Patient-Rated Wrist Evaluation Score Research Articles

Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial.

AIMTo compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.METHODSA prospective, randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate (n = 29), or another treatment modality (n = 27; cast immobilisation with or without wires or external fixator). Outcomes were measured at 12 wk. Functional outcome scores measured were the Patient-Rated Wrist Evaluation (PRWE) Score; Disabilities of the Arm, Shoulder and Hand and activities of daily living (ADLs). Clinical outcomes were wrist range of motion and grip strength. Radiographic parameters were volar inclination and ulnar variance.RESULTSPatients in the volar locking plate group had significantly better PRWE scores, ADL scores, grip strength and range of extension at three months compared with the control group. All radiological parameters were significantly better in the volar locking plate group at 3 mo.CONCLUSIONThe present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities. Anatomical reduction was significantly more likely to be preserved in the plating group. Level of evidence: II.

Minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws for repair of distal radius fracture: study protocol for a randomized controlled trial

Background: Conventional open reduction internal fixation and external fixation are not ideal treatment options for distal radius fracture. Minimally invasive surgery for distal radius fracture results in less trauma than other techniques; fully threaded headless cannulated compression screws can increase the stability of fracture fragments and contribute to functional recovery after wrist fracture. In this proposed study, we hypothesize that minimally invasive closed reduction and internal fixation of distal radius fracture with fully threaded headless cannulated compression screws will promote functional recovery of the wrist joint. Methods/Design: In this prospective, randomized, controlled trial, we will recruit 60 outpatients with distal radius fracture from the Department of Orthopedic Surgery, Central Hospital Affiliated to Shenyang Medical College, China. Patients will be assigned to one of two treatment groups: C-arm fluoroscopy-assisted minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws (experimental group) or open reduction (palmar and dorsal incisions) and internal fixation with titanium plate (control group). Internal fixation will be maintained for 24 weeks in both groups. Our primary outcome measures will be X-ray and CT examinations 24 weeks after surgery. Secondary outcome measures include patient-rated wrist evaluation scores, used to evaluate wrist joint function; fracture healing time; and Visual Analogue Scale score, used to evaluate the severity of the patient's pain. Discussion: With this study we hope to confirm that minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws for distal radius fracture repair has advantages over conventional open reduction internal fixation with titanium plates, providing superior fragment stability and allowing for early rehabilitation exercise of the wrist joint, which improves recovery of function. We hope to show that minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws is the more suitable surgical method for repair of distal radius fracture. Trial registration: ClinicalTrial.gov identifier: NCT02784678. Ethics: The study protocol was approved by the Ethics Committee of Central Hospital Affiliated to Shenyang Medical College, China. The trial protocol will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Prior to the trial, patients and their family members will be informed of the risks and benefits of this trial. Signed informed consent will be obtained from each patient.

Arthroscopically assisted mini-invasive management of perilunate dislocations and fracture–dislocations

The purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopically assisted mini-invasive reduction and fixation. Between June 2012 and May 2014, 24 patients who had a dorsal perilunate dislocation or fracture–dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 14.8 months (range, 6–32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo wrist score; Quick Disabilities of the Arm, Shoulder and Hand questionnaire; and Patient-Rated Wrist Evaluation score. Radiographic evaluations included time to scaphoid union, carpal alignments, and any development of arthritis. The range of flexion–extension motion of injured wrist averaged 86% of the values for contralateral wrist. The grip strength of the injured wrist averaged 83% of the values for the contralateral wrists. The mean Quick Disabilities of the Arm, Shoulder and Hand score was 6, and the mean Patient-Rated Wrist Evaluation score was 10. According to the Mayo wrist scores, overall functional outcomes were rated as excellent in 13 patients (54%), good in 6 (25%), fair in 4 (17%), and poor in 1 (4%). Scaphoid nonunion developed in 1 patient. Reduction obtained during the operation was maintained within normal ranges in all patients. Arthritis had not developed in any patient at final follow-up. Arthroscopically assisted mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate injuries according to our early follow-up results. Level IV, therapeutic.

Volar locking plate osteosynthesis for distal radial fractures.

