Finger Fractures Research Articles

Surgical management of mallet finger with extension block pinning

<p class="abstract"><strong>Background:</strong> Various surgical and nonsurgical treatments have been described in the management of mallet finger. The purpose of this study is to evaluate the effectiveness of extension block pinning in the management of displaced mallet finger fractures.</p><p class="abstract"><strong>Methods:</strong> We conducted a retrospective study in which extension block pinning was done for displaced Mallet finger fractures. We included 10 patients in our study who were treated between 2016 and 2018. Fractures were classified according to Wehbe and Schnieder’s classification. All the procedures were done using ring block anaesthesia. Postoperative radiographic assessment was done at each follow up at 15 days interval. Wires were removed after radiologic confirmation of fracture healing. Assessment of the outcome was done using Crawford’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> According to Wehbe and Schnieder’s classification IIB type was the most common. All fractures involved more than 30% of articular surface. Average operative time was 30 mins. Congruent anatomical reduction was achieved in all the patients (intrarticular step off less than 1 mm). Average healing time of the fractures was 40 days. Seven out of the ten patients had excellent results. No wire related complications were seen in our patients.</p><p class="abstract"><strong>Conclusions:</strong> Extensor block pinning when performed accurately is an easy, economical and effective technique in treatment of mallet fingers.</p>

Fractures in German elite male soccer players.

Aim of this retrospective cohort study was to identify fracture epidemiology and off times after different types of fractures in German male elite soccer players from the first division Bundesliga based on information from the public media. Exposure and fracture data over 7.5 consecutive seasons (2009/10 until the first half of 2016/17) were collected from two media-based register (transfermarkt.de® and kicker.de®). Overall, 357 fractures from 290 different players were recorded with an incidence of 0.19/1000 hours of exposure (95% CI: 0.14-0.24). Most fractures in German elite soccer players involved the lower extremities (35.3%), the head/face (30.3%) and the upper extremities (24.9%). The median off time after a fracture in German elite male professional soccer in 7.5 Season was 51.1 days (range 0-144). The number of fractures per 100 players per season decreased between 2009 and 2016. There was no significant difference in overall fracture incidence when comparing players at different position (P=0.11). Goalkeepers have a significantly (P<0.02) higher likelihood of suffering hand and finger fractures and they are significantly (P<0.03) less prone of suffering foot fractures, cranial and maxillofacial fractures (P<0.04). compared to outfield players. This study can confirm that male professional soccer teams experience 1-2 fractures per season in German elite soccer. The incidence of fractures in elite German soccer players decreased between 2009 and 2016. The most fractures occur in the lower extremities and there is no difference in overall fracture risk for players at different playing positions. The information from our study might be of a great importance to medical practitioners, soccer coaches and soccer manager.

What injuries should we expect in the emergency room?

IntroductionBeside serious and potentially fatal injuries, the majority of pediatric trauma patients present with minor injuries to emergency departments. The aim of this study was to evaluate age-related injury pattern, trauma mechanism as well as the need for surgery in pediatric patients. Patients and methodsRetrospective Study from 01/2008 to 12/2012 at a level I trauma center. All patients <18years of age following trauma were included. Injury mechanism, injury pattern as well as need for surgery were analyzed according to different age groups (0–3 years, 4–7 years, 8–12 years and 13–17 years). Major injuries were defined as fractures, dislocations and visceral organ injuries. Minor injuries included contusions and superficial wounds. ResultsOverall, 15300 patients were included (59% male, median age 8 years). A total of 303 patients (2%) were admitted to the resuscitation room and of these, 69 (0.5% of all patients) were multiply injured (median Injury Severity Score (ISS) 20 pts). Major injuries were found in 3953 patients (26%). Minor injuries were documented in 11347 patients (74%). Of those patients with a major injury, 76% (2991 patients) suffered a fracture, 3% (132 patients) a dislocation and 3% (131 patients) an injury of nerves, tendons or ligaments. The majority of fractures were located in the upper extremity (73%) (elbow fractures 16%; radius fractures 16%; finger fractures 14%). Patients with minor injuries presented with head injuries (34%), finger injuries (10%) and injuries of the upper ankle (9%). The most common trauma mechanisms included impact (41%), followed by falls from standing height (24%), sport injuries (15%) and traffic accidents (9%). Overall, 1558 patients (10%) were operated. Of these, 61% had a major and 39% a minor injury. ConclusionAlmost 75% of all children, who presented to the emergency department following trauma revealed minor injuries. However, 25% suffered a relevant, major injury and 0.5% suffered a multiple trauma with a median ISS of 20. Overall, 10% had to be operated. The most frequently found major injuries were extremity fractures, with elbow fractures as the most common fracture.

