Clinical outcomes in patients with scaphoid non-union treated with the vascularized medial femoral condyle technique a case series.

INTRODUCTION: Non-union is a prevalent complication of scaphoid fractures. Late diagnosis is common and has a clinical impact due to functional limitations for the patient. Multiple treatments have been proposed to manage this complication, ranging from conservative (i.e., orthopedic) to surgical treatment. The vascularized medial femoral condyle technique has shown satisfactory clinical and paraclinical results, mainly in presence of avascular necrosis of the proximal pole but data regarding functional outcomes and patient satisfaction is scarce. This case series aims to describe the clinical and patient-reported outcomes in a consecutive series of patients with non-union of the proximal third of the scaphoid treated with vascularized medial femoral condyle technique. METHODS: Case series reporting results for a consecutive - initial cohort of patients who presented with a non united fracture of the proximal pole of the scaphoid, avascular necrosis of the proximal pole was documented by CT od MRI imaging preoperatively in all patients. Measurement instruments include the q-DASH and PRWE questionnaires, radiographic images, goniometry, and assessment of grip strength. RESULTS: Twelve consecutive patients are included and they represent the initial cases for all surgeons involved; bone union was obtained in 10 patients (83%) after a mean follow-up time of 31 months (6-72), successful improvement in the range of motion and grip strength was documented. A high rate of satisfaction expressed by the patient was obtained, with an average score in Q-DASH of 17.3 and 20.1 in PRWE. CONCLUSIONS: The vascularized medial condyle technique in cases of nonunion of scaphoid fracture is a reproducible treatment in clinical terms, both in imaging and functional terms, and in patient satisfaction. The learning curve is flat for a dedicated multi surgeon team.

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.

Validación de la versión en español de la escala de función del miembro superior abreviada: Quick Dash / Validation of the Spanish version of the short Disabilities of the Arm, Shoulder and Hand Scale - Quick DASH

Introducción El objetivo del estudio es validar la versión corta de la escala de discapacidades de brazo, hombro y mano (QuickDASH) en español mediante pruebas de confiabilidad, consistencia y validez. Materiales y métodos Sobre 394 cuestionarios DASH de 298 sujetos participantes de un estudio previo, se corrieron pruebas de confiabilidad, consistencia, precisión, respuesta al cambio y validez. Resultados La confiabilidad medida mediante el coeficiente de concordancia de Lin fue de 0.8 IC95%: 0.67 a 0.93. La precisión transversal se estimó con intervalo de confianza de 95% en 12.72 y la precisión longitudinal (cambio mínimo detectable) se determinó en 20 puntos. Se obtuvo valores satisfactorios de capacidad de detectar respuesta al cambio y validez. Estas pruebas demostraron un comportamiento comparable entre el QuickDASH y el DASH ya validado en español. Discusión La versión abreviada de la escala perdió precisión tanto transversal como longitudinal debido a la disminución en la consistencia interna y en la estabilidad en la muestra estudiada, sin embargo conservó la capacidad de discriminar y de detectar cambio, estos resultados permiten recomendar su uso en ambiente clínico y de investigación. Nivel de Evidencia: II

Background aim of the study was to validate the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) in Spanish by testing reliability, consistency, and validity. Materials and methods A total of 394 DASH questionnaires, from 298 participants of a previous study, were tested for reliability, consistency, accuracy, validity and responsiveness to change. Results Reliability, measured by Lin concordance coefficient was 0.8, 95% CI: 0.67 to 0.93. Cross-sectional precision was estimated with a 95% confidence interval as 12.72, and longitudinal precision (minimum detectable change) was determined as 20 points. Satisfactory values regarding ability to detect response to change and validity were obtained. These tests showed comparable performance between QuickDASH and DASH and validated in Spanish. Discussion The shortened version of the scale lost both cross-sectional and longitudinal precision, due to the decrease in internal consistency and stability in the sample studied. As it retained the ability to discriminate and detect change, these results enable it to be recommended for use in the clinical and research setting. Evidence Level: II