bluuebunny/crossref_metadata_2025 huggingface dataset:
CATCH: Classroom Process Evaluation in a Multicenter Trial
Authors: Edmundson Elizabeth W. , Luton Susan C. , McGraw Sarah A. , Kelder Steven H. , Layman Ann K. , Smyth Mary H. , Bachman Kathryn J. , Pedersen Sheryl A. , Stone Elaine J.
Published: September 2016

The purpose of this paper is to describe the process evaluation model for the classroom curricula of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Project. The process evaluation plan specifically targets how much each curriculum was implemented, to what degree it was implemented as designed, and the barriers to implementation. Additionally, the rationale for each of the process evaluation measures and the instrument development process are presented. Data resulting from these measures will be essential in order to answer questions regarding the internal validity of the main outcomes of the project. Specific examples and sample results are provided from the CATCH third-grade classroom curriculum, which was implemented the first year of CATCH. A discussion also is presented of how the findings from a sample of these measures were used to gain additional insight on the salient features of the curriculum, and how those features may be related to student outcomes.
CATCH: Food Service Program Process Evaluation in a Multicenter Trial
Authors: Raizman Debra J. , Montgomery Deanna H. , Osganian Stavroula K. , Ebzery Mary Kay , Evans Marguerite A. , Nicklas Theresa A. , Zive Michelle M. , Hann Barbara J. , Snyder M. Patricia , Clesi Ann L.
Published: September 2016

Process evaluation is an essential element of a multicenter trial in order to explain study outcomes and monitor intervention progress. This paper presents the process evaluation model for the Eat Smart School Nutrition Program, the food service intervention component of the Child and Adolescent Trial for Cardiovascular Health (CATCH), and describes the process evaluation strategies developed to assess this program. The paper details (1) measures of program implementation including training, support visits, and program promotion, (2) food service staff characteristics, and (3) measures of mediating variables including secular trends and school meal participation.
CATCH: Physical Activity Process Evaluation in a Multicenter Trial
Authors: McKenzie Thomas L. , Strikmiller Patricia K. , Stone Elaine J. , Woods Sherry E. , Ehlinger Sally S. , Romero Kelly A. , Budman Susan T.
Published: September 2016

This paper presents the process evaluation model for the physical activity intervention component of the Child and Adolescent Trial for Cardiovascular Health (CATCH) and describes the major procedures used to monitor CATCH PE, the physical education intervention. The paper focuses on CATCH PE teacher training and in-service support as well as on the curriculum implementation. Monitoring training and support included assessing the in-service training workshops and the follow-up on-site assistance provided by staff. Monitoring the implementation included assessing the quantity and quality of CATCH PE instruction in terms of student physical activity engagement and lesson context, the fidelity of the curricular implementation, and the opportunities for other physical activity by children throughout the school day.
CATCH: Challenges of Conducting Process Evaluation in a Multicenter Trial
Authors: Lytle Leslie A. , Davidann Beth Z. , Bachman Kathryn , Edmundson Elizabeth W. , Johnson Carolyn C. , Reeds Jackie N. , Wambsgans Kathleen C. , Budman Susan
Published: September 2016

This paper discusses the challenges faced when collecting process evaluation information in a school-based, multicenter field trial. Experiences from the Child and Adolescent Trial for Cardiovascular Health (CATCH) are shared as a means of illustrating the challenges that are presented and ways of meeting the challenges. The scope and magnitude of the trial (96 schools across four sites) and the diverse population participating in the trial (including children and adults representing a cultural and socioeconomic mix) present challenges that are compounded by conducting research in a highly structured school setting. In such a trial, thoughtful consideration must be paid to what data should be collected, how data should be collected, how to collect data on tailored interventions, gaining and maintaining schools' cooperation, collecting data in year-round schools, and assuring data quality.
Incidence of Implant-Related Complications After Tension Band Thumb Metacarpophalangeal Joint Arthrodesis
Authors: Renfree Kevin J. , Lara Daniel
Published: September 2016

Objectives: We sought to determine the incidence of hardware removal or persistent irritation after tension band arthrodesis of the thumb metacarpophalangeal joint (MCPJ), and whether these outcomes were related to patient age, gender, body mass index (BMI), or angle of fusion. Materials and Methods: A retrospective review was performed of all (n = 39) thumb MCPJ arthrodesis done using tension band wire fixation by a single hand surgeon at a large tertiary academic medical center over a 14-year period. Thirty procedures in 28 patients (4 men, 24 women) with an average age of 65 years (range, 35-81 years) were available for long-term follow-up (mean, 82 months; range, 12-171 months). Average BMI was 26.2 (range, 17.4-35).Most were done in conjunction with a basal joint suspensionplasty. Results: One hundred percent of arthrodesis healed radiographically at a mean 3.8 months (range, 3-7 months). Mean fusion angle was 24° (range, 9°-45°). Of patients available for long-term follow-up (n = 30), 7 (23%) required hardware removal for pain at a mean of 36 months postoperatively, and another needed revision of hardware at 4 months postoperatively. An additional 3 patients (10%) expressed dissatisfaction with the hardware in place, but declined removal. There was no significant influence of the above variables on hardware removal or dissatisfaction. Conclusions: Tension band wire arthrodesis of the thumb MCPJ results in predictable bony union. Although it is a very cheap means of fixation, there is a 33% incidence of significant hardware-related pain after tension band arthrodesis of the thumb MCPJ. Twenty-five percent of patients may require a second surgery to revise or remove symptomatic hardware, which can negate any cost savings through the use of this technique. A study comparing this method with plate or single screw fixation would be beneficial.
Surgical Revascularization of Cryopreserved Allografts
Authors: Visser Noortje J. , Shin Alexander Y. , Bishop Allen T.
Published: September 2016