Ball-Contact Injuries in 11 National Collegiate Athletic Association Sports: The Injury Surveillance Program, 2009-2010 Through 2014-2015.

Surveillance data regarding injuries caused by ball contact in collegiate athletes have not been well examined and are mostly limited to discussions of concussions and catastrophic injuries. To describe the epidemiology of ball-contact injuries in 11 National Collegiate Athletic Association (NCAA) sports during the 2009-2010 through 2014-2015 academic years. Descriptive epidemiology study. Convenience sample of NCAA programs in 11 sports (men's football, women's field hockey, women's volleyball, men's baseball, women's softball, men's and women's basketball, men's and women's lacrosse, and men's and women's soccer) during the 2009-2010 through 2014-2015 academic years. Collegiate student-athletes participating in 11 sports. Ball-contact-injury rates, proportions, rate ratios, and proportion ratios with 95% confidence intervals were based on data from the NCAA Injury Surveillance Program during the 2009-2010 through 2014-2015 academic years. During the 2009-2010 through 2014-2015 academic years, 1123 ball-contact injuries were reported, for an overall rate of 3.54/10 000 AEs. The sports with the highest rates were women's softball (8.82/10 000 AEs), women's field hockey (7.71/10 000 AEs), and men's baseball (7.20/10 000 AEs). Most ball-contact injuries were to the hand/wrist (32.7%) and head/face (27.0%) and were diagnosed as contusions (30.5%), sprains (23.1%), and concussions (16.1%). Among sex-comparable sports (ie, baseball/softball, basketball, and soccer), women had a larger proportion of ball-contact injuries diagnosed as concussions than men (injury proportion ratio = 2.33; 95% confidence interval = 1.63, 3.33). More than half (51.0%) of ball-contact injuries were non-time loss (ie, participation-restriction time <24 hours), and 6.6% were severe (ie, participation-restriction time ≥21 days). The most common severe ball-contact injuries were concussions (n = 18) and finger fractures (n = 10). Ball-contact-injury rates were the highest in women's softball, women's field hockey, and men's baseball. Although more than half were non-time-loss injuries, severe injuries such as concussions and fractures were reported.

Surgical management of closed, isolated proximal phalanx fractures in the long fingers: Functional outcomes and complications of 87 fractures

Finger fractures are the most common skeletal injuries of the upper limbs. The purpose of this study was to evaluate the functional outcomes and complications after surgical management of isolated, closed fractures of the proximal phalanx (PP) of the hand (thumb excluded). Surgical management was indicated in 87 PP fractures. Fractures were reduced and fixed with pins, screws or a plate. Functional outcomes were assessed through the range of motion (ROM) in flexion–extension, hand and finger strength, and the QuickDASH and PRWHE scores. Fixation was done with pins in 32 cases, screws in 41 cases, and a plate in 14 cases. Rehabilitation was started an average of 1.7 weeks after surgery. There was no significant difference in the functional outcomes based on either fracture type or surgical approach. Nevertheless, the following significant differences were observed: PRWHE score (P=0.017) by injured finger; proximal interphalangeal (PIP) ROM (P=0.037) by fixation type; and grip strength (P=0.019), Quick DASH (P=0.017), and PRWHE (P=0.045) by rehabilitation delay. The most common clinical complications were minor malrotation and cold intolerance. Radiological assessment showed complete union in all cases. Surgical management of PP fractures leads to good functional outcomes, including a satisfactory recovery of finger ROM. The functional recovery of a fractured digit is dependent on the right fixation choice, complete bone union, and early rehabilitation. We suggest using screw fixation to achieve patient satisfaction and optimal functional recovery of closed, isolated PP fractures of the long fingers.

