Relationship between distal radius fracture malunion and arm-related disability: A prospective population-based cohort study with 1-year follow-up

<p>Abstract</p> <p>Background</p> <p>Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability.</p> <p>Methods</p> <p>The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated.</p> <p>Results</p> <p>The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength.</p> <p>Conclusion</p> <p>Malunion after distal radius fracture was associated with higher arm-related disability regardless of age.</p

Three Levels of Learning in Simulations: Participating, Debriefing, and Journal Writing

Simulations and games provide three levels of learning: through participating, debriefing and writing. While taking part in the simulation; the participant experiences different types off acts, emotions, relationships, strategies, and feelings. The participant learns to handle various social situations and experience the excitement of discovery. During the debriefing discussions, the student harnesses the vast information and makes sense out of these experiences by sharing his ideas and listening to other's impressions. The debriefer facilitates the discussion by using the four Es of debriefing: events, emotions, empathy, and explanations. The assumption of oral debriefing is that all participants learn the same things at the same time and in the same manner. Journal writing significantly extends the analytical learning process by requiring each participant to organize the material and debrief on an individual basis. The richness of the journal develops frm the writer weaving his own personal thread through his experiences, through other's encounters, and through theoretical concepts. The writing provides a record of each student's learning experience.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69040/2/10.1177_1046878192232005.pd