scholarly journals Vascular examination predicts functional outcomes in supracondylar humerus fractures: a prospective study

2020 ◽  
Vol 14 (6) ◽  
pp. 495-501
Author(s):  
Justin J. Ernat ◽  
Robert L. Wimberly ◽  
Christine A. Ho ◽  
Anthony I. Riccio
Keyword(s):  
Functional Outcome ◽  
Outcome Measures ◽  
Level Of Evidence ◽  
Vascular Abnormality ◽  
Supracondylar Humerus Fractures ◽  
Palpable Pulse ◽  
Humerus Fractures ◽  
Functional Outcome Measures ◽  
A Prospective Study

Purpose This article prospectively examines the functional outcome measures following management of vascular insult secondary to paediatric supracondylar humerus fractures (SCHFX) using validated outcome measures. Methods The three-year, prospective, IRB-approved study consecutively enrolled operative SCHFX patients. Clinical data included presence and symmetry of the radial pulse in injured and uninjured extremities, Doppler examination of non-palpable (NP) pulses and perfusion status of the hand. Pediatric Outcomes Data Collection Instruments (PODCI) and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) Measures were used to assess functional outcome at final follow-up. Multiple regression analysis was used to determine the relationship between the presence of a vascular abnormality and functional outcome while controlling for other injury parameters. Results A total of 146/752 enrolled patients (mean age 6.8 years; range 2 years to 13 years) completed functional outcome measures at final follow-up. Of these, 20 (14%) patients had abnormal vascular exams at presentation: nine (6%) with palpable asymmetric pulse and 11 (7.5%) with NP pulse. Of those with NP pulses, nine/11 (6%) were Dopplerable and two (1.5%) lacked identifiable Doppler signal. Patients with a symmetric, palpable pulse demonstrated better PODCI pain and comfort scores (95.2 versus 85.2) (p < 0.0001), and QuickDASH scores (10.9 versus 21.6) (p < 0.007) compared to those with any abnormal vascular examination. Patients with palpable pulses, regardless of symmetry, demonstrated ­significantly higher PODCI pain and comfort scores (94.6 versus 84.7) (p < 0.003) than NP pulses. Conclusions In children with operative SCHFX, an abnormal vascular examination at presentation is predictive of poorer outcomes in pain and upper extremity function. A palpable pulse, versus NP, is predictive of better pain and comfort at final follow-up. Level of evidence II

scholarly journals Is less more? Assessing the utility of early clinical and radiographic follow-up for operative supracondylar humerus fractures

2018 ◽  
Vol 12 (5) ◽  
pp. 502-508 ◽  
Author(s):  
R. M. Thompson ◽  
E. W. Hubbard ◽  
M. Elliott ◽  
A. I. Riccio ◽  
D. J. Sucato
Keyword(s):  
Postoperative Complications ◽  
Clinical Findings ◽  
Late Complications ◽  
Percutaneous Pinning ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Clinic Appointment ◽  
Supracondylar Humerus Fractures ◽  
Humerus Fractures

PurposePostoperative protocols following surgical management of supracondylar humerus fractures (SCFs) are often based upon surgeon preference rather than clinical merit. The purpose of this study is to determine the utility of early clinical and radiographic follow-up.MethodsA retrospective review of patients who underwent closed reduction and percutaneous pinning (CRPP) for SCF between 2009 and 2015 was performed using a database of prospectively-collected consecutive patient data. Previously undiagnosed neuropathies documented at the first postoperative visit were identified. Unscheduled visits and postoperative complications were compared between patients who were seen at one week and those with delayed first clinic visits.ResultsOf 873 patients, 823 (94.3%) were seen within ten days of surgery (early follow-up) and 50 (5.7%) had a delayed first clinic appointment. Among patients seen for early follow-up, 12 (1.5%) had a previously undocumented neuropathy diagnosed but only eight (1%) had an alteration of management secondary to clinical findings. Greater than 90% of patients seen for early follow-up had radiographs performed, but only one had an alteration in management due to radiographic findings. Patients seen for early follow-up had the same rate of unscheduled visits (2.9% versus 4%, p = 0.66) and postoperative complications (1.6% versus 0%, p > 0.99) as those with delayed first appointments. Radiographic parameters were comparable at final follow-up (Baumann’s angle 74.5° versus 73.7°, p = 0.40; lateral humeral condylar angle 40.2° versus 41.2°, p = 0.53).ConclusionThe early follow-up visit after CRPP of SCF rarely leads to alterations in care and does not reduce unscheduled visits or late complications.Level of EvidenceLevel IV

scholarly journals Newer generation straight humeral nails allow faster bone healing and better functional outcome at mid-term

