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1.
Instr Course Lect ; 69: 317-330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017735

RESUMO

Scaphoid fractures are common and notorious for their troublesome healing. The aim of this review is to reevaluate the current best evidence for the diagnosis, classification, and treatment of scaphoid fractures and nonunions. MRI and CT are used to establish a "definitive diagnosis" with comparable diagnostic accuracy although neither is 100% specific. Current classifications cannot reliably predict union or outcomes; hence, a descriptive analysis of fracture location, type, and extent of displacement remains most useful. Treatment of a nondisplaced scaphoid waist fracture remains an individualized decision based on shared decision-making. Open reduction and internal fixation may be preferred when fracture displacement exceeds 1 mm, and the fracture is irreducible by closed or percutaneous means. For unstable nonunions with carpal instability, either non-vascularized cancellous graft with stable internal fixation or corticocancellous wedge grafts will provide a high rate of union and restoration of carpal alignment. For nonunions characterized with osteonecrosis of the proximal pole, vascularized bone grafting can achieve a higher rate of union.


Assuntos
Fraturas não Consolidadas , Osso Escafoide , Traumatismos do Punho , Transplante Ósseo , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos
2.
J Wrist Surg ; 8(6): 441-445, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31815056

RESUMO

Objective Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. Methods We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured. A principal component analysis was used to find groups. Density mapping was used to image probable common fracture areas in the scaphoid. Results Forty-nine of 51 fractures had a similar pattern. It was not possible to identify subgroups based on fracture pattern. The mean volumetric size of the fracture fragments of the proximal (1.45 cm 3 ± 0.49 cm 3 standard deviation [SD]) and distal fracture fragments (1.53 cm 3 ± 0.48 cm 3 SD) was similar. There was a single common fracture area in the middle third of the bone. In the distal third, there were no horizontal fractures through-but only directly proximal to-the tubercle suggesting that these would be best classified as distal waist fractures. Conclusion Acute scaphoid fractures mainly occur in the middle third of the bone and tend to divide the scaphoid in half by volumetric size of the fracture fragments. There were two distinct grouping patterns: fractures through the proximal and middle third were horizontal oblique, whereas fractures of the distal third were vertical oblique. It seems that scaphoid fractures might be classified into proximal pole fractures, a range of waist fractures, and tubercle avulsion fractures. Level of evidence This is a Level IV study.

3.
J Wrist Surg ; 8(6): 446-451, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31815057

RESUMO

Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification ( P < 0.05). Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid fractures are uncommon (6%) and have somewhat different presentations compared to waist fractures. Simplifying the fracture classification slightly improves interobserver reliability, although remaining fair, and significantly reduces doubt. Level of Evidence This is a Level III, prognostic study.

4.
Ned Tijdschr Geneeskd ; 1632019 03 21.
Artigo em Holandês | MEDLINE | ID: mdl-30945828

RESUMO

Considering that pseudoarthrosis, or non-union, often occurs in patients with scaphoid fractures it is very important to start adequate treatment as soon as possible. On the basis of the literature, we advise immobilisation in a below-elbow cast, whereby the thumb is not immobilised and the wrist is in a slightly extended position. Despite the fact that non-dislocated fractures, at the very least, are usually consolidated within 4 weeks, we advise an immobilisation period of 6 weeks followed by clinical or radiological evaluation. If the fracture fails to consolidate, we advise prolonged immobilisation with two-weekly evaluation. There is no evidence in the literature of a positive effect of pulsed electromagnetic field therapy or pulsed low-intensity ultrasound therapy on healing of scaphoid fractures.

5.
PLoS One ; 13(8): e0201978, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30071104

RESUMO

[This corrects the article DOI: 10.1371/journal.pone.0161749.].

