Detecting Distal Radial Fractures from Wrist Radiographs Using a Deep Convolutional Neural Network with an Accuracy Comparable to Hand Orthopedic Surgeons.

In recent years, fracture image diagnosis using a convolutional neural network (CNN) has been reported. The purpose of the present study was to evaluate the ability of CNN to diagnose distal radius fractures (DRFs) using frontal and lateral wrist radiographs. We included 503 cases of DRF diagnosed by plain radiographs and 289 cases without fracture. We implemented the CNN model using Keras and Tensorflow. Frontal and lateral views of wrist radiographs were manually cropped and trained separately. Fine-tuning was performed using EfficientNets. The diagnostic ability of CNN was evaluated using 150 images with and without fractures from anteroposterior and lateral radiographs. The CNN model diagnosed DRF based on three views: frontal view, lateral view, and both frontal and lateral view. We determined the sensitivity, specificity, and accuracy of the CNN model, plotted a receiver operating characteristic (ROC) curve, and calculated the area under the ROC curve (AUC). We further compared performances between the CNN and three hand orthopedic surgeons. EfficientNet-B2 in the frontal view and EfficientNet-B4 in the lateral view showed highest accuracy on the validation dataset, and these models were used for combined views. The accuracy, sensitivity, and specificity of the CNN based on both anteroposterior and lateral radiographs were 99.3, 98.7, and 100, respectively. The accuracy of the CNN was equal to or better than that of three orthopedic surgeons. The AUC of the CNN on the combined views was 0.993. The CNN model exhibited high accuracy in the diagnosis of distal radius fracture with a plain radiograph.

The effect of diabetes on functional outcomes among individuals with distal radial fractures.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: Diabetes is reported to adversely affect outcomes; however, its effect on distal radial fractures (DRF) is not well examined. PURPOSE OF THE STUDY: This study investigated the effect of diabetes on pain, hand function, physical health status, grip strength, and wrist and forearm range of motion among patients with DRF. METHODS: A total of 479 patients with DRF were classified into patients with and without diabetes based on self-report. Patient-Rated Wrist Evaluation assessed pain and hand function. The Short Form-12 assessed physical health status. Both questionnaires examined DRF recovery at baseline, 3 month, and 1 year. RESULTS: There was a significant improvement in Patient-Rated Wrist Evaluation scores over time (69 [19] to 25 [22]; 76 [15] to 20 [20] for patients with and without diabetes respectively, P < .01) with a significant interaction between time and diabetes (P < .01), indicating that patients with diabetes recovered more slowly than the rest of the cohort. There was an improvement over time on physical status (36 [12] to 45 [12]; 39 [9] to 50 [9], P < .01), grip strength (16 [7] to 24 [10]; 15 [9] to 24 [10], P < .01), and range of motion (flexion [42 {14} to 49 {15}; 43 {15} to 54 {14}, P < .01], extension [45 {11} to 52 {11}; 46 {13} to 53 {12}, P < .01], pronation [73 {10} to 77 {9}; 73 {11} to 78 {9}, P < .01], and supination [58 {17} to 65 {14}; 61 {17} to 70 {12}, P < .01]) for patients with and without diabetes, respectively. Patients with diabetes did not differ significantly in these secondary outcomes compared to the rest of the cohort. DISCUSSION AND CONCLUSION: Although individuals with diabetes had good outcomes, their recovery was slower than the rest of the cohort. This may be due to the adverse effect of hyperglycemia on bone tissues and small blood vessels. Future studies are required to assess how severity and duration of diabetes affect outcomes after DRF.

Effect of illusory kinesthesia on hand function in patients with distal radius fractures: a quasi-randomized controlled study.