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fabrizio Mocini ◽  
Giuseppe Rovere ◽  
Domenico De Mauro ◽  
Edoardo Giovannetti De Sanctis ◽  
Amarildo Smakaj ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Bone Healing ◽  
Soft Tissues ◽  
Statistical Significance ◽  
Level Of Evidence ◽  
Healthy Side ◽  
Humerus Fractures ◽  
Quick Dash ◽  
Postoperative Shoulder

Abstract Purpose Although proximal and diaphyseal humerus fractures are frequent, the optimal management remains controversial. Antegrade nailing prevents further damage to the soft tissues and to the vascularization, but it has been associated with postoperative shoulder pain and dysfunction. During the latest years a straight nail design was developed to minimize these problems. Methods A total of 243 patients who had undergone surgery for antegrade intramedullary humeral nailing between January 2013 and July 2018 in A. Gemelli Trauma Center were divided into two groups according to the nail design used: straight nail group (S-group) and curvilinear nail group (C-group). Clinical data were collected using assessment forms (SF12-v2, Quick-DASH, ASES and Constant-Murley). Radiographic bone healing was assessed with RUST score at 30, 90 and 180 days after surgery. Results The S-group was made up of 128 patients with a mean age of 59 ± 19 (range 18–97) and a mean follow-up of 46 ± 9 months. The C-group was made up of 115 patients with a mean age of 53 ± 16 (range 18–88) and a mean follow-up of 51 ± 8 months. The S-group had a mental component summary (MCS) score of 54.3 ± 7.7 and a physical component summary (PCS) score of 46 ± 10.2, the C-group had a MCS score of 50.9 ± 8.4 and a PCS score of 44.1 ± 7.4. Quick-DASH and ASES were respectively 18.8 ± 4.3 and 78.6 ± 8.2 in the S-group, 28.3 ± 11.6 and 72.1 ± 13.5 in the C-group with statistical significance. Constant-Murley score was 73.9 ± 9.1 in the S-group (76% of the contralateral healthy side) and 69.4 ± 10.4 in the C-group (73% of the contralateral healthy side). The radiographic union score in the S-group was 4.1 ± 0.3 at 30 days after surgery, 7 ± 0.8 at 90 days and 10 ± 1.2 at 180 days, while in the C-group it was 4.2 ± 0.4 at 30 days, 6.4 ± 0.7 at 90 days and 9 ± 0.9 at 180 days. Conclusion Newer generation straight nails allow a faster bone healing and better functional outcome at mid-term follow up. Level of evidence III.

837 Clinical Experience Using Functional Outcome Measures in the Outpatient Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S257-S257
Author(s):  
Melissa Boals ◽  
Lisa Curtis ◽  
Amalia Cochran ◽  
John Kevin Bailey ◽  
Rebecca Coffey
Keyword(s):  
Lower Extremity ◽  
Functional Outcome ◽  
Grip Strength ◽  
Upper Extremity ◽  
Outcome Measures ◽  
Maximal Function ◽  
Burn Patients ◽  
Function Score ◽  
Functional Outcome Measures