To review the one-year outcome after volar locking plate fixation for distal radial fractures. Records of 22 men and 40 women aged 17 to 86 (mean, 52.5) years who underwent volar locking plate fixation for distal radial fractures were reviewed. According to the Fernandez classification, the distal radial fractures were classified as type 1 (n=20), type 2 (n=24), type 3 (n=6), type 4 (n=6), or type 5 (n=6). Three types of plate were used: Stryker Variax (n=33), Synthes LCP (n=20), and Smith & Nephew Peri-Loc (n=9). Wrist function was assessed at one year using the validated patient-rated wrist evaluation (PRWE) questionnaire. 14 (23%) of the 62 patients had 24 complications: stiffness (n=13), median nerve symptoms (n=4), malunion (n=2), implant removal for persistent pain and stiffness but no improvement shown (n=2), complex regional pain syndrome (n=2), and carpal arthritis (n=1). The complication rates for types 1, 2, 3, 4, and 5 fractures were 20%, 17%, 67%, 0%, and 33%, respectively (p=0.052). The complication rates for low-risk (types 1 and 2) and high-risk (types 3, 4, and 5) fractures were 18% and 33%, respectively (p=0.315). The complication rates for Stryker Variax, Synthes LCP, and Smith & Nephew Peri-Loc were 26%, 20%, and 14%, respectively (p=0.75). At one year, the mean PRWE score was comparable in patients with low-risk or high-risk fractures (14 vs. 19, p=0.5). 79%, 13%, and 8% of the patients recovered >50%, 20-50%, and <20% of range of movement of the contralateral side, respectively. Volar locking plate fixation followed by early rehabilitation for distal radial fractures achieved good outcome, with a low rate of implant-related complications.

Arthroscopic Partial Capitate Resection for Type Ia Avascular Necrosis: A Short-Term Outcome Analysis

To examine short-term clinical results of arthroscopic partial resection for type Ia avascular necrosis of the capitate. Patients who underwent arthroscopic treatment for type 1a avascular necrosis of the capitate with at least 1-year follow-up were identified through a retrospective chart review. The necrotic capitate head was arthroscopically resected with removal of the lunate facet and preservation of the scaphoid and hamate facets. Wrist range of motion, grip strength, and radiographic parameters--carpal height ratio, radioscaphoid angle, and radiolunate angle-were determined before surgery and at the latest follow-up. Patients completed a visual analog scale for pain; Disabilities of the Arm, Shoulder, and Hand measure; and the Patient-Rated Wrist Evaluation score before surgery and at the latest follow-up. Five patients (1 male, 4 females) with a mean age of 34 years (range, 16-49 years) and a mean follow-up duration of 20 months (range, 12-36 months) were identified during the chart review. All were type Ia (Milliez classification). Arthroscopy revealed fibrillation or softening with cartilage detachment at the lunate facet of the capitate head and an intact articular surface at the scaphoid and hamate facet. At the latest follow-up, the mean wrist flexion-extension was 123° (vs 81° before surgery) and grip strength was 74% (vs 37% before surgery). The visual analog scale score for pain; the Disabilities of the Arm, Shoulder, and Hand score; and the Patient-Rated Wrist Evaluation score before surgery showed a significant improvement following treatment. Radiographic parameters did not significantly change at the final follow-up, although the proximal carpal row trended toward flexion. Arthroscopic partial resection of the capitate head was an acceptable treatment for type Ia avascular necrosis of the capitate. It provided adequate pain relief and improved the range of wrist motion and grip strength during short-term follow-up. Therapeutic IV.

Proximal row carpectomy in total arthrodesis of the rheumatoid wrist

BackgroundAdvanced proximal carpal row damage is common in rheumatoid arthritis (RA). Proximal row carpectomy (PRC) simplifies total wrist arthrodesis, obviating the need for an iliac bone graft. In theory, PRC also improves the chances of healing, as fusion of a single joint space is needed for the procedure to be successful. Potential effects of the loss of carpal height related to PRC are unknown. HypothesisWe hypothesised that PRC performed concomitantly with total wrist arthrodesis in patients with RA produces good clinical and radiological outcomes, without inducing loss of strength or digital deformities. Material and methodsIn 38 total arthrodeses of rheumatoid wrists, a clinical evaluation was performed, including a visual analogue scale (VAS) pain score, the Patient-Rated Wrist Evaluation (PRWE), grip strength, digital deformities, and patient satisfaction. A standard radiographic workup was obtained to assess healing and carpal height indices. ResultsAfter a mean follow-up of 50 months, the mean VAS pain score was 0.4 (range: 0–7), the mean PRWE score was 21 (range: 0–80.5), and grip strength as a percentage of the contralateral limb was 76%. The healing rate was 92% (35/38 wrists), and 34 (90%) patients reported being satisfied or very satisfied. No effects of carpal height loss on clinical or radiographic parameters was detected. DiscussionTotal wrist arthrodesis combined with PRC provides reliable and reproducible benefits. This study found no evidence of adverse effects related to the loss of carpal height. Level of evidenceIV, retrospective study.