Traitement percutanée des fractures des phalanges en compression. Résultats préliminaires

Introduction One of the most commonly used technique for the treatment of the phalanges fractures, in which reduction can be obtained by closed method, is percutaneous K-wire fixation. This technique entails certain risks such as post-surgical immobilization, migration, double K-wires necessity and cutenaous reactions. The “Konico” device is similar to a compression screw with the proximal and distal parts prolonged by a smooth, cylindrical portion to facilitate percutaneous introduction by drilling. Material and methods From March 2014 and April 2015, we have treated ninety-eight phalangeal (P1 and P2) fractures of fingers in eighty-six patients. P3 fractures were excluded owing to the minimal diaphyseal length. Thirty-eight were oblique and transverse of the P1 (twenty two) and P2 (sixteen). Seventeen patients has been treated with Konico device for reduction of ten transverse fractures of the P1 (six patients) and P2 (four patients) and the remaining fractures (seven) were oblique in P2 (three cases) and P1 (four cases). All the patients underwent X-ray control at 4 weeks and K-wires removal for the cases treated with “normal” K-wires except those lacking of radiological consolidation's findings and simple X-ray control for the group treated with Konico device. Results In the group treated with K-wires, three patients lost the reduction (14.28%) at the X-Ray control, two patients showed proximal K-wire migration (0.8%) and open release has been requested, local cutaneous reaction (bacterial culture negative) has been found in three cases (14.28%). In four cases, K-wires had been left in place four two weeks more because of the lack of consolidation X-ray findings. The group treated with the Konico device demonstrated excellent maintenance of reduction at the four weeks X-ray control, no migration in any direction has been shown and cutaneous reaction has been detected above the site of the bended proximal part of the Konico closer to mcp joint. Conclusions Surgical technique with Konico device is more demanding than K wires because pre-surgery planning to determine pine size to be used during the procedure needs a perfect fracture reduction. While K wires technique allows several attempts, Konico device allows just one. Even if the technique is more demanding, we found better results and this could be a good alternative option in treatment of P1 and P2 transverse and oblique fracture.

Mallet Fractures of the Thumb Compared With Mallet Fractures of the Fingers

The purpose of this study was to look for differences in mechanism, radiographic findings, and treatment between mallet fractures of the thumb and mallet fractures of the index through small fingers. This retrospective study included 24 mallet fractures of the thumb and 392 mallet fractures of other digits. We compared demographics, injury factors (side, dominant hand, time between injury and first visit, and injury mechanism), subluxation, fragment size, treatment, and time from injury to final evaluation between the 2 groups. Mallet fractures of the thumb presented for treatment sooner after injury (2.9 vs 13 days on average), had less fragment displacement (27% vs 33%), and less articular involvement (39% vs 46% on average). None of the mallet fractures of the thumb had radiographic evidence of subluxation, whereas 25% of mallet fractures of other fingers had initial or later subluxation. Mallet fractures of the thumb are not likely to subluxate.

Open Finger Fractures: Incidence, Patterns of Injury and the Influence of Social Deprivation.

This study investigates the patterns and epidemiology of open finger fractures. There is little good data about these injuries. Data were collected prospectively in a single trauma unit serving a well-defined population. Over a 15 year period 1090 open finger fractures were treated in 1014 patients. These made up the vast majority of open fractures treated in the trauma unit during this period. The incidence of open finger fractures was 14.0 per 100,000 patients per year. Deprivation did not influence the incidence of open finger fractures but did affect treatment choices for women. Most open finger fractures resulted from crush injuries or falls and required only simple operative treatments: debridement, lavage and early mobilization. Open finger fractures formed the majority of the workload of open fractures at our trauma centre but usually required simple treatments only. Social deprivation was not shown to influence the patterns or epidemiology of these injuries but did affect treatment choices for women.

