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Comparing the Intensity of Pain and Incidence of Flare Reaction Following Trigger Finger Injections Using Betamethasone and Methylprednisolone: A Double-Blinded, Randomized Controlled Trial. 比较触发指注射倍他米松和甲基强的松后疼痛强度和耀斑反应发生率:一项双盲、随机对照试验
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-12-04 DOI: 10.1177/15589447231213383
Shafic Sraj, Samuel Schick, Kareem Wasef, Mark Haft, Skylar Braga, John S Taras, Andréa B Lese, B Joseph Prud'homme

Background: Considerable evidence supports corticosteroid injection as an effective treatment for trigger finger. One common side effect, the flare reaction, is a well-documented phenomenon of increased pain following steroid injections. Its incidence and intensity may be related to steroid composition. The purpose of this study was to determine whether betamethasone and methylprednisolone injections for trigger fingers have differing intensity of pain or incidence flare reaction.

Methods: Patients with symptomatic trigger finger were recruited during their hand surgery visits. Patients were randomized into 2 treatment groups: betamethasone (40 mg) and methylprednisolone (6 mg) mixed with lidocaine 1%. Treatment group assignment was blinded to the patients and investigators. Visual analog scale pain measurements were taken prior to injection, 5 minutes postinjection, and daily thereafter for 7 days.

Results: Sixty-four patients were randomized into the 2 treatment groups. Patients in the betamethasone group reported slightly higher baseline pain compared with the methylprednisolone group, but lower pain on day 1. None of the following days showed a statistically significant difference.

Conclusions: The incidence of flare and severe flare reactions of betamethasone injections for trigger finger management was roughly double that of methylprednisolone, but this difference was not statistically significant. Further studies are required to evaluate the relative course of nonflare postinjection pain for different corticosteroid injections for trigger finger injections.

背景:大量证据支持皮质类固醇注射是治疗扳机指的有效方法。一个常见的副作用,耀斑反应,是一个有充分证据的现象,即类固醇注射后疼痛增加。其发生率和强度可能与类固醇成分有关。本研究的目的是确定注射倍他米松和甲基强的松用于扳机指是否有不同的疼痛强度或发生率耀斑反应。方法:在手部手术就诊期间招募有症状的扳机指患者。患者随机分为倍他米松(40 mg)和甲泼尼龙(6 mg)混合1%利多卡因2个治疗组。治疗组的分配对患者和研究者是不知情的。注射前、注射后5分钟、注射后每天进行视觉模拟疼痛测量,持续7天。结果:64例患者随机分为2个治疗组。与甲泼尼龙组相比,倍他米松组患者报告的基线疼痛略高,但第1天的疼痛较低。在接下来的几天里,没有显示出统计学上的显著差异。结论:注射倍他米松治疗触发指发作和严重发作反应的发生率约为甲泼尼龙的两倍,但差异无统计学意义。需要进一步的研究来评估不同皮质类固醇注射触发指注射后无明显疼痛的相对过程。
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引用次数: 0
Admission of Upper Extremity Injuries Presenting to the Emergency Department: An NEISS Study. 急诊科收治的上肢受伤患者:一项 NEISS 研究。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-12-30 DOI: 10.1177/15589447231219711
Michael D Eckhoff, Brandon T Schwartz, Soham B Parikh, Matthew E Wells, Sean C Brugman

Background: Upper extremity injuries account for 36.5% of presentations to the emergency department in the United States. This study seeks to determine current rates of upper extremity injuries that present to the emergency department and the injury characteristics of patients requiring admission.

Methods: National Electronic Injury Surveillance System was queried for a 10-year period for upper extremity injuries. Further analysis was done to evaluate specific patient demographics, injury characteristics, and mechanisms of injury of those patients who were admitted to the hospital.

Results: Between 2012 and 2021, 39 160 365 persons are estimated to have presented to 100 United States emergency departments for managing upper extremity injuries, accounting for 28.8% of total presentations. A total of 12 662 041 upper extremity patients were pediatric (32.3%). Admissions occurred in 4.6% of presentations. The most common presenting diagnosis was laceration (24.9%), while the most common admission diagnosis was fracture (49.7%). The majority had injuries involving their forearms (19.9%). The most common injury-associated consumer product group was stairs, ramps, landings, and floors at 28.5%. Of the 445 644 patients, those estimated to have been injured by stairs, ramps, landings, and floors adults were 429 435 or 96.4%. The most common injury-associated product in pediatric populations was playground equipment (23.6%), of which 53.7% was from monkey bars and other climbing apparatuses.

