The role of the psychological attributes of parents and children, and fracture history in upper extremity fractures in school-age and adolescents: A case-control study.

OBJECTIVES: This study aims to investigate the influence of parents and children's psychological attributes and previous fracture history on upper extremity fractures in school-aged and adolescent children. PATIENTS AND METHODS: Between January 2022 and January 2023, a total of 194 participants consisting of 97 cases with upper extremity fractures (23 males, 74 females; median age: 10 years; range, 6 to 16 years) and 97 age-matched controls suffering from growing pains (47 males, 50 females; median age: 10 years; range, 6 to 16 years) were included in this case-control study. Both cases and controls were of school-age or over. The parents of the children were interviewed face-to-face using psychological scales including the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), the Autism-Spectrum Quotient (AQ), the Short Form of the Conners' Parent Rating Scale-Revised (CPRS-R:S), and the Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07). The results derived from these scales and the demographics of the participants were evaluated in terms of their association with the risk of upper extremity fractures. RESULTS: A household income below the official minimum monthly wage (MMW) and a previous fracture history showed a higher risk for upper extremity fractures (odds ratio [OR]=2.38, 95% confidence interval [CI]: 1.07-5.26 and OR=24.93, 95% CI: 3.27-189.98, respectively). In the univariate analyses, elevated scores on the hyperactivity subscale of CPRS-R:S (CPRS-R:SHS) were associated with a higher fracture risk (OR=1.14, 95% CI: 1.05-1.24). Furthermore, both a household income below MMW, a previous fracture history, and higher CPRS-R:S-HS scores were found as independent risk factors for upper extremity fractures in the multivariate regression analysis (OR=2.78, 95% CI: 1.13-6.86, OR=21.79, 95% CI: 2.73-174.03), and OR=1.11, 95% CI: 1.02-1.22, respectively). CONCLUSION: Our study results highlight the importance of known risk factors for upper extremity fractures such as lower monthly wage and the presence of previous fractures. The psychological states of parents and children should be evaluated together.

Psychological risk factors for upper extremity fractures in preschool children: A case-control study.

BACKGROUND: In school-age children, upper extremity fractures are associated with both parental and child-related factors and represent a multifactorial entity. This study aims to explore the psychological risk factors associated with upper extremity fractures in preschool children. METHODS: This single-center, hospital-based, age-matched case-control study involved 55 cases of upper extremity fractures and 55 controls experiencing growing pains. Parents of the children participated in face-to-face interviews. We examined the potential as-sociations between scores on the Mother-to-Infant Bonding Scale (MIBS), Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), Autism-Spectrum Quotient (AQ), State-Trait Anxiety Inventory (STAI), and Strengths and Difficulties Questionnaire (SDQ), and the risk of upper extremity fractures. RESULTS: Advanced parental age and lower household income emerged as risk factors for upper extremity fractures, while longer maternal educational attainment was identified as a protective factor. In the univariate analyses, elevated scores on the Autism-Spec-trum Quotient Communication subscale (AQ-C), overall AQ score, Strengths and Difficulties Questionnaire Hyperactivity subscale (SDQ-H), and Strengths and Difficulties Questionnaire Emotional and Peer Problems subscale (SDQ-Int) were associated with an increased fracture risk (Odds Ratio [OR] (95% Confidence Interval [CI]): 1.15 (1.05-1.27), OR: 1.05 (1.01-1.09), OR: 1.25 (1.01-1.54), and OR: 1.19 (1.04-1.37), respectively). The AQ-C and SDQ-Int scales remained statistically significant as risk factors for upper ex-tremity fractures (OR: 1.15 (1.02-1.28) and OR: 1.21 (1.02-1.43), respectively) in the multivariate regression analyses. CONCLUSION: Our findings suggest that psychological factors affecting both parents and children could potentially increase the risk of upper extremity fractures in preschool children.

Functional outcome and analysis of factors affecting health-related quality of life of surgically managed pelvic ring fractures: a cross-sectional study.

INTRODUCTION: Pelvic ring fractures, particularly those involving the posterior pelvis, pose significant challenges due to their inherent instability. The posterior pelvic ring is critical in providing structural support and stability to the pelvis. This study evaluates the functional outcomes and health-related Quality of life (HRQOL) of patients who underwent internal fixation for unstable pelvic fractures. Various factors influencing the outcomes are also investigated. MATERIAL AND METHODS: A single-center cross-sectional study was conducted on patients with unstable sacral fractures treated with posterior tension band plate or sacroiliac plating with or without symphyseal plating between 2016 and 2020. Patient demographics, injury mechanisms, associated injuries, surgical details, complications, and return-to-work data were collected. HRQOL was assessed using specific pelvic fracture instruments and general HRQOL questionnaires. Logistic regression analysis was performed to identify factors associated with lower SF-12 and SF-36 scores RESULTS: The study included 54 patients, predominantly males (55.6%), aged 18-70 years, with high-energy trauma mechanisms, such as road traffic accidents and occupational injuries. The majority of patients had lateral compression pelvic fractures. Overall, the functional outcomes were favorable, with excellent or good outcomes observed in 86.1% of cases. Patients with associated injuries, such as abdominal, chest, or head injuries, were likelier to have lower SF-12 physical component scores. Sexual satisfaction scores remained stable for most patients post-surgery. DISCUSSION: This study highlights the favorable functional outcomes and HRQOL for patients undergoing fixation for unstable pelvic ring fractures. Younger, working-age males were the most commonly affected demographic. Associated injuries significantly affected physical HRQOL scores. Despite high-energy trauma, patients generally reported satisfactory sexual function post-surgery.

