Mean QuickDASH Score Research Articles

Return to Sport After Conservative Management of Midshaft Clavicle Fractures in Professional Jockeys.

This study explores the functional recovery and rates return to play (RTP) of professional jockeys following midshaft clavicle fractures, which have been managed conservatively. The high incidence of these fractures in horse racing underscores the importance of evaluating nonsurgical recovery paths for effective RTP. We used a retrospective cohort study to assess treatment outcomes. The research is set in the professional horse racing scene of Ireland. Sixteen professional Irish jockeys with conservatively managed midshaft clavicular fractures were examined. Jockeys who underwent surgery or were inactive at injury time were excluded. The study involved no direct interventions. Recovery was assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and Patient-Reported Outcome Measures, alongside racing records to track RTP. The all-male cohort had an average age of 27 years. Results showed an average 67.1-day absence from racing, with 94% returning to preinjury competition levels. Complications were minimal, and patient outcomes were positive, as indicated by a mean QuickDASH score of 2.58, suggesting minimal residual disability. Findings highlight the success of conservative management for midshaft clavicle fractures in professional jockeys, enabling them to return to prior competitive levels with few complications and excellent functional recovery.

The association between ultrasonographic findings and pain, physical function, and symptoms in patients with shoulder pain.

Shoulder ultrasonography (US) is commonly employed to differentiate the causes of shoulder pain. However, the correlation between ultrasonographic findings and the individual's functional disability and daily activities remains unexplored. To investigate the relationship between shoulder US findings and physical function, disability, and pain. The study investigated patients with shoulder pain. Tendons of supraspinatus, infraspinatus, subscapularis, and long head of biceps brachii, acromiohumeral distance, and acromioclavicular joint (ACJ) degeneration were evaluated using US. The QuickDASH questionnaire was employed to evaluate physical function, symptoms, and disability, while the visual analog scale (VAS) was utilized to assess pain levels. The study included 84 patients (69 [82.1%] women, mean age = 55.7 ± 11.9 years). Ultrasonographic examination revealed ACJ degeneration in 61 (21.4%) patients and biceps tendinitis in 21 (25%) patients. In addition, supraspinatus tendinosis was identified in 51 (61%) patients, while 28 (33%) exhibited a supraspinatus tear. The patients demonstrated a mean VAS score of 7.03 ± 1.49 and mean QuickDASH score of 45.6 ± 15.3. Individuals with a supraspinatus tear exhibited higher VAS (P = 0.008) and QuickDASH (P = 0.016) scores. Patients presenting with ACJ degeneration demonstrated increased VAS scores (P = 0.014), whereas those with biceps tendinopathy showed higher QuickDASH scores (P = 0.035). The results obtained from our research demonstrate significant correlations between ultrasonographic data and pain, disability, and physical manifestations. The findings of this study indicate that shoulder US provides valuable information regarding the difficulties individuals face in their daily tasks and the degree of pain they endure.

Outcomes of wrist denervation and core decompression of the radius for Kienbock's disease

BackgroundThe definitive treatment of Kienbock's disease has yet to be determined. Wrist denervation combined with core decompression of the radius has not been previously studied as a combined treatment for Kienbock's disease. PurposeThe purpose of this study was to assess the efficacy of simultaneous wrist denervation and core decompression of the radius in the treatment of Kienbock's disease. MethodsAll patients with Kienbock's disease who were treated with simultaneous core decompression of the radius and wrist denervation by a single surgeon at a single institution from 2012 to 2022 were contacted for this study. Demographic, clinical and radiographic data were collected retrospectively. Quick DASH and Upper Extremity PROMIS scores were collected prospectively. ResultsTen patients met inclusion criteria. Mean age at time of surgery was 31 years old. One patient was Lichtman stage 2, 5 patients were stage 3a, and 4 patients were stage 3 b. Patient reported outcomes were collected at a mean of 5.1 years since surgery (7 month-10.3 years). The mean Upper Extremity Promise T-score was 49 (median 52; age >/ = 40, normal 51.2 ± 8.2; age <40, normal 55.9 ± 6.6) and the mean Quick DASH score was 13 (median 7; normal 0–20). Nine of 10 patients reported they were satisfied with the procedure, and 100 % of patients said they would choose to have the procedure again. ConclusionsPatients with Lichtman stage 2, 3a and 3 b Kienbock's disease treated with simultaneous core decompression and wrist denervation reported minimal to no disability at 5 years after surgery. All patients in this study reported they would choose to have the surgery again to treat their Kienbock's disease.

