Journal of Hand Surgery Global Online最新文献_第4页

The Effect of County-Level Food Insecurity on Baseline Patient-Reported Outcome Measures in Patients Undergoing Carpal Tunnel Release 县级食物不安全对接受腕管释放的患者报告的基线结果测量的影响

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-12 DOI: 10.1016/j.jhsg.2025.100927

Christy Zheng BS, MS , Leah Demetri MD , Philip Blazar MD , Brandon E. Earp MD , Dafang Zhang MD

Purpose

Patient-reported outcome measures (PROMs) are widely used in hand surgery to assess symptom severity prior to surgical intervention; however, little is known about how food insecurity, an important social determinant of health, influences these scores. We aimed to measure the correlation between county-level food insecurity and baseline PROMs in a cohort of patients undergoing carpal tunnel release (CTR) for idiopathic carpal tunnel syndrome (CTS).

Methods

Baseline PROMs were prospectively collected in 114 patients with electrodiagnostic study, ultrasound, or CTS-6 confirmed CTS treated with CTR at a single tertiary referral center. Feeding America’s Map the Meal Gap Dataset was used to identify county-level food-insecurity rate, average meal cost, and percent eligible for Supplemental Nutritional Assistance Program. Correlations between food-insecurity parameters and PROMs were assessed using correlation coefficients; bivariate analyses of continuous explanatory variables were performed using linear regression.

Results

Mean age was 61.6 ± 12.7 years. A total of 57.9% were women, and 93.9% were White. In total, 14.9% and 19.3% of our cohort reside in Massachusetts counties falling within the upper quartile and upper half of food-insecurity rates, respectively. No significant correlations were found between food-insecurity variables and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Younger age was associated with worse Boston Carpal Tunnel Questionnaire–Symptom Severity Scale scores and PROMIS Pain Interference scores.

Conclusions

We found no evidence that patients with food insecurity present with greater symptom severity at time of CTR.

Type of study/level of evidence

Prognostic IIb.

目的：患者报告结果测量（PROMs）被广泛用于手外科手术干预前评估症状严重程度；然而，作为健康的一个重要社会决定因素，人们对粮食不安全如何影响这些分数知之甚少。我们的目的是测量县级食品不安全与特发性腕管综合征（CTS）患者接受腕管释放（CTR）治疗的基线PROMs之间的相关性。方法前瞻性收集114例在单一三级转诊中心接受CTR治疗的电诊断、超声或CTS-6证实的CTS患者的基线PROMs。“喂饱美国”的膳食差距地图数据集用于确定县级粮食不安全率、平均膳食成本和符合补充营养援助计划条件的百分比。利用相关系数评价粮食不安全参数与prom之间的相关性；采用线性回归对连续解释变量进行双变量分析。结果患者平均年龄61.6±12.7岁。其中女性占57.9%，白人占93.9%。总的来说，我们的队列中有14.9%和19.3%的人居住在马萨诸塞州的县，分别处于食品不安全率的上四分之一和上一半。食物不安全变量与患者报告结果测量信息系统（PROMIS）评分之间没有显著相关性。年龄越小，波士顿腕管问卷-症状严重程度量表评分和PROMIS疼痛干扰评分越差。结论：我们没有发现食物不安全患者在CTR时出现更严重症状的证据。研究类型/证据水平

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引用次数: 0

Training and Integrating Advanced Practice Providers in Pediatric Hand Surgery 培训和整合儿科手外科的高级实践提供者

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-12 DOI: 10.1016/j.jhsg.2025.100926

Lauren Perry CPNP, RNFA , Weston Thomas PA-C , Carolina Gonzalez MSN, FNP-BC , Aaron Berger MD, PhD , Michael G. Galvez MD

The utilization of advance practice providers (APPs), such as a nurse practitioner or a physician assistant, in pediatric hand surgery has seen an increase over time within this growing field. In a pediatric setting, these skilled providers offer invaluable support as physician extenders, improving efficiency and capable of managing patient care independently. In the specialized field of pediatric hand surgery, APPs perform a multitude of roles within a multidisciplinary team that help streamline complex care in the clinic and operating room. Through their versatile skillset, APPs contribute to the overall quality and delivery of care in these specialized settings. Here, we provide a structured outline for training and integrating APPs in pediatric hand surgery.