Correlation between psychological status, revised Müller AO classification and patient-reported outcomes: a prospective cohort analysis.

INTRODUCTION: The impact of psychological status on clinical outcomes is valued in several medical conditions, but rare attention is given to it in orthopedic trauma. We aimed to assess the correlation between psychological status, fracture severity and patient-reported outcomes in fractured patients needing urgency surgical treatment. MATERIALS AND METHODS: We prospectively followed 139 consecutive patients undergoing urgency surgical treatment of a lower/upper limb fracture. Before surgery, all patients were divided into grades of fracture severity according to the Revised AO Müller Classification (AO grades). On the 15th and the 120th days after surgery, all patients underwent a psychological status assessment through the Hospital Anxiety and Depression Score (HADS), in addition to a pain evaluation through VAS. One year after surgery, patient-reported outcomes were obtained by using specific scales depending on the site of fracture. RESULTS: AO grades and VAS scores were significantly correlated to scores at HADS-A (anxiety component) and HADS-D (depression component), both on the 15th and the 120th. Patients presenting persistent HADS-A and HADS-D scores equal or greater than 8 points had a risk of more than 2.5 or 2.0 times of experiencing unsatisfactory surgical outcomes, respectively [HADS-A: RR = 2.8 (95% CI: 2.2-3.5)] [HADS-D: RR = 2.2 (95% CI: 1.7-3.1)]. AO grade C and the persistency of significant symptoms of anxiety or depression were independent predictors of unsatisfactory patient-reported outcomes (OR: 1.7, p = 0.03 // OR: 2.9, p < 0.01). Female gender, age, and BMI did not present any statistically significant utility in predicting unsatisfactory patient-reported outcomes. CONCLUSION: In fractured patients needing urgency surgical treatment, the risk of presenting unsatisfactory outcomes is more than twice as high in patients that present significant persistent changes in psychological status. Changes in psychological status are more frequent in patients presenting more severe pain and more severe fractures. AO grades and HADS scores are independent predictors of unsatisfactory outcomes in these patients.

Early Pain Catastrophizing Exacerbates Impaired Limb Loading and 6-Minute Walk Test Distance 12 Months After Lower Extremity Fracture.

OBJECTIVE: Disability is common after lower extremity fracture (LEF). Although psychosocial factors have been associated with patient-reported outcomes after LEF, they have not been associated with objective measures of function. Aberrant gait patterns are important markers of function, but are poorly defined after LEF. The primary purpose of this study was to explore whether pain catastrophizing and fear of movement 6 weeks after surgery were associated with injured limb loading outcomes and 6-minute walk test (6MWT) distance 12 months after femur or tibia fracture. The secondary purpose was to determine if limb loading characteristics differed between injured and uninjured limbs. METHODS: At 6 weeks after LEF, patients completed validated measures of pain catastrophizing, fear of movement, and depression. At 12 months, patients completed a 6MWT while wearing instrumented insoles that recorded the limb loading outcomes of stance time, impulse, and loading rate. Bivariate correlations assessed how patient and psychosocial characteristics at 6 weeks were associated with injured limb loading outcomes and 6MWT distance. Multivariable regression analyses were performed to determine if psychosocial variables were associated with each outcome after controlling for depression and patient demographic and clinical characteristics. Finally, paired t tests compared limb loading outcomes between limbs. RESULTS: Forty-seven participants completed the 6MWT at 12 months (65%), and 38 completed the 6MWT with the instrumented insoles. Fear of movement carried a poor relationship (r = 0.11-0.32) and pain catastrophizing a moderate relationship (r = 0.46-0.54) with 12-month outcomes. The regression results indicated that pain catastrophizing continued to be associated with all outcomes. Finally, the injured limb had significantly lower limb loading outcomes than the uninjured limb at 12 months (Cohen d = 0.54-0.69). CONCLUSION: Pain catastrophizing early after LEF was associated with impaired limb loading and 6MWT distance at 12 months. IMPACT: Impaired limb loading persists 12 months after LEF. Further research is needed to determine whether rehabilitative efforts focused on pain catastrophizing can restore limb loading after LEF.