Long Term Effects Of Covid-19 Pandemic On Management And Outcomes Of Distal Radius Fractures

Purpose: The purpose of this study was to assess the long-term effects of conservative orthopaedic practice during Covid-19 pandemic on management and long-term outcomes. Methods: Current longitudinal retrospective cohort study included patients at a single tertiary care center in India. Successive distal radius fractures of patients in pre-COVID (2018-19), COVID (2020-21) and postCOVID (2022-23) time period groups were treated and analysed. The primary outcome was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and secondary outcomes included wrist range of motion, grip strength and pain. Cohort findings were compared employing Repeated-measures analysis of variance. Results: In pre-COVID group 97(82.4%) patients presented within 3 days of injury which significantly declined to 48(49%) in COVID and 94(71.2%) in post-COVID group. There was a significant reduction in admissions for inpatient care (p&lt;0.05). The mean QuickDASH score at 1 year follow-up was 7.2(8.6) in COVID group that was clinically better than pre-COVID [8.5(9.2)] and post-COVID [9.7 (12.4)] cohorts. The number of reoperations or secondary surgeries required were significantly lower in the COVID group [1 (1%) patient]. Conclusions: COVID-19 pandemic had minimal long-term effects on results of distal radius fractures as the conservative treatment approach utilised was realistic and beneficial to patients as well as to the treating surgeons. Timely corrections of arising early treatment complications through efficient virtual clinics/telemedicine kept the prevalence of major late complications minimal. Comparatively minimal complications and prompt recovery were seen in patients being operated by percutaneous Kirschner wires fixation. Categories: Infectious Disease, Orthopaedics, Trauma

Effectiveness of Platelet-rich Plasma Injection as an Adjunct Treatment to Arthroscopy for TFCC Injury: A Retrospective Cohort Study.

Triangular fibrocartilage complex (TFCC) injuries can cause significant patient dysfunction. Platelet-rich plasma (PRP) has emerged as a potential adjunctive treatment for arthroscopic TFCC repair, with some studies suggesting improved outcomes. This study aims to evaluate and compare PRP as an adjunctive treatment in arthroscopic TFCC tear repair. This retrospective cohort study examined patients undergoing arthroscopic TFCC repair at Institut de la Main, Paris, France (December 2021-2022). Patients were split into two groups: arthroscopic repair alone (1) and repair with PRP injections (2). Physical examinations were conducted pre- and posttreatment, recording flexion, extension, and radial/ulnar deviation of the affected and contralateral wrists. A total of 33 patients (20 men and 13 women) with a mean age of 30.55 ± 9.17 years were included. PRP injections were given to 16 patients with arthroscopic TFCC repair; 17 had repair only. No significant differences existed preoperatively between groups in wrist function or pain (P > 0.05). The Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score differed significantly (P = 0.004). The non-PRP group demonstrated better postoperative upper extremity function, with a mean Quick DASH score of 7.75 ± 5.91 compared with 12.64 ± 6.79 in the PRP group. No significant difference between groups was observed in the pain visual analog scale (P > 0.05). PRP injections with TFCC repair did not improve function over repair alone. The non-PRP group showed better function (lower Quick DASH scores). Pain reduction was similar between groups. Larger trials and cost-effectiveness studies are needed to fully assess PRP's benefits in TFCC repair.

The recovery and independence of elbow flexion and forearm supination after Oberlin II transfer in brachial plexus injuries: a long term follows up study.