Conclusion: This study demonstrates an overall increase in admissions for upper extremity injuries in the setting of similar rates of overall upper extremity injuries with fractures and forearm being the most common diagnosis and body part involved, respectively.

Level of evidence: IV; Database.

背景:在美国,上肢受伤占急诊科就诊人数的 36.5%。本研究旨在确定目前急诊科就诊的上肢损伤率以及需要入院治疗的患者的损伤特征:方法:对国家电子伤害监控系统进行了为期 10 年的上肢伤害查询。结果:2012 年至 2021 年间,39,500 名急诊患者在急诊科就诊:结果:2012 年至 2021 年间,估计有 39 160 365 人因上肢受伤而前往美国 100 家医院的急诊科就诊,占就诊总人数的 28.8%。共有 12 662 041 名上肢伤患者是儿科患者(占 32.3%)。4.6%的患者需要入院治疗。最常见的就诊诊断是撕裂伤(24.9%),而最常见的入院诊断是骨折(49.7%)。大多数人的前臂受伤(19.9%)。最常见的受伤相关消费品类别是楼梯、坡道、平台和地板,占 28.5%。在 445 644 名患者中,估计因楼梯、坡道、平台和地板受伤的成人为 429 435 人,占 96.4%。在儿科人群中,最常见的与伤害有关的产品是游乐场设备(23.6%),其中 53.7% 来自单杠和其他攀爬装置:本研究表明,在上肢总体受伤率相似的情况下,因上肢受伤入院的人数总体增加,骨折和前臂分别是最常见的诊断和涉及的身体部位:证据等级:IV;数据库。
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引用次数: 0
Reverse or Ulnar-Sided, Greater Arc Perilunate Injury: Case Report and Systematic Review of Literature. 反向或尺侧,月骨周围大弧形损伤:病例报告和文献系统回顾。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-11-14 DOI: 10.1177/15589447231211605
Frantzeska Zampeli, Theodorakys Marín Fermín, Elisabet Hagert, Javier Arnaiz, Jonny K Andersson

Background: Perilunate injuries of carpal bones are uncommon, high-energy injuries that necessitate early diagnosis and appropriate management to prevent progressive carpal instability and posttraumatic osteoarthritis. A much more uncommon mechanism that starts from the lunotriquetral ligament and proceeds radially in an opposite direction than the classic mechanism may cause a reverse or ulnar-sided perilunate dislocation (PLD). The purposes were: (1) to present an uncommon case of greater arc reverse (ulnar-sided) perilunate fracture-dislocation (REPLFD); and (2) to conduct a systematic review (SR) to evaluate the current evidence on reverse perilunate injuries (REPLIs).

Methods: A novel pattern of injury of REPLFD with fractures of the ulnar styloid, triquetrum, and capitate is presented. A SR was conducted with primary outcome measures of the type of injury (pathoanatomy of lesions) and pathomechanics. Secondary outcome measures were choice of surgery and outcome on follow-up.

Results: The Murad's tool and modified Coleman Methodology Score revealed poor methodological quality of the available literature on REPLI. Evidence is lacking in the mechanism of injury and treatment of REPLI, especially regarding REPLFD.

Conclusions: The SR revealed poor methodological quality of the available literature and exposes that not all PLDs can be explained by the current existing pathomechanical injury classifications. However, following the management principles of perilunate injuries, REPLI tends to have good functional results with no major complications.

Level of evidence: Level V.

