Methods of assessment of the level of surgeons for minimally invasive fixation of distal radius fractures: "expertise" versus "performance".

INTRODUCTION: The results of surgical techniques vary depending on the level of the surgeon's experience. The level of expertise can be evaluated quantitatively or qualitatively. In this study, we evaluated the duration of the procedure and the size of the incision of minimally invasive fixation of distal radius fractures as a means of grading expertise and surgical performance. The null hypothesis of our study was that the level of expertise did not match the level of performance. MATERIAL AND METHODS: The study included 52 surgeons split in five levels of expertise who had performed 467 minimally invasive fixations of distal radius fractures. The performance of the surgeons in terms of duration of the procedure and size of the incision were scored according to the five levels of surgical experience using four different methodologies: clinical (setting limits compared to data found in literature), statistical (setting statistical limits of comparison in percentiles (20th, 40th, 60th, 80th) for each of the two parameters measured), arithmetical (setting limits compared to equal intervals for each of the 2 variables), and success rate (setting a threshold for each of the 2 variables). RESULTS: Our results showed a great disparity between levels of experience depending on the method used. The scores for levels 1 and 2 were 72% for expertise, 13% for performance according to the clinical method, 75% for the statistical method, 0% for the arithmetical method, and 57% according the success rate. The rate of level 3 was 23% for expertise, 41% for performance by the clinical method, 17% by the statistical method, 17% by the arithmetical method, and 15% by the success rate. The rates of levels 4 and 5 were 5% for expertise, 46% for performance clinical method, 8% by the statistical method, 83% by the arithmetical method, and 28% by the success rate. DISCUSSION: The null hypothesis of our study was confirmed by the results which show that there was no correlation between levels of expertise and performance. The clinical method of assessment appears to reflect best the true level of performance of the surgeon. CONCLUSION: Publications reporting the results of a surgical technique for a given pathology should always mention the level of performance as measured on a clinical scale.

Treatment of tendinous mallet fingers using a Stack splint versus a dorsal glued splint.

The goal of this study was to compare the results of a Stack splint compared to a dorsal glued splint in the treatment of tendinous mallet fingers. Our series included 100 patients, aged 47 years in average, among which 40 are women, with a 9-week follow-up. The first 50 patients (group I) were treated with a dorsal glued splint, and the 50 following patients (group II) were treated with a Stack splint. The average lack of active extension of the distal phalanx was 3.1° in group I and 1.74° in group II. The average pain was rated 0.22/10 in group I and 0.26/10 in group II. There were seven cases of nail dystrophies, 18 cases of macerations and five cases of swan neck deformities in group I. There were six cases of macerations and four cases of swan neck deformities in group II. The dorsal nail-glued splint gives comparable results to the Stack splint with the added advantage of leaving the fingertip free.

Results of the treatment of first carpometacarpal joint osteoarthritis: trapeziectomy alone versus trapeziectomy associated with suspensionplasty.

BACKGROUNDS: The goal of this study was to compare trapeziectomy alone to trapeziectomy associated with a technique of suspensionplasty using the abductor pollicis longus with a minimum of 6 years of follow-up in the treatment of osteoarthritis of the first carpometacarpal joint. METHODS: Our series included 46 trapeziectomies in 35 patients, aged 69 years in average, among which 27 were women. In 27 cases group I, a trapeziectomy alone was performed, and in 19 cases group II, a trapeziectomy associated with an abductor pollicis longus suspensionplasty was performed. RESULTS: At the last follow-up, the difference between pre- and postoperative Quick DASH was - 36.104 in average in group I and - 38.877 in average in group II p = 0.7717. The difference between pre- and postoperative pain was - 3.926 in average in group I and - 4.368 in average in group II p = 0.35. The difference of pre- and postoperative thumb opposition was 0.630 in group I and 0.421 in group II p = 0.3033. The average difference of pre- and postoperative key pinch was 0.389 in group I and 0.842 in group II p = 0.3303. No complication was reported. CONCLUSIONS: Our results suggest that it is unnecessary to perform a ligamentoplasty when a trapeziectomy is indicated.

Correction to: The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures.

With regards to Juan José Hidalgo Diaz, fifth author. The author's name is incorrectly listed on Pub-Med. The first and last name has been mixed up.Correct first name is: JJ (on PubMed: JJH.).Correct last name is: Hidalgo Diaz (on PubMed: Diaz).On SpringerLink the name is listed correctly, but on PubMed he is listed as Diaz JJH.

The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures.

The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. After 15-mm incision on the lateral aspect of the FCR tendon and all structures but the radial artery are reclined ulnarly, a plate is inserted under the pronator quadratus just proximal to the "watershed line." The distal epiphyseal screws are put in place, and the proximal part of the plate is exposed by flexion of the wrist to put in place the proximal screws. No drainage or postoperative immobilization is used. It offers the advantage of preserving ligamentotaxis which facilitates the reduction, and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intraarticular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.

Conservative treatment of distal fractures after the age of 65: a review of literature.