The Oberlin II double fascicular nerve transfer has been evaluated extensively for objective outcomes for elbow flexion in brachial plexus injuries (BPI). However, there is limited information available on the recovery pattern of supination and patient-reported activity in the long-term. Our study aimed to assess the functional results with a minimum of five years of follow-up. We evaluated patients with a minimum of five years after the Oberlin II procedure for post-traumatic BPI. They were evaluated using MRC grading, range of active movements, QuickDASH score and activity to check elbow flexion and forearm supination independent of finger and wrist flexion. 18 out of 26 patients responded with a mean follow-up of 79.4months (range: 61-98). 16 (88.9%) (p < 0.000) patients recovered to achieve active elbow flexion and forearm supination of either MRC grade 3 power or more. The average range of active elbow flexion was 113.9° (range: 0-140°) and active supination was 67.8° (0-90°). Patients who achieved grade 3 flexion or higher were found to regain supination after a delay. The recovery continues even after two years of surgery. The mean QuickDASH score was 21.8 (range: 2.3-63.6). There's a significant inverse correlation between QuickDASH with both flexion and supination (p < .001 and < 0.05). 15 patients (83.3%) could demonstrate a dissociation of elbow and forearm movements from digital and wrist movements. Our study demonstrated reliable functional results with independent elbow flexion, forearm supination and acceptable patient-reported outcomes for Oberlin II procedure in BPI.

Long-term results of the Malingue technique in the surgical treatment of Dupuytren's disease

ObjectivesThe choice of surgical technique for aponeurectomy in Dupuytren’s disease is controversial due to varying outcomes and complication rates. The Malingue plasty has shown mathematical and mechanical advantages, but long-term efficacy and results compared to other techniques have never been reported.This study aimed to evaluate the long-term functional, esthetic and recurrence outcomes of Malingue plasty in Dupuytren's disease. Material and methodsThe study included patients who underwent aponeurectomy with Malingue plasty performed by a highly experienced surgeon between January 2014 and December 2016, with a minimum follow-up of 5 years. Preoperative records were analyzed. At follow-up, extension lag was analyzed in each joint (metacarpophalangeal, proximal interphalangeal and distal interphalangeal) in each operated finger, as well as signs of recurrence or extension of the disease. Function and esthetics were assessed using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) questionnaire and the Michigan Hand Outcomes Questionnaire. ResultsOut of 107 eligible patients, 55 were included in the study after exclusions and loss to follow-up. Three patients required revision surgery for recurrence during follow-up. All preoperative deformities of the proximal interphalangeal and metacarpophalangeal joints were corrected postoperatively, and no intraoperative or postoperative complications occurred. Mean extension deficit at follow-up was 18.1 °. Only the little finger showed significant loss of correction (p = 0.02). Mean QuickDASH score was 13.2 and the overall Michigan Hand Outcomes Questionnaire score was 91.8%. Recurrence affected 50% of patients according to the Leclercq criteria and 27.5% according to the Felici criteria. ConclusionAlthough Malingue plasty did not improve the recurrence rate in Dupuytren's disease compared with other techniques, its advantages in terms of functional improvement and complications make it an interesting surgical option.

Surgical management and functional outcomes of perilunate dislocations and fracture dislocations through the dorsal approach.

Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6weeks, 12weeks, 6months, 1year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. Retrospective case series study.

Displaced proximal humeral fractures in skeletally immature patients: functional outcomes of surgical treatment.

