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Opponensplasty for Nerve Palsy: A Systematic Review. 神经麻痹的腓肠肌成形术:系统综述。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-06-02 DOI: 10.1177/15589447231174481
Nicholas Coulshed, Joshua Xu, David Graham, Brahman Sivakumar

Opposition is an essential function of the human thumb to enable fine pinch and grip strength. Loss of opposition can be caused by both congenital and acquired pathology resulting in significant disability. This systematic review aims to compare the different techniques available to restore opposition. A systematic review of opponensplasty techniques was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines using PubMed, Embase, Medline, and Web of Science. Studies published in English before April 2021 and that reported on original outcomes of opponensplasty techniques used in the context of neurologic dysfunction were eligible for inclusion. A total of 641 articles were included, of which 42 texts were eligible for inclusion with a total cohort of 873 patients. The most commonly used transfers were palmaris longus (PL), extensor indicis proprius (EIP), and flexor digitorum superficialis (FDS). These transfers all demonstrated an improvement in range of motion, pinch strength, and Kapandji scores. Complication rates of 19% and 12% were reported with FDS and EIP transfers, respectively, predominantly related to donor site morbidity. A complication rate of 6% was observed with PL transfers, which was most commonly related to bowstringing. Heterogeneity of outcomes precluded a direct statistical comparison. There is significant heterogeneity in the literature reporting on opponensplasty techniques. There is limited capacity of direct comparison; however, FDS and EIP appear to demonstrate better functional outcomes, at the cost of higher complication rates. Each technique has specific complications and advantages and importance in patient counseling and discussion. Further prospective comparative studies are warranted.

反握是人类拇指的一项基本功能,可实现精细捏合和握力。先天性和后天性病变均可导致拇指反握功能丧失,从而造成严重残疾。本系统性综述旨在比较现有的各种恢复拇指反握功能的技术。根据《系统综述和荟萃分析的首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-analysis)指南,我们使用 PubMed、Embase、Medline 和 Web of Science 对反握成形术进行了系统综述。2021年4月之前以英文发表的、报告了神经功能障碍情况下使用对侧腱膜成形术的原始结果的研究符合纳入条件。共纳入了 641 篇文章,其中 42 篇符合纳入条件,患者总数为 873 人。最常用的转移方法是掌长肌(PL)、本体伸肌(EIP)和指浅屈肌(FDS)。这些转移均能改善活动范围、夹持力量和 Kapandji 评分。据报道,FDS 和 EIP 转移的并发症发生率分别为 19% 和 12%,主要与供体部位发病率有关。PL转移的并发症发生率为6%,最常见的并发症与弓形线有关。由于结果的异质性,无法进行直接的统计比较。有关对侧乳房成形术技术的文献报道存在很大的异质性。直接比较的能力有限;不过,FDS和EIP似乎显示出更好的功能效果,但代价是更高的并发症发生率。每种技术都有特定的并发症和优势,在患者咨询和讨论中都很重要。有必要进一步开展前瞻性比较研究。
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引用次数: 0
Video Education for Trigger Finger: Considerations for a Promising Approach. 扳机指视频教育:考虑一个有前途的方法。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-11-27 DOI: 10.1177/15589447231210922
Mahindra Bandari, Alec Birnbaum, David Lo, Manisha Bandari
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引用次数: 0
Publicly Disclosed Pricing for Common Upper-Extremity Procedures: An Analysis of Hospital Chargemasters. 公开披露的常见上肢手术定价:医院收费标准分析》。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-02-09 DOI: 10.1177/15589447221150522
Yagiz Ozdag, Daniel S Hayes, Benchaa Boualam, Brian K Foster, Joel C Klena, Louis C Grandizio

Background: American hospitals are required to provide price transparency data (known as a chargemaster) for medical services, which is intended to allow consumers to accurately estimate the cost of medical services. Our purpose was to identify hospital compliance in publishing chargemaster documents and to assess the price information published for common upper-extremity services and procedures.

Methods: We performed a cross-sectional analysis of publicly available chargemaster data from 122 hospitals, which included the top-20-ranked Honor Roll hospitals from US News and World Report and 2 top-ranked hospitals from each state. Chargemaster files were accessed for each hospital, and price information was recorded for 10 common upper-extremity procedures including radiographs, injections, and surgeries. Mean procedural prices were compared between academic and nonacademic hospitals.

