The Association Between Psychological Factors and Outcomes After Distal Radius Fracture.

PURPOSE: The aim of this study was to identify psychological factors associated with pain intensity and disability following distal radius fracture. METHODS: We prospectively followed 216 adult patients with distal radius fracture for 9 months. Demographics, injury and treatment details, and psychological measures (Hospital Anxiety and Depression Score [HADS], Pain Catastrophizing Scale, Posttraumatic Stress Disorder Checklist-Civilian, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire Brief [IPQB], General Self-Efficacy Scale, and Recovery Locus of Control [RLOC]) were collected at enrollment. Multivariable linear regression was used to identify factors associated with Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Likert pain scores. RESULTS: Higher 10-week DASH scores were associated with increased age, the presence of a nerve pathology, increased HADS Depression subscale scores, increased IPQB scores, and lower RLOC scores. Higher 9-month DASH scores were associated with increased age, increased deprivation scores, increased numbers of medical comorbidities, a greater degree of radial shortening, increased HADS Depression subscale scores, and lower RLOC scores. A higher 10-week pain score was associated with increased deprivation and IPQB scores. A higher pain score at 9 months was associated with an increased number of medical comorbidities. CONCLUSIONS: Psychosocial factors measured early after fracture are associated with pain and disability up to 9 months after distal radius fracture. Illness perception is a potentially modifiable psychological construct not previously studied in hand conditions. It may provide a suitable target for psychological interventions that could enhance recovery. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

The changing epidemiology of open fractures in vehicle occupants, pedestrians, motorcyclists and cyclists.

AIMS: To investigate the changing epidemiology of open fractures in vehicle occupants, pedestrians, motorcyclists and cyclists. MATERIALS AND METHODS: Data on all non-spinal open fractures admitted to the Royal Infirmary of Edinburgh after a road traffic accident between 1988 and 2010 were collected and analysed to provide information about the changing epidemiology in different patient groups. Demographic information was collected on all patients with the severity of injury being analysed with the Injury Severity Score (ISS), Musculoskeletal Index (MSI) and the number of open fractures. The severity of the open fractures was analysed using the Gustilo classification. The 23-year study period was divided into four shorter periods and the results were compared. RESULTS: There were 696 patients treated in 23 years. Analysis showed that the incidence of RTA open fractures initially fell in both males and females and continued to fall in females during the 23 years. In males it levelled off about 2000. The age of the female patients also fell during the study period but it did not change in males. The only patient group to show an increased incidence of open fractures were cyclists. In vehicle occupants the incidence fell throughout the study period but it levelled off in pedestrians and motorcyclists. There was no difference in the severity of injury in any group during the study period. The most severe open fractures were those of the distal femur and femoral diaphysis although open tibial diaphyseal fractures were the most common fracture in all patient groups. CONCLUSIONS: Improved car design and road safety legislation has resulted in a reduction in the incidence of open fractures in vehicle occupants, pedestrians and motorcyclists. The most obvious group to have benefitted from this are older female pedestrians. The only group to show an increase in age during the study period were male motorcyclists.

Flexion contracture following primary total knee arthroplasty: risk factors and outcomes.

Function and satisfaction after total knee arthroplasty (TKA) are partially linked to postoperative range of motion (ROM). Fixed flexion contracture is a recognized complication of TKA that reduces ROM and is a source of morbidity for patients. This study aimed to identify preoperative risk factors for developing fixed flexion contracture following TKA and to quantify the effect of fixed flexion contracture on outcomes (Oxford knee score 12-60 and patient satisfaction) at 2 years. Pre-, intra-, and postoperative data for 811 TKAs were retrospectively reviewed. At 2 years postoperatively, the incidence of fixed flexion contracture was 3.6%. Men were 2.6 times more likely than women to have fixed flexion contracture (P=.012), and patients with preimplant fixed flexion contracture were 2.3 times more likely than those without to have fixed flexion contracture (P=.028). Increasing age was associated with an increased rate of fixed flexion contracture (P=.02). Body mass index was not a risk factor (P=.968). Incidence of fixed flexion contracture for those undergoing computer navigated TKA was 3.9% compared with 3.4% for those having conventional surgery (P=.711). Patients with fixed flexion contracture had poorer outcomes with a median [interquartile range] Oxford Knee Score of 25 [15] compared with 20 [11] for those without (P=.003) and lower patient satisfaction (P=.036). These results support existing literature for incidence of fixed flexion contracture after TKA, risk factors, and outcomes, indicating that these figures can be extrapolated to a wide population. They also clarify a previously contentious point by excluding body mass index as a risk factor.