Objective: The treatment of segmental bone defects remains challenging as complications frequently occur with the currently available methods, including vascularized autograft, prosthetic replacement, bone transport, and cryopreserved bone allograft (CBA). Although the use of CBA is comparatively simple, it lacks donor site morbidity and provides immediate stability; however, the grafts remain largely necrotic, resulting in high failure rates due to nonunion, infection, and stress fractures. Revitalizing the CBA has the potential to solve these problems. Previous studies in small animal models have shown the use of surgical revascularization to induce neoangiogenesis and improve bone viability in the CBA. The purpose of this study is to investigate if surgical revascularization enhances bone circulation and bone remodeling in a tibial defect orthotopic reconstruction model, placing a cryopreserved allograft in a Yucatan mini pig. Methods: Cryopreserved tibial bone allografts were transplanted in swine leukocyte antigen (SLA)-type-mismatched Yucatan mini pigs after creating a 3.5-cm segmental bone defect in the tibia. The anterior tibial arteriovenous bundle (AV-bundle) was inserted into the intramedullary canal. Eight pigs received a patent AV-bundle (revascularized group), 8 pigs received a proximally ligated AV-bundle (control group), and the contralateral side was used as an untreated control. The graft was fixated with a locking compression plate to provide a weightbearing construction. After 20 weeks, the pigs were killed and the tibia was removed and analyzed. Neoangiogenesis was evaluated by quantifying vascular volumes using the microcomputed tomography. Bone remodeling was measured by quantitative histomorphometry and micro-computed tomography. Results: Seven AV-bundles in the revascularized group were patent and 1 bundle was thrombosed due to partial dislocation of the graft. Total vascular volume was higher in the revascularized allografts (127 mm3) compared with both the control group (40 mm3, P = .003) and the contralateral side (29 mm3 P = .000). All patent bundles showed neovascularization extending into the cortical bone. Revascularized allografts had increased bone remodeling in the inner cortical area of the graft compared with the non-revascularized grafts (bone formation rate: 381 ± 60 µm3/µm3/year vs 299 ± 143 µm3/µm3/year, P = .05). In both the revascularized group and the control group, the bone formation rate exceed the contralateral side: In the revascularized grafts, the bone formation was 305% of contralateral side, and in the non-revascularized grafts, the bone formation was 179% of the contralateral side. There was no statistical significant difference in outer cortical bone formation between the revascularized and the non-revascularized allografts. Conclusion: Surgical revascularization of porcine tibial CBAs by implantation of an AV-bundle creates an enhanced autogenous neoangiogenic circulation and accelerates active bone formation.
Contralateral C7 Transfer via the Prespinal and Retropharyngeal Route to Repair C6 and C8 for Patients With Total Brachial Plexus Root Avulsion
Authors: Lei Xu , Yudong Gu
Published: September 2016

Objective: We sought to investigate a new way of neurotization to reconstruct the flexion of elbow, wrist, and finger of patients with total brachial plexus root avulsion. Methods: Nine patients were treated from October 2008 to November 2009. Their ages ranged from 6 to 45 years (average, 25 years). The operative delay was from 4 to 16 weeks (mean, 9 weeks). All patients had total brachial plexus avulsion, confirmed by intraoperative finding and electromyography. After a prespinal and retropharyngeal tunnel was made, the contralateral C7 nerve root was transferred to repair both C6 and C8 of the injured side via this route, with nerve grafting. The nerve graft was 5.61 ± 1.91 cm long for repairing C6 and 5.78 ± 2.32 cm long for repairing C8. Results: In 2 cases, we found early functional recovery of elbow flexion at the seventh month postoperatively. In all cases, we found recovery of elbow flexion at the 12th month postoperatively, and recovery of wrist and finger flexion at the 15th month postoperatively. Conclusion: This way of neurotization shortens the distance of nerve regeneration, and the nerve fibers of contralateral C7 are fully used to reconstruct the flexion of elbow, wrist, and finger. Results of follow-up show this method favors nerve regeneration and functional recovery.
Analysis of Causes for Congenital Ulnar-angled Thumbs at the Distal Phalanges in 43 Patients
Authors: Tian Xiaofei , Li Aiyan , Xiao Jun , LI Tianwu , Chen Wei , Qiu Lin , Fu Yuexian
Published: September 2016