To report the functional results of our experience and to describe intraoperative findings and complications due to the techniques used in our service. From January 2018 to December 2022, 27 Pediatric patients aged from 8 to 16years underwent surgery to treat proximal humerus fractures. Their demographic characteristics were evaluated, as well as their clinical characteristics on admission, type of reduction (closed/open), presence of interposition in open reductions, type of implant, complications, and functional range of movement according to two shoulder functional scores. Mean age was 11.2years (8-15), there was a predominance of males, who accounted for 70% of the cases, and sports accidents were the cause of injury in 44% of the cases. Anatomical location was balanced between patients, including 55% of physeal fractures and 45% of metaphyseal ones. Overall, 81.5% of patients required open reduction to achieve axis correction, and that 55.5% of fractures were fixed with Kirschner wires, and 44, 4% with elastic titanium nails. Mean QuickDASH score was 0.58 (0-1.7), and Constant score was 9 (3-24). There were no major complications, but 27% of cases subjected to open reduction presented a hypertrophic scar. Surgical treatment of severely displaced proximal humerus fractures is successful, both with closed and open reduction; type of implant does not play a key role and should be selected based on the characteristics of each case. Surgical training should prevail at the time of decision-making. When these recommendations are followed, results can be excellent and sequelae are infrequent.

Long-terms outcomes of radial head arthroplasty using a bipolar prosthesis.

In acute treatment of radial head fractures, a radial head prosthesis can be considered if open reduction and internal fixation are not technically feasible. We reviewed the data of 27 consecutive bipolar Judet radial head prostheses implanted in patients with unreconstructable radial head fractures and no other concomitant fractures (coronoid or olecranon factures). The lesions of the lateral collateral ligament were rated according to the McKee classification. Twenty-three patients with more than ten-year follow-up participated in this retrospective study All patients underwent assessments for pain, range of motion and stability using the Mayo Elbow Performance Score, the QuickDash questionnaire and a Visual Analogue Scale for pain. Radiography assessment was performed to determine the correct setting of the implant, presence of periprosthetic loosening, prosthetic disassembly, heterotopic ossification, capitellum and ulnohumeral degenerative changes. Mean follow-up was 149 months (± 12.2). Mean range of motion in flexion-extension was 111° (± 10.55), mean extension was 18° (± 14.32) and mean flexion was 130° (± 11.4). Mean arc of motion in supination-pronation was 150° (± 12.26). The mean Mayo Elbow Performance Score was 88, the mean QuickDash score was 7.3; 86% of the patients were satisfied. Seven patients (26%) required secondary surgery. The most frequent complication was heterotopic ossification, which had negative consequences on the functional result. Bipolar radial head prostheses are an option for acute treatment of isolated unreconstructable radial head fractures. During follow-up, three patients required implant revision and removal; the capitellum surface presented severe degenerative changes and the prosthesis was not replaced. Another complication was the risk of implant dislocation, in relation to implant design, incorrect positioning of the radial head stem or else to inadequate reconstruction of the lateral collateral ligament. Further work is needed to establish the long-term follow-up results of Judet implants in complex elbow fractures.

Hydrothermal ablation in recurrent or chronic olecranon bursitis: a prospective study

Olecranon bursitis can be difficult to treat, resulting in persistent or recurrent symptoms. Bursectomy is a frequently applied treatment option for refractory cases but has high complication rates. This is the first invivo study to investigate the safety and efficacy of hydrothermal ablation, a new treatment modality for recurrent or chronic olecranon bursitis that aims to cause thermal obliteration of the bursal lining by irrigation with heated saline. First, a pilot animal trial was set up to determine a safe irrigation temperature window. Second, in a human trial the bursae of patients with chronic, recurrent, or refractory olecranon bursitis were irrigated with a 3-mL/s flow of physiological saline for a duration of 180 seconds at temperatures between 50°C and 52°C. Patients were followed up for 6 months, allowing for assessment of the surgical site to screen for adverse events, volumetric ultrasonographic assessment of the bursae, and collection of the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Patient Global Impression Score, and Clinical Global Impression Score, as well as data on return to activities or work. Twenty-four elbows were prospectively included and underwent a full cycle of hydrothermal ablation. The mean age was 58.4 years (range 40.5-81.5), including 20 male and 4 female patients. None had clinical signs of septic bursitis. Bursal fluid cultures were positive in only 1 case. The average preoperative bursal volume was 11.18 mL (range 4.13-30.75). Eighteen of 24 elbows (75%) were successfully treated, showing a complete remission of symptoms or decided improvement within 6 weeks and without any signs of recurrence during the entire follow-up period of 6 months. The average reduction of ultrasonography-measured bursal volume was 91.9% in the group of patients who responded to treatment. In patients without recurrence, the mean QuickDASH scores before and after treatment were 13.6 (range 0-50) and 3.1 (range 0-27.5), respectively, showing a statistically significant improvement. All patients were able to fully return to work within 6 weeks after the index procedure. No serious adverse events were encountered. Moderate local adverse events were found in 2 patients. Increasing temperatures of irrigation did not result in a higher treatment efficacy. Hydrothermal ablation at temperatures between 50°C and 52°C is a safe treatment option for recurrent or chronic olecranon bursitis with fewer complications than open bursectomy and a comparable efficacy.