背景:腕骨骨月骨周围损伤是罕见的高能量损伤,需要早期诊断和适当的处理,以防止进行性腕骨不稳定和创伤后骨关节炎。一种更为罕见的机制,从月牙三叉韧带开始,沿与经典机制相反的方向径向发展,可能导致反向或尺侧月骨周围脱位(PLD)。目的是:(1)提出一个罕见的大弧形反向(尺侧)月骨周围骨折脱位(REPLFD)病例;(2)进行系统回顾(SR),以评估目前关于反向月骨周围损伤(REPLIs)的证据。方法:提出了一种新的伴尺茎突、三骨肌和头状骨骨折的复瓣畸形损伤模式。采用损伤类型(病变病理解剖)和病理力学的主要结局指标进行SR。次要观察指标为手术选择和随访结果。结果:Murad's工具和改良的Coleman方法学评分显示,关于REPLI的现有文献的方法学质量较差。目前,关于REPLI的损伤机制和治疗缺乏证据,特别是关于REPLFD。结论:SR揭示了现有文献的方法学质量较差,并表明并非所有pld都可以用当前现有的病理力学损伤分类来解释。然而,遵循月骨周围损伤的处理原则,REPLI往往具有良好的功能效果,无重大并发症。证据等级:V级。
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引用次数: 0
Incidence and Risk Factors for Revision Within 1 Year of Primary Carpal Tunnel Release. 原发性腕管松解术1年内翻修的发生率和危险因素。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-11-19 DOI: 10.1177/15589447231211608
Derek T Schloemann, Caroline P Thirukumaran, Warren C Hammert

Background: The annual volume of carpal tunnel release (CTR) in the United States has been estimated to be 577 000 per year. Our objectives were to evaluate the incidence and risk factors for revision CTR within 1 year of primary CTR.

Methods: We identified all adult patients undergoing primary CTR from October 2015 to September 2019 in the New York Statewide Planning and Research Cooperative System database using Current Procedural Terminology (CPT) codes. We used the CPT modifier codes to determine laterality of index and revision procedures. We estimated multivariable hierarchical logistic regression models to evaluate risk factors for revision CTR within 1 year.

Results: Of the 80 423 primary CTR procedures, 178 (0.22%) underwent a revision CTR within 1 year of the index surgery. The mean (SD) age of the entire cohort was 58.69 (14.43) years, 61.1% were women, 73.2% were non-Hispanic white, 42.9% were covered through private insurance, and 9.5% had diabetes mellitus. Workers' compensation insurance (odds ratio [OR] = 1.83, 95% confidence interval [CI], 1.13-2.98, P = .02) and simultaneous bilateral CTR (OR = 14.91, 95% CI, 9.62-23.12, P < .001) were associated with revision CTR within 1 year of the index procedure. No models demonstrated an association between endoscopic technique or surgeon volume and revision CTR.

Conclusions: The incidence of revision CTR within 1 year was lower than that previously reported. Patients covered by workers' compensation and those undergoing simultaneous bilateral CTR had higher likelihood of a revision CTR within 1 year, whereas endoscopic technique and surgeon volume were not associated with revision CTR within 1 year.

背景:美国每年的腕管释放量(CTR)估计为57.7万例。我们的目的是评估原发性CTR 1年内修订CTR的发生率和危险因素。方法:我们使用现行程序术语(CPT)代码在纽约州范围内的计划和研究合作系统数据库中确定了2015年10月至2019年9月期间接受原发性CTR的所有成年患者。我们使用CPT修正码来确定索引的侧边性和修订程序。我们估计了多变量层次逻辑回归模型来评估1年内修订CTR的危险因素。结果:在80423例原发性CTR手术中,178例(0.22%)在指数手术后1年内进行了CTR翻修。整个队列的平均(SD)年龄为58.69(14.43)岁,61.1%为女性,73.2%为非西班牙裔白人,42.9%为私人保险,9.5%患有糖尿病。工伤保险(优势比[OR] = 1.83, 95%可信区间[CI], 1.13-2.98, P = 0.02)和同时双侧CTR (OR = 14.91, 95% CI, 9.62-23.12, P < .001)与指数手术后1年内的修订CTR相关。没有模型表明内窥镜技术或外科医生体积与翻修CTR之间存在关联。结论:1年内改良CTR的发生率低于既往报道。工人补偿患者和同时进行双侧CTR的患者在一年内进行翻修CTR的可能性更高,而内窥镜技术和手术量与一年内翻修CTR无关。
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引用次数: 0
Utility of Routine Blood Cultures for Upper Extremity Abscesses. 上肢脓肿常规血培养的实用性
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-12-06 DOI: 10.1177/15589447231213890
Etka Kurucan, Nicolas J Echeverria, Evan Jacquez, Frederick V Ramsey, Mark Solarz

Background: Patients with skin and soft tissue infections (SSTIs) are often admitted by the emergency department for intravenous antibiotic therapy and surgical drainage of abscesses if necessary. As part of the initial diagnostic workup, blood cultures are routinely drawn at our institution in patients with SSTIs. This study seeks to identify the utility of performing blood cultures in patients with upper extremity abscesses as it relates to the number of incision and drainage (I&D) procedures performed, patient readmission rates, and length of hospital stay.