Three-Corner Arthrodesis With Scaphoid and Triquetrum Excision for Wrist Arthritis

To report the clinical and radiographic results of a consecutive series of patients who underwent the 3-corner arthrodesis (3CA) (arthrodesis of capitate, hamate, and lunate with scaphoid and triquetrum excision) procedure for wrist arthritis. This was a retrospective study of 30 consecutive patients who underwent a 3CA between 1994 and 2008. The indications were painful wrist osteoarthritis due to stage 2 or 3 scapholunate advanced collapse, scaphoid nonunion advanced collapse, or scaphoid chondrocalcinosis advanced collapse wrists. The clinical assessment consisted of range of motion, grip strength, and the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores. The radiographic assessment parameters consisted of bone fusion, carpal height and translation, lunate tilt, and appearance of the radiolunate joint space. The average follow-up was 6 years (± 4 years). The arthrodesis was performed with staples, 2 screws, or a plate and screws. Grip strength was 72% of the contralateral side. The mean range of motion in flexion-extension arc and ulnar-radial deviation arc was 70° and 36°, respectively. The mean Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist Evaluation scores were 17 (± 11) and 22 (± 24), respectively. The fusion incidence was 90% (27 of 30). The mean difference of radiolunate angle on preoperative and postoperative radiographs was 8° (16°-8° in dorsal direction). The radiolunate joint space had narrowed in 1 patient. Six surgical revisions (20%) were necessary owing to dorsal pain in patients operated using plates, staples, or excessively long screws. Three-corner arthrodesis results are comparable with 4-corner arthrodesis and proximal row carpectomy. We feel that it is simpler technically than 4-corner arthrodesis. Although 3CA is more complex than proximal row carpectomy, it preserves the native radiolunate joint. Complications that can be attributed to the dorsal fixation hardware (particularly staples and plates) were noteworthy. Therapeutic IV.

Results of Perilunate Dislocations and Perilunate Fracture Dislocations With a Minimum 15-Year Follow-Up

To evaluate the long-term clinical, functional, and radiological outcomes in 30 patients with at least 15 years of follow-up. We performed a retrospective study that identified 73 patients. Thirty patients agreed to participate and were included. The mean follow-up was 18 years (range, 15-24 years). There were 14 cases of perilunate dislocation and 16 cases of perilunate fracture-dislocation (including 13 transscaphoid perilunate fracture-dislocations). At the last follow-up, the clinical and functional evaluation was based on the range of motion, grip strength, the Mayo wrist score, the Quick Disabilities of the Arm Shoulder and Hand score, and the Patient-Rated Wrist Evaluation score. Radiological abnormalities, according to the Herzberg classification, were 5 type A1 cases, 7 type B, 16 type B1, and 2 type C. The mean flexion-extension arc, radial-ulnar abduction arc, and pronation-supination arc were, respectively, 68%, 67%, and 80%, relative to the contralateral side. The mean grip strength was 70%, relative to the contralateral side. The mean Mayo wrist score was 70, and the mean Quick Disabilities of the Arm Shoulder and Hand and Patient-Rated Wrist Evaluation scores were, respectively, 20 and 21. Five patients had secondary procedure. Six patients had a complex regional pain syndrome type1. Although arthritis occurred in 70% of cases, its clinical and functional impact appeared to be low. However, the 2 lowest Mayo wrist scores corresponded to the patients with the most advanced arthritis. Complex regional pain syndrome appeared to have an impact on long-term outcomes. Therapeutic IV.

