Chapter 43 Wrist Fracture and Ligament Injuries

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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THUMB COLLATERAL LIGAMENT INJURIES

Hand Clinics ◽

10.1016/s0749-0712(21)00576-x ◽

2000 ◽

Vol 16 (3) ◽

pp. 345-357 ◽

Cited By ~ 4

Author(s):

Charles P. Melone ◽

Steven Beldner ◽

Richard S. Basuk

Keyword(s):

Ligament Injuries ◽

Collateral Ligament

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Interaction of Loading and Ligament Injuries in Subtalar Joint Instability Quantified by 3D Weightbearing Computed Tomography

Journal of Orthopaedic Research® ◽

10.1002/jor.25126 ◽

2021 ◽

Author(s):

Burssens Arne ◽

Nicola Krähenbühl ◽

Amy L. Lenz ◽

Kalebb Howell ◽

Chong Zhang ◽

...

Keyword(s):

Computed Tomography ◽

Subtalar Joint ◽

Joint Instability ◽

Ligament Injuries

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The Incidence of Anterior Cruciate Ligament Injuries among Competitive Alpine Skiers

The American Journal of Sports Medicine ◽

10.1177/0363546507301083 ◽

2007 ◽

Vol 35 (7) ◽

pp. 1070-1074 ◽

Cited By ~ 94

Author(s):

Nicolas Pujol ◽

Marie Philippe Rousseaux Blanchi ◽

Pierre Chambat

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Injury ◽

Cruciate Ligament ◽

Injury Rate ◽

Ligament Injury ◽

Ligament Injuries ◽

Injury Rates ◽

Anterior Cruciate Ligament Injuries ◽

Alpine Skiers ◽

Anterior Cruciate

Background Little is known about the evolution of anterior cruciate ligament injury rates among elite alpine skiers. Purpose To evaluate epidemiologic aspects of anterior cruciate ligament injuries among competitive alpine skiers during the last 25 years. Study Design Descriptive epidemiology study. Methods Data were collected from elite French national teams (379 athletes: 188 women and 191 men) from 1980 to 2005. Results Fifty-three of the female skiers (28.2%) and 52 of the male skiers (27.2%) sustained at least 1 anterior cruciate ligament injury. The overall anterior cruciate ligament injury incidence was 8.5 per 100 skier-seasons. The primary anterior cruciate ligament injury rate was 5.7 per 100 skier-seasons. The prevalence of reinjury (same knee) was 19%. The prevalence of a bilateral injury (injury of the other knee) was 30.5%. At least 1 additional anterior cruciate ligament surgery (mean, 2.4 procedures) was required for 39% of the injured athletes. Men and women were similar with regard to primary anterior cruciate ligament injury rate (P = .21), career remaining after the injury (P = .44), and skiing specialty (P = .5). There were more anterior cruciate ligament injuries (primary, bilateral, reinjuries) among athletes ranking in the world Top 30 (P < .001). Anterior cruciate ligament-injured athletes had a career length of 7.5 years, whereas athletes with no anterior cruciate ligament injury had a career of 4.5 years (P < .001). Finally, injury rates remained constant over time. Conclusion Anterior cruciate ligament injury rates (primary injury, bilateral injury, reinjury) among national competitive alpine skiers are high and have not declined in the last 25 years. Finding a way to prevent anterior cruciate ligament injury in this population is a very important goal.

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