Consolidation rate in ulnar shortening osteotomy with the APTUS Wrist plate

IntroductionUlnocarpal impaction syndrome causes pain on the ulnar side of the wrist. Various surgical techniques have been described. Ulnar shortening osteotomy is now a standard treatment. However, it is associated with complications such as non-union of the osteotomy site.The main study objective was to report the rate of radiographic consolidation after ulnar shortening osteotomy with a cutting guide. Material and methodsThis multicenter retrospective study of 30 cases reported clinical and radiographic criteria at a minimum 6 month’s follow-up. ResultsThe non-union rate was 3.4%. One case presented non-union of the osteotomy site. 87% of patients were satisfied or very satisfied with the procedure. Mean VAS pain rating was 2.7 ± 2.4. Mean QuickDASH and PRWE scores were 24.7 ± 19.2 and 28.6 ± 25. Mean strength on Jamar dynamometer was 27.4 ± 8.9 kg. One patient developed complex regional pain syndrome. Five patients required plate removal for hardware-related discomfort. DiscussionUlna shortening osteotomy with the Aptus Wrist plate provides a standardized approach to the surgical treatment of ulnocarpal impaction syndrome. Compared with other series in the literature, the procedure provided satisfactory consolidation and clinical results.

Simple trapeziectomy for thumb basal joint arthrosis. Forty-four thumbs re-reviewed after 7.5 years

BackgroundDue to favorable results in the literature we changed our standard procedure in 2010 from trapeziectomy with LRTI to simple trapeziectomy for thumb basal joint arthrosis. A review of 49 operated hands after two years showed good results, similar to those we had obtained after LRTI. ObjectiveWe have now re-reviewed these patients to see if the good results persist over time. MethodsAll patients from the earlier study were contacted and 40 patients with 44 operated thumbs were re-reviewed after a mean of 7.5 years. ResultsThe mean pain score (0–100) was 14 (SD:22) compared to 18 (25) at the earlier review. There was no significant change in ability to perform ADL activities between reviews. Mean VAS (0–100) for clumsiness fell significantly between early and late review (67 (SD:18) versus 45(27); p ​< ​0.019), although clumsiness was reported by an increased number of patients. VAS for general satisfaction had improved from 23 (SD:28) to 13 (22) between reviews (p ​< ​0.01). The mean QuickDASH and PRWHE scores were practically unchanged. There was significantly improved thumb abduction and ulnar/radial deviation at the wrist. There was a significant reduction in power grip and key pinch in both the operated and the contralateral un-operated hands compared to the earlier review. Radiographs showed a slightly reduced mean distance between the first metacarpal and the scaphoid. ConclusionWe conclude that the good results after simple trapeziectomy persist.

Usage of Dermal Regeneration Templates (Pelnac) for Coverage of Exposed Hand Tendons in Acute Setting.