OBJECTIVES: We investigated the effects of the illusion of motion through tendon vibration on hand function in patients with distal radius fractures. SETTING: Kawachi General Hospital, Japan. SUBJECTS: A total of 22 patients with distal radius fractures were divided into either an illusory kinesthesia group ( n = 11) or a control group ( n = 11). INTERVENTION: We performed the intervention for seven consecutive days after surgery. Evaluations were performed at one day, seven days, one month, and two months postsurgery. MAIN MEASURES: Data were collected on pain at rest and pain during movement. The Patient-Rated Wrist Evaluation and Pain Catastrophizing Scale were also used. RESULTS: The illusory kinesthesia group showed significantly better scores on Patient-Rated Wrist Evaluation ( p < 0.01) compared with the control group at seven days, one month, and two months postsurgery. The mean (SD) of the Patient-Rated Wrist Evaluation total score was 97.6 (2.2) at one day postsurgery and 9.1 (5.3) at seven days postsurgery in the illusory kinesthesia group, while the Patient-Rated Wrist Evaluation total score was 96.3 (4.4) at one day postsurgery and 20.1 (17.0) at seven days postsurgery in the control group. CONCLUSION: Our results indicate that illusory kinesthesia is an effective postsurgery management strategy not only for pain alleviation, but also hand function in patients with distal radius fractures. Furthermore, the significant improvements persisted for up to two months after intervention in the illusory kinesthesia group, but not in the control group. In addition, patients in the kinesthetic illusions group showed increased use of the affected limb in daily living.

Influence of illusory kinesthesia by vibratory tendon stimulation on acute pain after surgery for distal radius fractures: a quasi-randomized controlled study.

OBJECTIVES: We investigated the effects of inducing an illusion of motion by tendon vibration on sensory and emotional aspects of pain and range of motion in patients with fractures of the distal radius. DESIGN: A quasi-randomized controlled trial. SETTING: Kawachi General Hospital, Japan. SUBJECTS: A total of 26 patients with fractures of the distal radius were distributed quasi-randomly to either the illusory kinesthesia group (n = 13) or control group (n = 13). INTERVENTION: The intervention was performed on seven consecutive days from postoperative Day 1. Evaluation was performed at seven days, one month, and two months after the surgery. MAIN MEASURES: Data were collected for pain at rest, movement pain, the pain catastrophizing scale, the Hospital Anxiety and Depression Scale, and range of motion. RESULTS: The illusory kinesthesia group reported improved pain at rest (p < 0.001), movement pain (p < 0.001), pain catastrophizing scale (p < 0.001), Hospital Anxiety and Depression Scale (p < 0.01), and range of motion (p < 0.05) compared with the control group at seven days, one month, and two months after the surgery. The mean (SD) score of the visual analogue scale of pain at rest was 51.3 (16.8) at one day and 4.2 (4.7) at seven days in the illusory kinesthesia group, and 56.8 (22.1) at one day and 35.5 (16.2) at seven days in the control group. CONCLUSION: Illusory kinesthesia group improves the sensory and emotion aspects of pain in patients with fractures of the distal radius.

Volar locking plate versus external fixation for the treatment of unstable distal radial fractures: a meta-analysis of randomized controlled trials.

BACKGROUND: The choice between volar locking plates (VLP) and external fixation (EF) for unstable distal radius fractures have not reached a consensus. The meta-analysis of randomized controlled trials was performed to compare VLP with EF to determine the dominant strategy. MATERIALS AND METHODS: Meta-analysis was performed with a systematic search of studies conducted by using the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. The randomized controlled trials that compared VLP with EF was identified. Characteristics, functional outcomes, radiological results, and complications were manually extracted from all the selected studies. RESULTS: Six studies encompassing 445 patients met the inclusion criteria. There was significant difference between two procedures in disabilities of the arm shoulder and hand scores at 3,6, and 12 mo, visual analogue scale at 6 mo, grip strength at 3 mo, supination at 3 and 6 mo, extension at 3 mo, ulnar variance at 12 mo, and reoperation rate at 12 mo, postoperatively. However, there was no significant difference between flexion, pronation, radial deviation, and ulnar deviation at all follow-up points postoperatively and overall complications at 12 mo, postoperatively. CONCLUSIONS: EF had less reoperative rate due to complications, however, VLP had advantages in functional recovery in the early period after surgery, but two methods had similar functional recovery at 12 mo, postoperatively. Clinician should make the treatment decision with great caution for the patients who sustained unstable distal radial fractures.

An anatomical study of thenar and hypothenar soft tissue thickness in men and women.

We hypothesized that reduced thenar soft tissue thickness may be a risk factor for distal radial fractures. We assessed MRI scans of the wrist in 78 adults. The 51 men had significantly higher palmar soft tissue thickness compared to the 27 women, even after adjusting for hand size.Level of evidence: IV.

