC 0.58 (0.43–0.73).Conclusion: The software for computerized texture analysis of subchondral bone developed to identify knee OA could not detect OA of the radiocarpal joint.
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| 2. |
- Ali, Muhanned, et al.
(author)
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Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations : A Long-Term Follow-up
- 2018
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In: Journal of Bone and Joint Surgery. American volume. - : LIPPINCOTT WILLIAMS & WILKINS. - 0021-9355 .- 1535-1386. ; 100:8, s. 633-639
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Journal article (peer-reviewed)abstract
- Background: The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations. Methods: In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of >= 10 degrees, ulnar variance of >= 3 mm, and/or radial inclination of <= 15 degrees. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up. Results: Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Mal union was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p < 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p > 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength. Conclusions: Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain.
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| 3. |
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| 4. |
- Ali, Muhanned, et al.
(author)
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Distal Radius Malunions
- 2021
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In: Evidence-Based Orthopedics : Second Edition - Second Edition. - : Wiley. - 9781119414001 - 9781119413936 ; , s. 855-859
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Book chapter (peer-reviewed)abstract
- This chapter presents a clinical scenario of a 59-year-old healthy woman who had injures in her dominant wrist after a fall at home. Her wrist radiographs show a displaced extra-articular distal radius fracture with a dorsal angulation of 15 ° (from 0 °) and an ulnar variance of 3 mm. The treating surgeon has a discussion with the patient about surgical and nonsurgical treatment options and the expected outcomes in case the fracture heals with malunion or in a near anatomical position. They also discuss which treatment method would be most effective in restoring near normal anatomy. Treatment of displaced distal radius fractures has shifted toward increasing use of open reduction and fixation with volar locking-plate. Distal radius osteotomy (sometimes combined with ulnar osteotomy) is a major surgical procedure that requires substantial postoperative rehabilitation.
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