The loss of soft tissue coverage of tendons is a challenging reconstructive problem after acute hand trauma. Subsequent tendon adhesions and the loss of range of movement in addition to the poor aesthetic outcome and donor site scarring should be avoided when deciding the plan of management. Pelnac is one of the commonly used skin substitutes in reconstructive surgery that can be used for coverage of exposed tendons, but the postoperative functional outcome needs to be addressed in detail. Twenty-six patients with acute isolated tendon injuries distal to the wrist joint were included. Two-stage reconstructive procedures were performed; the first one was the application of Pelnac. The second stage was carried out after the complete integration of Pelnac via the application of a split-thickness graft. The function outcome assesses the return of the normal range of motion to the affected hand and the QuickDASH score questionnaire. The aesthetic outcome was assessed using the Vancouver scar scale. The Pelnac was integrated in 100% of cases, with complete grafts taken in 22 of 26 patients. The mean QuickDASH score was 20.5 ± 15.7, and mean Vancouver scar scale was 3.53 ± 3.2. The full range of motion returned in 22 of 26 patients. Using Pelnac to cover the exposed hand tendons in an acute setting is a convenient and efficient procedure with minimal morbidity. It can offer a good option for their coverage with preservation of hand function and acceptable aesthetic outcome.

Outcomes of Surgical Treatment of Vaughan-Jackson Syndrome.

Background Vaughan-Jackson syndrome (VJS) is the attritional rupture of the extensor tendons secondary to arthritis or inflammation affecting the distal radioulnar joint. The surgical outcomes following Darrach's procedure and tendon transfers are not well described. The primary aim of this study was to report patient-reported functional outcome measures after surgery for VJS. Secondary aims were to report health-related quality-of-life scores, patient satisfaction, and complications Methods A single-center retrospective study was performed to identify patients who underwent surgical intervention for the management of VJS. Patient-reported outcomes were measured using the Patient-Rated Wrist and Hand Evaluation (PRWHE), Quick version of the Disability of the Arm, Shoulder, and Hand (QuickDASH), EuroQoL 5-dimensions 5-Likert (EQ-5D-5L), and calculation of the Net Promoter Score (NPS). Results We report postoperative patient-reported functional outcome measures for 12 cases of VJS treated with distal ulna excision and extensor tendon transfer. The mean age was 69 years (range: 45-87 years; standard deviation [SD]: 14.1), and eight patients were females. Five patients had rheumatoid arthritis, and there was one case each of seronegative polyarthritis, ankylosing spondylitis, and CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.) syndrome; the rest of the patients had osteoarthritis. At a mean of 53 months of follow-up, the mean PRWHE score was 34.5 (SD: 17.9), the mean QuickDASH score was 28.2 (SD: 18.6), and the mean EQ-5D-5L score was 0.71 (SD: 0.203). Ten patients were satisfied and the NPS was 42. Postoperatively eight patients had pain scores reported as none or mild, three as moderate, and one as severe. Two patients required further operations, both undergoing total wrist arthrodesis. Conclusion Although a degree of functional deficit persists after Darrach's procedure and tendon transfer for treatment of VJS, there are also high levels of patient satisfaction, a good NPS, and a low rate of operative reintervention. Level IV evidence.

Does simultaneous comminuted fracture of both radial ends represent a distinct fracture pattern?

Although isolated distal radius and radial head fractures are common injuries, simultaneous ipsilateral fractures are uncommon. They can range from simple undisplaced fractures at either end to severely comminuted ipsilateral proximal and distal radial fractures. Few cases have been reported with concomitant comminuted distal radius and radial head fractures, and no treatment guidelines are available. Decisions are often based on personal recommendations. The purpose of our study is to increase awareness of this injury pattern and to discuss the mechanism of injury, treatment approach, and functional outcome. Skeletally mature patients with comminuted simultaneous ipsilateral fractures of the distal and proximal radius from 2016 to 2021 were identified and studied retrospectively. Demographic information, mechanism of injury, treatment approach, and complication rate were analyzed. Radiographic assessment for inadequacy or loss of reduction and radiographic parameters of the distal radius, including radial inclination, radial length, and palmar inclination, was performed immediately postoperatively and at the final follow-up. Clinical outcomes were determined by calculating the Visual Analog Scale (VAS) score, measuring the range of motion in both joints, and using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at the final follow-up. A total of 11 patients met the inclusion criteria. All had ipsilateral Mason III radial head fractures and type C (according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification) intra-articular distal radius fracture. On-table radial head reconstruction and fixation with a proximal radius plate were used for radial head fractures, and osteosynthesis with an anatomic volar locking plate was used for distal radius fractures. The mean follow-up duration was 32 months (range 12-65 months). At the final follow-up, osseous union of both the radial head and distal radius was observed in all patients. The mean VAS score was 1.5 (range 0-7) at rest and 3.9 (range 0-9) with activities, while the mean QuickDASH score was 32 (range 12-65). No significant complications were recorded. Simultaneous comminuted fractures of the ipsilateral distal radius and radial head represent a distinct injury pattern, most likely resulting from high-energy trauma, such as falling from a height onto an outstretched hand. Greater emphasis should be placed on clinical examination and radiological imaging of the elbow in cases of wrist injuries and vice versa. Treatment involving on-table reconstruction of the radial head and open reduction and internal fixation with a volar plate can lead to good radiological and functional outcomes.