6.
J Bone Joint Surg Am ; 100(14): 1191-1202, 2018 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-30020124

RESUMO

BACKGROUND: Malunion is the most frequent complication seen after a fracture of the distal end of the radius. The primary aim of this study was to compare patient-reported outcome measures (PROMs) after corrective osteotomy for malunited distal radial fractures with and without 3-dimensional (3D) planning and use of patient-specific surgical guides. METHODS: From September 2010 to May 2015, 40 adult patients with a symptomatic extra-articular malunited distal radial fracture were randomized to 3D computer-assisted planning or conventional 2-dimensional (2D) planning for corrective osteotomy. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist Evaluation (PRWE) score, pain and satisfaction scores, grip strength, and radiographic measurements at 3, 6, and 12 months postoperatively. RESULTS: From baseline to 12 months of follow-up, the reduction in the mean DASH score was -30.7 ± 18.7 points for the 3D planning group compared with -20.1 ± 17.8 points for 2D planning (p = 0.103). Secondary functional outcome by means of the PRWE resulted in a similar reduction of -34.4 ± 22.9 points for the 3D planning group compared with -26.6 ± 18.3 points for the 2D planning group (p = 0.226). There were no significant differences in pain, satisfaction, range of motion, and grip strength. Radiographic analysis showed significant differences in the mean residual volar angulation (by 3.3°; p = 0.04) and radial inclination (by 2.7°; p = 0.028) compared with the templated side, in favor of 3D planning and guidance. The duration of preoperative planning and surgery as well as complication rates were comparable. CONCLUSIONS: Although there was a trend toward a minimal clinically important difference in PROMs in favor of 3D computer-assisted guidance for corrective osteotomy of extra-articular distal radial malunion, it did not attain significance because of (post hoc) insufficient power. Despite the challenge of feasibility, a trial of large magnitude is warranted to draw definitive conclusions regarding clinical advantages of this advanced, more expensive technology. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Diagnóstico por Computador/métodos , Osteotomia/métodos , Planejamento de Assistência ao Paciente , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Fraturas Mal-Unidas , Força da Mão , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Amplitude de Movimento Articular , Recuperação de Função Fisiológica
7.
Knee Surg Sports Traumatol Arthrosc ; 26(12): 3706-3710, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29752498

RESUMO

Patellar dislocation is a condition that is often reduced by itself or through closed manipulation from a trained professional. In this case of a traumatic lateral patellar dislocation, the patella was caught through the rupture in the lateral retinaculum, as is seen in Boutonniere-like lesions. Reduction of the dislocated patella was obtained by arthroscopic reduction.Level of evidence V.


Assuntos
Artroscopia/métodos , Manipulação Ortopédica/métodos , Luxação Patelar/cirurgia , Traumatismos em Atletas/cirurgia , Humanos , Masculino , Luxação Patelar/diagnóstico por imagem , Futebol/lesões , Adulto Jovem
8.
Knee Surg Sports Traumatol Arthrosc ; 25(7): 2247-2254, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27351547

RESUMO

PURPOSE: In this anatomical cadaver study, the distance between major nerves and ligaments at risk for injury and portal sites created by trainees was measured. Trainees, inexperienced in elbow arthroscopy, have received a didactic lecture and cadaver instruction prior to portal placement. The incidence of iatrogenic injury from novice portal placement was also determined. METHODS: Anterolateral, direct lateral, and anteromedial arthroscopic portals were created in ten cadavers by ten inexperienced trainees in elbow arthroscopy. After creating each portal, the trajectory of the portal was marked with a guide pin. Subsequently, the cadavers were dissected and the distances between the guide pin in the anterolateral, direct lateral, and anteromedial portals and important ligaments and nerves were measured. RESULTS: The difference between the distance of the direct lateral portal and the posterior antebrachial cutaneous nerve (PABCN) (22 mm, p < 0.001), the lateral antebrachial cutaneous nerve (4.0 mm, p < 0.001), and the radial nerve (25 mm, p < 0.001) was different from the average reported distances in the literature. A difference was found between the distance of the anterolateral portal and the PABCN (32 mm, p < 0.001) compared to previous studies. Three major iatrogenic complications were observed, including: laceration of the posterior bundle of the medial ulnar collateral ligament, lateral ulnar collateral ligament midsubstance laceration, and median nerve partial laceration. CONCLUSION: Surgeons increasingly consider arthroscopic treatment as an option for elbow pathology. In the present study a surgical complication rate of 30 % was found with novice portal placement during elbow arthroscopy. Furthermore, as the results from this study have indicated, accurate, precise, and safe portal placement in elbow arthroscopy is not easily achieved by didactic lecture and cadaver instruction session alone. Level of evidence V.


