Origins of the threshold for surgical intervention in intra-articular distal radius fractures

2021 ◽  
Vol 103-B (9) ◽  
pp. 1457-1461
Author(s):  
George Philip Esworthy ◽  
Nick A. Johnson ◽  
Pip Divall ◽  
Joseph J. Dias
Keyword(s):  
Joint Space Narrowing ◽  
Surgical Intervention ◽  
Threshold Value ◽  
Joint Space ◽  
British Society ◽  
Delphi Panel ◽  
Relevant Today ◽  
Clinical Presentations ◽  
Current Guidance ◽  
Further Development

Aims The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement. Methods A systematic review of three databases was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. This search identified papers investigating functional outcome, including presence of arthritis, following injury. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter (1986) were the first to quantify a threshold, with all their patients developing arthritis with > 2 mm displacement. Some papers have discussed using 1 mm, although 2 mm is most widely reported. Current guidance from the British Society for Surgery of the Hand and a Delphi panel support 2 mm as an appropriate value. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, radiological arthritis does not correlate with the clinical presentation. Function following injury has been shown to be equivalent to an uninjured population, with arthritis progressing slowly or not at all. Joint space narrowing has also been shown to often be benign. Conclusion Knirk and Jupiter originated the threshold value of 2 mm. The lack of correlation between the radiological and clinical presentations warrants further modern investigation. Measurement often varies between observers, calling a threshold concept into question and showing the need for further development in this area. The principle of treatment remains restoration of normal anatomical position. Cite this article: Bone Joint J 2021;103-B(9):1457–1461.

1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Esworthy ◽  
N Johnson ◽  
J Dias ◽  
P Divall
Keyword(s):  
Distal Radius ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Threshold Value ◽  
British Society ◽  
Relevant Today ◽  
Clinical Presentations ◽  
Post Traumatic ◽  
Current Guidance ◽  
Traumatic Arthritis

Abstract Background Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is > 2mm; this value is often used as an indication for surgery if closed reduction is not possible. Method A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with >2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation. Conclusions Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.

708 Examining the Management of Acute Lower GI Bleeds in Order to Improve Policies and Reflect Safe and Updated Guidance

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Han ◽  
H White ◽  
K Bosch ◽  
M Nair
Keyword(s):  
Gastrointestinal Bleeding ◽  
Surgical Intervention ◽  
Lower Gastrointestinal Bleeding ◽  
University Hospital ◽  
British Society ◽  
Shock Index ◽  
Surgical Department ◽  
Upper Gi ◽  
Cardiovascular Comorbidities ◽  
New Guidelines

Abstract Introduction Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG). Method Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines. Results We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations. Conclusions Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.

scholarly journals POS0967 DESCRIPTION OF SACROILIAC CT FINDINGS IN PATIENTS WITH ANKYLOSING SPONDYLITIS AGED OVER 50 YEARS: PRELIMINARY RESULTS OF THE CASIAGE STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 748.2-749
Author(s):  
O. Fakih ◽  
M. Chouk ◽  
C. Prati ◽  
D. Wendling ◽  
F. Verhoeven
Keyword(s):  
Ankylosing Spondylitis ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Pelvic Bone ◽  
Factors Associated ◽  
Ct Findings ◽  
Total Score Range ◽  
Computed Tomography Scanning ◽  
Duration Of Disease ◽  
Si Joint