The Minimal Clinically Important Difference of the Patient-Rated Wrist Evaluation Score for Patients with Distal Radius Fractures. A prospective cohort study: Level 2 Evidence

The Minimal Clinically Important Difference of the Patient-Rated Wrist Evaluation Score for Patients with Distal Radius Fractures. A prospective cohort study: Level 2 Evidence

Primary Wrist Hemiarthroplasty for Irreparable Distal Radius Fracture in the Independent Elderly.

Background Volar plating for acute distal radius fractures (DRF) in the elderly has been recommended. Some studies have suggested that open reduction with internal fixation (ORIF) in this situation results in frequent complications. Our purposes were to provide a definition of irreparable DRF in independent elderly patients and to review the results of a preliminary retrospective series of wrist hemiarthroplasty (WHA) in this patient population. Materials Between 2011 and 2014, 11 consecutive independent elderly patients (12 wrists) with irreparable intra-articular DRF were treated with primary WHA at the acute stage. A resection of the ulnar head was associated in nine wrists. A total of 11 wrists with more than 2 years of follow-up form the basis of this paper. Description of Technique The approach was dorsal longitudinal. An osteotome longitudinally entered the dorsal aspect of the fracture medial to the Lister tubercle. Two thick osteoperiosteal flaps were elevated radially and ulnarly in a fashion similar to opening a book. The distal radius articular surface was excised. The implant was pressed into the radial canal with attention to restoring distal radius length. The two osteoperiosteal flaps were brought back together and sutured so as to close, again like a book, the osseous and soft tissues around the implant. Results At mean follow-up of 30 months, average visual analog scale (VAS) pain was 1/10. Mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) score was 32, and mean Patient-Rated Wrist Evaluation (PRWE) score was 24. Mean forearm rotation arc was 151°. Mean active flexion-extension arc was 60°. Mean active extension was 34°. Mean grip strength was 14 kg (64% of contralateral wrist). Mean Lyon wrist score was 73%. Bone healing around the implants was satisfactory in all but one case. Conclusions Out data suggest that treatment of irreparable DRF in the independent elderly patient with a bone-preserving WHA may be a viable option. Longer-term follow-up and comparative studies are needed to confirm the validity of this concept.

CORR Insights: The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures.

CORR Insights: The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures.

Ulnar Head Replacement: 21 Cases; Mean Follow-Up, 7.5 Years

To report clinical and radiographic outcomes for the Herbert ulnar head prosthesis after a mean of 7.5 years (range, 2.0-12.5 years). We performed 22 Herbert ulnar head prosthesis arthroplasties between 2000 and 2011. Five were primary procedures, and the remaining 17 were done after an average of 2 (range, 1-5) previous operations. The mean age at surgery was 55 years (range, 31-74 years). Follow-up including clinical examination, standardized questionnaires, and radiographic examination was done after mean 7.5 years (range, 2.0-12.5 years) in 21 cases. We used the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Patient-Rated Wrist Evaluation questionnaire, and the Mayo wrist score questionnaire. Pain and satisfaction were evaluated with a 10-cm visual analog scale (VAS). Measurements of range of motion and strength for grip were recorded. Wrist range of motion was not affected by the arthroplasty except for supination, which significantly improved from 55° to 70°. At follow-up, grip strength averaged 25 kg (range, 10-48 kg) in the operated wrists and 31 kg (range, 8-74 kg) on the contralateral side. Visual analog scale-pain averaged 2.9 (range, 0-8.7) during activity and 1.7 (range, 0-7) at rest. Satisfaction VAS was 8.9 (range, 4.3-10). Five patients had VAS-pain above 5 during activity, and 1 patient was dissatisfied and regretted having undergone arthroplasty. Mean outcomes were 27 (range, 5-50) for Disabilities of the Arm, Shoulder, and Hand measure, 31 (range, 0-90) for the Patient-Rated Wrist Evaluation score, and 71 (range, 30-90) for the Mayo wrist score. One patient was reoperated with capsuloplasty 9 months after the arthroplasty owing to recurrence of painful instability. Full stability was not achieved but the pain resolved. None of the implants showed any radiographic signs of loosening. The Herbert ulnar head prosthesis was a safe method of treatment and provided satisfactory midterm results for selected cases of distal radioulnar joint disorders. Increased knowledge of performance for ulnar head implant arthroplasty may aid surgical decision making for distal radioulnar joint disorders. Therapeutic IV.