Sexual dysfunction following traumatic pelvic fracture.

BACKGROUND: While sexual dysfunction (SD) in men following traumatic pelvic fracture is common, little is known of how men experience changes in their sexual health after injury. The aims of the present study were to explore the personal and interpersonal impacts of SD in men after pelvic injury and to understood how interactions with the health care system can be optimized to improve patient-centered trauma survivorship care. METHODS: Fifteen semistructured interviews were conducted with men who had a history of traumatic pelvic fracture and self-reported SD. Interviews were audio recorded, transcribed, and uploaded to a web-based qualitative analysis platform. A codebook was developed, and intercoder reliability was verified. Inductive thematic analysis was performed to identify notable themes related to patient postinjury sexual health experiences. RESULTS: Median age of interviewees was 46 years (interquartile range, 44-54 years), with a median time since injury of 41 months (interquartile range, 22-55 months). Five primary themes were identified from the analysis: (1) effects on self-image and romantic relationships, (2) unknown care pathways and lack of communication, (3) inconsistencies with health care provider priorities, (4) provision of sexual health information and resources, and (5) the importance of setting expectations. Interviewees suggested that improved communication, provision of information related to possible adverse effects of their injuries, and expectation setting would improve posttrauma experiences. CONCLUSION: Men's experiences with SD after pelvic trauma can be heavily influenced by their interactions with health care providers and the value that is placed on sexual health as a component of survivorship. Incorporating these findings into a patient-centered trauma survivorship program may improve patient experiences. LEVEL OF EVIDENCE: Therapeutic, level V.

Patients Place More of an Emphasis on Physical Recovery Than Return to Work or Financial Recovery.

BACKGROUND: Value-based healthcare models aim to incentivize healthcare providers to offer interventions that address determinants of health. Understanding patient priorities for physical and socioeconomic recovery after injury can help determine which services and resources are most useful to patients. QUESTIONS/PURPOSES: (1) Do trauma patients consistently identify a specific aspect/domain of recovery as being most important at 6 weeks, 6 months, and 12 months after an injury? (2) Does the relative importance of those domains change within the first year after injury? (3) Are differences in priorities greater between patients than for a given patient over time? (4) Are different recovery priorities associated with identifiable biopsychosocial factors? METHODS: Between June 2018 and December 2018, 504 adult patients with fractures of the extremities or pelvis were surgically treated at the study site. For this prospective longitudinal study, we purposefully sampled patients from 6 of the 12 orthopaedic attendings' postoperative clinics. The participating surgeons surgically treated 243 adult patients with fractures of the extremities or pelvis. Five percent (11 of 243) of patients met inclusion criteria but missed their appointments during the 6-week recruitment window and could not be consented. We excluded 4% (9 of 243) of patients with a traumatic brain injury, 1% (2) of patients with a spinal cord injury, and 5% (12) of non-English-speaking patients (4% Spanish speaking [10]; 1% other languages [2]). Eighty-six percent of eligible patients (209 of 243) were approached for consent, and 5% (11 of 209) of those patients refused to participate. All remaining 198 patients consented and completed the baseline survey; 83% (164 of 198 patients) completed at least 6 months of follow-up, and 68% (134 of 198 patients) completed the 12-month assessment. The study participants' mean age was 44 ± 17 years, and 63% (125 of 198) were men. The primary outcome was the patient's recovery priorities, assessed at 6 weeks, 6 months, and 12 months after fracture using a discrete choice experiment. Discrete choice experiments are a well-established method for eliciting decisional preferences. In this technique, respondents are presented with a series of hypothetical scenarios, described by a set of plausible attributes or outcomes, and asked to select their preferred scenario. We used hierarchical Bayesian modeling to calculate individual-level estimates of the relative importance of physical recovery, work-related recovery, and disability benefits, based on the discrete choice experiment responses. The hierarchical Bayesian model improves upon more commonly used regression techniques by accounting for the observed response patterns of individual patients and the sequence of scenarios presented in the discrete choice experiment when calculating the model estimates. We computed the coefficient of variation for the three recovery domains and compared the between-patient versus within-patient differences using asymptotic tests. Separate prognostic models were fit for each of the study's three recovery domains to assess marginal changes in the importance of the recovery domain based on patient characteristics and factors that remained constant over the study (such as sex or preinjury work status) and patient characteristics and factors that varied over the study (including current work status or patient-reported health status). We previously published the 6-week results. This paper expands upon the prior publication to evaluate longitudinal changes in patient recovery priorities. RESULTS: Physical recovery was the respondents' main priority at all three timepoints, representing 60% ± 9% of their overall concern. Work-related recovery and access to disability benefits were of secondary importance and were associated with 27% ± 6% and 13% ± 7% of the patients' concern, respectively. The patients' concern for physical recovery was 6% (95% CrI 4% to 7%) higher at 12 months after fracture that at 6 weeks postfracture. The mean concern for work-related recovery increased by 7% (95% CrI 6% to 8%) from 6 weeks to 6 months after injury. The mean importance of disability benefits increased by 2% (95% CrI 1% to 4%) from 6 weeks to 6 months and remained 2% higher (95% CrI 0% to 3%) at 12 months after the injury. Differences in priorities were greater within a given patient over time than between patients as measured using the coefficient of variation (physical recovery [245% versus 7%; p < 0.001], work-related recovery [678% versus 12%; p < 0.001], and disability benefits [620% versus 33%; p < 0.001]. There was limited evidence that biopsychosocial factors were associated with variation in recovery priorities. Patients' concern for physical recovery was 2% higher for every 10-point increase in their Patient-reported Outcome Measure Information System (PROMIS) physical health status score (95% CrI 1% to 3%). A 10-point increase in the patient's PROMIS mental health status score was associated with a 1% increase in concern for work-related recovery (95% CrI 0% to 2%). CONCLUSION: Work-related recovery and accessing disability benefits were a secondary concern compared with physical recovery in the 12 months after injury for patients with fractures. However, the importance of work-related recovery was elevated after the subacute phase. Priorities were highly variable within a given patient in the year after injury compared with between-patient differences. Given this variation, orthopaedic surgeons should consider assessing and reassessing the socioeconomic well-being of their patients throughout their continuum of care. LEVEL OF EVIDENCE: Level II, therapeutic study.