Assuntos
Artroscopia/métodos , Competência Clínica , Articulação do Cotovelo/cirurgia , Adulto , Idoso , Artroscopia/efeitos adversos , Cadáver , Feminino , Humanos , Complicações Intraoperatórias , Ligamentos/lesões , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Fatores de Risco
9.
PLoS One ; 11(9): e0161749, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27631616

RESUMO

PURPOSE: The aim of this study was to determine the cumulative effect of a routine (hot-to-) cold shower on sickness, quality of life and work productivity. METHODS: Between January and March 2015, 3018 participants between 18 and 65 years without severe comorbidity and no routine experience of cold showering were randomized (1:1:1:1) to a (hot-to-) cold shower for 30, 60, 90 seconds or a control group during 30 consecutive days followed by 60 days of showering cold at their own discretion for the intervention groups. The primary outcome was illness days and related sickness absence from work. Secondary outcomes were quality of life, work productivity, anxiety, thermal sensation and adverse reactions. RESULTS: 79% of participants in the interventions groups completed the 30 consecutive days protocol. A negative binomial regression model showed a 29% reduction in sickness absence for (hot-to-) cold shower regimen compared to the control group (incident rate ratio: 0.71, P = 0.003). For illness days there was no significant group effect. No related serious advents events were reported. CONCLUSION: A routine (hot-to-) cold shower resulted in a statistical reduction of self-reported sickness absence but not illness days in adults without severe comorbidity. TRIAL REGISTRATION: Netherlands National Trial Register NTR5183.


Assuntos
Banhos , Temperatura Baixa , Emprego , Nível de Saúde , Temperatura Alta , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
J Wrist Surg ; 5(3): 194-201, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27574573

RESUMO

Coronal (or frontal plane) fractures of the scaphoid are distinctly uncommon. There are few published reports of coronal fractures of the scaphoid. This fracture is often missed on the initial X-ray films. A high index of suspicion should exist when there is a double contour of the proximal scaphoid pole on the anteroposterior X-ray view. A computed tomography scan is integral in making the diagnosis. Early recognition is key in salvaging the scaphoid fracture and in preventing articular damage. Level of Evidence IV. Retrospective case series.

11.
Arch Bone Jt Surg ; 4(2): 161-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27200396

RESUMO

BACKGROUND: An intra-articular distal humerus malunion can be disabling. To improve function, reduce pain and/or prevent further secondary osteoarthritis an intra-articular corrective osteotomy can be considered. Herein we present the indications, practical guidelines for pre- operative planning and surgical technique. Subsequently, we provide long-term results in a small series. METHODS: We included six consecutive patients operated for intra-articular distal humerus malunion. Mean follow-up was 88 months. At lastest follow up elbow function was assessed according to standardized questionnaires and classification systems. RESULTS: All six patients healed their osteotomies. Three patients had a postoperative complication which were treated succesfully. Range of motion improved significantly and all patients were satisfied with the outcome. The elbow performance scores were good to excellent in all. Correlation analyses showed that age and level of osteoarthritis are very strong predictors for the long-term elbow function and quality of life. CONCLUSION: An intra-articular corrective osteotomy for a malunited distal humerus fracture is a worthwhile procedure. Based on our results it should particularly be considered in young patients with minimal osteoarthritis and moderate to severe functional disability and/or pain.

12.
J Wrist Surg ; 5(2): 152-9, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27104083

RESUMO

Background In the lack of consensus, surgeon-based preference determines how acute scaphoid fractures are classified. There is a great variety of classification systems with considerable controversies. Purposes The purpose of this study was to provide an overview of the different classification systems, clarifying their subgroups and analyzing their popularity by comparing citation indexes. The intention was to improve data comparison between studies using heterogeneous fracture descriptions. Methods We performed a systematic review of the literature based on a search of medical literature from 1950 to 2015, and a manual search using the reference lists in relevant book chapters. Only original descriptions of classifications of acute scaphoid fractures in adults were included. Popularity was based on citation index as reported in the databases of Web of Science (WoS) and Google Scholar. Articles that were cited <10 times in WoS were excluded. Results Our literature search resulted in 308 potentially eligible descriptive reports of which 12 reports met the inclusion criteria. We distinguished 13 different (sub) classification systems based on (1) fracture location, (2) fracture plane orientation, and (3) fracture stability/displacement. Based on citations numbers, the Herbert classification was most popular, followed by the Russe and Mayo classifications. All classification systems were based on plain radiography. Conclusions Most classification systems were based on fracture location, displacement, or stability. Based on the controversy and limited reliability of current classification systems, suggested research areas for an updated classification include three-dimensional fracture pattern etiology and fracture fragment mobility assessed by dynamic imaging.