随着时间的推移，在这个不断发展的领域，儿科手外科中使用高级实践提供者（APPs），如执业护士或医师助理的情况有所增加。在儿科环境中，这些熟练的提供者提供宝贵的支持，作为医师扩展，提高效率和能够独立管理患者护理。在儿科手外科的专业领域，app在多学科团队中发挥着多种作用，帮助简化诊所和手术室的复杂护理。通过其多样化的技能，应用程序有助于在这些专业环境中提高护理的整体质量和提供服务。在此，我们为儿童手外科app的培训和整合提供了一个结构化的大纲。

引用次数: 0

A Rare Anatomical Variant Dual Radial Digital Nerves in the Right Ring Finger: Consideration in Hand Dissection 右无名指双桡指神经的罕见解剖变异：手部解剖的思考

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-09 DOI: 10.1016/j.jhsg.2025.100906

Nikolas Vlassis BS , Janse T. Schermerhorn MD , Genevieve Rambau MD

Digital nerve anatomy in the fingers is considered a predictable pattern of a single radial and ulnar neurovascular bundle, allowing for often safe midline dissection. In complicated cases, such as Dupuytren contracture or trauma, knowledge of digital nerve anatomy is paramount for safe dissection. The patient was a 68-year-old man with bilateral ring finger Dupuytren contractures. On the right hand, he had a 40° flexion contracture of the ring finger and underwent a palmar fasciectomy. Two distinct radial digital nerves were identified intraoperatively, with one branch in the traditional radial aspect of the digit, and a second branch centrally overlying the flexor tendons. This finding was later corroborated on the contralateral ring finger when he underwent subsequent palmar fasciectomy. Dual radial digital nerves are an uncommon anatomical variant that underscores the importance of careful neurovascular dissection. This case also raises concerns about percutaneous procedures distal to the metacarpophalangeal joint crease.

手指指神经解剖被认为是单一桡尺神经血管束的可预测模式，允许通常安全的中线解剖。在复杂的情况下，如Dupuytren挛缩或创伤，知识的指神经解剖是最重要的安全解剖。患者为68岁男性，双侧无名指挛缩。右手无名指40°屈曲挛缩，行掌筋膜切除术。术中发现了两个不同的桡指神经，其中一个分支位于手指的传统桡侧，另一个分支位于屈肌腱的中央。这一发现后来在对侧无名指进行掌筋膜切除术时得到证实。双桡指神经是一种罕见的解剖变异，强调了仔细的神经血管解剖的重要性。本病例也引起了对经皮手术远端经掌指关节皱褶的关注。

引用次数: 0

Management of Osteomyelitis of the Distal Forearm and Wrist With Function-Preserving Debridement 保留功能的清创术治疗前臂和手腕远端骨髓炎

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-07 DOI: 10.1016/j.jhsg.2025.100908

Timothy P. Liu MD , Nirbhay S. Jain MD , Katherine Choi MD , Prosper Benhaim MD , Kodi K. Azari MD , Arezou Yaghoubian MD

Purpose

Osteomyelitis of the wrist and distal forearm is rare but functionally devastating because of the extensive debridement needed for infection control and reconstructive surgery needed to regain function. Management guidelines and outcomes are poorly defined and often default to amputation as a last resort strategy for infection control. In this study, we present a series of wrist and distal forearm osteomyelitis patients managed with antibiotics and debridement, with minimal reconstruction in select cases, to help guide decisions on management and prognosis.

Methods

Patients over the age of 18 years diagnosed with wrist and/or distal forearm osteomyelitis were identified at a single institution between the years 2013 and 2023. A retrospective review was performed to identify demographics, infection characteristics, treatment strategies, and outcomes. Statistical analysis was performed via GraphPad.

Results

Eleven cases of distal forearm and wrist osteomyelitis were identified. Of those, 55% had primarily distal forearm osteomyelitis of the radius and ulna, and 45% had carpal or metacarpal involvement. Most patients had postoperative infection of hardware. All but one patient required surgical debridement with hardware removal and five patients required serial debridements. No patients required amputation. Antibiotic spacers were rarely used. Patients reported residual pain and stiffness in the wrist, and salvage procedures included wrist arthrodesis and tendon transfers.

Conclusions

Osteomyelitis of the distal forearm and carpus in this cohort is most commonly because of postoperative infection from contaminated hardware. These patients require aggressive debridement for infection control including frequent bony resection with salvage via arthrodesis, but amputation can often be avoided.

Type of study/level of evidence

Therapeutic IV.