Purpose: To explore anatomic abnormalities causing congenital ulnar-angled thumb at the distal phalanx, so as to identify the differential diagnosis and guide for surgical treatment. Methods: Reviewing the clinical manifestations, x-ray films, and operative findings of 43 children with congenital ulnar-angled thumbs in the distal phalanges without radially inserting terminal tendons at the base of distal phalanx, and analyzing their anatomic abnormality as well as differential diagnosis. Results: There were 57 ulnar-angled thumbs in this study. Abnormal hypertrophic epiphyses were found in 35 thumbs. In x-ray, distal phalanx was in good apposition with its epiphysis and they got pretty close to the average of less than 1 mm. In operation, we measured the length of the radial side of the hypertrophic epiphyseal averaged 3.2 mm. Extra bones were found to exist between the proximal phalanges and distal phalanges in the remaining 22 triphalangeal thumbs. The preoperative radiography showed a larger distance between the distal phalanx and the extra bone, which averaged to more than 2 mm. The length of the radial side of the hypertrophic epiphyseal measured in operation averaged 3.7 mm. Conclusions: Abnormal hypertrophic epiphysis and triphalangeal thumb are two different causes for congenital ulnar-angled thumb at the distal phalanx. The distance between the hypertrophic epiphysis and the distal phalanx is much smaller in x-ray so we can distinguish it from a triphalangeal thumb before surgery.
Factors That May Influence the Hand Grip Strength in an Adult Healthy Population
Authors: Neto Artur Costa , Resende Vera , Frada Ricardo , Queirós Carlos , Reais Nuno
Published: September 2016

Objective: Hand strength is an important independent surrogate parameter to assess outcome and risk of morbidity and mortality. This study aimed to determine the influence of cofactors in the grip strength in a sample of the population of our country. Material and Methods: A representative population survey was used as the basis for prediction analyses (n = 296). Intraindividual and interindividual variations of grip strength and their relation to several anthropometric factors were analyzed in a standardized manner for 296 healthy adults (women, n = 140; men, n = 156) aged between 20 and 69 years. We carried in each individual, 5 measurements alternately in each hand, calculating the average value. Cases in which there was a difference of more than 10% of the measurements were excluded. Measurements were done in neutral position of arm, forearm, and wrist with Jamar Hydraulic Hand Dynamometer. We also note the active side, profession, height, weight, and size of the hand. The results were statistically analyzed using SPSS. The sample characterization was performed by frequency analysis. Analysis of variance was used to study the correlation between variables. Results: Mean strength was about 38% less in women (right 26.6 kg; left 25.16 kg) than in men (right 43.13 kg; left 40.65kg). Grip strength peaks at 40 to 49 years of age with an important difference between those with less then 50 years and with more then 50 years old. Anthropometric variables such as hand size or sex showed a positive correlation with grip strength. Body mass index and type of work showed only a partial positive correlation or no correlation with grip strength. Conclusion: Easy-to-measure cofactors such as sex, age, and hand size have a high accurate prediction of normative pinch strength. Body mass index and type of work did not demonstrate significant predictive value. We recommend side adjustment of measured values for intraindividual comparison and inclusion of information regarding anthropometric characteristics, as well as using gender and age-adjusted reference values.
Reduced Risk of FPL-Tendon Rupture in Distal Radius Fracture Treated by a Palmar V-Shaped Plate
Authors: Gabl Markus , Arora Rohit , Schmidle Gernot , Klauser Andrea
Published: September 2016

Objectives: Palmar locking plates enabling early active motion are successfully used in distal radius fracture treatment. But some fracture types can necessitate to place a plate distally to the watershed line with the risk of rupture of the flexor pollicis longus (FPL) tendon. In addition, the indication for implant removal following palmar plating is still discussed controversially. Patients and Method: In this prospective follow-up study, 18 patients with distal radial fracture (DRF) were stabilized by a new anatomical designed V-shaped palmar plate (Medartis, Basel, Switzerland). Radial inclination (RI), dorsal tilt (DT), and ulnar variance (UV) were assessed. An independent radiologist investigated the FPL tendon by ultrasound to course within the V-space of the plate at its distal end. In addition, the gliding and course of the FPL tendon was investigated during surgery. Results: In lateral projection, the plate appeared Soong type 0 (n = 3), Soong type 1 (n = 12), and Soong type 2 (n = 3). RI measured 20° (minimum 14°, maximum 27°), DT 3.8° (minimum 0°, maximum 12°), and UV 0 mm (minimum −3, maximum 2). In sonography, the FPL tendon run within the V-space in all cases. In all Soong types, there was no contact of the FPL tendon with the plate found in ultrasound. In Soong type 2, the ulnar column of the plate protruded and caused friction of the flexor digitorum profundus (FDP) tendon in 2 patients when a fit bone/implant contact was missing. Protrusion was seen in dorsal displacement of the distal fragment ad latus and soft tissue interposition. Intraoperatively, the radial column of the plate ended proximal at the watershed line without contact to the FPL tendon. Proximal to the watershed line, the course of the FPL tendon was minimally altered after release of the pronator quadratus (PQ) and mobilizing the FPL muscle for plate positioning. It remained unaltered distal to the watershed line where the FPL tendon enters the nonreleased carpal tunnel. Conclusion: The V-shaped FPL plate spared the FPL tendon in all Soong-type plate positions. Achieved reduction of RI greater 14°, DT more than 0°, and UV better than −3 mm proofed sufficient for the V-space design to avoid friction of the FPL. Restoration of DT and firm bone/plate contact of the distal fragment are important in distal plate position. Implant removal of plates positioned Soong types 1 and 2 seems to be no more imperative. In Soong type 3, the FDP tendons should be considered to be of some risk.
Distal Radius Fracture
Authors: Abramo Antonio , Gadell Pia , Tagil Magnus
Published: September 2016