Non- or minimally displaced distal radius fractures in adult patients < 50 years of age : Three weeks of cast immobilisation versus one week of brace immobilisation: study protocol for a multicentre randomised controlled trial.

BACKGROUND: Currently, non- or minimally displaced distal radius fractures are treated by 3 to 5 weeks of cast immobilisation. Many patients with a distal radius fracture suffer from long-term functional restrictions, which might be related to stiffness due to cast immobilisation. Current literature indicates that 1 week of immobilisation might be safe; however, no level 1 evidence is available. This trial aims to compare 1 week of brace immobilisation with 3 weeks of cast immobilisation in patients with distal radius fractures that do not need reduction. METHODS: The aim of this trial is to evaluate the non-inferiority of 1 week of brace immobilisation in patients with non- or minimally displaced distal radius fractures. A two-armed single blinded multicentre randomised clinical trial will be conducted in three hospitals. Adult patients, between 18 and 50 years old, independent for activities of daily living, with a non- or minimally displaced distal radius fracture can be included in this study. The intervention group is treated with 1 week of brace immobilisation, and the control group with 3 weeks of cast immobilisation. Primary outcome is the patient-reported outcome measured by the Patient-Related Wrist Evaluation score (PRWE) at 6 months. Secondary outcomes are patient-reported outcome measured by the Quick Disabilities of the Arm, Shoulder and Hand score at 6 weeks and 6 months, PRWE at 6 weeks, range of motion, patient-reported pain score measured by VAS score, radiological outcome (dorsal/volar tilt, radial height, ulnar variance, presence of intra-articular step off), complications and cost-effectiveness measured by the EuroQol 5 Dimension questionnaire, Medical Consumption Questionnaire and Productivity Cost Questionnaire. DISCUSSION: This study will provide evidence on the optimal period of immobilisation in non-operatively treated displaced and reduced distal radius fractures. Both treatment options are accepted treatment protocols and both treatment options have a low risk of complications. Follow-up will be according to the current treatment protocol. This study will provide level 1 evidence on the optimal period and way of immobilisation for non- or minimally displaced distal radius fractures in adult patients. TRIAL REGISTRATION: ABR 81638 | NL81638.029.22 | www.toetsingonline.nl . 18th of October 2023.

Short Versus Regular Periods of Cast Immobilization for Distal Radial Fractures: A Systematic Review and Meta-Analysis.

The current research on the recommended durations for cast immobilization in adults with distal radial fractures (DRFs) lacks a clear consensus or definitive conclusion. The standard practice involves casting immobilization for five to six weeks. The debate revolves around the potential benefits of shorter periods (three to four weeks) without compromising patient outcomes. While previous research has delved into this subject through systematic reviews, our study stands out by conducting a meta-analysis, aiming for a more precise understanding of whether short or regular cast immobilization duration proves more effective for treating DRFs. A systematic search was conducted across PubMed, Embase, and the Cochrane Library databases to identify relevant studies. The focus was on comparing the outcomes of DRFs between short (three to four weeks) and regular (five to six weeks) periods of cast immobilization. The evaluated parameters include the shortened disabilities of the arm, shoulder, and hand questionnaire (quick (q) DASH); patient-rated wrist evaluation (PRWE); visual analog scale (VAS) score after cast removal; total complications; and the occurrence of complex regional pain syndrome (CRPS). Data synthesis employed the random-effects models, presenting the results as mean difference (MD) and weighted odds ratio (OR) with corresponding 95% confidence intervals (CI). We included three randomized controlled trials (RCTs) with 252 patients, of whom 125 (49.6%) were immobilized in a cast for three to four weeks. The average age of participants was 61.20 years, and the follow-up duration was one year. The QDASH scores were significantly lower at 12 weeks (MD -6.72; 95% CI -10.76 to -2.69; p = 0.001), six months (MD -4.46; 95% CI -7.42 to -1.50; p = 0.003), and one year (MD -4.89; 95% CI -7.45 to -2.33; p = 0.0002) in patients treated with short periods compared to those with regular periods. The PRWE scores at six months (MD -2.33; 95% CI -8.10 to 3.43; p=0.43) did not significantly differ between groups. Also, the PRWE scores were significantly lower at one year (MD -4.93; 95% CI -9.03 to -0.82; p = 0.02) in the shorter cast-immobilization-period group. There were no significant differences in VAS score after cast removal, total complications, or CRPS. The meta-analysis of RCTs on DRFs reveals that shorter periods of cast immobilization lead to better patient-reported functional outcomes (qDASH and PRWE). This suggests a potential benefit of reducing the immobilization duration for DRF patients, offering clinicians valuable insights for improved patient care and informed decision-making in clinical practice.

