scholarly journals Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950–2016

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Erika Bergman ◽  
Vasileios Lempesis ◽  
Lars Jehpsson ◽  
Björn E. Rosengren ◽  
Magnus K. Karlsson

Abstract Background The hand is the second most fractured region in children. It is therefore important to update fracture epidemiology to be able to identify time trends for adequate health care planning. This study reports pediatric hand fracture incidence 2014–2016 and, using published data, also long-term time trends in 1950–2016. Patients and methods The Swedish city of Malmö, with 328,494 inhabitants in 2016, has only one hospital. We used the hospital radiological archive, medical charts, and diagnosis registry to identify hand fractures in city residents < 16 years in 2014–2016. These data were compared to those from three published studies that evaluated periods in 1950–2006. Differences between two periods were calculated as both unadjusted and age- and sex-adjusted incident rate ratios (IRR) with 95% confidence intervals (95% CI). We used joinpoint regression to estimate time trends during the entire period and present annual percent changes (APC) with 95% CI. Results In 2014–2016 phalangeal fractures accounted for 71% of all hand fractures, metacarpal fractures for 24%, and carpal fractures for 5%. We identified 615 hand fractures (419 in boys and 196 in girls) during 181,617 person-years in 2014–2016, resulting in an unadjusted pediatric hand fracture incidence of 339/100,000 person-years (boys 452/100,000 person-years and girls 220/100,000 person-years). The age-adjusted incidence 2014–2016 was similar to 2005–2006, the most recently evaluated period (IRR in boys 0.9; 95% CI 0.8 to 1.01, and in girls 1.0; 95% CI 0.8 to 1.2). Looking at the entire period 1950–2016, we found that age-adjusted incidence increased in 1950–1979, in boys by APC + 3.8%; 95% CI 3.0 to 4.5 and in girls by + 3.9%; 95% CI 2.8 to 5.0, but decreased in 1979–2016, in boys by − 0.7%; 95% CI − 1.4 to − 0.003, and girls by − 1.3%; 95% CI − 2.4 to − 0.1. Conclusions Phalangeal fractures accounted for about three quarters of all hand fractures. The age-adjusted hand fracture incidence increased in both sexes in 1950–1979 and decreased in 1979–2016. Level of evidence III

Author(s):  
Erika Bergman ◽  
Vasileios Lempesis ◽  
Lars Jehpsson ◽  
Björn E. Rosengren ◽  
Magnus K. Karlsson

Abstract Background Distal forearm fracture is the most common pediatric fracture. As studies have indicated time trends in fracture incidence, we wanted to update the epidemiology and estimate time trends between 1950 and 2016 in Malmö, Sweden. Methods The city of Malmö, Sweden, had 318,107 inhabitants (58,585 of the population was aged <16 years) in 2014 and one hospital. We, therefore, used the hospital diagnosis registry and hospital medical records to identify and classify distal forearm fractures 2014 to 2016 in children aged 0 to 15 years. For long-term trend calculations, we also included published data from 1950 to 2006 (resulting in 17 evaluated years) and used joinpoint regression to estimate annual percent changes (APC). To describe differences in incidence between two periods, we calculated incident rate ratios (IRR) with 95% confidence intervals (95% CI) to describe uncertainty. Results Childhood distal forearm fracture incidence in 2014 to 2016 was 546/100,000 person-years (660 in boys and 427 in girls). The age-adjusted incidence in 2014 to 2016 and in 2005 to 2006 was similar (boys IRR 1.0, 95% CI: 0.9–1.2 and girls IRR 1.1, 95% CI: 0.9–1.3). Time-trend analyses from 1950 to 2016 revealed increasing age-adjusted incidence in both boys (APC +0.9%, 95% CI: 0.7–1.2) and girls (APC +0.6%, 95% CI: 0.3–0.9). Conclusion Distal forearm fracture incidence was similar in 2014 to 2016 and in 2005 to 2006. Age-adjusted incidence had increased in both sexes from 1950 to 2016. Level of Evidence This is a Level III b study.


2013 ◽  
Vol 60 (2) ◽  
pp. 49-52 ◽  
Author(s):  
Tomislav Palibrk ◽  
Aleksandar Lesic ◽  
Sladjana Andjelkovic ◽  
Ivan Milosevic ◽  
Rodoljub Stefanovic ◽  
...  