Treatment of 5th Metecarpal Neck Fractures with Titanium Elastic Nail Using Local Anesthesia and Hematoma Block

Objective:Surgical treatment of 5th metacarp neck fractures using titanium elastic nail (TEN) is performed under general anesthesia or axillary block. In this study, our aim is to present the clinical and radiological results of patients who underwent surgery under local anesthesia for the TEN entry site and hematoma block for fracture reduction. Methods: There were 14 patients who met the inclusion criteria in the study. Radiologically, metacarpal shortness and volar angulation angles at the time of admission, after reduction in the ER and after surgical intervention when the fusion had been achieved were evaluated. Clinically, rotational deformity, range of motion of the affected finger were evaluated according to Quick DASH scores. Results: The volar angulation before and after reduction in ER was found to be as a mean of 46.2° (33-60°) and 40.6° (30-48°) respectively. After surgical intervention a mean of 17.2° (10-22°) was achived at the final follow-up. The metecarpal shortness was determined to be mean 4.4 mm (1.8-7.3mm) on first presentation, 3 mm (2-5 mm) after reduction in ER, and 2 mm (1.2-3.3mm) at the final follow-up examination in surgically treated group compared to healthy side. Radiological bone union was observed in mean 35 days, there was no pain on palpation, and the TEN was removed. Finger flexion and extension were determined to be full at the end of the 3rd month and no rotational defomity was observed. The mean Quick DASH score of the patients was 1.5 (1.2-2). Conclusion:5. metacarpal fractures with TEN under hematoma blockage and local anesthesia and leaving the proximal end out of the skin is a safe method for the treatment of such fractures.

Relationship between musculoskeletal discomfort and cell phone use among young adults: A cross-sectional survey.

Cell phone usage is highly prevalent among young adults. They are used for multiple purposes including communication, studies, social networking and entertainment. However, its excessive usage has been associated with adverse health outcomes. The objective was to find the association of cell phone usage with musculoskeletal discomfort (MSD) and its associated factors. A cross-sectional study was conducted on young adult students from a low-middle income country over a period of 3 months from December 2018 to February 2019. A structured questionnaire based on the Disabilities of the Arm, Shoulder and Hand (QuickDASH scoring) was used to record the musculoskeletal discomfort. Out of 803 questionnaires, data of 754 (94%) were entered and the remaining questionnaires (n = 49) were discarded due to incomplete answers. The mean age was 20.83 (1.62) years. In our study, there were 194 (25.7%) males and 560 (74.3%) female participants. Neck and shoulder were the most frequently affected regions. A significant difference in QuickDASH score was observed between genders (p-value p ≤ 0.001). Left-handed individuals scored significantly higher on QuickDASH score compared to right-handed individuals (p < 0.05). Increased musculoskeletal discomfort was reported by individuals with daily cell phone use of more than four hours (p < 0.05). A positive significant correlation was found between continuous one hour cell-phone use and higher mean QuickDASH scores (correlation coefficient 0.124, p value 0.001). Shorter eye-to-screen distance was significantly associated with MSD (p < 0.05). Musculoskeletal discomfort is associated with the female gender, duration of cell phone use and a small eye-to-screen distance.