14.
J Hand Microsurg ; 5(1): 9-13, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24426663

RESUMO

Trapeziometacarpal arthrosis is expected with advancing age and a limited percentage of people seek medical attention for it. We studied patients after their first appointment to address trapeziometacarpal arthrosis with a hand surgeon to determine factors associated with return for a second visit and eventual election of operative treatment. A billing database identified 306 patients in the practice of three hand surgeons with a new diagnosis of TMC arthrosis and no associated diagnoses. Bivariate and multivariable logistic regression analyses sought factors associated with a second visit and operative treatment among demographic and visit related factors. One hundred and forty-three patients (47 %) returned for one or more additional visits and 46 (15 %) eventually elected operative treatment within the study period. Independent predictors of a return visit included injection at first visit, splint at first visit, and doctor's recommendation for a return visit. The predictors of surgery were treating surgeon and prescription of a splint at the first visit, but splint at first visit was only predictive for one of the three surgeons. When patients first learn about their trapeziometacarpal arthrosis, the behavior of the hand surgeon may have a strong influence on return visits and eventual choice of operative treatment.

15.
J Hand Surg Am ; 37(10): 2041-9, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22939826

RESUMO

PURPOSE: This study evaluated the functional outcome of corrective osteotomy for combined intra- and extra-articular malunions of the distal radius using multiple outcome scores. METHODS: We evaluated 18 skeletally mature patients at an average of 78 months after corrective osteotomy for a combined intra- and extra-articular malunion of the distal part of the radius. The indication for osteotomy in all patients was the combination of an extra-articular deformity (≥ 15° volar or ≥ 10° dorsal angulation or ≥ 3 mm radial shortening) and intra-articular incongruity of 2 mm or greater (maximum stepoff or gap), as measured on lateral and posteroanterior radiographs. The average interval from the injury to the osteotomy was 9 months. The average maximum stepoff or gap of the articular surface before surgery was 4 mm. RESULTS: All 18 patients healed uneventfully and the final articular incongruity was reduced to 2 mm or less. Final range of motion and grip strength significantly improved, averaging 89% and 84% of the uninjured side and 185% and 241% of the preoperative measures, respectively. The rate of excellent or good results was 72% according to the validated rating system Mayo Modified Wrist Score, and 89% according to the unvalidated system of Gartland and Werley. The mean Disabilities of the Arm, Shoulder, and Hand score was 11, which corresponds to mild perceived disability. Of the 18 cases, 11 normalized upper limb function. Five patients had complications; all were successfully treated. According to the rating system of Knirk and Jupiter, 4 had grade 1 and 1 had grade 2 osteoarthritis of the radiocarpal joint on radiographs. Two of those patients reported occasional mild pain. Radiographic osteoarthritis did not correlate with strength, motion, and wrist scores. CONCLUSIONS: Outcomes of corrective osteotomy for combined intra- and extra-articular malunions were comparable to those of osteotomy for isolated intra- and extra-articular malunions. A successful corrective osteotomy for the treatment of complex intra- and extra-articular distal radius malunions can improve wrist function. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Fraturas do Rádio/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Seguimentos , Fraturas Mal-Unidas/diagnóstico por imagem , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/classificação , Osteoartrite/diagnóstico por imagem , Medição da Dor , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular , Adulto Jovem
16.
J Bone Joint Surg Am ; 94(21): 1967-74, 2012 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-23014795

RESUMO

BACKGROUND: Fracture displacement is the most important factor associated with nonunion of a scaphoid waist fracture.We evaluated the performance characteristics of radiographs and computed tomography (CT) in the diagnosis of intraoperative displacement and instability of scaphoid waist fractures using wrist arthroscopy as the reference standard. METHODS: During a six-year period (2004 to 2010) at two institutions, forty-four adult patients with a scaphoid waist fracture underwent arthroscopy-assisted operative fracture treatment at a mean of nine days (range, two to twenty-two days) after injury. Subjects included all of those with a displaced scaphoid fracture seen on radiographs and a selection of patients with a nondisplaced scaphoid fracture. All patients had preoperative radiographs and CT. Arthroscopy with up to 5 kg of traction was the reference standard for fracture displacement and instability. RESULTS: The reference standard (arthroscopy) led to a diagnosis of twenty-two displaced fractures (all unstable) and twenty-two nondisplaced fractures (seven unstable). Displacement was diagnosed in eleven patients (25%) with the use of radiographs and in twenty (45%) with CT. The sensitivity, specificity, and accuracy for diagnosing intraoperative displacement were 45%, 95%, and 70%, respectively, with the use of radiographs and 77%, 86%, and 82%, respectively, with CT. The sensitivity, specificity, and accuracy for diagnosing intraoperative instability were 34%, 93%, and 55%, respectively,with the use of radiographs and 62%, 87%, and 70%, respectively, with CT. Assuming a 10% prevalence of fracture displacement and instability among all scaphoid waist fractures, the positive and negative predictive values for displacement were 53% and 94%, respectively, with the use of radiographs and 39% and 97% with CT whereas the positive and negative predictive values for instability were 36% and 93%, respectively, with radiographs and 34% and 95% with CT. CONCLUSIONS: Radiographs and CT scans cannot be relied on to accurately diagnose intraoperative scaphoid fracture displacement or instability compared with arthroscopic examination. The influence, with regard to the risk of nonunion, of intraoperative instability of a scaphoid fracture that is seen to be nondisplaced on radiographs or CT is currently unknown. LEVEL OF EVIDENCE: Diagnostic Level III.


