Peak incidence of distal radius fractures due to ice skating on natural ice in The Netherlands

An increase of distal radius fractures was seen in 2009 when an extended cold spell allowed natural ice skating in Amsterdam. This resulted in overload of our Emergency Departments and operating rooms. This study reports patient and fracture characteristics of these injuries. We also determined potential skating-related risk factors. All patients who sustained a distal radius fracture during natural ice skating between January 3 and January 12, 2009 were included. Patient and fracture characteristics, treatment, validated outcome (Quick DASH) at 3 months after injury were determined. Natural ice skating accounted for a 5.5-fold increase of distal radius fractures (92 fractures) compared to a similar time period without natural ice skating in 2008. Fracture types were AO-type A, n = 50, type B, n = 11 and type C, n = 31. Twenty-eight patients were casted without reduction. Fifty-four patients underwent at least one reduction before casting. The non-operative group consisted of 67 patients (68 fractures, male/female 18/49) with an average age of 55.5 years. Twenty-three patients (24 fractures) underwent internal fixation. Quick DASH for the whole group was a mean of 23.1 points (range 0–95). The mean Quick DASH for the non-operatively treated group was 19.9 points (range 0–95), for the operatively treated group 31.7 points (range 2–65). Distal radius fractures increased 5.5-fold during a period with natural ice skating. Women aged 50 and over were predominantly affected. Most fractures were extra-articular, and the vast majority was treated non-operatively. Utilization of wrist-protecting devices should be considered during future natural ice periods

Peak incidence of distal radius fractures due to ice skating on natural ice in The Netherlands

Abstract An increase of distal radius fractures was seen in 2009 when an extended cold spell allowed natural ice skating in Amsterdam. This resulted in overload of our Emergency Departments and operating rooms. This study reports patient and fracture characteristics of these injuries. We also determined potential skating-related risk factors. All patients who sustained a distal radius fracture during natural ice skating between January 3 and January 12, 2009 were included. Patient and fracture characteristics, treatment, validated outcome (Quick DASH) at 3 months after injury were determined. Natural ice skating accounted for a 5.5-fold increase of distal radius fractures (92 fractures) compared to a similar time period without natural ice skating in 2008. Fracture types were AO-type A, n = 50, type B, n = 11 and type C, n = 31. Twenty-eight patients were casted without reduction. Fifty-four patients underwent at least one reduction before casting. The non-operative group consisted of 67 patients (68 fractures, male/female 18/49) with an average age of 55.5 years. Twenty-three patients (24 fractures) underwent internal fixation. Quick DASH for the whole group was a mean of 23.1 points (range 0-95). The mean Quick DASH for the non-operatively treated group was 19.9 points (range 0-95), for the operatively treated group 31.7 points (range 2-65). Distal radius fractures increased 5.5-fold during a period with natural ice skating. Women aged 50 and over were predominantly affected. Most fractures were extra-articular, and the vast majority was treated non-operatively. Utilization of wrist-protecting devices should be considered during future natural ice periods

A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: The RAMBO trial

Background: The choice between operative or nonoperative treatment is questioned for partial articular fractures of the radial head that have at least 2 millimeters of articular step-off on at least one radiograph (defined as displaced), but less than 2 millimeter of gap between the fragments (defined as stable) and that are not associated with an elbow dislocation, interosseous ligament injury, or other fractures. These kinds of fractures are often classified as Mason type-2 fractures. Retrospective comparative studies suggest that operative treatment might be better than nonoperative treatment, but the long-term results of nonoperative treatment are very good. Most experts agree that problems like reduced range of motion, painful crepitation, nonunion or bony ankylosis are infrequent with both nonoperative and operative treatment of an isolated displaced partial articular fracture of the radial head, but determining which patients will have problems is difficult. A prospective, randomized comparison would help minimize bias and determine the balance between operative and nonoperative risks and benefits. Methods/Design. The RAMBO trial (Radial Head - Amsterdam - Amphia - Boston - Others) is an international prospective, randomized, multicenter trial. The primary objective of this study is to compare patient related outcome defined by the 'Disabilities of Arm, Shoulder and Hand (DASH) score' twelve months after injury between operative and nonoperative treated patients. Adult patients with partial articular fractures of the radial head that comprise at least 1/3rd of the articular surface, have ≥ 2 millimeters of articular step-off but less than 2 millimeter of gap between the fragments will be enrolled. Secondary outcome measures will be the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score (OES), pain intensity through the 'Numeric Rating Scale', range of motion (flexion arc and rotational arc), radiographic appearance of the fracture (heterotopic ossification, radiocapitellar and ulnohumeral arthrosis, fracture healing, and signs of implant loosening or breakage) and adverse events (infection, nerve injury, secondary interventions) after one year. Discussion. The successful completion of this trial will provide evidence on the best treatment for stable, displaced, partial articular fractures of the radial head. Trial registration. The trial is registered at the Dutch Trial Register: NTR3413

Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT

Interobserver reliability for the classification of proximal humeral fractures is limited. The aim of this study was to test the null hypothesis that interobserver reliability of the AO classification of proximal humeral fractures, the preferred treatment, and fracture characteristics is the same for two-dimensional (2-D) and three-dimensional (3-D) computed tomography (CT). Members of the Science of Variation Group--fully trained practicing orthopaedic and trauma surgeons from around the world--were randomized to evaluate radiographs and either 2-D CT or 3-D CT images of fifteen proximal humeral fractures via a web-based survey and respond to the following four questions: (1) Is the greater tuberosity displaced? (2) Is the humeral head split? (3) Is the arterial supply compromised? (4) Is the glenohumeral joint dislocated? They also classified the fracture according to the AO system and indicated their preferred treatment of the fracture (operative or nonoperative). Agreement among observers was assessed with use of the multirater kappa (κ) measure. Interobserver reliability of the AO classification, fracture characteristics, and preferred treatment generally ranged from "slight" to "fair." A few small but statistically significant differences were found. Observers randomized to the 2-D CT group had slightly but significantly better agreement on displacement of the greater tuberosity (κ = 0.35 compared with 0.30, p < 0.001) and on the AO classification (κ = 0.18 compared with 0.17, p = 0.018). A subgroup analysis of the AO classification results revealed that shoulder and elbow surgeons, orthopaedic trauma surgeons, and surgeons in the United States had slightly greater reliability on 2-D CT, whereas surgeons in practice for ten years or less and surgeons from other subspecialties had slightly greater reliability on 3-D CT. Proximal humeral fracture classifications may be helpful conceptually, but they have poor interobserver reliability even when 3-D rather than 2-D CT is utilized. This may contribute to the similarly poor interobserver reliability that was observed for selection of the treatment for proximal humeral fractures. The lack of a reliable classification confounds efforts to compare the outcomes of treatment methods among different clinical trials and reports

Operative treatment for femoral shaft nonunions, a systematic review of the literature

The objective of this article is to systematically review the currently available literature to formulate evidence-based guidelines for the treatment of femoral shaft nonunions for clinical practice and to establish recommendations for future research. Articles from PubMed/MEDLINE, Cochrane Clinical Trial Register, and EMBASE, that presented data concerning treatment of nonunions of femoral shaft fractures in adult humans, were included for data extraction and analysis. The search was restricted to articles from January 1970 to March 2011 written in the English, German, or Dutch languages. Articles containing data that were thought to have been presented previously were used once. Reports on nonunion after periprosthetic fractures, review articles, expert opinions, abstracts from scientific meetings, and case reports on 5 or fewer patients were excluded. The data that were extracted from the relevant articles included: type of nonunion, type of initial and secondary treatments, follow-up, union rate, and general complications. Most studies had different inclusion criteria and outcome measures, thus prohibiting a proper meta-analysis. Therefore, only the union rate and number of complications were compared between the different treatments. Methodological quality was assessed by assigning levels of evidence as previously defined by the Centre for Evidence-Based Medicine. This systematic review provides evidence in favour of plating if a nail is the first treatment; after failed plate fixation, nailing has a 96 % union rate. After failed nailing, augmentative plating results in a 96 % union rate compared to 73 % in the exchange nailing grou

What is the hardware removal rate after anteroinferior plating of the clavicle? A retrospective cohort study

Background: Plate position in the operative treatment of displaced midshaft clavicle fractures or nonunions is most often on the superior side. However, superior clavicular plating often results in complaints of plate prominence and local soft tissue irritation, necessitating hardware removal. We have used anteroinferior placement of the plate in the hope of increasing biomechanical stability and fixation and also of lowering complaints of plate prominence and soft tissue irritation. In this report, we set out to study the percentage of hardware removal in our group of patients treated with anteroinferior plating of the clavicle after longterm follow-up. Methods: In this retrospective review, we evaluated all patients who were surgically treated with anteroinferior plating for midshaft clavicle fracture, delayed union, or nonunion by the senior author between February 2003 and July 2015. Patients required a minimum age of 16 years at time of surgery and a follow-up of > 12 months. Patients with malunion, plating on the superior aspect, or double plating were excluded. Results: The medical records of 53 patients (54 fractures) were reviewed after a mean follow-up duration of 6.4 years (range, 1.1-13.1). The mean age at follow-up was 47.8 years (range, 20.4-80.7). All fractures and nonunions healed. In only 3 cases (5.6%), hardware removal was requested by the patient because of plate prominence. Conclusions: Anteroinferior plating of midshaft clavicle fractures, delayed unions, and nonunions resulted in low hardware removal rates in our cohort. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserve

Biomechanical and clinical evaluation of posterior malleolar fractures. A systematic review of the literature

INTRODUCTION: Ankle fractures often have involvement of the posterior malleolus. Treatment guidelines exist based on limited biomechanical evidence and still is considered controversial. The objective of this article is to review the biomechanical literature concerning changes in tibiotalar contract area, changes in contact pressures, changes in ankle stability and incongruency of the joint after a posterior malleolar ankle fracture, and to review the clinical literature concerning the outcome of operative and nonoperative treatment of these fractures. Ultimately, the goal is to try to formulate helpful recommendations for clinical practice. MATERIAL: The databases Pubmed/Medline, Cochrane Database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase were searched from 1988 to November 2007 to identify studies relating to changes in tibiotalar contact area, contact pressures, ankle stability, clinical outcome, and radiographic osteoarthritis after a posterior malleolar fracture. The search was restricted to articles written in the English, German, and Dutch language. RESULTS: Eight biomechanical studies, involving 96 cadaveric ankles were included and 10 clinical studies, involving 447 fractured ankles, were included. DISCUSSION: No consensus in the literature was found as to which fragment size of the posterior malleolus (=posterior tibial margin) should be internally fixed. This is partially because of the lack of standardization in examining functional outcomes, making it difficult to compare results. It is not the peak pressure or changes in tibiotalar contact area, but rather the changes in peak pressure distribution that play a large role in posttraumatic arthritis development. It seems important to restore the medial and lateral constraints of the ankle because these, rather than the articular surfaces, provide the majority of ankle stability after an ankle fracture involving the posterior malleolar ankle fractur