Results: Chargemaster files were able to be accessed for 107 (88%) of 122 institutions. Price estimates for imaging studies were more frequently reported (73%) than those of procedures (23%-41%). With 50 hospitals reporting a price estimate, carpal tunnel injection was the most frequently reported procedure, whereas trigger finger release was the least frequently reported (41% and 23%, respectively). Wide price ranges were noted, with mean charges for a total shoulder arthroplasty listed as US $51 723 (range, US $247-US $364 024). Mean prices between academic and nonacademic hospital systems were similar.

Conclusions: While most (88%) of the included hospitals have been compliant with publishing their price transparency files, price estimates for common upper-extremity procedures and imaging studies are inconsistently reported and, when present, demonstrate high levels of price variability between and within hospital systems.

背景:美国医院必须提供医疗服务的价格透明度数据(称为收费表),目的是让消费者能够准确估算医疗服务的成本。我们的目的是确定医院在公布收费标准文件方面的合规性,并评估医院公布的常见上肢服务和手术的价格信息:我们对 122 家医院公开的收费标准数据进行了横向分析,其中包括《美国新闻与世界报道》排名前 20 位的荣誉榜医院和每个州排名前 2 位的医院。我们调取了每家医院的收费标准档案,并记录了 10 种常见上肢手术的价格信息,包括放射检查、注射和手术。比较了学术医院和非学术医院的平均手术价格:在 122 家医院中,有 107 家(88%)的收费主文件可以访问。影像检查价格估算的报告率(73%)高于手术价格估算的报告率(23%-41%)。有 50 家医院报告了价格估算,腕管注射是最常报告的手术,而扳机指松解术是最少报告的手术(分别为 41% 和 23%)。价格范围很广,全肩关节置换术的平均费用为 51 723 美元(范围为 247 美元至 364 024 美元)。学术医院系统和非学术医院系统的平均价格相似:虽然大多数(88%)被纳入的医院都遵守了公布其价格透明度文件的规定,但常见的上肢手术和成像检查的价格估算报告并不一致,即使有,也显示出医院系统之间和内部的价格差异很大。
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引用次数: 0
Risks of Chronic Preoperative Opioid Use on Distal Radius Surgery Outcomes. 术前长期使用阿片类药物对桡骨远端手术结果的风险。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-03-22 DOI: 10.1177/15589447231160206
William N Newton, Jake A Sossamon, Jonathan R Pire, Dane N Daley

Background: The purpose of this study was to determine the influence of chronic preoperative opioid use on complications, reoperation rates, and postoperative opioid use among patients undergoing open reduction and internal fixation (ORIF) of distal radius fractures.

Methods: A retrospective review of 111 patients who underwent ORIF of a distal radius fracture from 2019 to 2021 at an academic medical center by the same fellowship-trained orthopedic hand surgeon was conducted. Patient demographics, medical comorbidities, perioperative details, surgical complications, and patient-reported outcome measures were analyzed. The SCRIPTS database was used to obtain opioid prescription data.

Results: A total of 10 patients (9.01%) were identified as preoperative chronic opioid users. This group was not associated with risk of increased complication. However, they were more likely to continue using narcotics at 90 and 180 days postoperatively. Patients with a history of substance use were at an increased risk of hardware complications and prolonged postoperative pain. In addition, these patients were more likely to receive narcotics at 90 and 180 days, and to have more refills postoperatively.

Conclusion: Patients with preoperative opioid use are not at an increased risk of surgical complication following ORIF of distal radius fractures. However, they are at an increased risk of prolonged postoperative opioid use. Patients with a known history of substance use were at an increased risk of hardware complications, prolonged pain, and increased postoperative opioid use. Surgeons should consider these associations to better manage individual patients in the postoperative period.