The Biomechanical Study of the Bioabsorbable Plates in Finger Fracture Fixation

Objectives: Plates and screws have been proven to be a strong construct for the treatment of finger fractures as it allows for immediate postoperative mobilization. However, plates made in metal can be high in profile and may lead to both adjacent tendons and soft tissue irritation. Meanwhile bioabsorbable plates and screws have the advantage of being more conforming and low in profile. Yet there are concerns on its biomechanical strength. This study aims to explore the biomechanical strength of bioabsorbable construct by comparing with its titanium counterpart. Materials and Methods: Fifty-four simulated bone models of hand with a transverse osteotomy were used to simulate a finger fracture. A control group of 18 bone models (group 0) were fixed with a standard 4-hole, 1.5-mm titanium straight plates. A second set of 18 bone models (group 1) were fixed by 1.5-mm bioabsorbable mesh plate which was fashioned to cover half of the circumference of the bone. For the remaining set of 18 bone models, similar fixation was employed using the bioabsorbable plates except that it covered two-third instead of half of the circumference of the bone. All bone models were mounted to the Servo-hydraulic MTS 858 Bionix testing machine for biomechanical testing. Six bone models from each group were tested for maximum bending force, maximum torsional force, and fatigue property. The fatigue property was to simulate the load that the fixation construct would encounter over a 6 weeks period, ie, a period that allows the bone to heal with callous. It was set at 100 000 cycles at a displacement rate of 1 mm/s. Results: The average maximum bending force for group 0, group 1, and group 2 were 67.0 ± 10.2 N, 40.8 ± 15.0 N, and 43.3 ± 15.0 N, respectively. There was a significance between the metal and both the bioabsorbable groups with P &lt; .001. For the average maximum torsional force, group 0 was 0.66 ± 0.06 Nm, group 1 was 0.27 ± 0.06 Nm and group 2 was 0.32 ± 0.07 Nm. A significance difference between the metal and both the bioabsorbable groups was noted at P &lt; .001. For the fatigue tests, all constructs, except 2 in group 1, were able to withstand 1 000 000 cycles. The subsequent force to failure of both the bioabsorbable constructs were only 10% of the titanium constructs (6.8 N vs 67.6 N) of which the P was &lt;.001. No significant difference was noted in maximum bending strength, maximum torsion force, and fatigue stress between the 2 groups of bioabsorbable constructs. Conclusion: The biomechanical strength of the bioabsorbable plates is inferior to the titanium plates. Yet as the requirement of finger fracture fixation is mainly to provide a stable environment for finger mobilization, the fatigue property of a construct appears to be more important. Thus, the strength of bioabsorbable plate and screw construct may still be strong enough to allow the fracture to heal.

Early Active Vector Adjustable Skin Traction (EAVAST) for Phalangeal Fractures

Background: Traction for phalangeal fractures utilizes the principle of “ligamentotaxis.” In Australia, a number of hand therapists and surgeons have contributed to the design of a skin traction method utilizing rigid sports tape, elastic, and hand-based thermoplastic splint. Aims: The study aims to determine the efficacy and outcomes of skin traction in the treatment of phalangeal fractures in comparison with surgical management. It also aims to define the vectors, force, types of phalangeal fracture, and degree of displacement that skin traction can improve. Method: A retrospective cohort trial is currently underway reviewing outcomes of 103 skin traction cases involving phalangeal and metacarpal fractures performed at the Nepean Hospital in New South Wales over a 3-year period and comparing these to surgical cases. Outcome measures being utilized include total active movement (TAM), grip strength, pain levels, and patient rated wrist and hand evaluation (PRWHE) scores. Radiological analysis is also being undertaken with the intention of developing an algorithm to match the type of fracture with recommended treatment method. We are currently in the process of collecting surgical group data and expect to be able to present this by the time of conference meeting. Results: Preliminary results according to Belsky’s criteria indicate an average of 227.50 total active motion for 54 phalangeal finger fractures treated with the technique. The results were excellent for 37 cases, good for 14 cases, and poor for 3 cases. Grip strength averaged 32.3 kg for the affected limb (99.3% of the non-affected limb). Gingrass criteria for thumb phalangeal outcomes in 6 cases showed average 82.2° TAM for five (5) cases. Excellent outcomes were achieved in 3 cases, and good outcomes were achieved in 2 cases. Pinch strength averaged 4.25 kg and was 79.7% of the non-affected thumb. Conclusion: Skin traction may provide a cost-effective and clinically effective tool for the management of phalangeal fractures.

The "Fish Hook" Technique for Bony Mallet Finger.

This study describes a new technique called the "fish hook" technique for the treatment of bony mallet finger. This technique catches the dorsal fragment with a bent K-wire shaped like a fish hook. Transarticular fixation is performed with another K-wire. This technique does not directly penetrate the bone fragment to prevent fragment comminution. This study included 26 patients with mallet finger fractures who underwent surgery using the fish hook technique between 2010 and 2014. The fractures were classified according to the method of Wehbe and Schneider. The fracture fragment was fixed with a fish hook technique in all patients. The K-wire was removed after 6 weeks, when bone union was achieved. Clinical parameters, including range of motion and extensor lag, were assessed at the distal interphalangeal joint according to Crawford's criteria. The mean follow-up period was 12.8 months. Mean extensor lag was 3°, and mean range of flexion of the distal interphalangeal joint was 76°. All patients achieved bone union after 6 weeks. According to Crawford's criteria, there were 20 excellent results, 5 good results, and 1 fair result. No complications, including skin necrosis, pin loosening, and nail deformity, occurred. The fish hook technique is an effective treatment option for bony mallet finger and provides good clinical and radiologic results. [Orthopedics.2016; 39(5):295-298.].