Although hand fractures are most common fractures treated in orthopedic practice, many practicians treat them as trivial injuries. Improperly managed they can cause consequences and impair hand function. Metacarpal and phalangeal fractures are classified based on geometry, anatomic localization and wound presence and treatment depend on mechanism of injury. Many of them can be treated nonoperatively with reposition and immobilization, but in some cases osteosynthesis is a method of choice. Surgeon can choose various range of fixation material, and choice depends on fracture type and surgeons affinity. Kirschner wire fixation is one of the most frequently used operative procedure for hand fracture treatment. It provides good stability, early mobilization and excellent functional result.


2020 ◽  
Vol 28 (2) ◽  
pp. 83-87
Author(s):  
Andrew J. Lovy ◽  
Isaiah Levy ◽  
Aakash Keswani ◽  
Michael R. Hausman

This study describes a novel method of pin care with a Betadine-soaked alcohol pad in conjunction with immobilization to reduce pin site complications in hand fractures treated with exposed Kirschner wires (K-wires). We conducted a retrospective review of all phalangeal and metacarpal fractures from 2010 to 2016 treated with K-wire fixation, a Betadine-soaked alcohol pad, and immobilization in a well-moulded plaster cast. A total of 155 patients with metacarpal or phalangeal fractures were identified, of which 149 were included with 164 fractures treated with 217 exposed K-wires. Overall complication rate was 6.1% (10/164), of which 3 fractures (1.8%) developed infections. Two infections occurred in patients with a history of organ transplantation. The most common complication was stiffness requiring closed manipulation under anesthesia (2.4%, 4/164), resulting in full range of motion in 3 of 4 patients. Exposed K-wires remain an effective method of hand fracture fixation associated with a low complication rate.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amir Ghareib ◽  
Sylwia Oniska ◽  
Laura Karran ◽  
Jamil Moledina

Abstract Introduction St. George’s University Hospitals NHS Foundation Trust is a tertiary trauma centre. We receive a high volume of hand referrals from all over the south West London region. Closed hand fractures represent a significant number of our referrals. COVID-19 has put more burden in all health service endangering poor management of these trauma patients. Aim To assess management of close hand trauma patients during COVID pandemic. Methods Retrospective evaluation of closed hand fracture referrals during June, July, and August 2020. Clinical documentations, operative details and follow up visit notes have been reviewed. Results 106 patients have been included. 47 patients treated surgically with 81% of them were in need for metalwork insertion. Most of operations were done within 8 days. Number of hospital visits was variable with a mean of six days for adult and two days for children. Patient who was in need for hand therapy have been seen within the first 8 days of their surgery. At three months follow up, only three cases had infection. Only one case had osteomyelitis and the other two case had infected metalwork. Most of the patents reported good movement in ASSH Total Active Movement of Hand score (TAM) at the end of the three months. Conclusion Despite COVID 19 pandemic our service managed to achieve acceptable results in dealing with these cases. Yet, securing a reasonable number of operating sessions and clinic appointments remains a challenge.


2020 ◽  
Vol 41 (11) ◽  
pp. 1342-1346
Author(s):  
Kimberly K. Broughton ◽  
Caroline Williams ◽  
Christopher P. Miller ◽  
Kristen Stupay ◽  
John Y. Kwon

Background: In the setting of apparently isolated distal fibula fractures, the gravity stress view (GSV) is a validated method to determine mortise stability. There is currently no published data evaluating whether dynamic muscle activation can reduce an unstable mortise. If patients with instability can overcome gravity, resultant images could yield false-negative results. The goal of this investigation was to determine if patient effort can influence medial clear space (MCS) measurements in proven unstable bimalleolar-equivalent ankle fractures. Methods: Patients presenting with Weber B fibula fractures were assessed for mortise stability using the GSV. If the GSV demonstrated instability based on MCS widening >4 mm, 3 additional views were performed: GSV with an assistant maintaining the ankle in a neutral position; GSV with the patient actively dorsiflexing to neutral; and GSV with the patient actively dorsiflexing and supinating the foot. Twenty-four consecutive patients met inclusion criteria, with a mean age of 48.7 (range, 22-85) years. Fifteen patients (62.5%) were female and 9 (37.5%) were male. The laterality was evenly divided. Results: The mean MCS was 5.8 ± 2.0 6.0 ± 2.6, and 6.2 ± 2.7 mm for the manual assist, active dorsiflexion, and active supination radiograph measurement groups, respectively ( P = .434). Only 5 of 24 subjects had any measurable decrease in their MCS with active supination, with a maximum change of 1.2 mm. The remainder of the patients had an increase in MCS ranging from 0.1 to 4.0 mm. Conclusion: There was no significant difference between measurement states indicating that muscle activation is unlikely to yield a false-negative result on GSV. Mortise instability, secondary to deep deltoid injury in the presence of gravity stress, is unlikely to be actively overcome by dynamic stabilizers, supporting the validity and specificity of the GSV. Level of Evidence: Level III, prospective study.