Functional Outcomes Following Bridge Plate Fixation for Distal Radius Fractures

To determine the functional outcomes of patients treated with dorsal spanning distraction bridge plate fixation for distal radius fractures. All adult patients at our institution who underwent treatment of a unilateral distal radius fracture using a dorsal bridge plate from 2008 to 2012 were identified retrospectively. Patients were enrolled in clinical follow-up to assess function. Wrist range of motion, grip strength, and extension torque were measured systematically and compared with the contralateral, uninjured wrist. Patients also completed Quick-Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation outcomes questionnaires. Eighteen of 100 eligible patients, with a minimum of 1 year from the time of implant removal, were available for follow-up (mean, 2.7 y). All fracture patterns were comminuted and intra-articular (AO 23.C3). There were significant decreases in wrist flexion (43° vs 58°), extension (46° vs 56°), and ulnar deviation (23° vs 29°) compared with the contralateral uninjured wrist. Grip strength was 86% and extension torque was 78% of the contralateral wrist. Comparison of dominant and nondominant wrist injuries identified nearly complete recovery of grip (95%) and extension (96%) strength of dominant-sided wrist injuries, compared with grip (79%) and extension (65%) strength in those with an injured nondominant wrist. Mean Quick-Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores were 16 and 14, respectively. There were 2 cases of postoperative surgical site pain and no cases of infection, tendonitis, or tendon rupture. Distraction bridge plate fixation for distal radius fractures is safe with minimal complications. Functional outcomes are similar to those published for other treatment methods. Therapeutic IV.

Functional Outcomes of the Aptis-Scheker Distal Radioulnar Joint Replacement in Patients Under 40 Years Old

To study the functional results after Aptis-Scheker distal radioulnar joint (DRUJ) replacement in young patients. We performed a retrospective study selecting all patients under age 40 years, with a clinical and radiological follow-up longer than 2 years, who underwent DRUJ replacement. Patients' charts were reviewed and age at surgery, profession, hobbies, comorbidities, diagnosis, previous procedures, and complications were recorded. Preoperative and postoperative Disabilities of Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores, visual analog scale score, grip strength, lifting capacity, and wrist range of motion were recorded. Functional results and characteristics of the patients were correlated with linear regression. A Kaplan-Meier curve was plotted. We performed 46 arthroplasties. Average patient age was 32 years. Forty-one arthroplasties were performed for pain and 5 for pain and instability. Average follow-up was 61 months. Thirty-seven patients underwent multiple procedures before DRUJ replacement (1.7 ± 1.2 procedures). Extensor carpi ulnaris release with implant coverage using a local adipofascial flap (5) or dermal-fat graft (4) was the most common procedure performed after implantation of the prosthesis. Thirty surgeries were undertaken to address complications after DRUJ replacement in 15 wrists. A total of 36 procedures not related to DRUJ replacement were performed in 15 wrists after the arthroplasty. Grip, lifting, Disabilities of Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores, visual analog scale score, and supination showed statistically significant improvement after surgery. Functional results were comparable in patients who received the implant with either a standard or extended stem. Patient age and number of the previous procedures did not correlate with functional results. The 5-year survival of the implant was 96%. In this group of young patients, the implant improved the functional status of the extremity. The most frequent complication was extensor carpi ulnaris tendonitis, which was addressed by interposition of an adipofascial flap. Therapeutic IV.

Midterm Outcome of Bone-Ligament-Bone Graft and Dorsal Capsulodesis for Chronic Scapholunate Instability