ANALIZA WSKAZAŃ DO I OCENA WYNIKÓW PO WTÓRNYCH OPERACJACH PO PIERWOTNYM ZAOPATRZENIU URAZÓW W OBRĘBIE KOŃCZYNY GÓRNEJ

The objective of the study was the analysis of the indications for, and assessment of the outcomes of secondary interventions after primary repair of injuries within the upper limb in the authors' institution--Department of General and Hand Surgery of the Pomeranian Medical University in Szczecin (a tertiary care unit). Answers on questionnaires (including DASH) mailed to 33 patients were the subject of the analysis. The group consisted of 27 men and 6 women, mean age 36 years, in whom secondary interventions were performed at a mean of 8 months after primary surgery. Injuries were grouped in five categories: tendon lacerations, hand or finger amputations, nerve sections, complex tissue injuries, and isolated finger fractures. The most common cause of secondary intervention was incomplete finger movement and lack of opposition of the thumb. The most common operations included tenolysis, arthrolysis and opponensplasty. The outcomes of secondary surgery from patients' perspective were overall good: 13 (39%) patients reported significant improvement, 16 (48%) moderate, and only 4 (13%) patients had no benefit. Twenty-five patients regained full, or almost full hand function (DASH scores 2-39), and 8 (24%) had moderately to severely impaired function (DASH 40-80). Twenty-eight patients returned to work. Primary repair of upper limb injuries (even severe) in the tertiary institution was adequate, and secondary interventions rarely necessary. The most common indication was incomplete finger movement caused by ineffective postoperative mobilization. The important role of rehabilitation for the final outcome of the treatment of hand injuries was emphasized.

Epidemiology of Pediatric Fractures Presenting to Emergency Departments in the United States.

Fractures in children are an important public health issue and a frequent cause of emergency room visits. The purpose of this descriptive epidemiological study was to identify the most frequent pediatric fractures per 1000 population at risk in the United States using the 2010 National Electronic Injury Surveillance System (NEISS) database and 2010 US Census information. The NEISS database was queried for all fractures in 2010 in children between the ages of 0 and 19 years. The NEISS national estimates were compared with the 2010 US Census data to extrapolate national occurrence rates. The annual occurrence of fractures increased from ages 0 to 14, peaking in the 10 to 14 age range (15.23 per 1000 children). The annual occurrence rate for the entire pediatric population (0 to 19 y) was 9.47 per 1000 children. Fractures of the lower arm (forearm) were the most common among the entire study population, accounting for 17.8% of all fractures, whereas finger and wrist fractures were the second and third most common, respectively. Finger and hand fractures were most common for age groups 10 to 14 and 15 to 19 years, respectively. The overall risk of a fracture occurring throughout childhood and adolescence was 180 per 1000 children, or just under 1 in every 5 children. Pediatric fractures represent a significant proportion of pediatric emergency department visits in the United States. Children between 10 and 14 years of age have the highest risk of having fractures. Overall, forearm fractures were the most common pediatric fractures. Most pediatric fractures can be treated on outpatient basis, with only 1 of 18 fractures requiring hospitalization or observation. Level III-Retrospective comparative study.

Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients

ObjectivesTo evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. MethodsTwenty-five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow-up was 18 months. ResultsThe results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty-one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). ConclusionSurgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

Abstract P150: Dietary Patterns and Fractures in Postmenopausal Women: Results From the Women’s Health Initiative Observational Study