Factors that interfere with immediate return to activity following volar locking plate fixation for distal radius fractures.

In the present study, the clinical findings that interfere with the immediate return to activity following volar locking plate (VLP) fixation for distal radius fractures were investigated. A total of 95 patients who underwent VLP fixation for distal radius fracture between July, 2014 and January, 2022 were divided into a good group (good score and outcome; n=86; 22 males and 64 females; median age, 61 years) and a poor group (poor score and outcome; n=8; 8 females; median age, 63.6 years) according to the quartiles of the disabilities of the arm, shoulder and hand (Q-DASH) score, at 1 month following VLP fixation. The duration from injury to surgery, the direction of fracture dislocation and radiographic parameters [radial inclination (RI), volar tilt (VT) and ulnar variance (UV)] at the time of injury were examined. Radiographic parameters (RI, VT and UV), the range of motion of the wrist joint, grip strength ratio and visual analog scale (VAS) at 1 month following VLP fixation were also examined. These parameters were compared among both groups. Moreover, logistic regression analysis was performed to determine whether these factors were independently associated with a poor Q-DASH score at 1 month following VLP fixation. At the time of injury, fracture displacement was significantly higher in the poor group (VT, -23.8˚; UV, 4.2 mm) than the good group (VT, -6.5˚; P=0.02; UV, 1.3 mm; P=0.01). No differences in the other parameters were observed between the groups. At 1 month following VLP fixation, the grip strength ratio (17.2%) in the poor group was significantly lower than that in the good group (43.8%, P<0.001), while the VAS score (5.6) in the poor group was significantly higher than that in the good group (2.4, P<0.001). Logistic regression analysis revealed that VT and UV at injury (P<0.05), grip strength ratio (P<0.001) and pain (VAS score) (P<0.001) were all independently associated with a poor Q-DASH score. On the whole, the present study suggests that large amounts of fracture displacement, weakness of grip strength and post-operative pain can be factors interfering with the return to activity immediately following VLP fixation.

Does formal education and training of staff reduce the operation rate for fractures of the distal radius?

BACKGROUND: Fractures of the distal radius are one of the most common extremity fractures, and operation rates are increasing. Staff within our unit felt that formal teaching, particularly of new medical staff, with regards to fracture reduction and appropriate cast application could result in a reduction in operation rates. METHODS: Retrospective data was extracted from FORD (Fracture Outcome and Research Database), including: number of fractures, number of fractures undergoing ORIF, fracture configuration, patient demographics, and mechanism of injury. All patients undergoing ORIF had their radiographs assessed by two separate reviewers. Information regarding adequate fracture reduction, adequate cast application (using Gap Index), and appropriate plaster cast moulding was recorded. Formal teaching was then given to the next group of medical staff rotating through the unit, and the same data was collected prospectively for that six-month period. Exclusion criteria included bilateral injuries, and polytrauma patients. RESULTS: A total of 1623 distal radial fractures were treated in our unit over the 12-month period, with 71 undergoing ORIF in the first 6 months and 39 in the second 6 months, this was statistically significant (p = 0.0009). Our study found that formal teaching and education significantly reduced the operation rate for distal radial fractures. This effect was most significant for extra-articular, dorsally angulated fractures of the distal radius. CONCLUSION: Our study proves that just 1 h of basic training at the beginning of an attachment can have significant benefits to both the unit and, more importantly, the patients.

[The analysis of the therapeutic effect for 10 cases of type C extreme distal radial fracture in micro needle plate internal fixation].

