Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction

<p>Abstract</p> <p>Background</p> <p>Distal radius fractures are common. The increasing prevalence of osteoporosis contributes to frequently complex articular injuries sustained even after low energy falls. The best method of treating complex type C distal radius fractures is debated. Locked volar plating and external fixation are both widely used with good reported results. Measures of success are traditionally based on technical measurements or the perception of the surgeon. Patient reported measures of outcome are increasingly recognised as important markers of surgical success. We report our experience using locked volar plating for complex type C distal radius fractures as well as patient reported measures of success and satisfaction.</p> <p>Methods</p> <p>Over a 12 month period we treated 21 patients with type C distal radius fractures using locked volar plating. These patients were followed up for at least 12 months and the outcome was assessed using clinical examination, grip strength measurements, radiographs and Patient Rated Wrist Evaluation (PRWE) scoring.</p> <p>Results</p> <p>The 21 patients studied had an average age of 48 years. There were 8 men and 13 women. All of the fractures had united by 3 months. There were no cases of wound infection or tendon injury/irritation. Patients reported low pain scores, good patient rated wrist evaluation scores and high levels of satisfaction.</p> <p>Conclusions</p> <p>Locked volar plating for complex distal radius fractures produces good results when assessed using patient reported measures of outcome. Further work should address whether locked volar plating offers superior outcomes and patient satisfaction compared to external fixation.</p

Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction

Background Distal radius fractures are common. The increasing prevalence of osteoporosis contributes to frequently complex articular injuries sustained even after low energy falls. The best method of treating complex type C distal radius fractures is debated. Locked volar plating and external fixation are both widely used with good reported results. Measures of success are traditionally based on technical measurements or the perception of the surgeon. Patient reported measures of outcome are increasingly recognised as important markers of surgical success. We report our experience using locked volar plating for complex type C distal radius fractures as well as patient reported measures of success and satisfaction. Methods Over a 12 month period we treated 21 patients with type C distal radius fractures using locked volar plating. These patients were followed up for at least 12 months and the outcome was assessed using clinical examination, grip strength measurements, radiographs and Patient Rated Wrist Evaluation (PRWE) scoring. Results The 21 patients studied had an average age of 48 years. There were 8 men and 13 women. All of the fractures had united by 3 months. There were no cases of wound infection or tendon injury/irritation. Patients reported low pain scores, good patient rated wrist evaluation scores and high levels of satisfaction. Conclusions Locked volar plating for complex distal radius fractures produces good results when assessed using patient reported measures of outcome. Further work should address whether locked volar plating offers superior outcomes and patient satisfaction compared to external fixation

Surgery with the Motec total wrist replacement: learning from earlier designs

The design of and applications for wrist arthroplasty continue to evolve but lag behind the results for hip and knee arthroplasty with respect to demonstrable durability and effectiveness. As we develop our knowledge, experience and the indications for wrist replacement surgery, it is important that we learn from past design and surgical experience. We report the case of a female patient treated with a Motec cementless metal-on-metal wrist replacement (Swemac Orthopaedics AB, Linköping, Sweden) for post-traumatic arthritis of the radiocarpal joint. Based on our experience with this case and others, we make two specific technical recommendations to improve the success and longevity of this implant

Wrist-Worn Wearables Based on Force Myography: On the Significance of User Anthropometry

Background Force myography (FMG) is a non-invasive technology used to track functional movements and hand gestures by sensing volumetric changes in the limbs caused by muscle contraction. Force transmission through tissue implies that differences in tissue mechanics and/or architecture might impact FMG signal acquisition and the accuracy of gesture classifier models. The aim of this study is to identify if and how user anthropometry affects the quality of FMG signal acquisition and the performance of machine learning models trained to classify different hand and wrist gestures based on that data. Methods Wrist and forearm anthropometric measures were collected from a total of 21 volunteers aged between 22 and 82 years old. Participants performed a set of tasks while wearing a custom-designed FMG band. Primary outcome measure was the Spearman’s correlation coefficient (R) between the anthropometric measures and FMG signal quality/ML model performance. Results Results demonstrated moderate (0.3&thinsp;≤|R|&thinsp;&lt;&thinsp;0.67) and strong (0.67&thinsp;≤&thinsp;|R|) relationships for ratio of skinfold thickness to forearm circumference, grip strength and ratio of wrist to forearm circumference. These anthropometric features contributed to 23–30% of the variability in FMG signal acquisition and as much as 50% of the variability in classification accuracy for single gestures. Conclusions Increased grip strength, larger forearm girth, and smaller skinfold-to-forearm circumference ratio improve signal quality and gesture classification accuracy

Total hip replacement: increasing femoral offset improves functional outcome

INTRODUCTION: The aim of this study was to assess the independent effect of radiographic measures of implant position, relative to pre-operative anatomical assessment, on the functional outcome of total hip arthroplasty according to change in the Oxford hip score (OHS) 1 year post surgery. METHODS: A prospective cohort study was preformed to assess whether improvement in functional outcome (change in OHS at 1 year) and the relationship with femoral offset and length, and acetabular offset and height. After a power calculation 359 patients were recruited to the study and radiographic measures were performed by blinded observers. Regression analysis was used to assess the independent effect of the four radiographic measurements after adjusting for confounding variables. RESULTS: There was a significant (p < 0.001) decrease in acetabular offset [5.3 mm, 95 % confidence interval (CI) 4.4–6.2] and increase in femoral offset (6.1 mm, 95 % CI 5.4–6.8). Hence there was no significant change in overall offset. Femoral offset was the only radiographic measure to be achieved statistical significance (r = 0.198, 95 % CI 0.063–0.333, p = 0.004) in relation to clinical outcome, with increasing offset being associated with a greater improvement in the OHS. On combining femoral and acetabular offset increasing offset was associated with a greater improvement in the OHS (r = 0.10, 95 % CI 0.01–0.19, p = 0.04). CONCLUSION: This study supports the long-held biomechanical theory of medialisation of the acetabular component with compensatory increased femoral offset results in improved functional outcome