To assess midterm outcomes of our bone-ligament-bone (BLB) grafts for chronic scapholunate (SL) instability and better define criteria for their use. We conducted a retrospective review of 26 patients treated with BLB grafts and dorsal capsulodesis between 1997 and 2009. Twenty-four patients were reviewed. Mean follow-up was 8.2 years. Two patients had dynamic lesions, 7 had SL dissociation, 14 had a dorsal intercalated segment instability lesion, and 1 had SL advanced collapse stage 1. Mean age at surgery was 46 years. All patients presented with pain and 14 had lack of strength. Results were reviewed clinically and radiologically. Images were assessed by 4 surgeons and 1 radiologist for radialstyloid, radioscaphoid, radiolunate, midcarpal, and scaphotrapeziotrapezoid degenerative changes. Five patients needed subsequent 4-corner arthrodesis. Of the remaining 19 patients at follow-up, both extension and flexion decreased to 73% of the contralateral side. Postoperative grip strength improved from 78% to 90% of the nonsurgical wrist. Quick Disabilities of the Arm, Shoulder, and Hand score was 10 of 100 and the Patient-Rated Wrist Evaluation score was 10 of 100. Radiologically, the SL gap was improved and maintained at follow-up. The SL angle (mean before surgery, 79°) was initially corrected to 69° but returned to preoperative values at follow-up. Eleven of the 19 cases had signs of midcarpal arthritis. Bone-ligament-bone grafts with SL dorsal capsulodesis were able to restore and maintain an improved SL interval in all patients. The technique achieved good clinical results and high patient satisfaction, but it did not stop the progression of arthritis, particularly at the midcarpal level. This technique is an option for isolated unrepairable lesion of the dorsal SL ligament with an easily correctable lunate and especially when restoration of grip strength is important. Therapeutic IV.

The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures.

BackgroundThe Patient-rated Wrist Evaluation (PRWE) is a commonly used instrument in upper extremity surgery and in research. However, to recognize a treatment effect expressed as a change in PRWE, it is important to be aware of the minimum clinically important difference (MCID) and the minimum detectable change (MDC). The MCID of an outcome tool like the PRWE is defined as the smallest change in a score that is likely to be appreciated by a patient as an important change, while the MDC is defined as the smallest amount of change that can be detected by an outcome measure. A numerical change in score that is less than the MCID, even when statistically significant, does not represent a true clinically relevant change. To our knowledge, the MCID and MDC of the PRWE have not been determined in patients with distal radius fractures.Questions/PurposesWe asked: (1) What is the MCID of the PRWE score for patients with distal radius fractures? (2) What is the MDC of the PRWE?MethodsOur prospective cohort study included 102 patients with a distal radius fracture and a median age of 59 years (interquartile range [IQR], 48–66 years). All patients completed the PRWE questionnaire during each of two separate visits. At the second visit, patients were asked to indicate the degree of clinical change they appreciated since the previous visit. Accordingly, patients were categorized in two groups: (1) minimally improved or (2) no change. The groups were used to anchor the changes observed in the PRWE score to patients’ perspectives of what was clinically important. We determined the MCID using an anchor-based receiver operator characteristic method. In this context, the change in the PRWE score was considered a diagnostic test, and the anchor (minimally improved or no change as noted by the patients from visit to visit) was the gold standard. The optimal receiver operator characteristic cutoff point calculated with the Youden index reflected the value of the MCID.ResultsIn our study, the MCID of the PRWE was 11.5 points. The area under the curve was 0.54 (95% CI, 0.37–0.70) for the pain subscale and 0.71 (95% CI, 0.57−0.85) for the function subscale. We determined the MDC to be 11.0 points.ConclusionsWe determined the MCID of the PRWE score for patients with distal radius fractures using the anchor-based approach and verified that the MDC of the PRWE was sufficiently small to detect our MCID.Clinical RelevanceWe recommend using an improvement on the PRWE of more than 11.5 points as the smallest clinically relevant difference when evaluating the effects of treatments and when performing sample-size calculations on studies of distal radius fractures.

Erratum to: The effect of local bone mineral density on the rate of mechanical failure after surgical treatment of distal radius fractures: a prospective multicentre cohort study including 249 patients

The aim of this prospective, multicentre study was to evaluate the influence of local bone mineral density (BMD) on the rate of mechanical failure after locking plate fixation of closed distal radius fractures. Between June 2007 and April 2010, 230 women and 19 men with a mean age of 67 years were enrolled. Dual energy X-ray absorptiometry measurements for BMD of the contralateral distal radius were made at 6 weeks post-surgery. Follow-up evaluations at 6 weeks, 3 months and 1 year included wrist mobility and strength as well as standard radiographs. Any local bone/fracture or implant/surgery-related complications were documented. The Disability of the Arm, Shoulder, and Hand (DASH), Patient Rated Wrist Evaluation (PRWE), and EuroQol-5D scores were also recorded at the nominated time points. Nine patients were reported with mechanical failure at an estimated risk of 3.6 %. The BMD measurements were generally low for the study population with no difference between patients with (0.561 g/cm2) and without (0.626 g/cm2) mechanical failure (p = 0.148). None of the patients achieved their pre-injury functional level and quality of life status after 1 year. 1-year DASH and PRWE scores as well as the difference in maximum grip strength of the affected wrist relative to the contralateral side were significantly higher for patients with mechanical failure (p ≤ 0.036). Our study could not identify a clear association between bone mineral density status and the risk of mechanical failure. Although the risk for mechanical failure after treatment of distal radius fractures with palmar locking plates is low, these complications must be avoided to prevent negative impact on long-term patient functional and quality of life outcome.