Patient Satisfaction Is Improved With Exposure to Trauma Recovery Services.

INTRODUCTION: The purpose of this study is to assess the impact of Trauma Recovery Services (TRS), a program facilitating engagement and recovery on satisfaction after orthopaedic trauma. METHODS: Two hundred ninety-four patients with surgically managed extremity fractures were prospectively surveyed. Satisfaction was assessed after 12 months using a 13-question telephone survey, rated on a Likert scale from 1 to 5 (with five being excellent). TRS resource utilization during and after hospitalization was recorded. Eighty-eight patients (30%) used TRS. RESULTS: Overall satisfaction was high with a mean score of 4.32. Although no differences were observed between the control group and patients with TRS utilization in age, sex, race, insurance, smoking history, or employment status, TRS patients sustained more high-energy mechanisms (81% versus 56%) and had more associated psychiatric illness (33% versus 17%), both P < 0.01. Multivariable regression indicated general exposure to TRS to be an independent predictor of higher overall care ratings (B = 1.31; P = 0.03). DISCUSSION: Utilization of TRS was the greatest predictor of better overall care ratings. This study builds on existing evidence demonstrating the positive impact of Trauma Survivor Network programming. We conclude that a hospital-wide program supporting patient education and engagement can effectively increase patient satisfaction after traumatic injury. LEVEL OF EVIDENCE: Prognostic Level II.

Psychosocial factors affecting variation in patient-reported outcomes after elbow fractures.

BACKGROUND: The purpose of this study was to identify factors associated with limitations in function measured by patient-reported outcome measures (PROMs) 6-9 months after elbow fractures in adults from a range of demographic, injury, psychological, and social variables measured within a week and 2-4 weeks after injury. METHODS: We enrolled 191 adult patients sustaining an isolated elbow fracture and invited them to complete PROMs at their initial visit to the orthopedic outpatient clinic (within a maximum of 1 week after fracture), between 2 and 4 weeks, and between 6 and 9 months after injury; 183 patients completed the final assessment. Bivariate analysis was performed, followed by multivariable regression analysis accounting for multicollinearity. This was evaluated using partial R2, correlation matrices, and variable inflation factor assessment. RESULTS: There was a correlation between multiple variables within a week of injury and 2-4 weeks after injury with PROMs 6-9 months after injury in bivariate analysis. Kinesiophobia measured within a week of injury and self-efficacy measured at 2-4 weeks were the strongest predictors of limitations 6-9 months after injury in multivariable regression. Regression models accounted for substantial variance in all PROMs at both time points. CONCLUSIONS: Developing effective coping strategies to overcome fears related to movement and reinjury and finding ways of persevering with activity despite pain within a month of injury may enhance recovery after elbow fractures. Heightened fears around movement and suboptimal coping ability are modifiable using evidence-based behavioral treatments.

Effects of psychological factors on the clinical outcomes of fifth metacarpal neck fractures and their relation to injury etiology.