Abstract Introduction For patients with severe burns, the emphasis has shifted from survival to maximizing functional outcomes. Outcome measures are tools that help establish a baseline status and monitor progression towards meaningful tasks such as activities of daily living (ADLs) and mobility (Staley et al. 1996). The goal of this retrospective study is to describe the use of functional outcome measures in burn patients in an outpatient setting using standardized measures. Methods A retrospective chart review of burn patients seen in the outpatient burn clinic between February 1, 2017 and May 31, 2019 was conducted. Only patients seen for burn injury, treated as outpatients, and with functional outcome measures recorded were included in the study. Pertinent demographic and clinical data were collected as well as outcome measures. All patients had grip strength dynamometry performed. Patients with upper extremity and lower extremity burns were administered the The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Lower Extremity Functional Scale (LEFS). Return to work data was also collected if the patient was employed at baseline. Results A total of 113 out patients were included in the analysis. Mean age was 43 years (20–88 years) with a mean TBSA of 6.1% (0.1 -67%). The mean number of OT and PT visits in the clinic were both 1.4. Initial grip strength measurements were obtained in 67 patients at a mean of post burn day (PBD) 33 and an average grip strength of 21.29 kg (right) and 26.8 kg (left). Follow up grip strength measurements were obtained in 45 patients on mean PBD 43 with right hand 49.98 kg and left hand of 51.28 kg. Initial QuickDASH was administered to 89 patients on PBD 47 with a mean percent disability of 48.72 (0–100). Second QuickDASH was given to 45 patients on PBD 68 with a mean percent disability score of 37.01 (0 – 95.45) - Initial LEFS was given to 77 patients mean PBD 61 with a mean % of maximal function score of 44%. Second LEFS was given to 40 patients mean PBD 71 with a mean % maximal function score of 58%. Mean return to work for the 46 patients who were employed was 53.6 days post burn. Conclusions Positive improvements were shown in grip strength and lower extremity function, but a decline in function was demonstrated for upper extremity function. This decline may be the result of a nearly 50% attrition rate on follow up QuickDASH measures due to discharge of highly functional individuals, meaning the remaining upper extremity burn patients had more severe injuries and dysfunction. Applicability of Research to Practice Ongoing research is needed to identify the best timing of outcome measures and how to best incorporate this information into burn treatment plans.

scholarly journals Correlation Between Radiological Parameters and Functional Outcomes in Patients Older Than 60 Years of Age With Distal Radius Fracture

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 770-775 ◽  
Author(s):  
Rodrigo Gutiérrez-Monclus ◽  
Héctor Gutiérrez-Espinoza ◽  
Jonathan Zavala-González ◽  
Cristian Olguín-Huerta ◽  
David Rubio-Oyarzún ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Distal Radius Fracture ◽  
Outcome Measures ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Correlation Study ◽  
Radius Fracture ◽  
Radiological Parameters ◽  
Functional Outcome Measures

Background: The relationship between radiographic and functional outcomes is controversial in the elderly. The objective of this study is to determine whether there is a correlation between functional outcome and acceptable distal radius fracture (DRF) alignment in patients older than 60 years of age. Methods: This correlation study was carried out at the Central Metropolitan Health Service of Chile. A total of 180 patients diagnosed with extra-articular DRF, according to the AO classification, were prospectively recruited. Radiological parameters, including radial inclination, residual dorsal angulation, ulnar variance, and articular step-off, were evaluated to assess the results of orthopedic reduction. Functional outcome was assessed immediately following cast removal and again at the 6-month follow-up. The Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires were administered to assess upper extremity function, and the visual analog scale (VAS) was used to assess pain intensity. Results: Only 68 patients (37.8%) showed acceptable DRF alignment. After cast removal, the correlations between alignment and the functional outcome measures were as follows: DASH 0.071 ( P = .546), PRWE 0.03 ( P = .823), and VAS 0.12 ( P = .631). At the 6-month follow-up, the correlations between alignment and the functional outcome measures were as follows: DASH 0.029 ( P = .768), PRWE 0.014 ( P = .895), and VAS 0.09 ( P = .614). Conclusions: There was no significant correlation between acceptable alignment according to radiological parameters and short- or medium-term functional outcome in patients older than 60 years with extra-articular DRF treated conservatively.

scholarly journals Evaluation of functional outcome after osteosynthesis of intra articular distal humerus fracture with pre contoured locking compression plates

2020 ◽  
Vol 6 (6) ◽  
pp. 1215
Author(s):  
Faisal S. Mohammed ◽  
Akshay B. Ingale
Keyword(s):  
Functional Outcome ◽  
Distal Humerus ◽  
Distal Humerus Fracture ◽  
Performance Score ◽  
Mayo Elbow Performance Score ◽  
Locking Compression Plates ◽  
Humerus Fractures ◽  
Distal Humerus Fractures ◽  
Extensor Lag

