Casting Data on Wrist Fracture Outcomes

The presentation of this case study involves an exploration of the patient's journey in detail after having a traumatic wrist fracture, which is recognised as one of the most common fractures encountered daily in emergency services by junior doctors and practitioners. However, this article not only analyses the medical guidance for this type of case, but also the importance of the surgical care practitioner role in trauma and orthopaedics. All practitioners attending patients in emergency services are required to develop a good knowledge of anatomy, physiology, patient’s examination technique, classifications and consequently being aware of the possible surgical options for treatment of the fracture. They will also need to fully understand the legal implications of consent to ensure safe practice.

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71 Ultrasound directed reduction of Colles’ type distal radial fractures in ED (UDiReCT): a feasibility randomized controlled trial

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.21 ◽

2020 ◽

Vol 37 (12) ◽

pp. 835.3-836

Author(s):

Hamza Malik ◽

Andrew Appelboam ◽

Gordon Taylor ◽

Daryl Wood ◽

Karen Knapp

Keyword(s):

Data Collection ◽

Controlled Trial ◽

Wrist Fracture ◽

Recruitment Rate ◽

Feasibility Trial ◽

Point Of Care Ultrasound ◽

Distal Radial Fractures ◽

Definitive Trial ◽

Randomised Controlled

Aims/Objectives/BackgroundWrist fractures are among the commonest injuries seen in the emergency department (ED). Around 25% of these injuries have Colles’ type fracture displacement and undergo manipulation in the ED. In the UK, these manipulations are typically done ‘blind’ without real time imaging and recent observational studies show that over 40% of the injuries go on to require surgical fixation (due to inadequate initial reduction or re-displacement). Point of care ultrasound has been used to guide and improve wrist fracture reductions but it’s effect on subsequent outcome is not established. We set up and ran the UK’s first randomised controlled feasibility trial comparing standard and ultrasound guided ED wrist fracture manipulations to test a definitive trial protocol, data collection and estimate recruitment rate towards a future definitive trial.Methods/DesignWe conducted a 1:1, single blind, parallel group, randomised controlled feasibility trial in two UK hospitals. Adults with Colles’ type distal radial fractures requiring manipulation in the ED were recruited by supervising emergency physicians supported by network research nurses. Participants were randomised to ultrasound directed fracture manipulation (intervention) or standard care with sham ultrasound (controls). The trial was run through Exeter Clinical Trials Unit and consent, randomisation and data collection conducted electronically in REDCap cloud. All participants were followed up at 6 weeks to record any surgical intervention and also underwent baseline and 3 month quality of life (EQ-5D-5L) and wrist function (Patient Rated Wrist Evaluation (PRWE) assessments.Results/ConclusionsWe recruited 47 patients in total, with 23 randomised to the interventional arm and 24 randomised to the control arm. We were able to follow up 100% of the patients for the 6 week follow up. Data analysis and results will be presented at the time of the conference.

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Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative mini C-arm Fluoroscopy

Hand ◽

10.1177/1558944721994257 ◽

2021 ◽

pp. 155894472199425

Author(s):

Kiran R. Madhvani ◽

Matthew J. R. Clark ◽

Alex A. J. Kocheta

Keyword(s):

Radiation Dose ◽

Fracture Fixation ◽

Wrist Fracture ◽

Radiation Doses ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Audit Data ◽

Small Joint ◽

Open Fixation ◽

Phalangeal Fracture

Background: Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification. Methods: Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included. Results: The median radiation dose for wrist fracture open fixation was 2.73 cGycm2, Kirschner wiring (K-wiring) procedures was 2.36 cGycm2, small joint arthrodesis was 1.20 cGycm2, small joint injections was 0.58 cGycm2, and phalangeal fracture fixation was 1.05 cGycm2. Conclusions: Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.