目的手腕和前臂远端骨髓炎是罕见的，但由于需要广泛的清创以控制感染和重建手术以恢复功能，因此功能上具有破坏性。管理指南和结果定义不清，通常默认将截肢作为控制感染的最后手段。在本研究中，我们介绍了一系列手腕和前臂远端骨髓炎患者，这些患者采用抗生素和清创治疗，在某些情况下进行了最小程度的重建，以帮助指导管理和预后的决策。方法在2013年至2023年期间，在单一机构发现年龄在18岁以上诊断为手腕和/或前臂远端骨髓炎的患者。进行回顾性审查，以确定人口统计学，感染特征，治疗策略和结果。通过GraphPad进行统计分析。结果发现前臂远端及腕部骨髓炎16例。其中55%的患者主要患有桡骨和尺骨的前臂远端骨髓炎，45%的患者有腕骨或掌骨受累。大多数患者术后发生硬体感染。除1例患者外，其余患者均需要手术清创并取出硬体，5例患者需要连续清创。没有病人需要截肢。抗生素间隔剂很少使用。患者报告腕部残留疼痛和僵硬，抢救手术包括腕部关节融合术和肌腱转移。结论前臂远端和腕骨骨髓炎最常见的原因是术后脏器感染。这些患者需要积极清创以控制感染，包括通过关节融合术进行骨切除术，但通常可以避免截肢。研究类型/证据水平治疗性IV。

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引用次数: 0

Rat Bite Fever: It’s Still a Threat 鼠咬热：它仍然是一个威胁

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-02 DOI: 10.1016/j.jhsg.2025.100901

Alexander J. Bergeson MS , Kyler A. Hardie MD , Robert E. Van Demark Jr MD , Matthew C. Anderson MD

Streptobacillus moniliformis is considered normal flora of the upper respiratory tract of rodents and is the predominant cause of rat bite fever in North America. Although patients with rat bite fever oftentimes present with migratory polyarthralgia, cultures of affected joints do not grow bacteria in the vast majority of cases. We present a case of a 32-year-old woman who initially presented with a painful, swollen right index finger proximal interphalangeal (PIP) joint following a bite from her pet rat. After initial treatment with empiric antibiotics did not clear the infection, PIP joint irrigation and debridement revealed culture-positive septic arthritis. This case illustrates the patient’s unusual presentation of S. moniliformis infection through septic arthritis of the PIP joint.

念珠链杆菌被认为是啮齿动物上呼吸道的正常菌群，是北美鼠咬热的主要原因。虽然患鼠咬热的患者经常表现为迁移性多关节痛，但在绝大多数情况下，受影响关节的培养物不生长细菌。我们提出一个32岁的妇女谁最初提出了疼痛，肿胀的右手食指近指间（PIP）关节后咬她的宠物鼠。经经验性抗生素治疗后，感染未清除，PIP关节冲洗和清创显示培养阳性脓毒性关节炎。本病例显示患者通过PIP关节脓毒性关节炎表现为念珠菌感染。

引用次数: 0

Investigating Techniques to Reduce Flexor Tendon Rupture Risk During Manipulation for Dupuytren Contracture 探讨在双腱挛缩术中降低屈肌腱断裂风险的技术

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-27 DOI: 10.1016/j.jhsg.2025.100909

Peter Y. Joo MD, MPH , Xuan Luo MD

Purpose

The purpose of this study was to explore the strength required to extend the small finger using these techniques.

Methods

Healthy adult participants without current hand injury or pathology were tested for small finger manipulation strength using a calibrated scale as the flexed small finger proximal interphalangeal joint was brought into extension with resistance. Both wrist flexion and quadriga effect were tested first, then quadriga effect alone, then wrist flexion, then without restrictions. This was to prevent fatigue as a confounding factor (weakest to strongest). Measurements were obtained for bilateral small fingers. The means of each of the categories were then compared using analysis of variance.

Results

A total of eight participants (16 hands), seven right-handed and one left-handed, were included. Five women and three men were included, with an average age of 28. The force required to fully extend the small finger using both wrist flexion and quadriga effect was 2.5 kg. The force to extend the small finger with quadriga alone was 2.8 kg, wrist flexion alone was 3.0 kg, and baseline without any restrictions was 3.2 kg. The combined intervention required significantly less force to fully extend the small finger compared to other methods (P < .001). Quadriga alone was also noted to require significantly less force to extend the small finger compared to baseline (6.1 vs 7.1, P = .048).