Preliminary Outcomes of Scapholunate Ligament Augmentation with Internal Brace Technique

Injury to the scapholunate (SL) interosseous ligament (SLIL) is a common cause of carpal instability. Internal brace augmentation has been used in various ligament repair procedures; however, further investigation of its outcomes in hand surgery is needed. This study aimed to examine outcomes for patients who underwent SLIL repair with internal brace augmentation. Patients who underwent SLIL repair with the internal brace technique and had at least 1 year of follow-up were contacted. Available patients returned for an in-person evaluation with new radiographs and physical examination. If patients could not be contacted but had x-rays and physical examinations performed at greater than 1 year after surgery, these data were collected from their medical records. Participating patients completed the QuickDASH and Patient-Rated Wrist Evaluation surveys and rated their satisfaction with the surgery. Outcomes assessed included wrist range of motion, grip strength, scaphoid shift test, SL gap, SL angle, and radiographic evidence of radiocarpal arthritis. We collected outcomes for 14 SLIL repairs among 13 patients (12 male). Mean length of the follow-up was 41 months (n= 14, 17-64). Mean QuickDASH and Patient-Rated Wrist Evaluation scores were 6.1 (0-43.2) and 9.6 (0-65), respectively. Radiographic measurements remained stable from immediate to latest follow-up, and no radiocarpal arthritic changes were noted. However, SL gap decreased from a mean of 5.33 mm (3.4-6.7) before surgery to 3.34 mm (2-4.6) at the latest follow-up, and SL angle decreased from a mean of 79.5° (67°-97°) before surgery to 67.3° (51°-85°) at the latest follow-up. All scaphoid shift tests were stable. Therefore, SL internal brace augmentation has favorable short-term results with improvements in pain, function, satisfaction, and carpal alignment at greater than 1 year postoperatively. This technique can be an effective option for the management of SL instability in the short term. Therapeutic IV.

Reverse Wafer Procedure

Abstract Purpose This study aimed to present the results of an alternative technique for treating ulnar impaction syndrome, the “reverse wafer procedure,” and assess the mid-term clinical outcomes of patients treated with this technique. Methods A retrospective evaluation was conducted on 14 patients who underwent the reverse wafer procedure for ulnar impaction syndrome between 2013 and 2020. The inclusion criteria for the study were persistent ulnar-sided wrist pain, even after a minimum of 3 months of nonoperative treatment, the presence of a chondral lesion on the lunate, and an intact triangular fibrocartilage complex (TFCC) based on arthroscopic evaluation. Postoperative clinical and subjective functional outcomes were assessed using measures such as wrist range of motion (ROM), grip strength, the Turkish version of the quick disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), and pain levels measured on a visual analog scale (VAS) and were compared with preoperative values. Patient satisfaction was also evaluated postoperatively. Results The mean follow-up period was 42.2 months (range: 24–68 months). Postoperatively, none of the patients experienced any restriction in ROM. Grip measurements significantly increased after the surgery (p = 0.003). Preoperatively, the patients had a grip strength of 41.14 kg (range 28–48 kg), which improved to 44 kg (range 30–52 kg) postoperatively. Postoperative VAS values and QDASH scores significantly decreased compared with the preoperative values (p &lt; 0.001, p = 0.001). The mean VAS score decreased from 6.1 (range 4–8) preoperatively to 0.9 (range 0–5) postoperatively. The mean Quick DASH score decreased from 49.44 (range 25–68.3) preoperatively to 10.13 (range 3.3–36) postoperatively. When asked about their satisfaction with the operation, 13 out of 14 patients reported being highly satisfied with the results. Conclusions The reverse wafer procedure presents an alternative treatment option for ulnar impaction syndrome in cases where the TFCC is intact. The mid-term results of this described technique are promising. However, further comparative studies with longer follow-ups are necessary to support these findings. Level of Evidence IV Therapeutic.