Trajectory of Recovery following ORIF for Distal Radius Fractures.

Background Distal radius fractures are commonly seen among the elderly, though studies examining their long-term outcomes are limited. Purpose The aim of this study was to describe the 5-year trajectory of recovery of distal radius fractures treated with open reduction and internal fixation (ORIF). Methods Patients with distal radius fractures (AO/OTA 23.A-C) treated by ORIF were prospectively studied. Patient-Rated Wrist Evaluation (PRWE) score was measured at baseline (preinjury recall) and postoperatively at 6 months, 1 year, and 5 years. Clinically relevant change in PRWE score was assessed using the minimal clinically important difference (MCID). Results A total of 390 patients were included, of which 75% completed 5-year follow-up. Mean baseline PRWE score was 1.25 (standard deviation, SD: 2.9). At 6 months, mean PRWE score was at its highest up to 20.2 (SD: 18.4; p < 0.01). A significant improvement in mean PRWE score was observed at 1 year down to 15.2 (SD: 17.6; p < 0.01); 44% of patients were still one MCID outside of their baseline PRWE score at 1 year. Further significant improvement in mean PRWE score occurred at 5 years down to 9.4 (SD: 13.4; p < 0.01); 29% of patients remained one MCID outside of their baseline PRWE score at 5 years. Conclusion Recovery after ORIF for distal radius fractures showed significant worsening after surgery, followed by significant improvements up to 1 year and between years 1 and 5, albeit to a lesser extent. Statistically and clinically relevant wrist pain and disability persisted at 5 years. Future research should examine different treatment modalities and include a nonoperative treatment arm for comparison. Level of Evidence Prognostic level II.

Impact of chronic wrist hypermobility on proprioception, strength, and functional performance in young adults.

BACKGROUND: Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established. PURPOSE: This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based. STUDY DESIGN: This was a quasi-experimental cross-sectional study. METHODS: Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation. RESULTS: A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t-tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function. CONCLUSIONS: CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study's specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH.

A systematic review and network meta-analysis of outcomes after total wrist arthroplasty in inflammatory and non-inflammatory arthritis.

This systematic review analysed the available evidence on the clinical outcomes of total wrist arthroplasty (TWA) in patients with inflammatory and non-inflammatory arthritis. After screening, 12 studies met the inclusion criteria. They involved 359 patients with 378 TWA implants. The results showed that TWA significantly improved Disabilities of the Arm, Shoulder and Hand (DASH)/Quick-DASH scores and pain visual analogue scale scores in both arthritis groups compared with preoperative values. However, there was no statistically significant difference in the outcome scores between the two groups. Three studies reported Patient-Rated Wrist Evaluation (PRWE) scores, and TWA significantly improved PRWE scores in non-inflammatory arthritis but not in inflammatory arthritis, with no significant difference in postoperative outcome scores between the two groups. Although the included studies have limitations, the review suggests that TWA may be a successful treatment for wrist pain in individuals with either inflammatory or non-inflammatory arthritis. However, further high-quality trials are needed to confirm these findings.

Validity, reliability and responsiveness of the French translation of the Patient-Rated Wrist Evaluation Questionnaire (PRWE).