OBJECTIVE: To analyze the clinical outcomes of mini-plate combined with wireforms in the treatment of Type C distal radial fractures with marginal articular fragments. METHODS: This retrospective study included a total of 10 cases, including 5 males and 5 females, with 6 cases involving the left side and 4 cases involving the right side, of Type C distal radial fractures with marginal articular fragments. The age of the patients ranged from 35 to 67 years old. All patients underwent surgical treatment utilizing mini-plate combined with wireforms for internal fixation. RESULTS: The follow-up period ranged from 6 to 18 months. Complete fracture healing was observed in all cases, with healing times ranging from 10 to 16 weeks. During the entire follow-up period, patients reported high levels of satisfaction with the treatment outcomes, and there were no incidences of incision infection, chronic wrist pain, or wrist traumatic arthritis. At the final follow-up assessment, the Mayo score for the wrist joint ranged from 85 to 95, with 7 cases rated as excellent and 3 cases as good. CONCLUSION: Mini-plate combined with wireforms proves to be an effective fixation method for Type C distal radial fractures with marginal articular fragments. The early initiation of wrist joint exercises, strong fixation, maintenance of proper reduction, minimal complications, and high rates of excellent and good outcomes demonstrate the reliability and efficacy of this treatment approach.

Validation of a Novel Smartphone-Based Electronic Data Capture System Following Surgical Fixation of Distal Radial Fractures.

BACKGROUND: Large prospective institutional data provide the opportunity to conduct level II and III studies using robust methodologies and adequately powered sample-sizes, while circumventing limitations of retrospective databases. We aimed to validate a prospective data collection tool, the Orthopaedic Minimal Data Set Episode of Care (OME), implemented at a tertiary North American health care system for distal radial fracture (DRF) open reduction and internal fixation (ORIF). METHODS: The first 100 DRF ORIFs performed after OME inception (February 2015) were selected for this validation study. A blinded review of the operative notes and charts was performed, and extracted data of 75 perioperative DRF ORIF procedure variables were compared with OME collected data for agreement. Outcomes included completion rates and agreement measures in OME versus electronic medical record (EMR)-based control datasets. Data counts were evaluated using raw percentages and McNemar tests. Cohen (κ) and concordance correlation coefficient analyzed categorical and numerical variable agreement, respectively. RESULTS: Overall, OME demonstrated superior completion and agreement parameters versus EMR-based retrospective review. Nine data points (12.0%) demonstrated significantly higher completion rates within the OME dataset (P < .05, each), and 88% (66/75) of captured variables demonstrated similar completion rates. Up to 80.0% (60/75) of variables either demonstrated an agreement proportion of ≥0.90 or were solely reported in the OME. Of 33 variables eligible for agreement analyses, 36.4% (12/33) demonstrated almost perfect agreement (κ > 0.80), and 63.6% (21/33) exhibited almost perfect or substantial agreement (κ > 0.60). CONCLUSIONS: The OME is a valid and accurate prospective data collection tool for DRF ORIF that is reliably able to match or supersede traditional retrospective chart review. Future investigations could use this tool for large-scale analyses investigating peri/intraoperative DRF ORIF variables.

A Case of a Combined Distal Radius and Lunate Fracture in Association With Kienböck's Disease.

The natural history of Kienböck's disease (KD) is often indolent until it progresses to an advanced stage causing pain and stiffness. Lunate fragmentation and collapse can sometimes occur with trauma. However, concomitant fracture of the distal radius is a rare phenomenon, and this combination can limit treatment options. The aim of this case report is to outline our management algorithm in the operative fixation of a young mechanic with known ipsilateral KD who was involved in a road traffic accident and suffered a combined distal radius and lunate fracture. He was managed with an open reduction internal fixation using a volar plate and a temporary dorsal spanning internal fixator. At a later date, the internal fixator was removed and a scaphocapitate fusion was performed to offload the lunate in order to avoid a total wrist fusion.

Prolonged Operative Time Associated with Increased Healthcare Utilization after Open Reduction and Internal Fixation of Intra-Articular and Extra-Articular Distal Radial Fractures: An Analysis of 17,482 Cases.