2013 ◽  
Vol 5 (4) ◽  
pp. 248
Author(s):  
Elias Wehbi ◽  
Karen Hersey ◽  
Tony Finelli ◽  
Neil E. Fleshner

Introduction: Results from randomized trials are least prone tosystematic bias and represent the highest level of evidence in medicalpractice. We carried out a demographic analysis examiningrandomized controlled trials (RCTs) in prostate cancer. Particularemphasis was placed on newly conducted phase II/III RCTsbetween January 1997 and March 2006.Methods: We searched the MEDLINE database using the heading“prostate neoplasms” between January 1997 and March 2006. Theresults were then crossed with the MeSHs “Clinical trial.mp. ORclinical trial.pt. OR random:.mp. OR tu.xs;” this cross-checkingis considered an optimal search strategy for detecting RCTs inMEDLINE® literature. The search yielded 7831 articles in totalfor the defined period. Of this total number, 7314 articles weremanually analyzed and excluded as they did not represent RCTs.The qualifying 517 articles were then analyzed with emphasis onmodality of therapy, cohort size, principal author, participatingcountry and journal type.Results: Among the 517 randomized trials, most trials investigatedmedical therapies (42.7%). This was followed by diagnostic studies(13.2%), while the remaining categories made up 44.1%. A trendtowards more completed RCTs is noted in the later years of thecohort. Cohort sizes were generally greater than 100 participants(63.1%). Urologists were the lead investigators in 48.2% of thetrials. Trials were largely conducted in Europe and the United States(43.1% and 38.3%, respectively). About 7% of studies were basedin Canada. Articles were generally published in surgical journals(48.4%), followed by medical journals (36.9%).Conclusions: Given that initial searches yielded nearly 8000 articleslisted as RCTs in prostatic oncology, only a small percentage(5.4% to 8.6%) of these were actually RCTs which reported novelresults. Most of the published data were either review articles orcommentaries. It is abundantly clear that new recruitment strategiesneed to be developed to encourage patients to enrol in RCTs andthat such studies need to be undertaken in urologic oncology toprovide definitive answers to the abundant and unanswered questionsin urologic oncology.Introduction : Les résultats d’essais randomisés sont les moinssujets à une partialité d’emblée et représentent le plus haut niveaude données probantes en médecine. Nous avons mené une analysedémographique des essais contrôlés et randomisés (ECR) sur lecancer de la prostate, en portant attention plus particulièrementaux plus récents essais de phase II/III, menés entre janvier 1997et mars 2006.Méthodologie : Nous avons interrogé la base de données MEDLINEavec le titre « prostate neoplasms » pour la période entre janvier1997 et mars 2006. Les résultats ont ensuite été recoupés avec unerecherche dans la base de données MeSH avec les clés « Clinicaltrial.mp. OU clinical trial.pt. OU random:.mp. OU tu.xs »; cerecoupement est vu comme une stratégie optimale de recherchepour cerner les ECR dans les articles classés dans MEDLINE. Larecherche a produit un total de 7 831 articles pour la périodedéfinie. De ce nombre, 7 314 articles ont été analysés manuellementet exclus puisqu’ils ne traitaient pas d’ECR. Les 517 articlesadmissibles ont ensuite été analysés, avec une attention particulièreaux modalités de traitement, à la taille de la cohorte, à l’auteurprincipal, au pays participant et au type de périodique.Résultats : Sur les 517 essais randomisés, la plupart examinaient destraitements médicamenteux (42,7 %). Venaient ensuite les étudesdiagnostiques (13,2 %), alors que le reste (44,1 %) entrait dansles autres catégories. On a noté une tendance vers une complétudeplus élevée des ECR dans les dernières années de la période.Les cohortes comptaient habituellement plus de 100 participants(63,1 %). Les chercheurs principaux étaient des urologues dans48,2 % des essais. La grande majorité des essais ont été menésen Europe et aux États-Unis (43,1 % et 38,3 %, respectivement).Environ 7 % des études étaient menées au Canada. Règle générale,les articles étaient publiés dans des revues en chirurgie (48,4 %),suivies des revues médicales (36,9 %).Conclusions : Comme les recherches initiales ont généré près de8 000 articles classés comme des ECR en oncologie prostatique,seul un petit pourcentage (5,4 % à 8,6 %) de ces articles était enfait des ECR signalant des résultats inédits. La majorité des donnéesétaient publiées sous forme d’articles de synthèse ou de commentaires.Il est très clair que de nouvelles stratégies de recrutement doivent être établies pour encourager les patients à s’inscrire aux ECR et que de tels essais doivent être entrepris en oncologie urologique afin de fournir des réponses claires aux nombreusesquestions qui restent à élucider dans le domaine.