INTRODUCTION: The patient-rated wrist evaluation questionnaire (PRWE) is a specific wrist questionnaire, developed in Canada that has been validated and proved reliable and sensitive. It assesses pain and function. Unfortunately, there was no validated French-language version. It is important that a translation should be methodologically rigorous, as both linguistic and cultural factors come into play. OBJECTIVE: To produce a French-language version of the PRWE, culturally adapted to the French-speaking populations of Europe and North America. MATERIALS AND METHODS: A validated protocol was used to produce a French-language version of the PRWE (PRWE-Fr) that would be culturally acceptable for the French-speaking populations of Europe and North America. Reliability and responsiveness analyses were performed and PRWE-Fr scores were compared to F-QuickDASH-D/S (French translation of short-form Disabilities of the Arm, Shoulder and Hand-Disability/Symptoms) scores to assess validity. RESULTS: A French-language version of the PRWE (PRWE-Fr) was accepted by a multinational committee, then validated in 65 French-speaking subjects, divided into 2 groups for analyses. A strong positive correlation was found between PRWE-Fr and F-QuickDASH-D/S scores. Comparison of results between two PRWE-Fr sessions at a 1-week interval found a very strong correlation (ρ=0.93; r2=0.868; p<0.001). The intraclass correlation coefficient for total PRWE-Fr score demonstrated excellent reliability (ICC: 0.93; 95% CI: [0.859; 0.969]; p<0.001). Responsiveness analysis revealed greater sensitivity to change than for the F-QuickDASH-D/S (standardized response mean [SRM], 1.14 versus 1.04 respectively). DISCUSSION: A French-language version of the PRWE was produced and validated for use in French-speaking populations. It should facilitate evaluation of results in French-speaking settings, collaboration in multinational studies and comparison between studies performed in different countries. LEVEL OF EVIDENCE: II; Multicenter cohort study.

Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial).

BACKGROUND: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. METHODS: This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0-100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. DISCUSSION: Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. TRIAL REGISTRATION: Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. CLINICALTRIALS: gov NCT04755127. Registered after the start of inclusion on 15 February 2021.

Distal ulna fractures in adults-subcapitular, transverse fractures did not benefit from surgical treatment.

INTRODUCTION: Fractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome. MATERIALS AND METHODS: Patients, 18 years or older, treated for a fracture of the distal third of ulna in our county, were included. Fractures of the styloid tip were excluded. The radiographs of the fractures were independently classified by two specialists in radiology according to the 2018 AO/OTA classification. Follow-up was performed 5-7 years after the injury, through the questionnaire Patient-Rated Wrist Evaluation (PRWE) and new radiographs of both wrists. RESULTS: Ninety-six patients with 97 fractures were included and filled out the PRWE. 65 patients also had new radiographs taken. 79 patients were women and the mean age at the time of injury was 63 years (SD 14.5). The most common fracture class was the extra-articular transverse fracture, 2U3A2.3 (42%). We found that 40% of the fractures had been treated by internal fixation and only 2 fractures had not healed, one conservatively treated and one operated. The median PRWE was 15 (IQR 33.5). The PRWE score was significantly worse in the operated ulna fractures (p = 0.01) and this was also true for extra-articular transverse fractures 2U3A2.3 (p = 0.001). Initial displacement was more common in operated transverse fractures, but it could not be proven that this was the reason for the inferior result. CONCLUSIONS: Distal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.

Assessment of Patients' Quality of Life during Conservative Treatment after Distal Radius Fracture.

Introduction: This study aimed to assess patients' quality of life after distal radius fracture treatment (at least six months, but no more than ten years, after the treatment) based on the analysis of objective and subjective parameters and the influence of the fractured side on the final results. Materials and Methods: The study sample consisted of 30 women who claimed to be right-handed, divided depending on the side of the fracture (left vs. right limb). Patients were evaluated with a goniometer for active wrist movement, pronation, and supination in the elbow joint. Furthermore, the global grip strength of the upper limb was assessed using a dynamometer (Biometrics Ltd.) device, after which patients were asked to complete a wrist evaluation questionnaire (PRWE) and the Polish version of the SF-36 questionnaire assessing the quality of life. Results: There were statistically significant differences in the active movement of the wrist of the injured limb compared to the non-injured limb. In addition, inferior results were reported for injury of the right limb to those of the left. Conclusions: Injury of the right limb as opposed to injury of the left limb can have a negative impact on the assessment of quality of life in patients with right-limb dominance.

A Six-Year Clinical Profile of Distal Radius Fractures in a South Asian Population.