研究背景本研究旨在确定术前长期使用阿片类药物对桡骨远端骨折切开复位内固定术(ORIF)患者的并发症、再手术率和术后阿片类药物使用的影响:对一家学术医疗中心在 2019 年至 2021 年期间接受桡骨远端骨折切开复位内固定术(ORIF)的 111 名患者进行了回顾性研究,这些患者均由同一位接受过研究员培训的骨科手外科医生治疗。研究分析了患者的人口统计学特征、合并症、围手术期细节、手术并发症以及患者报告的结果指标。SCRIPTS数据库用于获取阿片类药物处方数据:结果:共有 10 名患者(9.01%)被确认为术前长期阿片类药物使用者。这一群体与并发症增加的风险无关。不过,他们在术后 90 天和 180 天继续使用麻醉剂的可能性更大。有药物使用史的患者发生硬件并发症和延长术后疼痛时间的风险更高。此外,这些患者更有可能在术后90天和180天接受麻醉药物治疗,而且术后需要重新配药的次数也更多:结论:术前使用阿片类药物的患者在桡骨远端骨折 ORIF 术后发生手术并发症的风险并不会增加。结论:术前使用阿片类药物的患者不会增加桡骨远端骨折术后出现手术并发症的风险,但会增加术后长期使用阿片类药物的风险。已知有药物使用史的患者发生硬件并发症、疼痛时间延长和术后阿片类药物使用增加的风险更高。外科医生应考虑这些关联,以便在术后更好地管理患者。
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引用次数: 0
Extensor Carpi Ulnaris Instability: A Comprehensive Review of Pathology and Operative Techniques. 拇趾外展肌不稳:病理学和手术技术的全面回顾。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-05-24 DOI: 10.1177/15589447231168908
Jeyvikram Thirumavalavan, Zainab Ibrahim, Rory A Byrne, Kaetlyn R Arant, Joseph A Gil

The extensor carpi ulnaris (ECU) is primarily responsible for extension and ulnar deviation at the wrist. Secondary to repetitive loading of, or acute trauma to the flexed, supinated and ulnarly deviated wrist, the ECU tendon can be a common source of ulnar-sided wrist pain. Common pathology includes ECU tendinopathy, tenosynovitis, tendon instability, and tendon rupture. Extensor carpi ulnaris pathology commonly occurs in athletes and patients with inflammatory arthritis. Given the multitude of available methods to treat ECU tendon pathology, the aim of our study was to outline operative management of ECU tendon pathology, with emphasis on reviewing techniques for addressing ECU instability. We acknowledge a continuing debate between anatomical and nonanatomical techniques for ECU subsheath reconstruction. However, use of a portion of the extensor retinaculum for nonanatomical reconstruction is commonly used and demonstrates successful outcomes. Future comparative studies on ECU fixation are required to increase data on patient outcomes, to further define and standardize these techniques.

伸腕肌腱(ECU)主要负责腕部的伸展和尺侧偏斜。由于屈腕、仰腕和尺侧偏斜腕部的重复负荷或急性创伤,ECU肌腱可能是尺侧腕部疼痛的常见原因。常见病理包括 ECU 肌腱病、腱鞘炎、肌腱不稳定和肌腱断裂。尺侧伸肌病变通常发生在运动员和炎症性关节炎患者身上。鉴于治疗腕阔肌肌腱病变的方法多种多样,我们的研究旨在概述腕阔肌肌腱病变的手术治疗,重点是回顾治疗腕阔肌肌腱不稳定的技术。我们承认,ECU鞘下重建的解剖和非解剖技术之间仍存在争论。不过,使用部分伸肌缰绳进行非解剖重建是常用的方法,并取得了成功的结果。今后需要对ECU固定进行比较研究,以增加有关患者疗效的数据,进一步确定和规范这些技术。
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引用次数: 0
Long-term Trends in Open vs Endoscopic Carpal Tunnel Release Among the Medicare Population in the United States. 美国医保人群中开放式与内窥镜腕管松解术的长期趋势。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-05-06 DOI: 10.1177/15589447231168977
Jack M Haglin, Nathaniel B Hinckley, Michael L Moore, David G Deckey, Cara H Lai, Kevin J Renfree

Background: Carpal tunnel release (CTR) surgery is the most common surgery billed to Medicare by hand surgeons. As such, the purpose of this study was to evaluate trends for CTR surgeries billed to Medicare from 2000 to 2020.

Methods: The publicly available Medicare Part B National Summary File from 2000 to 2020 was queried. For both open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR), the number of procedures and total Medicare reimbursement were extracted. For year 2020, the specialty of the performing surgeon was recorded. Descriptive statistics were reported.