Introduction: Distal radius fractures (DRFs) are often accompanied by an associated fracture at the base of the ulnar styloid. The base of the ulnar styloid is an anchor for the deep portion of the Triangular Fibrocartilage Complex (TFCC), which helps to stabilize the distal radio ulnar joint. In our hospital, TFCC injuries and basal ulnar styloid fractures are not primarily operated, but only secondarily in case of symptomatic instability. Objectives: The objective was to test whether the outcome differed between patients with or without a basal ulnar styloid fracture after internal fixation. Methods: Scrutinizing the radiograms of the patients in our prospective register of all DRFs in patients 18 years and older, 65 operated patients were identified having an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C fracture operated with internal fixation between January 2008 and June 2010. Patients with a simultaneous fracture at the base of the ulnar styloid and patients with unaffected ulnar styloid were invited to a clinical and radiographic examination and evaluated regarding wrist function (Quick Disability of the Arm, Shoulder and Hand [QuickDASH]); Visual Analog Scale (VAS) regarding pain at rest, work, and function; grip strength; range of motion (ROM); and the stability of the distal radio ulnar joint. In all, 45 patients were included; 7 patients declined to participate, and 3 patients could not be reached leaving 35 patients in the study groups. Results: Nineteen patients had a fractured styloid and 16 patients had an intact styloid. The ROM in the ulnar/radial deviation was better (93% vs 79% ( P = .003) in the patients with a fractured styloid compared with the uninjured. There were no differences in QuickDASH, VAS, stability, grip strength, or ROM in supination/pronation or flexion/extension. The mean follow-up time was 27 (15-40) months, and no patients were operated during this time due to distal radio ulnar joint (DRUJ) instability. Conclusion: Fracture at the base of the ulnar styloid did not worsen the outcome of wrist function and pain at medium to long time, in patients with AO type C fracture operated with internal fixation. It thus appears unnecessary to fix a fracture at the base of the ulnar styloid in these patients.
Distal Radius Fracture Patients Show Reduced Ability of Dynamic Body Balancing
Authors: Fujita Koji , Kaburagi Hidetoshi , Miyamoto Takashi , Wakabayashi Yoshiaki , Kato Ryuichi , Okawa Atsuhi
Published: September 2016

Background: Fragility fractures of the distal radius are associated with an increased risk of future hip and spine fracture so the importance of body balancing ability and bone quality in fall and secondary fracture prevention is well recognized. We assessed body balancing ability, grip strength (GS), and bone quality of patients with distal radius fractures who underwent surgery. Methods: A prospective multicenter study, approved by institutional review board (IRB), of 94 women (age, >45 years) with their first fragility fracture of the distal radius who underwent surgery in registered hospitals from January to December in 2015 was conducted. Two weeks after surgery, their body balancing ability was measured by 4 methods: Functional Reach Test (FRT), Timed Up and Go (TUG) test, 2-Step Test (2ST), and Timed Unipedal Stance (TUS) test with eyes open. 2ST is the score obtained by dividing height by the maximum length of the double stride. GS on the nonfracture side and bone density ( T-score) were also measured at the same time point. Statistical analysis was performed using the Student’s t test to compare the results with Japanese normative values, and P < .05 was considered significant. Results: FRT was 29.6 cm in women in their 40s ( P = .03), 31.1 cm in women in their 50s ( P = .002), 32.5 cm in women in their 60s ( P < .001), and 28.2 cm in women in their 70s ( P < .001). TUG was 7.7 seconds in women in their 50s ( P < .001), 7.1 seconds in women in their 60s ( P = .002), and 8.1 seconds in women in their 70s ( P = .004). 2ST was 1.40 in women in their 40s ( P = 0.20), 1.32 in women in their 50s ( P = .003), 1.29 in women in their 60s ( P < .001), 1.21 in women in their 70s ( P < .001), and 1.02 in women in their 80s ( P = .01). TUS was 55 seconds in women in their 60s ( P < .001). GS was 20.9 kg in women in their 50s, 19.3 kg in women in their 60s, and 18.2 kg in women in their 80s. Only 25% of participants showed a lower T-score than −2.5. Summary: (1) Patients with distal radius fractures in their 50s, 60s, and 70s showed significantly lower body balancing ability, especially during dynamic motion like FRT, TUG, and 2ST. GS was also significantly lower in women in their 50s, 60s, and 80s. (2) Three-quarters of patients did not show osteoporosis. This is compatible with the fact that distal radius fractures tend to be primary fragility fracture, and patients were relatively younger. (3) Patients with distal radius fractures should be identified as those at “high risk” of falls and secondary fractures. Intensive training could be effective for fall prevention.
The Role of CT in Changing the Classification and Treatment of the Fractures of the Distal Radius Compared With Conventional Radiography Regarding Interobserver Agreement
Authors: Ferreira Gustavo Pacheco Martins , de Andrade Marco Antonio Percope , de Mendonça Helio Pires , de Gouvea Schneiter Henrique , Costa Marcella Rodrigues
Published: September 2016