Assuntos
Fraturas Ósseas/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Artroscopia , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Estudos Prospectivos , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Tomografia Computadorizada por Raios X , Articulação do Punho/cirurgia
17.
J Hand Surg Am ; 37(5): 1095-100; quiz 1101, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22541157

RESUMO

The primary risk factor for nonunion of the scaphoid is displacement/instability, but delayed or missed diagnosis, inadequate treatment, fracture location, and blood supply are also risk factors. Untreated nonunion leads to degenerative wrist arthritis-the so-called scaphoid nonunion advanced collapse wrist. However, the correlation of symptoms and disease is poor; the true "natural history" is debatable because we evaluate only symptomatic patients presenting for treatment. It is not clear that surgery can change the natural history, even if union is attained. The diagnosis of nonunion is made on radiographs, but computed tomography or magnetic resonance imaging scans can be useful to assess deformity and blood supply. Treatment options vary from percutaneous fixation to open reduction and internal fixation with vascularized or nonvascularized bone grafting to salvage procedures involving excision and/or arthrodesis of carpals.


Assuntos
Transplante Ósseo/métodos , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Artrodese , Diagnóstico por Imagem , Fêmur/irrigação sanguínea , Fêmur/transplante , Fraturas não Consolidadas/diagnóstico , Humanos , Ílio/irrigação sanguínea , Ílio/transplante , Rádio (Anatomia)/irrigação sanguínea , Rádio (Anatomia)/transplante , Fatores de Risco , Terapia de Salvação
18.
J Hand Surg Am ; 37(7): 1405-10, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22633223

RESUMO

PURPOSE: To identify factors associated with arthroscopically diagnosed scaphoid fracture displacement and instability. METHODS: This was a secondary use of data from 2 prospective cohort studies. The studies included 58 consecutive adult patients with a scaphoid fracture who elected arthroscopy-assisted operative fracture treatment: some for displacement, some as part of a prospective protocol, and others to avoid a cast. All patients had preoperative computed tomography with reconstructions in planes defined by the long axis of the scaphoid. RESULTS: Arthroscopy revealed 38 unstable fractures (movement between fracture fragments; 66%), 27 of which were also displaced. All arthroscopically determined displaced fractures were unstable, and 11 of the 31 arthroscopically determined, nondisplaced fractures were unstable. There was a significant correlation between radiographic comminution (more than 2 fracture fragments) and arthroscopically determined displacement and instability. CONCLUSIONS: Radiographic comminution is associated with displacement and instability as determined by arthroscopy.


Assuntos
Artroscopia/métodos , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Consolidação da Fratura , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/cirurgia , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Osso Escafoide/diagnóstico por imagem , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Clin Orthop Relat Res ; 470(7): 2029-34, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22290132

RESUMO

BACKGROUND: The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability. QUESTIONS/PURPOSES: We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans. METHODS: Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel's multirater kappa and the Z-test was used to test for significance. RESULTS: There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups. CONCLUSIONS: Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.


Assuntos
Competência Clínica , Instrução por Computador , Erros de Diagnóstico/prevenção & controle , Educação Médica Continuada/métodos , Fraturas Ósseas/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Feminino , Humanos , Internet , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Osso Escafoide/lesões , Inquéritos e Questionários
20.
J Hand Surg Am ; 37(3): 500-502.e1, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22321437

RESUMO

This report describes 2 patients with apparent ulnar to radial dorsal fracture-dislocation: 1 had a transtriquetrum, translunate fracture dislocation and the other had a reverse stage 2 lesser arc perilunate dislocation with fracture of the ulnar styloid at its base.


Assuntos
Ossos do Carpo/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Ulna/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Adulto , Ossos do Carpo/lesões , Ossos do Carpo/cirurgia , Humanos , Luxações Articulares/cirurgia , Masculino , Radiografia , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Articulação do Punho/cirurgia , Adulto Jovem
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