Results: A total of 3 429 471 CTR surgeries were performed in the Medicare population from 2000 to 2020. For these procedures, Medicare paid surgeons over $1.23 billion. During this period, there was a 101.8% increase in annual CTR procedures (91 130 in 2000, 183 911 in 2020). Further, annual volume of ECTR increased by 456.2%, and accounted for an increasing percentage of total CTR procedures (9.1% in 2012, 25.2% in 2020). The average adjusted Medicare reimbursement per procedure decreased by 1.5% for OCTR, and decreased by 11.6% for ECTR. In 2020, orthopedic surgeons performed 85.1% of CTR procedures.

Conclusions: The volume of CTR surgeries among the Medicare population has increased from 2000 to 2020, and ECTR is accounting for a growing proportion of surgeries. When adjusted for inflation, average reimbursement has decreased, with a greater decrease among ECTR. Orthopedic surgeons perform most of such surgeries. These trends are important to assure adequate resource allocation as treating carpal tunnel becomes more common among the aging Medicare population.

背景:腕管松解术(CTR)是手外科医生向医疗保险开具账单的最常见手术。因此,本研究旨在评估 2000 年至 2020 年期间向医疗保险开具账单的 CTR 手术趋势:方法:对公开的 2000 年至 2020 年医疗保险 B 部分国家汇总档案进行了查询。提取了开放式腕管松解术(OCTR)和内窥镜腕管松解术(ECTR)的手术数量和医疗保险报销总额。对于 2020 年,记录了手术医生的专业。报告了描述性统计结果:结果:从 2000 年到 2020 年,医疗保险人群中共进行了 3 429 471 例 CTR 手术。医疗保险为这些手术向外科医生支付了超过 12.3 亿美元的费用。在此期间,每年的 CTR 手术量增加了 101.8%(2000 年为 91 130 例,2020 年为 183 911 例)。此外,ECTR的年手术量增加了456.2%,在CTR总手术量中所占的比例也越来越高(2012年为9.1%,2020年为25.2%)。经调整后,OCTR 每项手术的平均医疗保险报销额下降了 1.5%,ECTR 则下降了 11.6%。2020年,85.1%的CTR手术由骨科医生实施:结论:从 2000 年到 2020 年,医疗保险人群中的 CTR 手术量有所增加,ECTR 在手术中所占比例越来越大。经通货膨胀调整后,平均报销额有所下降,其中ECTR的下降幅度更大。骨科医生承担了大部分此类手术。随着老龄化的医疗保险人群中治疗腕管病症越来越普遍,这些趋势对于确保充分的资源分配非常重要。
{"title":"Long-term Trends in Open vs Endoscopic Carpal Tunnel Release Among the Medicare Population in the United States.","authors":"Jack M Haglin, Nathaniel B Hinckley, Michael L Moore, David G Deckey, Cara H Lai, Kevin J Renfree","doi":"10.1177/15589447231168977","DOIUrl":"10.1177/15589447231168977","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel release (CTR) surgery is the most common surgery billed to Medicare by hand surgeons. As such, the purpose of this study was to evaluate trends for CTR surgeries billed to Medicare from 2000 to 2020.</p><p><strong>Methods: </strong>The publicly available Medicare Part B National Summary File from 2000 to 2020 was queried. For both open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR), the number of procedures and total Medicare reimbursement were extracted. For year 2020, the specialty of the performing surgeon was recorded. Descriptive statistics were reported.</p><p><strong>Results: </strong>A total of 3 429 471 CTR surgeries were performed in the Medicare population from 2000 to 2020. For these procedures, Medicare paid surgeons over $1.23 billion. During this period, there was a 101.8% increase in annual CTR procedures (91 130 in 2000, 183 911 in 2020). Further, annual volume of ECTR increased by 456.2%, and accounted for an increasing percentage of total CTR procedures (9.1% in 2012, 25.2% in 2020). The average adjusted Medicare reimbursement per procedure decreased by 1.5% for OCTR, and decreased by 11.6% for ECTR. In 2020, orthopedic surgeons performed 85.1% of CTR procedures.</p><p><strong>Conclusions: </strong>The volume of CTR surgeries among the Medicare population has increased from 2000 to 2020, and ECTR is accounting for a growing proportion of surgeries. When adjusted for inflation, average reimbursement has decreased, with a greater decrease among ECTR. Orthopedic surgeons perform most of such surgeries. These trends are important to assure adequate resource allocation as treating carpal tunnel becomes more common among the aging Medicare population.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1069-1074"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9784690","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
Distal Radius Fracture Outcomes After Dorsal Spanning Plate Fixation. 桡骨远端骨折背板固定术后的疗效
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-04-21 DOI: 10.1177/15589447231163942
Matthew W DeFazio, Natalie Godfrey, Evan Offord, Emmanuel Budis, Nathanael Olson, Marci Jones