Background:Diagnosis of axial spondyloarthritis (SpA) is nowadays commonly made with the help of pelvic radiography or MRI. However, there is an important inter-observer variability for radiographs, and MRI is subject to possible false positives, and is not the best modality for studying structural lesions. Conversely, pelvic CT has an excellent specificity and appears to be more effective than radiography for the diagnosis of SpA [1]. However, CT findings in patients over 50 years of age have not been studied.Objectives:To describe sacroiliac (SI) joint CT characteristics in patients with ankylosing spondylitis (AS), aged 50 years or older.Methods:An observational, cross sectional study was performed using medical records from Besançon University Hospital’s rheumatology department, which were screened to identify patients with AS. A search was then carried out for patients over 50 years old in the hospital’s imaging archiving system to identify those who had benefited from a CT which included the SI joints in their entirety. Non-inclusion criteria were the existence of pelvic bone lesions and a history of pelvic radiotherapy. For each patient, CT was interpreted using a score previously used by Diekhoff et al. [2], dividing each SI joint into 12 regions, for each of which joint space narrowing (JSN), erosions, and sclerosis are assessed. For this study, we also observed the existence of intra-articular gas and diffuse idiopathic skeletal hyperostosis (DISH) lesions for each region. Quantitative variables are expressed as mean ± standard deviation, qualitative variables as numbers and percentages. Wilcoxon rank-sum test was used to determine factors associated with a higher CT score.Results:A total of 66 patients were included. Mean (SD) age was 65.10 ± 10.59 with a mean (SD) duration of disease of 22.87 ± 14.95 years. 60.29% were male, and 87.04 % were HLA-B27 positive. 40.30% had a bamboo spine. CT findings are described in Table 1. The vast majority of patients have a positive JSN score but significant erosions are found in only a minority of cases. This is partly explained by the fact that 55.9% of the patients had at least one complete bilateral ankylosis (and therefore no erosions) on one of the three slices studied. Bilateral anklylosis was associated with a longer duration of disease (p<0.001) and presence of bamboo spine (p<0.001). Also noteworthy is the low proportion of DISH compared to the general population in this age group, which is 15-25%.Factors associated with a higher total CT score were male sex (p=0.017), longer duration of disease (p<0.001), tobacco use (p=0.033), presence of bamboo spine (p=0.004), absence of DISH (p=0.045) and absence of intra-articular gas (p<0.001). The distribution of lesions appeared to be homogenous over all 24 regions studied (Figure 1).Conclusion:CT findings in AS patients over 50 years of age are mostly represented by changes in joint space, with bilateral ankylosis present in half of the patients. AS appears to be a protective factor for DISH.References:[1]Devauchelle-Pensec V, D’Agostino MA, Marion J, et al. Computed tomography scanning facilitates the diagnosis of sacroiliitis in patients with suspected spondylarthritis: Results of a prospective multicenter French cohort study. Arthritis Rheum 2012;64:1412–9. doi:10.1002/art.33466[2]Diekhoff T, Hermann K-GA, Greese J, et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis 2017;76:1502–8. doi:10.1136/annrheumdis-2016-210640Table 1.Sacro-iliac CT findings using a score modified from Diekhoff et al.Mean total score (range 0-108)70.36±38.90Presence of joint space narrowing58 (85.29 %)Presence of erosion20 (29.41 %)Presence of sclerosis15 (22.06 %)Presence of Intra-articular gas22 (32.35 %)Presence of DISH3 (4.41 %)Figure 1.Mean scores per region in the anterior, central and posterior SI slices (JSN: joint space narrowing (0-4), Ero: erosions (0-3), Scl: sclerosis (0-2)).Disclosure of Interests:None declared.

Film-Screen Vs. Digital Radiography in Rheumatoid Arthritis of the Hand

1994 ◽  
Vol 35 (4) ◽  
pp. 311-318 ◽  
Author(s):  
Á. Jónsson ◽  
A. Borg ◽  
P. Hannesson ◽  
K. Herrlin ◽  
K. Jonsson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Soft Tissue ◽  
Digital Radiography ◽  
Joint Space Narrowing ◽  
Digital Images ◽  
Roc Curves ◽  
Joint Space ◽  
Hard Copy ◽  
Significant Difference ◽  
Soft Tissue Swelling