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Validity and reliability of a wearable-controlled serious game and goniometer for telemonitoring of wrist fracture rehabilitation

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01657-5 ◽

2021 ◽

Author(s):

Henriëtte A. W. Meijer ◽

Maurits Graafland ◽

Miryam C. Obdeijn ◽

Marlies P. Schijven ◽

J. Carel Goslings

Keyword(s):

Range Of Motion ◽

Intraclass Correlation ◽

Internal Validity ◽

Wrist Fracture ◽

Serious Game ◽

Reference Standard ◽

Validity And Reliability ◽

Good Reliability ◽

Rater Reliability ◽

Flexion Extension

Abstract Purpose To determine the validity of wrist range of motion (ROM) measurements by the wearable-controlled ReValidate! wrist-rehabilitation game, which simultaneously acts as a digital goniometer. Furthermore, to establish the reliability of the game by contrasting ROM measurements to those found by medical experts using a universal goniometer. Methods As the universal goniometer is considered the reference standard, inter-rater reliability between surgeons was first determined. Internal validity of the game ROM measurements was determined in a test–retest setting with healthy volunteers. The reliability of the game was tested in 34 patients with a restricted range of motion, in whom the ROM was measured by experts as well as digitally. Intraclass-correlation coefficients (ICCs) were determined and outcomes were analyzed using Bland–Altman plots. Results Inter-rater reliability between experts using a universal goniometer was poor, with ICCs of 0.002, 0.160 and 0.520. Internal validity testing of the game found ICCs of − 0.693, 0.376 and 0.863, thus ranging from poor to good. Reliability testing of the game compared to medical expert measurements, found that mean differences were small for the flexion–extension arc and the radial deviation-ulnar deviation arc. Conclusion The ReValidate! game is a reliable home-monitoring device digitally measuring ROM in the wrist. Interestingly, the test–retest reliability of the serious game was found to be considerably higher than the inter-rater reliability of the reference standard, being healthcare professionals using a universal goniometer. Trial registration number (internal hospital registration only) MEC-AMC W17_003 #17.015.

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In vivo measurement of distal radioulnar translation following distal radius fracture

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211016668 ◽

2021 ◽

pp. 175319342110166

Author(s):

Grey E. B. Giddins ◽

Greg T. Pickering

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Distal Radioulnar Joint ◽

Wrist Fracture ◽

Radius Fracture ◽

Normal Range ◽

Radioulnar Joint ◽

In Vivo Measurement ◽

Objectively Measured

The incidence of distal radioulnar joint instability following a distal radius fracture is estimated around one in three based upon clinical examination. Using a validated rig, we objectively measured distal radioulnar joint translation in vivo following distal radius fracture. Dorsopalmar translation of the distal radioulnar joint was measured in 50 adults with previous distal radius fractures. Measurements were compared with the uninjured wrist and against a database of previous measurements within healthy and clinically lax populations. Translation at the distal radioulnar joint was greater in injured wrists at 12.2 mm (range 10–15, SD 1.2) than the uninjured wrists at 6.4 (range 4–9, SD 0.8) ( p < 0.001) and was always outside the established normal range. There was no statistically significant link between translation and the severity of the injury. Instability appears almost inevitable following a distal radius (wrist) fracture, albeit subclinical in the vast majority.

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Wrist Fracture Cooperative Biomechanics Research Project

10.1115/imece2001/met-25513 ◽

2001 ◽

Author(s):

Richard B. Englund ◽

Timothy E. Cooney ◽

Frank L. Buczek

Keyword(s):

Data Collection ◽

Medical Center ◽

Axial Loading ◽

Wrist Fracture ◽

Research Project ◽

Engineering Technology ◽

Pendulum System ◽

Penn State ◽

Collection Practices ◽

Financial Arrangements

Abstract While injuries are common from skating sports, few biomechanics studies have compared fracture rates with and without protective wrist guards. All published testing results have been obtained from cadaveric specimens, generally with substantially axial loading. Loads to failure have been reported for slow loading by universal testing machines, and fracture patterns have been reported from more rapid loading with a pendulum system. An orthopaedic resident at Hamot Medical Center had an interest in in-line skating injuries and proposed to investigate whether wrist guards provided a reduction in the incidence of fractures from skating falls. The project started with the goal of demonstrating the value, or lack thereof, of wrist guards, and ended with simply trying to determine methodology which closely simulates wrist injury arising from a skating fall. The hospital does not have engineering staff in the research department, nor extensive fabrication capabilities, and approached the School of Engineering and Engineering Technology of Penn State at Erie for assistance in design, construction, and data collection for a research project to investigate the efficacy of wrist guards. Assistance in kinematic aspects of falls was sought from the Motion Analysis Laboratory of Shriners Hospitals for Children - Erie. The logistics of a cooperative project between three institutions is the subject of this paper. Initial planning for the project, revisions to the scope of the project, the financial arrangements, equipment design and construction, and data collection practices are described in this paper. Concluding remarks about the resources necessary for cooperative projects between medical schools and Engineering Technology departments are presented.

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