BACKGROUND: The fifth metacarpal neck fracture injuries are commonly found in patients who applied to emergency clinics. The mechanism of trauma in these types of injuries seems to be different and, in some cases, appears to be intentional. Psychological factors play an important role in the treatment and rehabilitation, as well as in the etiology of metacarpal neck fractures. However, to the best of our knowledge, no research has yet compared the clinical outcomes of patients with fifth metacarpal neck fractures caused intentionally with those of patients with such fractures caused by unintentional injuries. Our goal is to investigate the relationships between the mechanism of injury, socioeconomic status, and clinical outcomes of patients with fifth metacarpal neck fractures. METHODS: The study included 59 patients with fifth metacarpal neck fractures. The patients were separated into two groups. Group 1 consisted of patients with intentional injuries, and Group 2 consisted of patients with unintentional injuries. Both groups were evaluated in terms of the anger analysis, impulsivity, and the level of anxiety in relation to somatic findings Visual Analogue Scale (VAS) and The Disabilities of the Arm, Shoulder and Hand Score (QDASH). In addition, the relationship between anger, impulsivity, and anxiety scores with the socioeconomic status and educational level was assessed. RESULTS: It was observed that the anger and impulsivity values of Group 2 patients were lower than the Group 1, and the decrease in Group 2 was correlated with the VAS and Q-DASH values. Group 1 barrat impulsivity score 61.5 (42-78), anxiety score 64 (55-77), state anger score 20 (16-30), and Group 2 barrat impulsivity score 61 (55-69), anxiety score 66 (58-72), and anger score 19 (14-26) were found as mean values. The impulsivity score and anger score were found to be lower in Group 2 at the low educational level. The number of patients with a low income was found to be high in both groups, and the impulsivity score and the anger score were higher in Group 1, while the anxiety score was higher in Group 2. CONCLUSION: Sociodemographic factors and the etiology of intentional injuries could not be detected, but psychological factors play a role in the clinical sequelae of intentional fifth metacarpal fractures, their effects thereof on the hand function and the pain course after treatment.

Health-related Quality of Life After Fractures of the Lateral Third of the Clavicle in Children and Adolescents.

INTRODUCTION: The health-related quality of life after pediatric fractures of the lateral third of the clavicle is unknown. Given the trend in the literature toward surgical management of clavicular fractures in adults, we frequently receive referrals for surgical management of lateral clavicular fractures in children.Therefore, we examined (1) the health-related quality of life of patients who sustained a fracture of the lateral third of the clavicle in childhood and who were treated at a large regional pediatric trauma center, (2) if the health-related quality of life was associated with the age at the time of the injury, and (3) whether fracture and displacement patterns were associated with health-related qualify of life. METHODS: This is a retrospective case series. We were able to identify 69 patients (21 girls and 48 boys) who sustained a fracture of the lateral third of the clavicle between the period spanning from January 2004 to June 2015. These patients were asked to fill in a questionnaire that included the Quick version of the Disability of Arm, Shoulder, and Hand (DASH) (primary outcome) and the Pediatric Quality of Life Inventory (Peds-QL). Until July 2017, we were able to get a response from 56 of these patients, resulting in a follow-up of 81%. RESULTS: Treatment was conservative in all cases but one. In these cases, after a mean follow-up of 6.5 years (range, 1 to 13.2 y), the mean Quick-DASH was 1.2 (SD, 4.4) at a scale of 0 to 100, with lower values representing better quality of life. The mean physical function score of the Peds-QL was 97.8 (SD, 4.4), and the mean psychosocial function score was 91.8 (SD, 10.8), both at a scale of 0 to 100, with higher values representing better quality of life.There was no statistically significant association of age at the time of injury on the primary outcome Quick-DASH.There were no statistically significant associations between fracture or displacement patterns with regard to health-related quality of life. CONCLUSIONS: Conservative treatment of lateral clavicular fractures in children and adolescents is associated with excellent health-related quality of life, as measured with the disease-specific Quick-DASH and the non-disease-specific Peds-QL at a mean follow-up of 6.5 years (range, 1 to 13.2 y). There was no effect of age at the time of injury, and we were unable to identify associations to commonly analyzed risk factors, such as displacement patterns.As the conservative treatment of this type of fracture in children and adolescents is associated with such a good health-related quality of life, it is unlikely that these results could be further improved by surgical interventions. LEVEL OF EVIDENCE: Level IV-case series.

The role of psychiatric status on pediatric extremity fractures: a prospective analysis.

PURPOSE: The aim of the study was to investigate the relationship between attention deficit and hyperactivity disorder (ADHD), anxiety, and depression with pediatric extremity fractures. METHODS: Between November 2014 and November 2016, consecutive 138 patients with pediatric extremity fractures were prospectively investigated in terms of the tendency to anxiety, depression, or ADHD in the study group. Consecutive 168 non-trauma patients who were admitted to general pediatrics outpatient clinic were included the control group. Patients were performed with Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form (T-DSM-IV S), The Screen for Child Anxiety-Related Emotional Disorders (SCARED), and The Children's Depression Inventory (CDI). RESULTS: There were not any significant differences between study and control groups regarding the age, gender distribution, economical level, or previous psychiatric admission rates (p > 0.05). In the study group, the previous ADHD history and previous fracture history were significantly higher than the control group (p < 0.05). In the study group, the severity of depressive signs and anxiety were significantly higher than the control group (p = 0.000 and p = 0.019; respectively). Regarding the previous fracture history, conduct disorder and tendency to depression were significantly higher in the study group (p = 0.001 and p = 0.011; respectively). CONCLUSIONS: The signs of ADHD, anxiety, and depression were determined to be higher in children with extremity fractures compared with the non-traumatic population. In patients with especially behavioral problems and depressive signs, directing to the child and adolescent psychiatrists will be protective to prevent re-fractures and high-energy traumas.