Background: The description, types and management of distal radius fractures have not been evaluated for a South Asian population. The aim of this study was to describe the clinical profile of distal radius fractures in adults over a 6-year period. Methods: The medical records of distal radius fracture patients, aged 18 years and above admitted between August 2014 and 2020 were assessed. Epidemiological profile, fracture classification, treatment and reasons for implant removal were assessed. Results: A total of 1066 distal radius fractures in 1005 inpatients were identified. The mean age was 42.1 ± 15.3 years (50.2 years [male] & 39.7 years [female]). A total of 65.5% patients sustained high-energy injury. 38.6% (n = 411) of fractures were classified as extra-articular AO-23-A, 24.3% (n = 259) as partially intra-articular AO-23-B and 39% (n = 416) as intra-articular AO-23-C. The treatment was non-surgical for 20.9% and surgical for 79.1% of cases. Plate fixation was the most frequently used surgical method followed by percutaneous pinning and external fixation. The proportion of patients treated by each modality remained constant based on a year-wise analysis of data. A total of 56 patients underwent implant removal, most commonly at the request of the patient. Conclusions: Our study is the longest study in a South Asian setting where the population is younger, with a male pre-ponderance, sustaining high-energy injury as compared to the literature. This can be attributed to our study population being inpatients only. As population-based fracture registry is not available in our country, hospital-based studies such as ours provide the best option to study fracture patterns, distribution and trends in treatment. Level of Evidence: Level IV.

Functional performance of the upper limb and the most common boxing-related injuries in male boxers: a retrospective, observational, comparative study with non-boxing population.

BACKGROUND: To investigate the functional status and recording the most common injuries of the upper limb in male Greek boxing squad in comparison to the general population. METHODS: A retrospective injury surveillance study using an electronic questionnaire was performed in 2021. The questionnaire was sent to male members of the Greek Boxing Federation and consisted of three parts. Demographic data, functional status scales, training conditions, hours of training, the location and description of upper limb injuries and whether the injury occurred during competition or training and also whether it was a new or a recurrent one were gathered. The same questionnaire was sent to non-boxer males (military recruits), but without asking them to report any training parameters. Inclusion criteria were age < 35 years-old for all participants and no involvement in martial arts for the control group. Also, all participants (boxers and non-boxers) completed the Patient Rated Wrist Evaluation (PRWE) scale and the Quick Disabilities of Arm, Shoulder and Hand (quick-DASH) score. RESULTS: The final study cohort was consisted of 62 elite or amateur boxers and 75 non-boxer males, less than 35 years old. The quick-DASH score was found to be significantly lower (better) in boxers in comparison to the general population (15.65 ± 10.25 vs. 12.55 ± 8.62; p = 0.020) whereas the PRWE score was similar in both groups (9.25 ± 14.96 vs. 8.61 ± 13.05; p = 0.843). Physical therapy sessions, thumb injuries and boxer's knuckle were also found to be significantly higher in the boxers group. On the other hand, upper limb surgeries were significantly less in the boxers group. Finally, the size of boxing gloves was associated to the number of finger fractures, thumb injuries and ulnar sided wrist pain in boxers. CONCLUSIONS: Although a controversial sport, boxing appears to have no long-term consequences to the upper limb function, especially regarding hand performance. The size of gloves during heavy bag training was found to be an aggravating factor for hand injuries.

Medium to long term functional and radiographic outcomes in patients with Madelung's deformity treated by isolated or combined radioulnar osteotomy.