In a prospective investigation the diagnostic accuracy of film-screen and digital radiography in rheumatoid arthritis of hands was compared. Seventy hands of 36 patients with established rheumatoid arthritis were included in the study. Each of 11 joints in every hand was evaluated regarding the following radiologic parameters: soft tissue swelling, joint space narrowing, erosions and periarticular osteopenia. The digital images were obtained with storage phosphor image plates and evaluated in 2 forms; as digital hard-copy on film and on a monitor of an interactive workstation. The digital images had a resolution of either 3.33 or 5.0 lp/mm. ROC curves were constructed and comparing the area under the curves no significant difference was found between the 3 different imaging forms in either resolution group for soft tissue swelling, joint space narrowing and erosions. The film-screen image evaluation of periarticular osteopenia was significantly better than the digital hard-copy one in the 3.33 lp/mm resolution group, but no significant difference was found in the 5.0 lp/mm group. These results support the view that currently available digital systems are capable of adequate diagnostic performance.

scholarly journals High systemic bone mineral density increases the risk of incident knee OA and joint space narrowing, but not radiographic progression of existing knee OA: the MOST study

2009 ◽  
Vol 69 (01) ◽  
pp. 163-168 ◽  
Author(s):  
M C Nevitt ◽  
Y Zhang ◽  
M K Javaid ◽  
T Neogi ◽  
J R Curtis ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Joint Space Narrowing ◽  
Weight Bearing ◽  
Joint Space ◽  
Whole Body ◽  
Mineral Density ◽  
Knee Oa ◽  
Increased Risk

Objectives:Previous studies suggest that high systemic bone mineral density (BMD) is associated with incident knee osteoarthritis (OA) defined by osteophytes but not with joint space narrowing (JSN), and are inconsistent regarding BMD and progression of existing OA. The association of BMD with incident and progressive tibiofemoral OA was tested in a large prospective study of men and women aged 50–79 years with or at risk for knee OA.Methods:Baseline and 30-month weight-bearing posteroanterior and lateral knee radiographs were scored for Kellgren-Lawrence (K-L) grade, JSN and osteophytes. Incident OA was defined as the development of K-L grade ⩾2 at follow-up. All knees were classified for increases in grade of JSN and osteophytes from baseline. The association of gender-specific quartiles of baseline BMD with risk of incident and progressive OA was analysed using logistic regression, adjusting for covariates.Results:The mean (SD) age of 1754 subjects was 63.2 (7.8) years and body mass index was 29.9 (5.4) kg/m2. In knees without baseline OA, higher femoral neck and whole body BMD were associated with an increased risk of incident OA and increases in grade of JSN and osteophytes (p<0.01 for trends); adjusted odds were 2.3–2.9-fold greater in the highest compared with the lowest BMD quartiles. In knees with existing OA, progression was not significantly related to BMD.Conclusions:In knees without OA, higher systemic BMD was associated with a greater risk of the onset of JSN and K-L grade ⩾2. The role of systemic BMD in early knee OA pathogenesis warrants further investigation.

The importance of periodontal screening in children. A case report

Dental Update ◽  
2021 ◽  
Vol 48 (6) ◽  
pp. 474-476
Author(s):  
Francesca Capaldi ◽  
Eleni Besi ◽  
Elizabeth M Roebuck
Keyword(s):  
Case Report ◽  
Secondary Care ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Multidisciplinary Care ◽  
Paediatric Dentistry ◽  
British Society ◽  
General Dental Practitioner ◽  
Permanent Molars ◽  
First Permanent Molars

The British Society of Periodontology, in collaboration with the British Society of Paediatric Dentistry, published guidelines in 2012 for the periodontal screening of children and adolescents. The guidelines recommended a simplified Basic Periodontal Examination (BPE) of six teeth for children aged 7–17 years. This is further modified for ages 7–11, using codes 0–2 from the 0–4 BPE adult chart. An unusual case of an 11-year-old boy who attended his general dental practitioner for a check-up is reported. Periodontal screening led to the detection of 13-mm pockets associated with the two mandibular first permanent molars that required surgical intervention and multidisciplinary care. CPD/Clinical Relevance: This case report highlights the importance of paediatric periodontal screening in both primary and secondary care.

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