Self-esteem following maxillofacial and orthopedic injuries: preliminary observations in sub-Saharan Africans.

BACKGROUND: The face is a vital component of one's personality and body image while extremities are important in function (mobility, routine daily activities). Recovery and rehabilitation from acquired maxillofacial and orthopedic traumas are psychological in nature. METHODS: This was a prospective study of recruited subjects in a Nigerian University teaching hospital. A total of 160 participants (80 with maxillofacial injuries and 80 with orthopedic injuries) had repeated review assessments within 1 week of arrival in the hospital (time 1), 4-8 weeks after initial contact (time 2), and 10-12 weeks thereafter (time 3), using Rosenberg's Self-Esteem Questionnaire. RESULTS: Thirty-three (41.3%) participants in the maxillofacial injured and 12 (15.0%) in the orthopedic injured subjects scored between 0 and 14 at time 1. At time 2, 39 (51.3%) subjects in the maxillofacial fracture group and 20 (29.0%) in the orthopedic injured group scored between 0 and 14, while at time 3, 7 (9.2%) in the maxillofacial fracture group and 1 (1.5%) in the orthopedic injured group scored between 0 and 14. There was a statistical significant difference between the two groups when compared at times 1, 2, and 3 with p < 0.001, p = 0.006, and p = 0.041 respectively. Subjects with maxillofacial fracture consistently had lower self-esteem compared to subjects with orthopedic injured for times 1, 2, and 3. CONCLUSIONS: Self-esteem may be reduced following maxillofacial injuries; therefore, measures should be taken by surgeons to minimize the risk of facial scarring by careful handling of tissues. Also, management of these injuries should integrate multidisciplinary care that will address psychological needs of patients. TRIAL REGISTRATION: Not applicable.

Evaluation of Treatment Outcome Following Closed Reduction of Nasal Bone Fractures.

INTRODUCTION: The closed reduction of a displaced nasal fracture is a preferred method in oral and maxillofacial surgery. This prospective study was conducted to evaluate the treatment outcome following closed reduction of nasal bone fractures. MATERIALS AND METHODS: A total of 20 patients with nasal bone fracture who underwent closed reduction were included in the study. The cases were operated under local or general anesthesia. The outcome of treatment was evaluated pre- and postoperatively through systematic follow-ups. Clinical assessment was done to evaluate functional (airway patency, nasal obstruction, crepitus) as well as esthetic parameters (facial symmetry, swelling, and nasal deviation). Functional and esthetic satisfaction of patients was assessed using visual analog scale (VAS) pre- and post-operatively. RESULTS: It was observed that there was significant improvement in both functional and esthetic parameters following closed reduction of nasal fractures. CONCLUSION: The present study suggested that closed reduction of nasal bone fracture is very effective in the management of nasal bone fractures. However, further studies with larger sample size in different clinical situations should be considered to confirm the efficacy of the same. CLINICAL SIGNIFICANCE: Closed reduction can be a viable and more conservative alternative in management of nasal fractures.

Acetabular fractures: Is it possible to regain the same patient's related quality of life before trauma?

INTRODUCTION: acetabular fractures are difficult to treat with often an unsatisfactory results for patients. The aim of this study is to investigate about the health-related quality-of-life outcome of patients with a traumatic acetabular fracture, as recorded at least 24 months after their surgery. METHODS: a cohort of patients underwent a dedicated acetabular surgical reconstruction for a pelvic trauma between November 2011 and May 2016, were enrolled to investigate, at least two years after injury, their midterm quality of life; SF-36 and LiSat-11 were used. RESULTS: 35 patients were enrolled but only 28 patients were revisited, 20 males (714%) and 8 females (286%) with a mean age of 43 years (19-73). The most common cause was motor vehicle accident (655%). Lower score after trauma are reported in both tests, SF-36 and LiSat 11, for all items. DISCUSSION: comparing the SF-36 score in the Italian normative sample with our SF-36 score before the trauma there is no statistically significant difference (p = 0.1661) underlining how the patients before the trauma were healthy and in good health. Both scores, SF-36 and LiSat-11, before and after trauma are statistically different with respectively p = 0,0002 and p = 0,049 which proves the lower quality of life after trauma in comparison to their life before trauma. CONCLUSIONS: Although the treatment protocols of acetabular fractures have greatly improved over the years, these continue to have disabling consequences that hardly allow to recover a good quality of life two years after the trauma.