Objectives: Fractures of the distal end of the radius are very common and can lead to future degenerative changes if not treated properly. The computed tomographic (CT) scan is considered to show more precisely the steps and rotational deviations of these fractures but is not routinely used for initial patient assessment. The objective of the present study was to determine whether CT scan is useful for planning and treating the fractures of the distal radius in adults showing the level of interobserver agreement for classifying and treating fractures, and whether CT scan changes the directions of the treatment previously indicated only with conventional radiography. Materials and Methods: Five observers with similar professional backgrounds in hand surgery evaluated the CT scans and radiographs of 36 patients with fractures of the distal radius that were distributed by a moderator in a blind form, by chance. These patients were accepted and included in the study in a trauma reference hospital in the 6-month period. A total of 180 CT scans and 180 x-rays were evaluated. Fractures were classified using the universal and Arbeitsgemeinschaft für Osteosynthesefragen (AO) methods by the observers who indicated, as well, one of the five treatments previously predetermined, evaluating randomly the x-rays and CT scans on both situations. Interobserver agreement was researched for each one of the classifications and for the indication of treatment with the use of CT scan and x-ray thereafter. Results: The Kappa evaluation showed the same range of agreement (0.20-0.39) on both examinations. There were fewer indications of nonsurgical treatment (23 indications with CT scan against 41 with the x-ray) and an increased number of indications of more complex forms of treatment when CT scan was analyzed. Conclusions: It is concluded that CT scan and radiography have similar levels of interobserver agreement for classification and indication of treatment of fractures of the distal end of the radius. CT scan showed to be a useful imaging method, besides the use of radiography, for initial evaluation and also for indication of the treatment of fractures of the distal end of the radius. CT changed this indication in a significant way when compared with x-ray. Although some studies recommend CT only for indicating the preferred treatment option after the surgical decision, our study demonstrated that tomography evaluation is important even before the indication of the treatment because it adds more information for classification, and therefore, to change treatment planning, which may be a great benefit to reduce the degenerative processes and other complications.
Tendon Rupture After Volar Locking Plate Fixation of Distal Radius Fractures
Authors: Sato Kotaro , Furumachi Katsuro
Published: September 2016

Background: The volar locking plate (VLP) has been widely used over the past 2 decades in patients with distal radius fractures (DRFs). However, flexor pollicis longus (FPL) ruptures are a well-known postoperative complication of using the VLP system, although the incidence of tendon ruptures following VLP fixation remains unclear. The purpose of the present study was to assess the frequency of FPL rupture on a large scale in patients with DRFs who were treated with the VLP system. Materials and Methods: A questionnaire was administered by an orthopedic surgeon who performed the surgeries in patients with DRFs in our prefecture. Thirty institutions were enrolled in this study. The questionnaire consisted of 2 parts. The first part comprised the number of patients who underwent surgery using the VLP and the number of patients who suffered a tendon rupture between January 2011 and December 2014. The second part comprised the surgeon’s policy for removing the implant after bone union was achieved. Results: All 30 institutions responded to the first part of the questionnaire, and 50 orthopedic surgeons who were working at the institutions answered the second part of the questionnaire. During the 4-year period, 2787 patients with DRFs underwent fixation using a VLP. The overall incidence of FPL rupture, extensor pollicis longus rupture, flexor digitorum profundus (index finger) rupture, and extensor digitorum communis rupture was 0.35% (10/2787), 0.29% (8/2787), 0.04% (1/2787), and 0.04% (1/2787), respectively. Regarding the question about implant removal, 18 surgeons responded that they removed the implant in almost all cases, 25 answered that they removed the implant depending on the case, and 7 responded that they usually do not remove the implant. Conclusion: This study evaluated 2787 patients with DRFs who underwent fixation using a VLP. FPL rupture occurred in 10 patients (0.35%), whereas other tendon ruptures occurred less often. Implant removal was performed by more surgeons in our prefecture.
Primary Wrist Hemiarthroplasty for Irreparable Distal Radius Fractures in the Independent Elderly
Authors: Herzberg Guillaume , Burnier Marion
Published: September 2016