2020 ◽  
Vol 45 (5) ◽  
pp. 488-494
Author(s):  
Anna Barnard ◽  
Victoria Jansen ◽  
Mark G. Swindells ◽  
Melanie Arundell ◽  
Frank D. Burke

We report a single-blinded randomized controlled trial comparing acupuncture to sham (non-penetrating) needling for relief of symptoms of basal thumb joint arthritis. Seventy acupuncture naive patients with basal thumb joint arthritis were randomized to receive true acupuncture or sham needling with 35 patients in each arm. Blinded baseline and post-treatment assessments included visual analogue pain scores for different grips and movement. Function was assessed using the Nelson questionnaire. Both groups showed statistically and clinically significant improvements in pain at week one post-treatment compared with baseline, but there was no difference between the treatment groups. The pain relief was comparable with published data for some standard treatments. Acupuncture did not perform better than sham needling in this study, indicating that pain relief may have been achieved through non-specific mechanisms. Level of evidence: I


2020 ◽  
Vol 45 (6) ◽  
pp. 547-559
Author(s):  
Michel E. H. Boeckstyns

In treating hand fractures, we have to make a proper decision about conservative treatment versus surgical intervention and decide on individual surgical methods. This article reviews recent publications, technical advances, and outcome measures in treating metacarpal fractures, phalangeal fractures, complex fractures of the proximal interphalangeal joints, bony mallet fingers, and fractures of the thumb. My personal preferences and considerations are presented. At the end, the current challenges that hand surgeons are facing in treating frequent phalangeal and metacarpal fractures are discussed.


2019 ◽  
Vol 40 (11) ◽  
pp. 1157-1164 ◽  
Author(s):  
Anthony Ballan ◽  
Samer Jabbour ◽  
Youssef El Rayess ◽  
Khalil Jabbour ◽  
Lena El Hachem ◽  
...  

Abstract Background Different technical variations exist for the utilization of quilting sutures (QS) in rhytidectomy. No systematic review or meta-analysis of the studies describing the use of QS in facelifts has been published to date to the authors’ knowledge. Objectives The objective of this study was to summarize all the published data regarding the utilization of QS in rhytidectomy, compare QS techniques, and evaluate their effect on postoperative complications. Methods On April 1, 2019, a systematic search of the Medline, Embase, and Cochrane databases was conducted. All the studies describing the usage of QS in facelifts were included in this review. Studies reporting hematoma rate in a QS group and a control group were included in the meta-analysis part of this study. Results The initial search of the databases yielded 93 results. Four trials were included in the systematic review and 2 were included in the meta-analysis. The total number of included patients with QS was 527. Two studies employed internal QS and the remaining studies utilized external QS. The meta-analysis found a lower rate of hematoma in the QS group (relative risk, 0.02; 95% confidence interval = 0.00-0.13; P &lt; 0.0001). Conclusions QS can be applied either internally or externally and are very effective in reducing hematomas after facelifts. QS could be a great asset in facelifts but should be utilized with caution because additional work is needed to confirm their safety and efficacy. Level of Evidence: 2


2010 ◽  
Vol 26 (7) ◽  
pp. 1293-1302 ◽  
Author(s):  
Fabíola Stolf Brzozowski ◽  
Giovana Bacilieri Soares ◽  
Jucemar Benedet ◽  
Antonio Fernando Boing ◽  
Marco Aurélio Peres

The aim of this study was to describe suicide time trends in Brazil from 1980 to 2005. The data were obtained from the National Mortality Information System and the Brazilian Institute of Geography and Statistics (IBGE). Suicides rates were calculated for the entire period for the country as a whole and the 26 States and Federal District. Annual increases or decreases in mortality rates were also estimated using Prais-Winsten generalized linear regression. The mean suicide rate was 4.12 per 100,000 inhabitants (6.45/100,000 in men and 1.80/100,000 in women). The study showed an increasing suicide trend in men (+1.41% per year, 95%CI: 1.00;1.23) and a decreasing trend in women (-0.53% per year, 95%CI: -0.04;-1.02). Suicide rates increased with age. In general, for all age groups and for both genders, the highest rates were in São Paulo and in the States of the South and Central-West regions.


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