Early Improvement in Pain and Functional Outcome but Not Quality of Life After Surgery for Metastatic Long Bone Disease.

BACKGROUND: Bone metastases represent the most frequent cause of cancer-related pain, affecting health-related quality of life and creating a substantial burden on the healthcare system. Although most bony metastatic lesions can be managed nonoperatively, surgical management can help patients reduce severe pain, avoid impending fracture, and stabilize pathologic fractures. Studies have demonstrated functional improvement postoperatively as early as 6 weeks, but little data exist on the temporal progress of these improvements or on the changes in quality of life over time as a result of surgical intervention. QUESTIONS/PURPOSES: (1) Do patients' functional outcomes, pain, and quality of life improve after surgery for long bone metastases? (2) What is the temporal progress of these changes to 1 year after surgery or death? (3) What is the overall and 30-day rate of complications after surgery for long bone metastases? (4) What are the oncologic outcomes including overall survival and local disease recurrence for this patient population? METHODS: A multicenter, prospective study from three orthopaedic oncology centers in Quebec, Canada, was conducted between 2008 and 2016 to examine the improvement in function and quality of life after surgery for patients with long bone metastases. During this time, 184 patients out of a total of 210 patients evaluated during this period were enrolled; of those, 141 (77%) had complete followup at a minimum of 2 weeks (mean, 23 weeks; range, 2-52 weeks) or until death, whereas another 35 (19%) were lost to followup but were not known to have died before the minimum followup interval was achieved. Pathologic fracture was present in 34% (48 of 141) of patients. The median Mirel's score for those who underwent prophylactic surgery was 10 (interquartile range, 10-11). Surgical procedures included intramedullary nailing (55), endoprosthetic replacement (49), plate osteosynthesis (31), extended intralesional curettage (four), and allograft reconstruction (two). Seventy-seven percent (108 of 141) of patients received radiotherapy. The Musculoskeletal Tumor Society (MSTS), Toronto Extremity Salvage Score (TESS), Brief Pain Inventory (BPI) form, and Quality Of Life During Serious Illness (QOLLTI-P) form were administered pre- and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. Analysis of variance followed by post hoc analysis was conducted to test for significance between pre- and postoperative scores. The Kaplan-Meier estimate was used to calculate overall survivorship and local recurrence-free survival. A p value of < 0.05 was considered statistically significant. RESULTS: MSTS and BPI pain scores improved at 2 weeks when compared with preoperative scores (MSTS: 39% ± 24% pre- versus 62% ± 19% postoperative, mean difference [MD] 23, 95% confidence interval [CI], 16-32, p < 0.001; BPI: 52% ± 21% pre- versus 30% ± 21% postoperative, MD 22, 95% CI, 16-32, p < 0.001). Continuous and incremental improvement in TESS, MSTS, and BPI scores was observed temporally at 6 weeks, 3 months, 6 months, and 1 year; for example, the TESS score improved from 44% ± 24% to 73% ± 21% (MD 29, p < 0.001, 95% CI, 19-38) at 6 months. We did not detect a difference in quality of life as measured by the QOLLTI-P score (6 ± 1 pre- versus 7 ± 4 postoperative, MD 1, 95% CI, -0.4 to 3, p = 0.2). The overall and 30-day rates of systemic complications were 35% (49 of 141) and 14% (20 of 141), respectively. The Kaplan-Meier estimates for overall survival were 70% (95% CI, 62.4-78) at 6 months and 41% (95% CI, 33-49) at 1 year. Local recurrence-free survival was 17 weeks (95% CI, 11-24). CONCLUSIONS: Surgical management of metastatic long bone disease substantially improves patients' functional outcome and pain as early as 2 weeks postoperatively and should be considered for impending or pathologic fracture in patients whose survival is expected to be longer than 2 weeks provided that there are no immediate contraindications. Quality of life in this patient population did not improve, which may be a function of patient selection, concomitant chemoradiotherapy regimens, disease progression, or terminal illness, and this merits further investigation. LEVEL OF EVIDENCE: Level II, therapeutic study.

Patient-related outcome of unstable pelvic ring fractures stabilized with a minimal invasive screw-rod system.