INTRODUCTION: Madelung's deformity is a rare congenital condition of the wrist that can cause pain, aesthetic concerns, reduced range of motion and grip strength. Currently, there is no consensus on the optimal age for surgery or whether operative procedures can be isolated or combined depending on the extent of the deformity. The main objective of our study was to analyze the postoperative functional clinical results at a minimum of 3-years follow-up in patients operated on for Madelung's deformity. The secondary objectives were (1) comparison of preoperative and postoperative radiographic parameters, and (2) to assess whether certain preoperative radiographic parameters influence the choice of surgical procedure. HYPOTHESIS: The surgery offered at our center achieves clinical and radiological result necessary for long-term activities of daily living, and varies according to the severity of the distal radial deformity. PATIENTS AND METHODS: We carried out a retrospective observational monocentric study including patients operated on between 2004 and 2016. Clinical (VAS, mobility), functional (PRWE score), and radiographic assessments were performed before and after the last follow-up. RESULTS: The study included 11 patients (12 wrists) with a mean age of 17±7.3 years and a mean follow-up of 8.1 years (4-12.3). The mean VAS was 2.3 (0-6) and the mean PRWE score was 37 (0-108). The mean flexion-extension arc was 134° and that of pronation and supination was 142°. The mean grip strength was 25.8±11.8kg. Four out of 6 radiographic criteria were significantly improved. An isolated radial osteotomy or combined radioulnar osteotomy was performed when the sagittal radial tilt was greater than 30° and protrusion of the lunate greater than 5mm, otherwise below these values, an isolated ulnar osteotomy was performed. DISCUSSION: Our center offers surgical management of Madelung's deformity by osteotomy which improves the majority of postoperative radiographic parameters and gives satisfactory clinical and radiographic results after a mean follow-up of 8.1 years. The surgery is influenced by the severity of the distal radial deformity, including protrusion of the lunate and sagittal radial tilt. LEVEL OF EVIDENCE: IV, Retrospective study.

Psychometric properties of patient-reported outcome measures (PROMs) in wrist osteoarthritis: test-retest reliability and construct validity.

BACKGROUND: Patient-reported outcome measures (PROMs) are frequently used to assess the effects of treatments in patients with wrist osteoarthritis (OA), but their psychometric properties have not been evaluated in this group of patients. Our aim was to evaluate the psychometric properties of the Numeric Rating Scale (NRS pain at rest, pain on motion without load, and pain on load), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Patient Rated Wrist Evaluation (PRWE) questionnaires in patients with wrist OA regarding test-retest reliability and construct validity. METHODS: The NRS, DASH and PRWE were self-administered by 50 patients (40 men and 10 women, mean age 66 years) in a postal survey on two occasions, two weeks apart. Test-retest reliability was evaluated by Kappa statistics and the Spearman rank correlation coefficients (rho) were calculated to evaluate construct validity. RESULTS: The Kappa coefficients for DASH, PRWE and NRS pain on motion without load and NRS pain on load were > 0.90, 95% CI ranging from 0.84 to 0.98, while NRS pain at rest was 0.83, 95% CI 0.73-0.92. The construct validity of the PROMs was confirmed by three formulated hypotheses: a higher correlation between PRWE and NRS (rho 0.80-0.91, p < 0.001) was found, compared to DASH and NRS (rho 0.68-0.80, p < 0.001); the NRS pain on motion without load and NRS pain on load correlated more strongly to PRWE and DASH (rho 0.71-0.91, p < 0.001) compared to NRS pain at rest (rho 0.68-0.80) and a high correlation between PRWE and DASH was found (rho 0.86, p < 0.001). CONCLUSIONS: The NRS, DASH and PRWE demonstrate excellent test-retest reliability and moderate to high construct validity in patients with wrist OA. These PROMs are highly related, but they also differ. Therefore, they complement each other in ensuring a comprehensive evaluation of perceived disability in wrist OA. As PRWE showed the highest test-retest reliability and the highest relation to the other PROMs, the sole use of the PRWE can be recommended in clinical practice.

A systematic review and meta-analysis of Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE) measurement properties, translation, and/ or cross-cultural adaptation.