Methods: A retrospective chart review of 314 patients aged 18 to 89 years who underwent 1 or more I&D procedures of upper extremity abscesses were included in the study. Patient demographic data, comorbidities, laboratory values, wound and blood culture results, number of I&D procedures performed, length of stay, and readmission rates were evaluated.

Results: Increasing age and white blood count were associated with an increased number of I&Ds performed. Obtaining blood cultures, whether positive or negative, was associated with increased length of stay. There was no association between obtaining blood cultures and number of procedures performed on multivariable analysis. Positive blood cultures were associated with increased readmission rates.

Conclusions: Routinely obtaining blood cultures in patients with upper extremity abscesses may not be beneficial. Obtaining blood cultures is not associated with an increased number of I&D procedures or readmission rates. Furthermore, obtaining blood cultures, regardless of positivity, is associated with increased lengths of hospital stay.

背景:皮肤和软组织感染(SSTI)患者通常会被急诊科收治,接受静脉抗生素治疗,必要时还需进行脓肿手术引流。作为初步诊断工作的一部分,我院常规对 SSTI 患者进行血液培养。本研究旨在确定对上肢脓肿患者进行血液培养的效用,因为这与进行切开引流(I&D)手术的次数、患者再入院率和住院时间有关:研究对 314 名年龄在 18-89 岁之间、接受过一次或多次上肢脓肿切开引流手术的患者进行了回顾性病历审查。研究评估了患者的人口统计学数据、合并症、实验室值、伤口和血液培养结果、进行的脓肿切开术次数、住院时间和再入院率:结果:年龄和白细胞计数的增加与所进行的伤口拆检次数增加有关。获得血液培养结果(无论阳性或阴性)与住院时间的延长有关。在多变量分析中,血液培养与手术次数之间没有关联。血培养阳性与再入院率增加有关:结论:对上肢脓肿患者进行常规血液培养可能并无益处。结论:对上肢脓肿患者进行常规血液培养可能并无益处,获取血液培养与I&D程序或再入院率的增加无关。此外,无论阳性与否,获得血液培养都会延长住院时间。
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引用次数: 0
Incidence, Prevalence, and Outcomes of Hand Manifestations in Patients With Diabetes Mellitus: A Comprehensive Literature Review. 糖尿病患者手部表现的发生率、患病率和预后:综合文献综述。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2024-01-30 DOI: 10.1177/15589447231219522
Thomas G Knoedler, Aidan P Gaertner, Paul J Wilkinson, A Neil Salvapongse

Diabetes mellitus is a metabolic disease that results in long-term hyperglycemia. Among the many long-term complications associated with diabetes, manifestations in the hand include Dupuytren's contracture, trigger finger, compressive neuropathies, and infections. These conditions can have a profound impact on a patient's quality of life, highlighting the importance of timely recognition and treatment of these manifestations. This review aims to provide updated information regarding the incidence and outcomes of these clinical manifestations in the diabetic versus nondiabetic population. A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was performed. The literature search included the use of PubMed and Ovid databases to find relevant articles that were then selected based on an inclusion criterion that required level 4 evidence. Diabetes mellitus results in an increased incidence of Dupuytren's contracture, trigger finger, carpal tunnel syndrome, cubital tunnel syndrome, and hand infections. Dupuytren's, trigger finger, and carpal tunnel syndrome all had similar outcomes, while diabetic patients had worse outcomes related to infections. There was a lack of data regarding the effect of diabetes on cubital tunnel syndrome. Future studies should be performed to analyze the effects of diabetes mellitus on hand manifestations, particularly regarding the outcomes of diabetic patients with cubital tunnel syndrome.

