Predictors of chronic pain and disability in patients treated conservatively after distal radius fracture: a prospective cohort study.

PURPOSE: To determine predictors of chronic pain and disability among patients with distal radius fractures (DRF) treated conservatively with closed reduction and cast immobilization. METHODS: This was a prospective cohort study. Information on patient characteristics, post-reduction radiographic parameters, finger and wrist range of motion, psychological status (Hospital Anxiety and Depression Scale or HADS), pain (Numeric Rating Scale or NRS), and self-perceived disability (Disabilities of the Arm, Should, and Hand or DASH) were taken at baseline, cast removal, and 24 weeks. Differences in outcomes between time points were determined using analysis of variance. Multiple linear regressions were used to determine predictors of pain and disability at 24 weeks. RESULTS: One hundred forty patients with DRF (70% women, age: 67.0 ± 17.9) completed 24 weeks of follow-up and were included in the analysis. NRS (off-cast), range of ulnar deviation (off-cast), and greater occupational demands were significant predictors of pain at week 24 (adjusted R2 = 0.331, p < 0.001). Significant predictors of perceived disability at week 24 were HADS (off cast), sex (female), dominant-hand injury, and range of ulnar deviation (off cast) (adjusted R2 = 0.265, p < 0.001). CONCLUSIONS: Off-cast NRS and HADS scores are important modifiable predictors of patient-reported pain and disability at 24 weeks in patients with DRF. These factors should be targeted in the prevention of chronic pain and disability post-DRF.

Prevalence of Flexor Carpi Radialis Brevis in Chinese Patients with Volar Wrist Plating Performed for Distal Radius Fracture.

Background: Volar locking plates were increasing popular as treatment of distal radius fractures. Various distal forearm anatomical variants were encountered during surgery. Flexor carpi radialis brevis (FCRB) was one of the most common and relevant anatomical variants because of its close proximity to fracture site. Methods: This is a retrospective single-centre study. In a 3.5-year period from March 2015 to August 2018, 133 patients who suffered from distal radius fracture requiring volar wrist plating were identified. Operation records and clinical photos were reviewed. All patients were followed up for at least 1 year. Any complications were recorded. Results: 9 patients with FCRB variant were identified. The prevalence was 6.8%. Hypoplastic pronator quadratus were found in 5 cases out of the 9 cases. None of these cases had any neurovascular injuries. No complications were noted during follow-up at 1 year. Conclusions: In Chinese population with volar locking plate done for distal radius fracture, the prevalence of flexor carpi radialis brevis was 6.8%. Surgeons should be aware of the possibility of FCRB variant.

Concomitant fungal and bacterial atlanto-axial osteomyelitis: a case report.

Concomitant fungal and bacterial atlanto-axial osteomyelitis in immunocompetent individuals is rare. We report one such patient who underwent transoral anterior decompression and posterior occipital cervical fusion, together with antibiotic and antifungal treatment. At 16-month follow-up, the patient had made a full recovery with solid fusion. Prompt diagnosis requires a high degree of clinical suspicion, with timely use of modern imaging modalities. When the diagnosis is early, antibiotic treatment alone should suffice.