PURPOSE: To critically appraise, summarize, and synthesize the evidence on the psychometric, translation and/or cross-cultural adaptation properties of the Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE). MATERIALS AND METHODS: Four electronic databases were searched from 1998 to February 2021. Studies addressing psychometric, translation and/or cross-cultural adaptation properties were included. Two independent reviewers extracted data and assessed methodological quality of the studies using the COSMIN checklist. Where possible, meta-analysis was conducted to pool the estimates of each measurement property. Otherwise, qualitative synthesis was conducted. The overall quality of evidence on each measurement property was provided using GRADE principles. RESULTS: Forty-four studies were eligible for data extraction. The PRWE/PRWHE has been translated into 21 languages. The best factor structure was a one-dimensional construct with three unidimensional subscales. High-quality evidence supports very good structural and cross-cultural validity, internal consistency, test-retest reliability, measurement error, and hypothesis testing for construct validity against DASH in wrist and hand injuries. However, low-quality evidence supports acceptable responsiveness property. The minimal clinically important difference for the PRWE/PRWHE was 24 points for patient-level comparisons and 17 for groups. CONCLUSION: High-quality evidence supports the use of PRWE/PRWHE as a reliable, valid, and structurally sound questionnaire to assess pain and disability in patients with various wrist and hand injuries. Registration code: CRD42020180250IMPLICATION FOR REHABILITATIONSThe PRWE/PRWHE is a reliable and valid anatomical region-specific measure to assess pain and disability in patients with wrist and hand injuries.Each individual subscale of the PRWE/PRHWE (pain, specific activities, and usual activities) can be used separately as a measure of pain and disability.Change scores less than 9/100 in the total score, should be considered as measurement error, not real change. Changes in the total score between 17 and 24/100 could be assumed as the minimal clinically important change in the condition of patients over time. The PRWE/PRWHE is available in 21 different languages and has been successfully adapted into highly diverse cultures. This point could be considered as one of the merits of using PRWE/PRWHE in clinical settings in multi-lingual and multi-cultural countries, when clinicians need a psychometrically sound patient reported wrist/hand measure. .

Long-term patient-reported outcomes for open surgery of the triangular fibrocartilage complex.

AIMS: Studies on long-term patient-reported outcomes after open surgery for triangular fibrocartilage complex (TFCC) are scarce. Surgeons and patients would benefit from self-reported outcome data on pain, function, complications, and satisfaction after this surgery to enhance shared decision-making. The aim of this study is to determine the long-term outcome of adults who had open surgery for the TFCC. METHODS: A prospective cohort study that included patients with open surgery for the TFCC between December 2011 and September 2015. In September 2020, we sent these patients an additional follow-up questionnaire, including the Patient-Rated Wrist Evaluation (PRWE), to score satisfaction, complications, pain, and function. RESULTS: A total of 113 patients were included in the analysis. At ≥ 60 months after an open TFCC reinsertion, we found a mean PRWE total score of 19 (SD 21), a mean PRWE pain score of 11 (SD 11), and a PRWE function score of 9 (SD 10). The percentage of patients obtaining minimum clinically important difference rose from 77% at 12 months to 83% at more than 60 months (p < 0.001). Patients reported fewer complications than surgeons, and overall complication rate was low. CONCLUSION: Outcomes of patient-reported pain, function scores, and satisfaction are improved five years after open surgery for the TFCC. Cite this article: Bone Jt Open 2021;2(11):981-987.

Cross-Cultural Adaptation and Validation of the Translated Patient-Rated Wrist Evaluation Score.

Introduction The purpose of this study is to perform a cross-cultural adaptation and validation of the translated Patient-Rated Wrist Evaluation (PRWE) score exclusively for pathologies of the wrist. Materials and Methods A methodological study of cross-cultural validation of clinical scores was performed through a test-retest reliability analysis, internal consistency, response to change, and criterion validity assessment. Results The test was applied to 57 patients with 139 surveys. Stability evaluated through Lin's concordance correlation coefficient was 0.98, with 95% confidence interval (CI) = 0.97-0.99; Cronbach's alpha was > 0.91; the difference in score was 24.26 (standard deviation: 26.59); the standardized response mean was 0.912; the effect size was 0.924; the Spearman's coefficient between the differences of PRWE and DASH-Disabilities of the Arm, Shoulder, and Hand-scores was r = 0.899, with 95% CI = 0.811-0.947; Spearman's nonparametric correlation test between PRWE and DASH was 0.82, with 95% CI = 0.711-0.890. Conclusions We successfully validated the Spanish translation of the PRWE scale. It showed valid and reliable interpretation of functional status and response to treatment after distal radius fracture, for Colombian population. Level of Evidence This is a level II, methodological study for scale validation.