Conclusions

Collagenase clostridium histolyticum injection and manipulation for treatment of Dupuytren contracture has a small risk of flexor tendon rupture. While wrist flexion is described in the technique guide, using the quadriga effect to lessen the force needed to extend the small finger has not been explored. This study found that combining wrist flexion and remaining finger extension during manipulation decreases the force required to extend the small finger, suggesting a decrease in stress seen by the flexor tendons during manipulation.

Type of study/level of evidence

Therapeutic IV.

目的本研究的目的是探讨使用这些技术伸展小指所需的力量。方法对无手部损伤或病理的健康成年参与者，在小指屈曲近端指间关节进入有阻力的伸展状态时，使用校准的量表测试小指操作强度。首先测试手腕弯曲和四边形效应，然后是单独的四边形效应，然后是手腕弯曲，然后是无限制的。这是为了防止疲劳成为一个混杂因素（从最弱到最强）。测量双侧小指。然后使用方差分析比较每个类别的平均值。结果共8例（16只手），其中7例为右撇子，1例为左撇子。其中包括5名女性和3名男性，平均年龄为28岁。使用腕屈和四边形效果充分伸展小指所需的力为2.5 kg。单四边形伸小指力为2.8 kg，单屈曲腕关节力为3.0 kg，无任何限制的基线力为3.2 kg。与其他方法相比，联合干预需要更少的力来完全伸展小指（P < .001）。与基线相比，Quadriga单独拉伸小指所需的力也显着减少（6.1 vs 7.1, P = 0.048）。结论胶原酶溶组织梭菌注射加手法治疗屈肌腱挛缩的风险小。虽然手腕屈曲在技术指南中有描述，但使用四重体效果来减少伸展小指所需的力尚未被探索。这项研究发现，在操作过程中，结合手腕屈曲和剩余手指伸展可以减少伸展小指所需的力，这表明在操作过程中屈肌腱的压力减少。研究类型/证据水平治疗性IV。

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引用次数: 0

The Prevalence of Focal Carpal Chondromalacia Concurrent With Chronic Dynamic Scapholunate Instability 局灶性腕关节软骨病并发慢性动态舟月骨不稳定的患病率

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-26 DOI: 10.1016/j.jhsg.2025.100912

Kian Steppe BS , Houshang Seradge MD , Kamran Steppe BS , Cyrus Steppe MD , Carrie Seradge BS , Winfred Parker BS

Purpose

There is a paucity of information regarding the prevalence of focal chondromalacia with chronic dynamic scapholunate instability (CDSI), and current treatment algorithms do not account for its presence. We aimed to determine the prevalence and distribution of chondromalacia in CDSI.

Methods

We conducted a retrospective, longitudinal, cohort study of all wrist arthroscopies performed from January 2008 to December 2020. We included wrists with an arthroscopically confirmed primary diagnosis of CDSI. Patients were grouped based on the presence (CDSI+C) or absence (CDSI−C) of focal carpal chondromalacia. All ligament tears were debrided, and focal chondral lesions were treated with chondral shaving to partial carpectomy. We followed the Debride-First-Then-Wait protocol, which incorporates a waiting period for patients to assess if arthroscopic intervention alone is sufficient to return to normal daily activities. The surgeon considers the patient’s perceived wellness when determining the need for a subsequent Dynadesis (tendon-to-tendon transfer through the distal scaphoid) or partial fusion.

Results

Of 255 wrist arthroscopies, 164 wrists (155 patients) met the inclusion criteria. Focal chondromalacia was arthroscopically identified in 48% of wrists, with a notably higher occurrence in older patients and those with lunotriquetral ligament or triangular fibrocartilage tears. The most frequent sites of chondromalacia were the radial styloid (27%) and the scaphoid body (15%). Dynadeis was performed in 29% of wrists in the CDSI+C cohort and 47% in the CDSI−C cohort. Four percent of CDSI+C wrists necessitated partial wrist fusion.

Conclusions

Focal chondromalacia is common in patients with CDSI. The presence of focal lesions alone did not notably decrease the efficacy of arthroscopic treatment as <50% of patients needed a secondary procedure (7.4-year follow-up). The distribution of focal chondromalacia suggests injuries to other wrist ligaments. We recommend using the Debride-First-Then-Wait protocol to aid in selecting a personalized and lower-risk treatment for CDSI.

Type of study/level of evidence

Therapeutic IIb.