Background: Dorsal spanning plate fixation can be used to treat comminuted distal radius fractures not amenable to volar plating. However, there is a relative paucity of outcomes data; so, the aim of this retrospective study was to investigate outcomes and complications after dorsal spanning plate fixation for distal radius fractures.

Methods: Distal radius fractures treated with dorsal spanning plate fixation at a level-1 trauma center were retrospectively identified via Current Procedural Terminology coding and chart review from 2014 to 2019. Patient demographics, fracture pattern characteristics, fixation techniques, and clinical outcomes were all obtained via chart review using the electronic medical record.

Results: In all, 43 dorsal plates were identified out of 369 operatively treated distal radius fractures (12%). Of these, 84% were AO type C, 28% were open fractures, and 86% resulted from falls. At the time of dorsal plating, 28% had an additional procedure. One patient had a major complication after surgery, requiring unplanned surgery for a radius nonunion. Average final follow-up occurred 9 weeks after dorsal plate removal, with mean range of motion at the wrist measuring: 36° flexion, 48° extension, 75° pronation, and 63° supination. Finger flexion was also measured, using either tip of finger to palm distance or total active motion, depending on the available data. These were measured at an average of 1.2 cm and 194°, respectively.

Conclusions: Dorsal spanning plate fixation provides a safe and effective method for treating complex distal radius fractures. In our series, patients had good functional outcomes with few complications.

背景:背侧跨接钢板固定术可用于治疗桡骨远端粉碎性骨折,但不适于外侧钢板固定。然而,相关结果数据相对较少;因此,本回顾性研究旨在调查桡骨远端骨折背侧跨接钢板固定术后的结果和并发症:方法:通过当前程序术语编码和病历审查,对 2014 年至 2019 年期间在一级创伤中心接受背侧跨接钢板固定治疗的桡骨远端骨折进行回顾性鉴定。患者的人口统计学特征、骨折形态特征、固定技术和临床结果均通过电子病历的病历审查获得:在 369 例手术治疗的桡骨远端骨折中,共发现了 43 块背板(12%)。其中,84%为AO C型,28%为开放性骨折,86%为跌倒所致。在进行背板固定时,28%的患者需要进行额外的手术。一名患者术后出现重大并发症,需要进行计划外手术治疗桡骨不愈合。平均最终随访时间为背板移除后 9 周,腕关节的平均活动范围为:屈曲 36°,伸展 48°:屈曲36°、伸展48°、前倾75°、上举63°。此外,还根据现有数据,使用指尖到手掌的距离或总活动量测量了手指的弯曲度。测量结果分别为平均 1.2 厘米和 194°:结论:背侧跨接钢板固定为治疗复杂的桡骨远端骨折提供了一种安全有效的方法。在我们的系列研究中,患者的功能预后良好,并发症很少。
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引用次数: 0
Determining the Optimal Dosage of Corticosteroid Injection in Trigger Finger. 确定皮质类固醇注射在扳机指中的最佳剂量
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-05-16 DOI: 10.1177/15589447231170326
Jared Bookman, Madeline Rocks, Karen Noh, Omri Ayalon, Jacques Hacquebord, Louis Catalano, Steven Glickel

Background: Corticosteroid injection is the mainstay of nonoperative treatment for trigger finger (stenosing tenosynovitis), but despite substantial experience with this treatment, there is minimal available evidence as to the optimal corticosteroid dosing. The purpose of this study is to compare the efficacy of 3 different injection dosages of triamcinolone acetonide for the treatment of trigger finger.

Methods: Patients diagnosed with a trigger finger were prospectively enrolled and treated with an initial triamcinolone acetonide (Kenalog) injection of 5 mg, 10 mg, or 20 mg. Patients were followed longitudinally over a 6-month period. Patients were assessed for duration of clinical response, clinical failure, Visual Analog Scale (VAS) pain scores, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores.