Objective: Despite the improvement of open reduction and internal fixation (ORIF) of distal radius fractures (DRFs) provided by locked volar plating in elderly patients, there are still complex distal DRF not amenable to any satisfactory fixation. The purpose of this article is to define irreparable acute DRF in autonomous elderly patients and to review the preliminary results of a prospective series using wrist hemiarthroplasty at the acute stage. Methods: A total of 12 wrists in 10 women were prospectively included. The average age was 74 years (range, 65-87). All patients were autonomous at home. All were intra-articular Arbeitsgemeinschaft für Osteosynthe-sefragen (AO) “C” type fractures. Circumferential comminution was present in all cases. Impaction and cartilage defect were present in all cases. All patients sustained wrist hemiarthroplasty through a single dorsal approach. The proximal part of a total wrist arthroplasty was used in 10 cases and a modified implant with a longer stem was used in 2 cases. An ulnar head resection was associated in 10/12 cases whereas the ulnar head could be kept intact in 2 wrists. Postoperative immobilization was 3 weeks followed by a splint for 3 weeks. Follow-up consisted of clinical and radiographic evaluation at 6 weeks and 2, 6, and 12 months. The average clinical and radiological follow-up was 27 months (minimum 12, maximum 41). Results: There were no dislocation, loosening, or implant removal. One wrist was reoperated on for stiffness followed by a significant improvement. Complex pain regional syndrome (CPRS) was present in 3 patients. At follow-up, Visual Analog Scale (VAS) pain was 10/100. Average Quick Disability of the Arm, Shoulder and Hand (QuickDASH) was 32 points and Patient-Rated Wrist Evaluation (PRWE) was 24.7. Mean active motion values were as follows: pronation 74°, supination 77°, extension 34°, and flexion 26°. The average grip strength was 14 kg, 67% of the contralateral side. The average wrist score was 69%. Radiologically, periprosthetic bone healing was observed in all cases. We observed 1 radial and 3 ulnar inclination of the implant. This was not observed with the longer stem implant. Discussion: Implant surgery at the acute stage for complex fractures in the elderly is an old validated concept for hip, shoulder, and elbow. Indeed some DRFs in the autonomous elderly are beyond any ORIF possibilities due to the combination of comminution and a very distal fracture line. Our results suggest that primary wrist hemiarthroplasty is a viable method to treat these difficult wrist injuries in this specific population. Further controlled prospective studies are necessary to validate this concept.
Accuracy of Radiographic Evaluation of Ulnar Styloid Base Fracture by Simple Radiogram
Authors: Lee Yong-Suk , Kang Jin-Woo , Shin Seung-Han , Chung Yang-Guk
Published: September 2016

Purpose: There remains uncertain whether to fix an ulnar styloid fracture accompanied by distal radius fracture. Fixation should be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep portion of triangular fibrocartilage. We analyzed the patients with ulnar styloid fracture accompanied by distal radius fracture using simple radiograph and 3D computed tomography (3D CT) scan images, respectively, and compared accuracy of evaluation for the types of ulnar styloid fractures, which might designate the treatment methods. Materials and Methods: We retrospectively reviewed 168 patients who underwent surgery for distal radius fracture in our hospital from January 2005 to March 2015, and evaluated whether ulnar styloid base was involved using simple radiographs and 3D CT scan images. The accuracy of evaluation by simple radiographs was compared with the findings of 3D CT scan images. To avoid the effect of memory, evaluation using 3D CT scan images was performed in a randomized order 2 weeks after initial evaluation for simple radiograph. Results: On simple radiographs, 64 patients (38%) had ulnar styloid base fractures; however, 21 cases of these revealed nonbase fractures by 3D CT scan images. And 7 out of 104 cases, on simple radiographs, determined as nonbase fracture by simple radiographs, were diagnosed as base fractures by 3D CT scans. Based on the findings of 3D CT scan images, the accuracy of simple radiographic evaluation for types of ulnar styloid fractures was 83%, with 86% sensitivity and 82% specificity. The positive predictive value was 67% and the negative predictive value was 93%. Conclusion: Accuracy of radiographic evaluation of ulnar styloid base fracture accompanied by distal radius fracture, when compared with 3D CT, was 83%. Therefore, we recommend that 3D CT scan image–based evaluation should be performed in case of unclear involvement sites so as to determine whether to fix it or not.
Magnetic Resonance Imaging Evaluation of the Distal Oblique Bundle in the Distal Interosseous Membrane of the Forearm
Authors: Gong Hyun Sik , Park Jin Woo , Kim Ka Hyun , Lee Seung Hoo , Baek Goo Hyun
Published: September 2016

Purpose: We aimed to determine whether the presence of the distal oblique bundle (DOB) can be evaluated in magnetic resonance imaging (MRI) examinations. Methods: We retrospectively reviewed 468 wrist and forearm MRIs taken in patients without acute fractures, infections, or tumors, and selected 80 MRIs that provided adequate coverage of the distal interosseous membrane (DIOM). We measured the thickness of the DIOM in the T2- weighted transverse plane. We used a picture archiving and communicating system and a model-based clustering method to determine whether some individuals have thicker DIOMs that can be considered as the DOB. Results: The thickness of the DIOM demonstrated a bimodal distribution, indicating the presence of patients with a thick DIOM (DOB). The model-based clustering method indicated that the optimal cutoff point was 1.0 mm. Twenty-six individuals (32.5%) had thick DIOMs with a mean thickness of 1.4 mm (SD, 0.2 mm), whereas 54 individuals (67.5%) had thin DIOMs with a mean thickness of 0.6 mm (SD, 0.2 mm). Conclusions: This study demonstrates that MRI can identify the presence of the DOB. The incidence and thickness of the DOB in this study support the findings of previous cadaveric studies on its morphology.
The Surgical Outcomes of the Coronoid Process Fractures of the Ulna Using the Novel “Hooked Kirschner Wire Technique”
Authors: Shin Dongju , Byun Youngsoo , Han Jaehwi , Nam Seoungoh , Kim Minguek
Published: September 2016