糖尿病是一种代谢性疾病,会导致长期高血糖。在与糖尿病相关的众多长期并发症中,手部表现包括杜普伊特伦挛缩症、扳机指、压迫性神经病和感染。这些病症会对患者的生活质量产生深远影响,因此及时识别和治疗这些表现尤为重要。本综述旨在提供有关糖尿病与非糖尿病人群中这些临床表现的发病率和结果的最新信息。根据《系统综述和元分析首选报告项目》清单进行了系统综述。文献检索包括使用 PubMed 和 Ovid 数据库查找相关文章,然后根据要求 4 级证据的纳入标准筛选出相关文章。糖尿病会导致杜普伊特伦挛缩症、扳机指、腕管综合征、肘管综合征和手部感染的发病率增加。杜普伊特伦挛缩症、扳机指和腕管综合征的治疗效果相似,而糖尿病患者的感染治疗效果较差。关于糖尿病对肘管综合征的影响,目前还缺乏相关数据。今后应开展研究,分析糖尿病对手部表现的影响,尤其是对患有腕管综合征的糖尿病患者的影响。
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引用次数: 0
Complications in Hand Surgery During Early Independent Practice: A Single Surgeon's 5-Year Experience. 早期独立实践中的手外科并发症:一位外科医生5年的经验。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-10-03 DOI: 10.1177/15589447231201875
Richard Samade, Adam M Gordon, Parth Vaghani, Kanu S Goyal

Background: The objective of this study was to understand the frequency and types of complications, and the associated postoperative outcomes within the first 5 years of practice after hand and upper extremity surgery fellowship.

Methods: This was a retrospective observational study of all patients seen and surgically treated by a single surgeon at a single institution from August 2014 to September 2019. This corresponded to the first 5 years of practice after fellowship. Data collected included patient demographics, perioperative data, complication type, and outcome of the complication (better/same/worse than preoperative status). Complications were classified using the Clavien-Dindo system and a unique, self-derived system.

Results: In total, 3301 surgeries were performed during the first 5 years of practice. The overall complication rate was 7.9% (261 complications from 239 patients). The 30-day complication rate was 5.2% (171/3301). Eleven (4.2%) of the 261 complications occurred intraoperatively. The total number of complications significantly declined during the first 5 years of practice as follows: 74, 71, 46, 37, and 33 (P = .010, R2 = .92). Hand and wrist were the most frequent anatomic locations involved and bone pathology was the predominant indication.

Conclusion: The overall surgical complication rate for hand and upper extremity surgery was 7.9%, with a 30-day complication rate of 5.2% (171/3301). The rate of complications after fellowship declined over the first 5 years of independent practice. Superficial infections were the most common complication. More than 90% of patients ultimately improved after addressing the complication.

Level of evidence: IV.

背景:本研究的目的是了解手部和上肢手术奖学金后前5年内并发症的频率和类型,以及相关的术后结果。方法:这是一项回顾性观察性研究,对2014年8月至2019年9月在一家机构由一名外科医生就诊和手术治疗的所有患者进行了研究。这相当于研究生毕业后的前5年实践。收集的数据包括患者人口统计学、围手术期数据、并发症类型和并发症的结果(比术前状态更好/相同/更差)。使用Clavien-Dindo系统和一个独特的、自衍生的系统对并发症进行分类。结果:在执业的前5年,共进行了3301次手术。总并发症发生率为7.9%(239例患者中有261例并发症)。30天并发症发生率为5.2%(171/3301)。261例并发症中有11例(4.2%)发生在术中。在前5年的实践中,并发症总数显著下降,如下:74、71、46、37和33(P=.010,R2=.92)。手和手腕是最常见的解剖部位,骨骼病理是主要指征。结论:手部和上肢手术的总并发症发生率为7.9%,30天并发症发生率5.2%(171/3301)。在最初5年的独立实践中,联谊后的并发症发生率有所下降。浅表感染是最常见的并发症。超过90%的患者在解决并发症后最终得到改善。证据级别:四。
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引用次数: 0
Preoperative Anemia Is Associated With Worse Postoperative Outcomes After Open Reduction Internal Fixation of Distal Radius Fractures. 术前贫血与桡骨远端骨折切开复位内固定术后不良预后相关
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-10-24 DOI: 10.1177/15589447231205615
Jessica Schmerler, Jarod T Olson, Niyathi Prasad, Dawn LaPorte

Background: Preoperative anemia has been shown to be associated with complications after numerous orthopedic procedures. No studies to our knowledge have examined its impact on outcomes after open reduction internal fixation (ORIF) of distal radius fracture (DRF). We hypothesized that patients with preoperative anemia would have increased likelihood of adverse outcomes, and likelihood would increase with severity of anemia.