Results: A total of 146 patients (163 trigger fingers) were enrolled over a 26-month period. At 6-month follow-up, injections were still effective (without recurrence, secondary injection, or surgery) in 52% of the 5-mg group, 62% of the 10-mg group, and 79% of the 20-mg group. Visual Analog Scale at final follow-up improved by 2.2 in the 5-mg group, 2.7 in the 10-mg group, and 4.5 in the 20-mg group. The QuickDASH scores at final follow-up improved by 11.8 in the 5-mg group, 21.5 in the 10-mg group, and 28.9 in the 20-mg group.

Conclusions: Minimal evidence exists to guide the optimal dosing of steroid injection in trigger digits. When compared with 5-mg and 10-mg doses, a 20-mg dose was found to have a significantly higher rate of clinical effectiveness at 6-month follow-up. The VAS and QuickDASH scores were not significantly different between the 3 groups.

背景:皮质类固醇注射是扳机指(狭窄性腱鞘炎)非手术治疗的主要方法,但尽管这种治疗方法经验丰富,但关于皮质类固醇的最佳剂量却鲜有证据。本研究的目的是比较三种不同剂量的曲安奈德注射液治疗扳机指的疗效:方法:对确诊为扳机指的患者进行前瞻性登记,并首次注射 5 毫克、10 毫克或 20 毫克的曲安奈德(Kenalog)。对患者进行为期 6 个月的纵向随访。对患者的临床反应持续时间、临床失败、视觉模拟量表(VAS)疼痛评分以及手臂、肩部和手部快速残疾(QuickDASH)评分进行评估:共有 146 名患者(163 个扳机指)接受了为期 26 个月的治疗。在 6 个月的随访中,52% 的 5 毫克组、62% 的 10 毫克组和 79% 的 20 毫克组患者的注射仍然有效(无复发、二次注射或手术)。在最终随访中,5 毫克组的视觉模拟量表提高了 2.2,10 毫克组提高了 2.7,20 毫克组提高了 4.5。最终随访时,5 毫克组的 QuickDASH 评分提高了 11.8 分,10 毫克组提高了 21.5 分,20 毫克组提高了 28.9 分:结论:只有极少数证据可指导扳机指注射类固醇的最佳剂量。与 5 毫克和 10 毫克剂量相比,20 毫克剂量在 6 个月随访时的临床有效率明显更高。三组之间的 VAS 和 QuickDASH 评分无明显差异。
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引用次数: 0
Six-Week Radiographic Follow-up Does Not Change Management for Nonoperatively Treated Extraarticular Metacarpal Shaft Fractures. 对非手术治疗的掌骨关节外骨折进行六周的放射学随访不会改变治疗方法。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-05-24 DOI: 10.1177/15589447231170249
Zachary Crawford, Robert B Ponce, Michael Moore, Adam Schumaier, Phillip Ross, Peter Stern

Background: Metacarpal fractures are common and account for over 30% of all hand fractures. Previous literature has shown similar outcomes between operative and nonoperative management of metacarpal shaft fractures. There is little information regarding the natural history of conservatively managed metacarpal shaft fractures and changes in management based on follow-up radiographs.

Methods: A retrospective chart review was performed on all patients who presented to a single institution with an extraarticular metacarpal shaft or base fracture between 2015 and 2019.

Results: Thirty-one patients with 37 metacarpal fractures were included for review: average age 41 years, male 48%, right hand dominant 91%, and average follow-up duration 7.3 weeks. At follow-up, a change of 2.4° in angulation (P = .0005) and a change in shortening of 0.1 mm (P = .0386) were noted over the 6-week time interval. No fractures had malrotation at presentation, and none developed malrotation during the follow-up period.

Conclusions: Recent systematic reviews and meta-analysis have suggested that metacarpal fractures treated nonoperatively had similar outcomes to surgical fixation at 12 months of follow-up. We found that extraarticular metacarpal shaft fractures that do not meet operative indications at the initial visit should be expected to heal reliably with minimal change in angulation and shortening over time. The transition to removable brace or no brace at the 2-week follow-up is likely sufficient, and additional follow-up is not necessary and will reduce cost.

Level of evidence: Level III.