Long-term outcomes and complications associated with operative and nonoperative treatment of distal radius fractures. Do we need to restore anatomy to have satisfactory clinical outcome?

A i m: The aim of this study was to assess long-term outcomes and complications associated with conservative and operative treatment of distal radius fractures and to determine if restoration of radio- graphic parameters influences functional outcomes. I n t r o d u c t i o n: Distal radius fractures (DRFs) are common injuries associated with many complications. Numerous studies suggest that operative treatment with anatomic reduction and restoration of radiographic parameters leads to better functional outcomes than nonsurgical treatment.Materials and Methods: We enrolled 207 patients with isolated DRF (mean age 64 ± 17.9 years, women 150 (72.5%)) to our retrospective, single-center study (101 treated operatively, 106 treated non-operatively). There were no significant differences in sex, age, AO type fracture between study groups. After 3.9 ± 1.6 years (mean ± SD) clinical, functional and radiological assessment was conducted using Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE), 9-Hole Peg Test (9-HPT), grip and pinch strength tools. R e s u l t s: We found higher rates of malunion in nonoperative group (p <0.0001) and worse radiologic parameters such as volar tilt (p <0.0001), teardrop angle (p <0.0001) versus operative cohort. Nevertheless radiological parameters were not correlated with DASH and PRWE results. Moreover, patients aged 50 years and above treated operatively had similar functional outcomes (DASH, PRWE) to those treated nonoperatively. C o n c l u s i o n s: Restoration of anatomic and thus radiologic parameters of radius may not be obligatory to achieve satisfactory functional outcome in patients with DRF aged 50 years or above. Patient is the most important 'factor' in determining appropriate and successful treatment method of distal radius fractures.

How to ease the fixation of carpal bones? Twenty-four lesions treated by 1,5 mm headless compression screws.

BACKGROUND: Carpal bone lesions are common, even in acute injuries or as sequalae of missed fractures. If not correctly diagnosed and treated, can lead to loss of function, especially in active patients. The surgical management remain difficult particularly in case of small, atypical or non-unions fragments. The treatment of heterogenic shape fractures should require a fragment specific fixation using, traditionally, Kirschner-wire (K-wire). This method of treatment remains the most popular but could be prone to some complication as: not stable fixation, need to long time immobilization and wire mobilization. Methods Nineteen patients presented with carpal bone lesions were treated by the use of HCS 1,5 mm headless compression screws. Patients were evaluated post-operative by Patient-Rated Wrist Evaluation (PRWE), the Visual Analogic Scale (VAS), Quick-DASH Score and the grip strength was measured by Jamar dynamometer. RESULTS: Authors observed improvement of pain control and common activity; fine movements were restored; we observed no post-operative functional instability. CONCLUSIONS: HCS 1,5 mm headless compression screws are suitable and smart technique to treat these uncommon fractures to achieve a stable primary fixation and allow an early mobilization and conciliate the versatility of K-wire and the compression action due to screws also in small bone fragment.

Patient-reported outcomes and function after reinsertion of the triangular fibrocartilage complex by open surgery.