目的：关于局灶性软骨软化伴慢性动态舟月骨不稳定性（CDSI）的患病率的信息缺乏，目前的治疗方法也没有考虑到它的存在。我们的目的是确定CDSI中软骨软化症的患病率和分布。方法对2008年1月至2020年12月期间进行的所有腕部关节镜检查进行回顾性、纵向、队列研究。我们纳入了经关节镜确诊为原发性CDSI的腕关节。根据局灶性腕关节软骨软化症的存在（CDSI+C）或不存在（CDSI−C）对患者进行分组。所有韧带撕裂均行清创，局灶性软骨病变行软骨刮除至部分肩胛骨切除术。我们采用了先清理后等待的方案，其中包括一段等待期，让患者评估关节镜干预是否足以恢复正常的日常活动。外科医生在决定是否需要后续的动态移位（通过远端舟状骨进行肌腱到肌腱的转移）或部分融合时，会考虑患者的健康状况。结果在255例关节镜检查中，164例腕关节（155例）符合纳入标准。48%的患者在关节镜下发现了局灶性软骨软化症，其中老年患者和月牙三叉韧带或三角纤维软骨撕裂患者的发生率明显更高。软骨软化症最常见的部位是桡骨茎突（27%）和舟状体（15%）。CDSI+C组29%的患者和CDSI - C组47%的患者接受了Dynadeis治疗。4%的CDSI+C腕关节需要部分腕关节融合。结论局灶性软骨软化症在CDSI患者中较为常见。局灶性病变的单独存在并未显著降低关节镜治疗的疗效，因为50%的患者需要二次手术（7.4年随访）。局灶性软骨软化的分布提示手腕其他韧带损伤。我们建议使用先清理后等待方案来帮助选择个性化和低风险的CDSI治疗方法。研究类型/证据水平：治疗性IIb。

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引用次数: 0

Pediatric Lunate Fracture Treated With Percutaneous Screw Fixation 经皮螺钉内固定治疗小儿月骨骨折

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-24 DOI: 10.1016/j.jhsg.2025.100905

Jordan T. Holler MD, MPH , Timothy P. Liu MD , Timothy A. Schaub MD

Pediatric lunate fractures are exceedingly rare, with limited evidence to guide management. We present the case of a 12-year-old boy who sustained bilateral wrist injuries with a displaced right lunate fracture after an electric bicycle fall. The fracture was reduced and fixed percutaneously with a headless compression screw. At 8 months, radiographs confirmed union and the patient had full, pain free wrist motion without evidence of osteonecrosis or instability. We propose that percutaneous compression screw fixation is a reasonable option for achieving reliable union in older pediatric patients with a sufficiently ossified carpus.

小儿月骨骨折极为罕见，指导治疗的证据有限。我们提出的情况下，一个12岁的男孩谁持续的双侧手腕损伤和移位的右月骨骨折后，电动自行车摔倒。骨折复位并经皮用无头加压螺钉固定。8个月时，x线片证实愈合，患者腕部活动充分、无痛，无骨坏死或不稳定迹象。我们建议经皮加压螺钉固定是实现腕骨充分骨化的老年儿童患者可靠愈合的合理选择。

引用次数: 0

Radiographic Manifestation of Cosmetic Hand Rejuvenation With Calcium Hydroxyapatite 羟基磷灰石钙美容手部年轻化的影像学表现

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-24 DOI: 10.1016/j.jhsg.2025.100902

Alyssa Barré MD , Ahmed Al-Bayati MD , Chase Kluemper MD

Hand rejuvenation procedures using dermal fillers are becoming increasingly popular as patients seek to restore dorsal hand volume and camouflage tendons and veins. Calcium hydroxyapatite is a commonly used filler that is inherently radiopaque and may produce imaging findings that mimic disease. We report the case of a 75-year-old woman who presented for follow-up of radiocarpal arthritis. Although her radiographs confirmed degenerative arthritis, they also demonstrated diffuse, clustered radiopaque foci in the dorsal soft tissues. These findings initially suggested metabolic or dystrophic calcification, but on further history, the patient disclosed recent cosmetic hand rejuvenation with calcium hydroxyapatite filler, establishing the true etiology. To our knowledge, the radiographic appearance of dermal filler in the hand has not been previously described. As the popularity of cosmetic hand rejuvenation continues to increase, both hand surgeons and radiologists should be aware of this phenomenon to prevent misdiagnosis and unnecessary diagnostic work-up.