<p><strong>Background:</strong> Intra articular distal humerus fractures are challenging and cumbersome to treat. Therefore osteosynthesis of such fractures is required. The aim of our study was to evaluate the functional outcome of intra articular distal humerus fractures AO type  13C by osteosynthesis using olecranon osteotomy with pre contoured locking compression plates in orthogonal plate configuration.</p><p><strong>Methods:</strong> Thirty patients were included in our study comprising of 18 males and 12 females. Mean age was 39.63 years with mean follow up of 34 weeks. 7 were AO type 13C1, 9 were AO type 13C2 and 14 were AO type 13C3. Osteosynthesis was done for all fractures by olecranon osteotomy approach. Functional outcome was assessed using mayo elbow performance score.</p><p><strong>Results:</strong> Mean flexion attained at the end of follow up was 127.56 degrees with mean extensor lag of 7.16 degrees. Mean arc of motion was 120.4 degrees. Mean mayo elbow performance score at the end of follow up was 80.36. Mayo elbow performance score in patients aged less than 40 years of age was not statistically significant as compared to patients more than 40 years of age. Functional outcome was also dependent on fracture subtype.</p><p><strong>Conclusions:</strong> Osteosynthesis of distal humerus fractures AO type 13C using pre contoured locking compression plates in orthogonal plate configuration by olecranon osteotomy provides excellent visualization of fracture and better functional outcome.</p>

scholarly journals Humerus trochlear angle (HTa)—a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gang Chen ◽  
Lu Cui ◽  
Jiaqi Shi ◽  
Peng Zhang ◽  
Jun Li ◽  
...  
Keyword(s):  
Articular Surface ◽  
Operation Time ◽  
Contralateral Side ◽  
Gender And Age ◽  
Supracondylar Humerus Fractures ◽  
Significant Difference ◽  
Reliable Parameter ◽  
Cosmetic Outcomes ◽  
Humerus Fractures

Abstract Background The supracondylar humerus fractures are the most common fracture in children’s elbows. Generally, close reduction and percutaneous pinning can provide satisfactory outcomes after adequate reduction. Baumann angle is commonly used to evaluate reduction quality, however, it may fail to assess reduction well when the elbow is in flexion and/or when the patient is young. We conducted this study to evaluate the potential value of the humerus trochlear angle (HTa) for the reduction evaluation and compare it with the Baumann angle. Methods We retrospectively reviewed supracondylar humerus fractures in our trauma center from 2016 to 2019. Patients were grouped as followed: in the HTa group, an arthrogram was used to evaluate the HTa angle and reduction (HTa, defined by the intersection of the axis of the humerus shaft and the tangent of the articular surface of the trochlear); In the Baumann group, the Baumann angle was used to assess the reduction. Baumann angle ratio (BA of injured side/BA of contralateral side) was calculated to evaluate the reduction quality between groups. Flynn’s grading criteria were utilized to evaluate both function and cosmetic outcomes in two groups during the follow-up. Operation time, fluoroscopy shots, complications and Flynn’s grading scores were compared between groups. Results A total of 57 patients with an average age of 4.62 years and follow-up duration of 21.49 ± 5.40 months were included in the analysis. The gender and age distributions were similar in the two groups. Fluoroscopy shots in the HTa group were significantly less than in Baumann group (16.17 ± 0.73 vs. 21.85 ± 0.78, p < 0.0001), and operation time were also less in HTa group (45.78 ± 1.96 min vs. 62.21 ± 1.58 min, p < 0.0001). Baumann ratio showed no significant difference between the two groups (1.002 ± 0.023 in the Baumann group and 1.01 ± 0.023 in HTa group, p < 0.0001). Length of hospitalization, complications, and Flynn’s grading scores were similar between groups. The HTa angle was positively correlated with Baumann angle in the HTa group (R-value is 0.71 and P = 0.0002). Conclusions There was no significant difference in reduction quality and Flynn’s scores between HTa and Baumann groups. Furthermore, HTa was associated with shorter operation time and less radiation exposure in this investigation. Therefore, HTa may be a convenient and reliable parameter that could guide the reduction of supracondylar humerus fractures, especially for young children.

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