Objective: The coronoid process, one of the main constraints providing ulnohumeral joint stability, provides a buttress against posterior displacement of the elbow joint. It is still a challenging problem even for an expert surgeon to fix this small fracture although many fixation methods are introduced and available. Aim: We want to introduce the novel method, “hooked Kirschner wire technique,” and report the clinical outcomes of these methods for the treatment of 24 patients with coronoid fractures with instability of the ulnohumeral joint. Methods: The average age was 46 years (range, 17-79). Twelve cases had initial dislocation of the elbow and 7 of them had radial head fractures (terrible triad). According to O’Driscoll’s classification, there were 3 tip types, 18 anteromedial types, and 3 base types. All cases were treated by the hooked K-wire technique and followed for an average of 12 months (range, 6-27) with outcomes evaluated using the Mayo Elbow Performance Scoring (MEPS) system. Results: One coronoid fracture was not healed and underwent second operation. The average active motion of the elbow joint was 126° (range, 78-160). The average score of MEPS was 96 (range, 80-100). There were 19 excellent and 5 good results. Conclusion: The hooked K-wire technique provided a stable fixation and a satisfactory union for displaced coronoid process fractures with the unstable elbow. This technique has some advantages. First, it is cheap and easy to handle. Second, the small fragment can be fixed medially or laterally. Last, it could be used as a temporary fixator for additional plating or screwing.
Online Database for Prospective and Retrospective Scientific Evaluation of Surgical Results
Authors: Urbán Ferenc , Czinke Zoltán , Bajdik Beáta , Rimaszéki Zsolt , Bábás Géza , Szabó Zsolt
Published: September 2016

Objective: There is an increased need for evidence-based data in surgery. The scientific value of old-fashioned retrospective studies with a lot of inaccurate data nowadays is limited. A well-designed prospective trial needs a great amount of work and important financial support. We have designed a prospective system for collecting scientifically valuable data on a disease and/or surgical procedure. Our objective is to present and share this system with our colleagues. Methods: We have prepared the structure of a web-based system with well-designed questionnaires for different hand disorders. The questions are specific for the investigated problem. The number of questions is limited in order to make possible data collection and registration during the real-life patient care. Filling a questionnaire should be less than 2 minutes at a time. Privacy regarding patient and uploader (the only owner of the uploaded data) has the priority during all the process. As the questionnaires are uniform, the system makes it possible to compare the outcome data of the different users or institutes but only based on their decision and agreement of collaboration. Even small number of cases or rare conditions based on a multicenter upload of the system can provide statistically sufficient series in a relatively short period. Results: A pilot study using the aforementioned structure is already running for carpal tunnel syndrome, trigger finger, metacarpal fractures, and extensor tendon injuries, and there are several more condition protocols under construction. Only a few months of data collection for the carpal tunnel syndrome has demonstrated the unforeseen value of the system as in a few hours, 5 different hypotheses of this condition were able to be confirmed or denied. The easily achievable large number of patients makes possible the construction of several evidence-based data and conclusions in a relatively short time. Conclusions: By using our register with a little effort on filling a questionnaire at every patient meeting, the benefit will be almost the same as of a prospective trial. This way, the cost-benefit ratio can be changed to your favor. The information from the database could be used to evaluate your own results, compare them with other colleges, organize multicenter studies, and present them at live events or publishing them.
Arthroscopic Release for the Severely Stiff Elbow
Authors: Temporin Ko , Shimada Kozo , Oura Keiichiro
Published: September 2016

Objective: Arthroscopic release for the stiff elbow is widely spreading recently, but no report is published concerning severely stiff elbows. We investigate the outcomes of the arthroscopic release for the severely stiff elbow. Methods: Eleven patients, 11 severely stiff elbows (flexion/extension arc ≤60°), were enrolled in this study, who had surgeries since 2008, mainly performed arthroscopically. They were 5 men and 6 women, and average age at the operation was 49.6 years (21-67 years). Etiologies of the stiffness were 2 posttraumatic stiffness, 4 osteoarthritis, and 5 rheumatoid arthritis. Operation was performed under general anesthesia in the prone position. Under arthroscopy, capsular release, resection of the intra-articular fibrous tissue, osteophyte resection, and partial excision of the radial head were performed. If necessary, mini-open procedure at the medial side was added for the release of the posterior oblique ligament of the medial collateral ligament and the release or the transposition of the ulnar nerve. Partial excision of the radial head was performed mainly in the patients of rheumatoid arthritis, who had pain with crepitus around the humeroradial joint in motion. We followed the patients for an average of 18 months (6-63 months), and investigated range of motion, Mayo Elbow Performance Index, and complications. Results: We performed the anterior capsular release in 8 patients, osteophyte resection in 7 patients, partial excision of the radial head in 5 patients, and the medial open procedure in 4 patients. Range of motion was significantly improved from 89° flexion and −53° extension to 110° flexion and −30° extension, respectively, after the surgery. Pronation was also improved from 56° to 64°. Supination was improved, although not significant, from 50° to 58°. Mayo Elbow Performance Index improved from 60 to 85 points. One case of osteoarthritis showed osteophyte re-formation, and needed open revision surgery 1 year after the initial surgery. There was no neurovascular injury. Another case of rheumatoid arthritis had the severely stiff elbow of 110° flexion, −70° extension, 30° pronation, and 10° supination. She had arthroscopic release including partial excision of the radial head, and the range of motion was improved. For the additional improvement, we had the second arthroscopic surgery 17 months after the initial surgery. Finally, she gained good range of motion; 125° flexion, −40° extension, 70° pronation, and 60° supination. Conclusions: The arthroscopic release is technically demanding, especially in the severe cases, but it may be the promising procedure for the rapid recovery with minimal invasion and the improvement of the range of motion. In the surgery, we need to suppress the complications, using all knowledge of the anatomy and experiences. Additional medial side mini-open procedure is sometimes necessary and effective for good outcomes.
The Rate of Radial Head Prosthesis Removal or Revision
Authors: Kachooei Amir R. , Baradaran Aslan , Ebrahimzadeh Mohammad H. , Chen Neal
Published: September 2016