Methods: A total of 14 136 patients underwent ORIF for DRF over 2012-2021, identified in the National Surgical Quality Improvement Program database. Patients were classified by World Health Organization criteria as nonanemic (hematocrit >36% for women, >39% for men), mildly anemic (hematocrit 33%-36% for women, 33%-39% for men), or moderately to severely anemic (hematocrit <33% for women or men). Multivariable regressions adjusted for age, sex, race, and comorbidities statistically different between anemic and nonanemic patients were used to examine the effect of anemia on postoperative outcomes.

Results: Mildly anemic patients had significantly longer length of stay and were significantly more likely to experience readmission and sepsis (P < .05 all). Moderately to severely anemic patients had significantly longer length of stay and were significantly more likely to experience readmission, postoperative transfusion, septic shock, and any adverse event (P < .05 all).

Conclusions: Preoperative anemia is associated with increased likelihood of adverse outcomes after ORIF for DRF, and likelihood increases with severity of anemia. Surgeons should monitor patients for preoperative anemia and endeavor to identify the source of and, if safe and possible, correct the anemia preoperatively or manage and educate patients postoperatively.

背景:术前贫血已被证明与许多骨科手术后的并发症有关。据我们所知,没有研究检测其对桡骨远端骨折(DRF)切开复位内固定术(ORIF)后疗效的影响。我们假设术前贫血的患者出现不良后果的可能性会增加,而且这种可能性会随着贫血的严重程度而增加。方法:共14种 2012年至2021年,136名患者因DRF接受了ORIF治疗,这些患者已在国家外科质量改进计划数据库中确定。根据世界卫生组织的标准,患者分为非贫血(女性红细胞比容>36%,男性>39%)、轻度贫血(女性血细胞比容33%-36%,男性33%-39%)或中度至重度贫血(红细胞比积结果:轻度贫血患者的住院时间明显更长,更容易再次入院和败血症(P均<0.05)。中度至重度贫血患者的住院时间明显更长,更容易再次入院、术后输血、感染性休克和任何不良事件(P均<0.05)。结论:术前贫血与DRF ORIF后不良结果的可能性增加有关,并且这种可能性随着贫血的严重程度而增加。外科医生应监测患者术前贫血的情况,并努力确定贫血的来源,如果安全可行,应在术前纠正贫血,或在术后管理和教育患者。
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引用次数: 0
Racial Disparities in Surgical Versus Nonsurgical Management of Distal Radius Fractures in a Medicare Population. 医疗保险人群桡骨远端骨折手术治疗与非手术治疗的种族差异。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-09-22 DOI: 10.1177/15589447231198267
Peter Y Joo, Scott J Halperin, Meera M Dhodapkar, Giscard J Adeclat, Ali Elaydi, Christopher Wilhelm, Jonathan N Grauer

Background: As racial/ethnic disparities in management of distal radius fractures (DRFs) have not been well elucidated in the literature, this study sought to evaluate the correlation of race/ethnicity on surgical versus nonsurgical management of DRFs in a Medicare population.

Methods: The PearlDiver Standard Analytical Files Medicare claims database was used to identify patients ≥65 years old with isolated DRF. Patients with polytrauma or surgery performed for upper extremity neoplasm were excluded. Surgical versus nonsurgical management was compared based on demographics, comorbidity (Elixhauser Comorbidity Index, ECI), race/ethnicity, and whether the fracture was open or closed. Univariate and multivariable analyses were used to assess for independent predictors.

Results: Of 54 564 isolated DRFs identified, surgery was performed for 20 663 (37.9%). On multivariable analysis, patients were independently less likely to receive surgical management if they were: older (relative to 65- to 69-year-olds, incrementally decreasing by age bracket up to >85 years where odds ratio [OR] was 0.27, P < .001), higher ECI (per 2 increase OR: 0.96, P < .001), and closed fractures (OR: 0.35, P < .001). For race/ethnicity: black (OR: 0.64, P < .001), Hispanic (OR: 0.71, P < .001), and Asian (OR: 0.60, P < .001) patients were less likely to undergo surgery.