Objective: To determine whether adherence to dietary patterns assessed by the alternative Mediterranean diet score (aMED), the Healthy Eating Index (HEI) 2010, the Alternate Healthy Eating Index (AHEI) 2010 or the Dietary Approach to Stop Hypertension (DASH) diet score is associated with hip or total fractures in postmenopausal women. Methods: The Women’s Health Initiative Observational Study (WHI-OS) prospectively followed 90,014 postmenopausal women. Food frequency questionnaires were used to assess adherence to established healthy eating patterns at baseline. Incident total and hip fractures were queried annually. We excluded toe, finger, sternum and clavicle fractures as total fracture events since these fractures are less likely related to osteoporosis. Associations of first incident fractures with dietary patterns were estimated using covariate-adjusted Cox proportional hazards models. Results: During a median follow-up of 15.9 years, we documented 2,121 hip fractures and 28,718 self-reported total fractures. In multivariable analyses, adhering to aMED was associated with a lower risk for hip fractures (HR Q5 = 0.80, 95% CI, 0.66, 0.97; p trend = 0.02) but not for total fractures (HR Q5 = 1.01, 95% CI, 0.95, 1.07; p trend = 0.77). Greater adherence to HEI-2010 or DASH was inversely related to hip fracture risk (p trend = 0.02 and 0.03, respectively) but not to total fracture risk (p trend = 0.15 and 0.47, respectively). The AHEI-2010 was not associated with total or hip fractures. Conclusions: Higher aMED, HEI-2010 or DASH dietary scoring was associated with lower risk for hip fractures. These results support that following a healthy dietary pattern is one cornerstone to maintain bone health in postmenopausal women. Table. Hazard Ratios (95% CI) for hip fractures and total fractures by quintiles of dietary pattern in the Women’s Health Initiative Observational Study 1 *Model 1 adjusted for age, race/ethnicity and body mass index. ** Model 2 model adjusted for age, race/ethnicity, body mass index, smoking status, physical activity, self-reported health, diabetes status, history of fracture at age ≥ 55, physical function score, number of chronic medical conditions, number of psychoactive medications and use of HT, bisphosphonates, calcitonin and SERM. 1 AHEI-2010, Alternative Healthy Eating Index[[Unable to Display Character: &amp;#8211;]]2010; aMED, alternate Mediterranean Diet; DASH, Dietary Approaches to Stop Hypertension; HEI-2010, Healthy Eating Index[[Unable to Display Character: &amp;#8211;]]2010; MCI, Mild Cognitive Impairment; PD, Probable Dementia. Quintile 1 (Q1) represents the least healthy quintile, whereas quintile 5 (Q5) represents the healthiest quintile.

Clinical Research is Challenging: Commentary on “Factors Related to Distal Interphalangeal Joint Extension Loss After Extension Block Pinning of Mallet Finger Fractures”

Clinical Research is Challenging: Commentary on “Factors Related to Distal Interphalangeal Joint Extension Loss After Extension Block Pinning of Mallet Finger Fractures”

ASSESSMENT OF FRACTURES RISK USING THE FRAX® TOOL (A TEN-YEAR RETROSPECTIVE STUDY)

Актуальность. Использование российской модели FRAX® для решения вопроса о назначении антиостеопоротического лечения актуально для нашей страны. Однако на сегодняшний день нет данных, подтверждающих ее высокую прогностическую ценность для широкой клинической практики. Цель исследования – оценить чувствительность и специфичность российской модели FRAX® у женщин в возрасте 50 лет и старше. Материал и методы. В пилотное исследование включены 117 женщин в возрасте от 50 до 79 лет (средний возраст 64±7,1 года), обследованных в 2003 г. в ФГБУ «Научно-исследовательский институт ревматологии» РАМН, на которых ретроспективно был заполнен вопросник FRAX® для определения десятилетнего абсолютного риска переломов. Риск основных остеопоротических переломов оценивался в соответствии с порогом терапевтического вмешательства, предложенным Российской ассоциацией по остеопорозу в 2012 г., с учетом и без учета минеральной плотности кости (МПК). В 2013 г. проведен телефонный опрос для регистрации возможных переломов за прошедший десятилетний период. Результаты. За исследуемый период переломы при минимальном уровне травмы произошли у 67 (57%) женщин (переломы пальцев рук, ног и костей черепа не учитывались). Средний показатель FRAX® для основных остеопоротических переломов без учета МПК у лиц с вновь случившимися переломами был выше, чем у пациенток без таковых (p=0,005), а средние значения FRAX® для переломов бедра в этих группах статистически не различались. Аналогичные данные были получены и при включении в модель показателей МПК шейки бедра. Значения FRAX® без учета МПК выше порога терапевтического вмешательства были выявлены у 41 (35%) женщины. Достоверных различий по частоте встречаемости высокого показателя FRAX®, как для основных остеопоротических переломов, так и только для переломов бедра, среди пациенток с новыми переломами и без таковых не было. Чувствительность российской модели FRAX® без учета показателей МПК для основных остеопоротических переломов составила 42%, а специфичность – 74%. С учетом показателей МПК шейки бедра чувствительность алгоритма FRAX® для основных остеопоротических переломов уменьшилась до 28%, а специфичность увеличилась до 84%. Наличие переломов в анамнезе увеличивало риск последующих в 2,7 раза (отношение шансов (ОШ) 2,74 [95% доверительный интервал (ДИ) 1,21-6,28], p=0,02), независимо от показателя FRAX®. При значении FRAX® выше порога терапевтического вмешательства и ранее перенесенных переломах риск новых переломов увеличивался в 10,8 раза (ОШ 10,78 [95% ДИ 2,48-55,97], p=0,0001). Курение, ранняя менопауза, перелом бедра у родителей в сочетании с высоким значением FRAX® не увеличивали дополнительно риск новых переломов. Заключение. Полученные нами предварительные данные указывают на низкую чувствительность и специфичность настоящей версии порога терапевтического вмешательства в российской модели FRAX® для основных остеопоротических переломов, что требует проведения дальнейших эпидемиологических исследований для ее коррекции.