Objectives: To determine the overall rate of radial head prosthesis removal or revision and the rate of removal or revision based on the type of prosthesis fixation (cemented, uncemented loose, uncemented pressfit), material (metal, vitallium, titanium, pyrocarbon, polymethyl methacrylate), and design (short stem vs long stem, and monopolar vs bipolar), and to determine reasons for prosthetic removal/revision. Methods: Data Sources—We searched the literature, including MEDLINE, MEDLINE preprints, SCOPUS, EMBASE, and the Cochrane Central Register of Controlled Trials. Study Eligibility Criteria—We identified studies reporting the clinical outcome of radial head arthroplasties. Participants: We included 31 studies with a total of 1055 patients out of whom 85 prostheses were removed and 45 prostheses were revised. Synthesis Method—We calculated the pooled event rate and the risk ratio with 95% confidence interval (CI) using a random effects model to create a Forest plot. Results: The pooled rate of radial head prosthesis removal or revision was 10.6% (95% CI, 7.9%-14.2%). Subgroup analysis showed that the rate of removal/revision was lowest with the cemented fixation, longer stem, Vitallium material, and bipolar prosthesis. More than half of the prostheses were removed/revised for excision of the heterotopic ossification in (28%) and for the treatment of stiffness and limitation of motion (25%). Other recorded reasons were pain (16%), loosening (9.2%), overstuffing (7.7%), instability (6.9%), infection (5.4%), and prosthesis disassembly (2.3%). Limitations: Most of the studies were small case series and retrospective with short- to midterm follow-up. Conclusions: The current data show that the highest rate of removal/revision occurred within 2 years after implantation. Moreover, there seems to be differences in the reasons of removal/revision between different designs. It appears that most radial head arthroplasties have an acceptable and comparable midterm longevity; however, it is unclear whether long-term longevity will differ between devices.
Anesthesia for Closed Reduction of Distal Radius Fractures in the Emergency Department
Authors: Wollstein Ronit , Koren Lior , Ginesin Eyal , Elias Shahem , Israelit Shlomo
Published: September 2016

Objective/Hypothesis: Distal radius fractures (DRFs) are still treated conservatively with closed reduction in the emergency department (ED) for certain indications such as infirmity or patient preference. The quality of reduction depends on multiple variables such as inherent stability of the fracture, quality of casting, patient adherence, and the type of anesthesia used in the ED. The purpose of this study was to compare the quality of radiographic fracture reduction performed in the ED using sedation anesthesia with that of using hematoma block anesthesia. Materials and Methods: A retrospective case-control study of 240 DRF reductions was done. Thirty of them were treated with sedation and 210 with a hematoma block. Inclusion criteria included age greater than 18 years and availability of adequate radiographic series including pre- and post-reduction true posteroanterior (PA) and lateral radiographs. Exclusion criteria included immediate hospitalization for operative reduction and fixation, pregnancy, and chronic cognitive impairment. Pre- and post-reduction radiographs were reviewed for volar tilt, radial angulation, radial height, and ulnar variance. Patient charts were reviewed for demographic data, background disease, and experience of the reducing surgeon. Results: Both groups were similar in gender, background illnesses, concomitant injuries, surgeon experience, and fracture radiographic classification. Surgeon experience did not affect the quality of reduction. No complications related to the anesthesia were noted. The sedation group spent more time in the ED ( P = .001). Post-reduction values of volar tilt were better in the sedation group ( P = .03). Volar tilt and ulnar variance improved more in the sedation group ( P = .001). Conclusions:(1) Both types of anesthesia carried minimal complications and achieved reduction. (2) Sedation seemed to be more efficient than hematoma block in supporting closed reduction of DRF in the ED. However, it required certified personnel and the patient spent more time in the ED. (3) Because both types of anesthesia are acceptable, we suggest using sedation when the ED reduction is the final reduction, ie, when the patient is planned to continue with conservative treatment.