Conclusions: While age, comorbidities, and fracture type are known to affect surgical decision-making for DRF, race/ethnicity has not previously been reported, and its independent prediction of nonsurgical management for several groups points to a disparity in surgical decision-making/access to care. This highlights the need for increased attention to initiatives that seek to provide equitable care to all patients.

Level of evidence: Level III-Retrospective review of national database.

背景:由于文献中尚未很好地阐明桡骨远端骨折(DRF)治疗中的种族/民族差异,本研究试图评估医疗保险人群中种族/民族对DRF手术治疗与非手术治疗的相关性。方法:PearlDiver标准分析文件医疗保险索赔数据库用于识别≥65岁的孤立性DRF患者。排除多发性创伤或上肢肿瘤手术患者。根据人口统计学、合并症(Elixhauser合并症指数,ECI)、种族/民族以及骨折是开放性还是闭合性,对手术治疗与非手术治疗进行比较。单变量和多变量分析用于评估独立预测因素。结果:共54个 发现564个孤立的DRF,对20个进行了手术 663(37.9%)。在多变量分析中,如果患者年龄较大(相对于65至69岁,按年龄段递增,直至>85岁,比值比[OR]为0.27,P<.001),ECI较高(每增加2个比值比:0.96,P<0.001),和闭合性骨折(OR:0.35,P<.001)。对于种族/民族:黑人(OR:0.64,P<0.001)、西班牙裔(OR:0.71,P<-001)和亚裔(OR:0.60,P<001)患者接受手术的可能性较小。结论:虽然年龄、合并症和骨折类型已知会影响DRF的手术决策,但种族/民族此前尚未报道,其对几个群体非手术治疗的独立预测表明,在手术决策/获得护理方面存在差异。这突出表明,需要更多地关注旨在为所有患者提供公平护理的举措。证据级别:对国家数据库进行三级回顾性审查。
{"title":"Racial Disparities in Surgical Versus Nonsurgical Management of Distal Radius Fractures in a Medicare Population.","authors":"Peter Y Joo, Scott J Halperin, Meera M Dhodapkar, Giscard J Adeclat, Ali Elaydi, Christopher Wilhelm, Jonathan N Grauer","doi":"10.1177/15589447231198267","DOIUrl":"10.1177/15589447231198267","url":null,"abstract":"<p><strong>Background: </strong>As racial/ethnic disparities in management of distal radius fractures (DRFs) have not been well elucidated in the literature, this study sought to evaluate the correlation of race/ethnicity on surgical versus nonsurgical management of DRFs in a Medicare population.</p><p><strong>Methods: </strong>The PearlDiver Standard Analytical Files Medicare claims database was used to identify patients ≥65 years old with isolated DRF. Patients with polytrauma or surgery performed for upper extremity neoplasm were excluded. Surgical versus nonsurgical management was compared based on demographics, comorbidity (Elixhauser Comorbidity Index, ECI), race/ethnicity, and whether the fracture was open or closed. Univariate and multivariable analyses were used to assess for independent predictors.</p><p><strong>Results: </strong>Of 54 564 isolated DRFs identified, surgery was performed for 20 663 (37.9%). On multivariable analysis, patients were independently less likely to receive surgical management if they were: older (relative to 65- to 69-year-olds, incrementally decreasing by age bracket up to >85 years where odds ratio [OR] was 0.27, <i>P</i> < .001), higher ECI (per 2 increase OR: 0.96, <i>P</i> < .001), and closed fractures (OR: 0.35, <i>P</i> < .001). For race/ethnicity: black (OR: 0.64, <i>P</i> < .001), Hispanic (OR: 0.71, <i>P</i> < .001), and Asian (OR: 0.60, <i>P</i> < .001) patients were less likely to undergo surgery.</p><p><strong>Conclusions: </strong>While age, comorbidities, and fracture type are known to affect surgical decision-making for DRF, race/ethnicity has not previously been reported, and its independent prediction of nonsurgical management for several groups points to a disparity in surgical decision-making/access to care. This highlights the need for increased attention to initiatives that seek to provide equitable care to all patients.</p><p><strong>Level of evidence: </strong>Level III-Retrospective review of national database.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"258-262"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41128046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Accuracy of MRI in Assessment of High-Grade Partial Distal Biceps Tears. MRI评估高级别肱二头肌远端部分撕裂的准确性。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2025-03-01 Epub Date: 2023-09-14 DOI: 10.1177/15589447231196906
Gregory J Schmidt, James P Fischer, Reed W Hoyer, Jeffrey A Greenberg, Nicholas E Crosby

Background: Magnetic resonance imaging (MRI) is commonly used to diagnose and assess the extent of partial distal biceps injuries. The aim of this study was to report on the accuracy of MRI and the effect of injury history and study timing on its performance.