Background The current literature does not contain a quantitative description of the associations between operative time and adverse outcomes after open reduction and internal fixation (ORIF) of distal radial fractures (DRF). Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative health care utilization and 2) the incidence of local wound complications. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for DRF ORIF cases (January 2012-December 2018). A total of 17,482 cases were identified. Primary outcomes included health care utilization (length of stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time category. Secondary outcome was incidence of wound complications per operative-time category. Multivariate regression was conducted to determine operative-time categories associated with increased risk while adjusting for demographics, comorbidities, and fracture type. Spline regression models were constructed to visualize associations. Results The 121 to 140-minute category was associated with significantly higher risk of a LOS > 2 days (odds ration [OR]: 1.64; 95% confidence interval [CI]:1.1-2.45; p = 0.014) and nonhome discharge (OR: 1.72; 95% CI:1.09-2.72; p = 0.02) versus 41 to 60-minute category. The ≥ 180-minute category exhibited highest odds of LOS > 2 days (OR: 2.08; 95%CI: 1.33-3.26; p = 0.001), nonhome discharge disposition (OR: 1.87; 95% CI: 1.05-3.33; p = 0.035), and 30-day reoperation occurrence (OR: 3.52; 95% CI: 1.59-7.79; p = 0.002). There was no association between operative time and 30-day readmission ( p > 0.05 each). Higher odds of any-wound complication was first detected at 81 to 100-minute category (OR: 3.02; 95% CI: 1.08-8.4; p = 0.035) and peaked ≥ 181 minutes (OR: 9.62; 95% CI: 2.57-36.0; p = 0.001). Spline regression demonstrated no increase in risk of adverse outcomes if operative times were 50 minutes or less. Conclusion Our findings demonstrate that prolonged operative time is correlated with increased odds of health care utilization and wound complications after DRF ORIF. Operative times greater than 60 minutes seem to carry higher odds of postoperative complications.

Rapid Synthesis of the Literature on the Evolution of Gamification in Distal Radial Fracture Rehabilitation.

Distal radial fractures (DRF) are often encountered in upper limb fractures globally, and their associated complications affect the functional independence of the individual following the injury. The potential of gamification in applied rehabilitation is expanding its horizons in the rehabilitation of conditions ranging from neuromotor deficits to cognitive impairments. However, the synthesis of the literature is aimed at analyzing and summarizing the evolution of gamification in DRF rehabilitation. A comprehensive search and extraction of relevant literature were conducted and reviewed for the applicability of population analysis, interventional methodology, comparative factors, outcome measures, and the type of study. Thirteen studies were included and evaluated, including randomized controlled trials (RCTs), literature reviews, systematic reviews, meta-analyses, and bibliometric analyses. The conclusions demonstrated an improvement with gamification and addressed it as an effective rehabilitation method. Based on the analysis of the data that was extracted, the conclusion supports the use of gamification in the rehabilitation of DRF and looks into how it can help improve the person's functional capacity.

Plaster immobilization versus anterior plating for dorsally displaced distal radial fractures in elderly patients in Pakistan.

This prospective, multi-centred, randomized trial examined outcomes of 3- and 12-month follow-ups of 159 elderly participants aged more than 75 years with isolated distal radial fractures, treated by anterior locking plate or closed reduction and cast immobilization. The primary outcome was the patient-rated wrist evaluation (PRWE) score. The PRWE score at 12 months was not significantly different between the two groups; however, the radiological outcomes and complications rates were worse in the casting group.Level of evidence: III.

Complications of Volar Plating of Distal Radial Fractures: A Review.

Although the overall complication rate of volar plating approaches 15%, less than 5% require reoperation. Certain factors involving the patient, the fracture, and/or the surgeon may affect the overall complication risk. Patient factors, including body mass index greater than 35 and diabetes mellitus, may increase complication risk with volar plating, but older patient age does not seem to significantly alter risk.

Common Complications of Distal Radial Fractures.

Distal radial fractures are associated with good outcomes; however, although they occur at low rates, complications can significantly impair treatment success. Therefore, the treating surgeon should be aware of potential complications associated with each treatment type and how to best prevent them. Although certain patient-specific and fracture-specific factors may increase the risk of adverse outcomes, most are nonmodifiable risk factors at the time of presentation, so it is imperative that every effort is made to mitigate these risk factors to prevent long-term morbidity. Patients should be well-informed about these complications and potential symptoms so that they can be addressed expeditiously.

Application of ultra-low-dose CT in 3D printing of distal radial fractures.