The goal of this study was to evaluate the role of conservative treatment of distal radius fractures in the elderly since 2000. Our series included 22 articles, of which 3 reviews, 2 meta-analyses, 6 descriptive series of conservative treatment, 10 series comparing surgical and conservative treatments and 1 series comparing different types of conservative treatments. The reduction was performed by closed reduction in 7 cases and by traction in 3 cases. A short-arm cast was used in 8 cases and a long-arm cast in 4 cases for an average length of 6 weeks. The indications of conservative treatment were varied: AO type A fractures in 2 cases, type C fractures in 1 case, types A and C in 8 cases and types A, B and C in 3 cases. No article reported any significant difference between surgical and conservative treatments in terms of DASH or PRWE, whereas strength was sometimes improved when surgical treatment was used. Radiological results were always better after surgical treatment. The rate of complications varied greatly, greater, equally or lower compared to conservative treatment depending on the series. All in all, there is no consensus to assert that a conservative treatment is more justified than a surgical treatment to treat distal radius fractures after the age of 65. Most authors consider that the long-term clinical outcome is identical and that the radiological result is better after surgical treatment. The fact that the fixation of a distal radius fracture by a volar locking plate after 65 years speeds up the recovery remains to be proven.

Minimally invasive anterior plate osteosynthesis of the distal radius: A 710 case-series.

INTRODUCTION: Since the 2000s, internal fixation of distal radius fracture by volar locking plate on an extended flexor carpi radialis (FCR) approach has become the gold standard. OBJECTIVE: The present study aimed to assess medium-term results of minimally invasive plate osteosynthesis (MIPO) in distal radius fracture. MATERIAL AND METHODS: The series comprised of 710 cases (512 female; mean age, 58 years). The 15mm approach was on the lateral edge of the FCR. The plate was slipped under the pronator quadratus. Closure used intradermal running suture without drain or orthosis. RESULTS: At a mean 7 months' follow-up, mean scar length was 17mm (range, 10-40mm), pain 1.13/10 (0-8), Quick-DASH 13.28 (0-86.36), and patient-rated wrist evaluation (PRWE) 11.48 (0-91). Compared to contralateral values, mean flexion was 87.23%, extension 88.52%, pronation 96.17%, supination 93.41%, and grip strength 79.68%. Hardware was removed in 45.92% of cases. There were 16 cases of secondary displacement, with 4 revision procedures, one of sepsis at 6 months, 10 of complex regional pain syndrome, and 14 of median nerve paresthesia, with 4 carpal tunnel release procedures. DISCUSSION: The minimally invasive FCR approach can be used for volar plate fixation of distal radial fracture. It has the advantage of conserving ligamentotaxis, facilitating reduction and improving scar esthetics. The incision can be extended if need be. LEVEL OF EVIDENCE: III; single-centre retrospective study.

Asymmetrical after-effects of prism adaptation during goal oriented locomotion.

In healthy subjects, sensorimotor after-effects of prism adaptation are known to be symmetric (they appear after using leftward and rightward optical deviations), whereas cognitive after-effects are asymmetric (they appear after using a leftward optical deviation) and rightward oriented. Sensorimotor and cognitive after-effects have been classically studied using different specific tasks. The purpose of the current study was to investigate whether both after-effects may be involved in a same visuo-spatial task. Therefore we compared the amplitude of after-effects following adaptation to a rightward or leftward optical deviation. After-effects were assessed by manual pointing or goal oriented locomotor task. The main result showed a greater amplitude for rightward locomotor after-effects (after adaptation to a leftward deviation) than for leftward locomotor after-effects (after adaptation to a rightward deviation). This means that cognitive after-effects may add to sensorimotor after-effects following adaptation to a leftward optical deviation. This asymmetry challenges the classical distinction between sensorimotor and cognitive after-effects of prism adaptation. Implications for the functional mechanisms and the neuroanatomical substrate of prism adaptation are discussed.

Volar Locking Plate Fixation of Distal Radius Fractures: Splint versus Immediate Mobilization.

Background The goal of this study was to demonstrate that the use of a splint after performing an osteosynthesis of the distal radius with a volar locking plate is unnecessary. The main hypothesis was that postoperative flexion of the wrist was greater without a splint. Secondary hypothesis was that patients who were allowed immediate mobilization got better results in terms of pain, Quick Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), strength, extension, pronation, and supination. Case Description Our series included 72 patients, aged 59 years in average of which 59 were female patients. All patients had been operated for a volar locking plate fixation of a distal radius fracture. The first 36 patients (group I) were immobilized by a splint at 30° of extension of the wrist for 2 weeks. The following 36 patients (group II) were not immobilized. Results At 3 months, all the average variables were better in the group without splint (group I: flexion 74.83%, extension 83.13%, pronation 92.07%, supination 88.11%, pain 1.72/10, Quick DASH 21.78/100, PRWE 22.97/100, strength 62.96%; group II: flexion 85.50%, extension 83.4%, pronation 92.96%, supination 92.96%, pain 1.28/10, Quick DASH 19.57/100, PRWE 20.56/100, strength 66.34%). No complication was reported. Conclusion Overall, our results demonstrate that wearing a splint after volar locking plate fixation of a distal radius fracture is unnecessary.

Static postural control in children with developmental dyslexia.

The present investigation tries to better understand potential association and causal relationship between phonological and postural impairment due to developmental dyslexia. The study included 50 boys with developmental dyslexia and selected on the basis of their overall reading difficulties, and 42 control boys. Body sway during a quite standing posture eye open and eye closed on a force platform were tested in the two groups of subjects that were between 10 and 13 years of age. Analysis of classical parameters quantifying the centre of pressure (CP) displacements along antero-posterior and lateral axes showed a significant difference between the two groups. Dyslexic children showed on average greater instability, with greater length, variability and mean power frequency of CP displacements with or without vision. Our results demonstrate that postural parameters may discriminate between children with dyslexia and age-equivalent controls.