Methods: A retrospective review of all patients who underwent surgical treatment of partial thickness distal biceps tears at a single center by multiple surgeons was performed. Inclusion criteria consisted of the performance of a preoperative MRI and documentation of the intraoperatively visualized extent of the tear, and 68 patients met the criteria for inclusion. A chart review was completed to evaluate the symptom duration, injury history, and tear extent.

Results: All patients had distal biceps tears of greater than 50% intraoperatively. However, MRI did not indicate any tearing in 20 (29%) patients, and its sensitivity for high-grade tear was 44%. Magnetic resonance imaging was significantly less likely to be read as high-grade tears in patients with insidious onset of their symptoms in comparison with patients who reported a traumatic onset (27% vs 55%, P = .024). However, the time from symptom onset to MRI did not significantly correlate with diagnosis of a high-grade tear on MRI (r = -0.15, P = .21).

Conclusions: These results indicate that MRI can underreport partial distal biceps tear extent, and this more commonly occurs in patients with insidious onset of pain.

背景:磁共振成像(MRI)通常用于诊断和评估部分远端肱二头肌损伤的程度。本研究的目的是报道MRI的准确性以及损伤史和研究时间对其性能的影响。方法:回顾性分析所有接受单中心手术治疗的肱二头肌远端部分厚度撕裂的患者。纳入标准包括术前MRI表现和术中撕裂程度的记录,68例患者符合纳入标准。回顾图表以评估症状持续时间、损伤史和撕裂程度。结果:所有患者术中二头肌远端撕裂率均大于50%。然而,20例(29%)患者的MRI未显示任何撕裂,其对高度撕裂的敏感性为44%。与报告创伤性发作的患者相比,具有隐匿性发作症状的患者的磁共振成像被解读为高级别撕裂的可能性显着降低(27% vs 55%, P = 0.024)。然而,从症状出现到MRI检查的时间与MRI诊断的高级别撕裂没有显著相关性(r = -0.15, P = 0.21)。结论:这些结果表明,MRI可以低估部分远端二头肌撕裂程度,这更常见于潜伏性疼痛的患者。
{"title":"Accuracy of MRI in Assessment of High-Grade Partial Distal Biceps Tears.","authors":"Gregory J Schmidt, James P Fischer, Reed W Hoyer, Jeffrey A Greenberg, Nicholas E Crosby","doi":"10.1177/15589447231196906","DOIUrl":"10.1177/15589447231196906","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging (MRI) is commonly used to diagnose and assess the extent of partial distal biceps injuries. The aim of this study was to report on the accuracy of MRI and the effect of injury history and study timing on its performance.</p><p><strong>Methods: </strong>A retrospective review of all patients who underwent surgical treatment of partial thickness distal biceps tears at a single center by multiple surgeons was performed. Inclusion criteria consisted of the performance of a preoperative MRI and documentation of the intraoperatively visualized extent of the tear, and 68 patients met the criteria for inclusion. A chart review was completed to evaluate the symptom duration, injury history, and tear extent.</p><p><strong>Results: </strong>All patients had distal biceps tears of greater than 50% intraoperatively. However, MRI did not indicate any tearing in 20 (29%) patients, and its sensitivity for high-grade tear was 44%. Magnetic resonance imaging was significantly less likely to be read as high-grade tears in patients with insidious onset of their symptoms in comparison with patients who reported a traumatic onset (27% vs 55%, <i>P</i> = .024). However, the time from symptom onset to MRI did not significantly correlate with diagnosis of a high-grade tear on MRI (<i>r</i> = -0.15, <i>P</i> = .21).</p><p><strong>Conclusions: </strong>These results indicate that MRI can underreport partial distal biceps tear extent, and this more commonly occurs in patients with insidious onset of pain.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"291-295"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10235551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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