使用真皮填充物的手部年轻化手术越来越受欢迎，因为患者寻求恢复手背体积和伪装肌腱和静脉。羟基磷灰石钙是一种常用的填充物，它本身不透射线，可能产生类似疾病的影像学表现。我们报告的情况下，75岁的妇女谁提出了随访桡腕关节炎。虽然她的x线片证实了退行性关节炎，但也显示了背部软组织弥漫性、聚集性不透射线的病灶。这些发现最初提示代谢性或营养不良性钙化，但在进一步的病史中，患者透露最近使用羟基磷灰石钙填充剂美容手部年轻化，确定了真正的病因。据我们所知，手部真皮填充物的x线摄影表现以前没有被描述过。随着手部美容年轻化的普及，手外科医生和放射科医生都应该意识到这一现象，以防止误诊和不必要的诊断检查。

引用次数: 0

Distal Radius Fracture Classifications in Real Life: Reliability and How They Change Treatment 桡骨远端骨折分类在现实生活中：可靠性和他们如何改变治疗

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-24 DOI: 10.1016/j.jhsg.2025.100910

Sang Anh Nguyen MD, MSc , Anh Hoang Dang MD, PhD , Doanh Quoc Tran MD, PhD

Purpose

To evaluate the reliability, clinical utility, and prognostic value of distal radius fracture (DRF) classification systems and to translate current evidence into a decision-oriented framework for everyday care.

Methods

We conducted a PRISMA-guided narrative review with structured searches of PubMed and Scopus (January 2010 to September 2025). Eligible adult studies assessed at least one DRF classification (eg, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, Fernandez, Frykman, Melone, IDEAL) and reported reliability, clinical utility (treatment selection, complications/reoperation), or prognostic associations (patient-reported outcome measures, radiographic restoration). Study selection, extraction, and risk of bias assessment followed predefined procedures; data were synthesized thematically by imaging modality, rater expertise, and category granularity.

Results

Interobserver agreement was typically fair–moderate on radiographs; computed tomography yielded modest improvements. Increasing granularity (more categories/subcategories) consistently reduced κ/intraclass correlation coefficient, while a brief rater calibration session improved agreement. Across studies linking taxonomy to care, classification alone rarely changed management once radiographic thresholds of instability (shortening, tilt, intra-articular step-off) and patient factors (age/bone quality, functional demand) were applied. Prognostic associations between subtype and patient-reported outcome measures were inconsistent after adjustment for reduction quality. We operationalize these findings via reliability, morphology, age of bone, patient demands, yielding actionable pathways with explicit quality targets: restoration of radial height and tilt, intra-articular step-off ≤2 mm, and early motion.

Conclusions

The DRF classifications remain valuable as a shared language and research scaffold, but their stand-alone reliability and prognostic power are limited. A pragmatic, reliability, morphology, age of bone, patient demands, yielding actionable pathway-based approach integrates classification with instability thresholds and patient factors to support auditable, evidence-based decisions.

Type of study/level of evidence

Therapeutic V.

目的评估桡骨远端骨折（DRF）分类系统的可靠性、临床应用和预后价值，并将现有证据转化为日常护理的决策导向框架。方法采用prisma引导的叙述性综述，对PubMed和Scopus进行结构化检索（2010年1月至2025年9月）。符合条件的成人研究评估了至少一种DRF分类（例如，Arbeitsgemeinschaft f r Osteosynthesefragen/Orthopaedic Trauma Association, Fernandez, Frykman, Melone， IDEAL）并报告了可靠性、临床效用（治疗选择、并发症/再手术）或预后相关性（患者报告的结果测量、放射学恢复）。研究选择、提取和偏倚风险评估遵循预先确定的程序；数据按成像方式、专家知识和分类粒度进行主题合成。结果观察者间在x线片上的一致性一般为中等偏下；计算机断层扫描取得了适度的改善。增加粒度（更多的类别/子类别）持续降低κ/类内相关系数，而简短的分级校准会话提高了一致性。在将分类学与护理联系起来的研究中，一旦应用不稳定性的放射学阈值（缩短、倾斜、关节内踏步）和患者因素（年龄/骨质量、功能需求），单独分类很少改变管理。在调整复位质量后，亚型和患者报告的结果测量之间的预后关联不一致。我们通过可靠性、形态学、骨龄、患者需求来操作这些发现，得出具有明确质量目标的可操作路径：恢复桡骨高度和倾斜、关节内台阶≤2mm和早期运动。结论DRF分类作为一种共享语言和研究框架仍有价值，但其单独的可靠性和预后能力有限。实用、可靠、形态学、骨龄、患者需求、产生可操作的基于通路的方法将分类与不稳定性阈值和患者因素相结合，以支持可审计的、基于证据的决策。研究类型/证据水平

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引用次数: 0