Osteossíntese do dedo em martelo com placa e parafuso: avaliação de 25 pacientes

ObjectivesTo evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. MethodsTwenty‐five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow‐up was 18 months. ResultsThe results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty‐one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). ConclusionSurgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

Accuracy of bedside ultrasonography for the diagnosis of finger fractures

ObjectiveDiagnosis of bone fractures by ultrasonography is becoming increasingly popular in emergency medicine practice. We aimed to determine the diagnostic sensitivity and specificity of point-of-care ultrasonography (PoCUS) compared with plain radiographs in proximal and middle phalanx fractures. MethodsBetween August 2012 and July 2013, adult patients presenting to our emergency department with a possible (by clinical evaluation) proximal or middle phalanx fracture of finger were invited to participate in this prospective cohort study. From those granting consent to participate, anteroposterior and lateral radiographs were obtained. PoCUS was then performed by emergency physicians blinded to the radiograph results. The criterion standard test for diagnosis was radiograph interpretation by an orthopedic surgeon blinded to the ultrasonographic findings. ResultsDuring the study period, 212 patients with an injury to the proximal or middle phalanx presented to the emergency department. Of these, 93 patients met exclusion criteria; thus, data were analyzed from the remaining 119 patients. Fracture prevalence was 24.3%. Diagnostic sensitivity of PoCUS was 79.3% (95% confidence interval [CI], 59.7%-91.2%), specificity was 90% (95% CI, 81.4%-95.0%), positive predictive value was 71.8% (95% CI, 53.0%-85.6%), negative predictive value was 93.1% (95% CI, 85.0%-97.1%), positive likelihood ratio was 7.93 (95% CI, 4.15-15), and negative likelihood ratio was 0.23 (95% CI, 0.11-0.47). ConclusionEmergency physician–performed PoCUS was moderately sensitive and specific for diagnosing proximal and middle phalanx fractures.

Factors Related to Distal Interphalangeal Joint Extension Loss After Extension Block Pinning of Mallet Finger Fractures

To identify factors related to postoperative extension loss when treating mallet finger fractures with extension block pinning. We reviewed 31 consecutive patients with a mallet finger fracture treated with extension block pinning. We measured range of motion of the distal interphalangeal (DIP) joint including extension lag. We investigated the injury mechanism and checked radiographic factors such as DIP joint subluxation, fixation angle, fragment size index, fracture angle, and amount of articular involvement. We performed statistical analyses such as correlation analysis, multiple regression analysis, and independent t test to investigate factors related to postoperative extension loss. Mean voluntary extension loss at final follow-up was 5° (range, 0° to 20°) and mean active flexion of the DIP joint was 84° (range, 75° to 90°). Sixteen patients had a forceful flexion injury and 15 had a simple blow injury. Fixation angle was not associated with postoperative extension loss. Postoperative extension loss increased significantly in the forceful flexion group compared with that in the simple blow injury group. Fragment size index, fracture angle, and amount of articular involvement decreased significantly in the forceful flexion group compared with that in the simple blow injury group and were negatively linearly correlated with postoperative extension loss. Multiple regression analysis showed that sex and injury mechanism affected postoperative extension loss. Sex, injury mechanism, fragment size index, fracture angle, and amount of articular involvement should be considered to anticipate postoperative extension loss even though mallet finger fractures were successfully reduced and healed using extension block pinning. Therapeutic III.