AIMS: Patients with a triangular fibrocartilage complex (TFCC) injury report ulnar-sided wrist pain and impaired function. The surgical procedure of TFCC reinsertion aims to improve function in patients with this injury in whom conservative treatment has failed. The purpose of this study was to investigate the outcomes of open TFCC reinsertion. METHODS: The study involved 274 patients who underwent open repair of the TFCC between December 2013 and December 2018. The patients completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire, and scored pain and function using a visual analogue scale (VAS). Range of motion (ROM) was assessed by experienced hand therapists. RESULTS: Clinically significant improvements were reported in pain, function, and grip strength in 220 patients (80%) three and 12 months postoperatively. CONCLUSION: These data will help surgeons to make decisions about the outcomes of open repair of the TFCC and to counsel patients appropriately. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(4):711-717.

Patient-Related Outcomes of Arthroscopic Resection of Ganglion Cysts of the Wrist.

Background Ganglion cysts of the wrist can cause pain and loss of functionality. No consensus exist on optimal treatment. Arthroscopic resection shows promising results but is poorly studied. Furthermore, only few studies have used patient-related outcomes to evaluate arthroscopic treatment. Purpose The purpose of this study was to assess patient-related outcomes following arthroscopic resection of wrist ganglion cysts. Patients and Methods This was a retrospective study of all consecutive patients that underwent arthroscopic resection of a dorsal or volar wrist ganglion. Minimum follow-up was 6 months. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were recurrence rate and complications. Results A total of 53 patients were included with a mean follow-up of 13 months (interquartile range: 6-23 months). Twenty-six patients (49%) presented with a recurrence following prior treatment. Mean PRWE was 13 (standard deviation [SD] = 1.8), with no difference between patients with dorsal or volar ganglion cysts. There were five recurrences (9%), of which three occurred in the first five patients who were operated. There were three patients with complications (6%), consisting of neuropraxia, extensor carpi ulnaris tendinitis, and painful scar tissue. Conclusion Arthroscopic resection results in good patient-related outcome and low complication and recurrence rates when performed by an experienced surgeon. Recurrence and complication rates are similar to arthroscopic resections described in literature and superior to open resection and needle aspiration. Well-designed randomized clinical trials will be necessary to confirm these findings. Level of Evidence This is a level IV, retrospective study.

A comparison of six outcome measures across the recovery period after distal radius fixation-Which to use and when?

PURPOSE: Many standardized outcome measures exist to measure recovery after surgical fixation of distal radius fractures, however, choosing the optimal instrument is difficult. We evaluated responsiveness, ceiling/floor effects, and criterion validity over multiple time intervals across a 2-year follow-up period for six commonly used instruments. METHODS: A total of 259 patients who received open reduction and internal fixation for distal radius fractures between 2012 and 2015 were recruited. Patients were administered the Patient-Rated Wrist Evaluation (PRWE), Shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), Green and O'Brien score (Cooney modification) (CGNO), Gartland and Werley score (Sarmiento modification) (SGNW), flexion-extension arc (FEArc), and grip fraction test (GripFrac) at 1.5, 3, 6, 12, and 24 months postoperatively. Responsiveness was evaluated by calculating standardized response means (SRM) and Cohen's d effect sizes (ES), and by correlating each instrument's change scores against those of QuickDASH and PRWE, which were also used as external comparators to assess criterion validity. Ceiling/floor effects were calculated for all measures at each time point. RESULTS: SRM (1.5-24 months) were 1.81, 1.77, 1.43, 1.16, 2.23, 2.45 and ES (1.5-24 months) were 1.81, 1.82, 1.95, 1.31, 1.99 and 2.90 for QuickDASH, PRWE, CGNO, SGNW, FEArc, and GripFrac respectively. Spearman correlation coefficients against QuickDASH at 24 months were: 0.809, 0.248, 0.563, 0.285, and 0.318 for PRWE, CGNO, SGNW, FEArc, and GripFrac respectively. Significant (>15% of patients reaching maximum score) ceiling effects were observed before 6 months for PRWE and SGNW. CONCLUSIONS: Our evidence supports the use of QuickDASH, PRWE, FEArc and GripFrac up to 6 months postsurgery, and QuickDASH and PRWE after 6 months. LEVEL OF EVIDENCE: Level II.