BACKGROUND: Clinical and radiological outcomes of operatively treated unstable pelvic ring fractures are well documented, whereas little is known about the patient's related outcome. The purpose of this study is to evaluate the patient-reported outcome after minimal invasive treatment of pelvic ring fractures using the SF-36 and EQ-5D medical outcome scores. METHODS: Patients with unstable pelvic ring fractures treated in our trauma department with a minimal invasive screw-rod system between 01/2004 and 12/2014 were included. Next to patient data (sex, age), injury related details (fracture type, additional injuries, Injury Severity Score (ISS)) as well as operation details (method, time to operation, general complications, adverse events associated with the surgical procedure, revision surgery, fracture reduction) were assessed. The patient related outcome was evaluated using the SF-36 and the EQ-5D score. RESULTS: A total of 105 patients (57 men; 48 women; mean age 56 ± 21 years) were identified as candidates for the study. 60 patients completed the SF-36 and EQ-5D score after a mean follow-up of five years (60.5 months (14-142 months)). Of these patients 77% were multiply injured with a mean ISS of 26 ± 19. Within the respondent group 22% showed type B and 78% type C pelvic ring fractures. In 82% the dorsal pelvic ring fracture was stabilized using a minimally invasive transiliac internal fixator, in 18% an iliolumbar fixation was performed respectively. The mean physical component score of the SF-36 was 37.9 ± 12.0, the mean mental component score was 49.8 ± 12.5. The mean EQ-5D VAS reached 70.5 ± 24.4. CONCLUSION: Patients being multiply injured and treated with minimal invasive treated dorsal pelvic ring fractures were suffering more especially concerning physical domains compared to the healthy reference population. Nevertheless, the overall patient-related outcome is comparable to pelvic ring fractures in general. TRIAL REGISTRATION NUMBER: Clinical Trial Registry University of Regensburg Z-2017-0878-3 . Registered 22. July 2017. Retrospectively registered.

Plating for midshaft clavicular fractures: The impact on quality of life and functional outcome.

INTRODUCTION: Several studies report on functional outcome after operative treatment for midshaft clavicular fractures. According to the published data not much is known about the quality of life after operative treatment. The purpose of this study is to investigate long term patient reported quality of life (QoL) and functional outcome after plating for midshaft clavicular fractures. METHODS: Patients between 16 and 65 years of age, with a midshaft clavicular fracture which were treated with plate fixation between 2006 and 2014, were included. Information was extracted from hospital records and all patients were asked to participate in an online survey. Primary outcome was QoL (SF-36 and EQ-5D-5L). Secondary outcomes were complications, reoperation rate, patient- and cosmetic satisfaction, pain, and functional outcome (DASH). RESULTS: In a retrospective cohort design, 164 patients were included, 101 completed the online survey. Patients reported a good QoL and functional outcome. The mean physical- and mental SF36 score were 53.9±7.3 and 52.3±9.9 (0-100), the EQ-5D-5L score was 0.88±0.17 (-0.59 to 1.0) and the average DASH was 8.45±14.0 (0-100). Furthermore, there was a strong correlation between the functional outcome and QoL (p<0,001). Seventeen patients developed at least one complication (10%) and seventy-seven patients got a reoperation, with isolated implant removal as the leading cause of reoperation (80,5%). CONCLUSION: Patients which received operative treatment for a midshaft clavicle fracture have an excellent QoL, and a good functional outcome. Furthermore, there is a strong relationship between functional outcome and the QoL.

The effects of low-intensity pulsed ultrasound on fresh fracture: A meta-analysis.

BACKGROUND: Low-intensity pulsed ultrasonography (LIPUS) is a form of mechanical stimulation that is delivered via a special device to the fracture site for the acceleration of fracture healing. We conducted a meta-analysis to assess the effect of LIPUS for fresh fractures in adults. METHODS: MEDLINE, EMBASE and the Cochrane Library searched between Jan 1980 and Nov 2016. Studies should be quasi-randomized and randomized controlled trials (RCTs) comparing treatment with LIPUS to placebo or no treatment in adults with fresh fractures, reporting outcomes such as function; time to union; delayed union or non-union. Summary standard mean difference (SMD) and the risk ratio (RR) with their 95% confidence interval (CI) calculated with a random effects model. I statistic was used to assess the heterogeneity. Risk of bias was assessed by the Cochrane risk-of-bias tool. The GRADE system was used to evaluate the evidence quality. RESULTS: A total of 12 trials with 1099 patients were included. The pooled results showed that LIPUS significantly reduced the time to fracture union (SMD: 0.65, 95% CI: 1.13 to 0.17), improved the quality of life (SMD: 0.20, 95% CI: 0.03-0.37) without affecting the time to full weight bearing (SMD: 0.76, 95% CI: 1.92 to 0.4), the time to return to work (SMD: 0.06, 95% CI: 0.14 to 0.27), or the incidence rate of delayed union and nonunion (RR: 1.02, 95% CI: 0.60-1.74). CONCLUSIONS: Moderate-to-high quality evidence shows that LIPUS treatment reduces the time to fracture union and improves the quality of life without affecting functional recovery and incident rate of delayed union and nonunion, suggesting that LIPUS treatment may be a good treatment modality for adults with fresh fractures. However, there are some methodological limitations in the eligible trials, further studies are needed to determine the clinical circumstances under which LIPUS is truly valid and to examine the optimal approach for the use of this adjunctive therapy.