PURPOSE: To explore the effect of ultra-low-dose computed tomography (CT) on three-dimensional (3D) printing models and the diagnosis of wrist fractures. METHOD: This study enrolled 76 patients with distal radial fractures (DRFs). All patients underwent 320-row detector CT and were divided randomly into two groups. In Group A, 38 patients were scanned with the standard-dose protocol using a tube voltage of 120 kV and current of 100 mA. In Group B, 38 patients were scanned with the ultra-low-dose protocol using a tube voltage of 80 kV and current of 10 mA. For objective image quality assessment, the noise, CT number, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured. Subjectively, two experienced orthopaedic surgeons blinded to the scan parameters evaluated the clarity of the 3D printing model and fracture line using a 3-point scale (the diagnosis was considered acceptable with scores ≥2). The mean radiation dose was calculated. The diagnostic performances for the fractures between the two groups were compared. RESULTS: The effective radiation dose was significantly reduced by 97.1 % in Group B, compared to Group A (0.28 ± 0.05vs. 9.75 ± 2.23 µSv, respectively). Quantitative objective image quality parameters (e.g., CNR, SNR, and CT numbers) were higher in the standard-dose group (p < 0.001). However, there was no difference in subjective scoring of the 3D printing model. Although the fracture line score was higher in Group A (2.92±0.27 vs. 2.16 ± 0.37; p < 0.001), the diagnostic performance of the two groups was consistent (all scores ≥2). There were no statistically significant differences in the sensitivity, specificity or accuracy between standard-dose group and ultra-low-dose group. CONCLUSIONS: The ultra-low-dose protocol effectively reduced the radiation dose by 97.1 %, while maintaining the image quality for diagnosis of DRFs. Therefore, this protocol can meet the needs of 3D printing models for preoperative assessments.

The outcome for surgical fixation of distal radial fractures in patients with idiopathic Parkinson's disease: a cohort study.

INTRODUCTION: Idiopathic Parkinson's disease (PD) is a progressive neurologic disorder causing postural instability and unsteady gait. These patients are at increased risk for fractures and have inferior outcomes after treatment. Several studies have evaluated the incidence and outcome of PD patients after hip fractures. However, there are limited studies assessing the outcome of upper extremity fractures in these patients. In this study, we evaluated the outcome of PD patients that received surgical intervention for distal radial fractures (DRF). We hypothesize that these patients have an inferior outcome after surgery in comparison with non-PD patients. METHODS: Between May 2005 and May 2017, we retrospectively reviewed all of the patients with DRF and subsequently underwent open reduction and internal fixation (ORIF) at a level 1 trauma center. All of the surgeries were performed by fellowship-trained orthopedic surgeons. The inclusion criteria include patients with a definitive diagnosis of PD, non-pathological DRF, and a minimum follow-up of 1 year or up until the time of treatment failure was noted. Each PD patient was matched for age and gender to 3 non-PD patients. The primary objective was to determine the failure rate after surgical fixation for DRF. The secondary outcomes include time to treatment failure, reoperation rate, readmission rate, length of hospital stay, and postoperative complications. RESULTS: A total of 88 patients were included in this study (23 PD, 65 non-PD patients). All underwent ORIF and received standard postoperative follow-ups. The overall treatment failure rate in PD was 39.1% vs. 4.6% in the non-PD group (p < 0.05). The time to treatment failure were 9.11 ± 3.86 weeks and 14.67 ± 5.8 weeks for PD and non-PD, respectively (p < 0.05). PD patients had a significantly higher rate of failure when k-wires and ESF were used (p < 0.05%), while loss of reduction was the most common mode of failure in PD (44.4%). The length of hospital stay for PD was 5.3 ± 4.69 days compared with 3.78 ± 0.96 days for non-PD (p = 0.01). There were 3 PD patients readmitted within 30 days after surgery, and 1 patient had pneumonia after the surgery. CONCLUSION: This study revealed that patients with PD have a high treatment failure rate despite surgical intervention for DRF. PD patients had a longer hospital stay and had a shorter time to treatment failure. In treating PD patients complicated with DRF, the surgeon must take into consideration the complex disease course of PD and the associated comorbidities such as osteoporosis, frail status, and frequent falls. Rehabilitation and disposition plans should be discussed in advance and longer hospital stays should be expected. Level of evidenceLevel IV, retrospective cohort study.