背景介绍掌骨骨折很常见,占所有手部骨折的 30% 以上。以往的文献显示,手术和非手术治疗掌骨骨折的结果相似。有关保守治疗掌骨骨折的自然病史以及根据随访X光片改变治疗方法的信息很少:方法:对2015年至2019年期间在一家机构就诊的所有关节外掌骨干或基底骨折患者进行回顾性病历审查:31名患者共涉及37处掌骨骨折,平均年龄41岁,男性占48%,右手占优势91%,平均随访时间7.3周。随访发现,在 6 周的时间间隔内,成角变化为 2.4°(P = 0.0005),缩短变化为 0.1 mm(P = 0.0386)。没有骨折在出现时发生错位,也没有骨折在随访期间发生错位:最近的系统综述和荟萃分析表明,掌骨骨折非手术治疗在随访12个月后的效果与手术固定相似。我们发现,初次就诊时不符合手术指征的关节外掌骨干骨折应能可靠愈合,随着时间的推移,其成角和缩短的变化也应最小。在两周的随访中,过渡到可移动支架或不使用支架可能就足够了,无需进行额外的随访,而且还能降低成本:证据等级:三级。
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引用次数: 0
Improved Outcomes in Operative Management of Concomitant Distal Radius and Scaphoid Fractures. 改善桡骨远端和肩胛骨同时骨折的手术治疗效果。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-04-12 DOI: 10.1177/15589447231163943
Luke Verlinsky, Clinton Ulmer, Alec Rose, Christina Brady, Ryan Rose

Background: This study aims to investigate the characteristics of concomitant distal radius and scaphoid fractures and determine outcome differences of operative and nonoperative management.

Methods: A retrospective search of a level-1 trauma center's database over a 15-year period (2007-2022) for concomitant distal radius and scaphoid fractures in adult patients was completed. In all, 31 cases were reviewed for mechanism of injury, method of fracture management, distal radius fracture AO Foundation/Orthopaedic Trauma Association classification, scaphoid fracture classification, time to radiographic scaphoid union, time to motion, and other demographics. A multivariate statistical analysis was completed comparing outcomes in operative versus conservative management of the scaphoid fracture in these patients. Outcomes were defined as time to radiographic union and time to motion.

Results: In all, 22 cases of operative fixation of the scaphoid and 9 cases of nonoperative management of the scaphoid were reviewed. One case of nonunion was identified in the operative group. Operative management of scaphoid fractures resulted in a statistically significant reduction in time to motion (2-week reduction) and time to radiographic union (8-week reduction).

Conclusions: This study demonstrates that operative management of scaphoid fractures in the setting of a concomitant distal radius fracture reduces the time to radiographic union and time to clinical motion. This suggests that operative management is ideal in patients who are good candidates for surgery and desire earlier return of motion. However, conservative management should be considered, as nonoperative care showed no statistical difference regarding union rates of scaphoid or distal radius fractures.

背景:本研究旨在调查桡骨远端和肩胛骨同时骨折的特征,并确定手术和非手术治疗的结果差异:本研究旨在调查桡骨远端和肩胛骨同时骨折的特征,并确定手术和非手术治疗的结果差异:方法:对一级创伤中心数据库中15年(2007-2022年)内成人桡骨远端和肩胛骨同时骨折的病例进行回顾性检索。共对 31 例病例的损伤机制、骨折处理方法、桡骨远端骨折 AO 基金会/骨科创伤协会分类、肩胛骨骨折分类、肩胛骨放射学结合时间、活动时间和其他人口统计学特征进行了回顾。我们完成了一项多变量统计分析,比较了这些患者肩胛骨骨折手术治疗与保守治疗的结果。结果:结果:共审查了 22 例手术固定肩胛骨的病例和 9 例非手术治疗肩胛骨的病例。手术组中有一例未愈合。对肩胛骨骨折进行手术治疗可显著缩短活动时间(2周后复位)和影像学结合时间(8周后复位):这项研究表明,在同时发生桡骨远端骨折的情况下,对肩胛骨骨折进行手术治疗可缩短影像学结合时间和临床活动时间。这表明,对于适合手术且希望尽早恢复活动的患者来说,手术治疗是理想的选择。不过,也应考虑保守治疗,因为非手术治疗在肩胛骨或桡骨远端骨折的愈合率方面没有统计学差异。
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