Arthroscopic treatment of perilunate dislocations and fracture dislocations.

Background The key to a successful result in the treatment of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) is the restoration of normal alignment of the carpal bones, followed by stable maintenance until healing. This article aimed to assess whether arthroscopic techniques are a reliable surgical option for the treatment of this challenging injury. Materials and Methods Twenty patients with an acute PLD or PLFD were treated by an arthroscopic technique. They were retrospectively reviewed at an average follow-up of 31.2 months (range 18-61 months). Functional outcomes were assessed with the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and Patient-Rated Wrist Evaluation (PRWE) score as well as radiographic evaluations. Description of Technique Arthroscopic reduction and percutaneous fixation was performed to the scapholunate and lunotriquetral intervals using Kirschner wires (K-wires) as joysticks as well as to the scaphoid using a cannulated headless screw for transscaphoid-type injuries. The K-wires were removed at 10 weeks postoperation. Results Overall functional outcomes according to the MMWS were rated as excellent in three patients, good in eight, fair in seven, and poor in two. The mean DASH score was 18, and the mean PRWE score was 30. On the basis of radiographic parameters, reduction obtained at the operation was maintained within normal ranges in 15 patients. No patient had developed arthritis by the last follow-up. Conclusions The medium-term results show that arthroscopic treatment can provide proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes for acute perilunate injuries. Level of Evidence Level IV.

Arthroscopically assisted mini-invasive management of perilunate dislocations.

Purpose The purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopically assisted mini-invasive reduction and fixation. Methods Between June 2012 and May 2014, 24 patients who had a dorsal perilunate dislocation or fracture-dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 14.8 months (range 6-32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo Wrist Score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire; and Patient-Rated Wrist Evaluation (PRWE) score. Radiographic evaluations included time to scaphoid union, carpal alignments, and any development of arthritis. Results The range of flexion-extension motion of the injured wrist averaged 86% of the values for the contralateral wrist. The grip strength of the injured wrist averaged 83% of the values for the contralateral wrists. The mean QuickDASH score was 6, and the mean PRWE score was 10. According to the Mayo Wrist Scores, overall functional outcomes were rated as excellent in 13 patients (54%), good in 6 (25%), fair in 4 (17%), and poor in 1 (4%). Scaphoid nonunion developed in one patient. Reduction obtained during the operation was maintained within normal ranges in all patients. Arthritis had not developed in any patient at final follow-up. Conclusions Arthroscopically assisted mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate injuries according to our early follow-up results. Level IV, Therapeutic.

Influence of associated lesions of the intrinsic ligaments on distal radius fractures outcome.

We aimed to evaluate the influence of associated scapholunate (SL) and/or lunotriquetral ligament (LT) injury on the outcome of distal radius fractures. This prospective study included 40 patients with surgically treated distal radius fracture. Wrist arthroscopy was used to identify associated lesions of the scapholunate and lunotriquetral ligaments and classify them according to Geissler. Patients were divided in two groups by presence (injured group) or absence (intact group) of associated injury of the SL and/or LT ligament. The patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaires were used to evaluate disability 3 and 6months after injury. Grip strength was also evaluated. Wrist arthroscopy identified SL and/or LT injury in 15 patients (37.5%). Mean total PRWE score for the intact group was 26.64 at 3months and 16.22 at 6months, and 50.47 (at 3months) and 20.7 (at 6months) for the group with ligament injury. Mean DASH scores were 26.03 and 13 at 3 and 6months for the intact group, and 49.5 and 24.11 for the injured group. Mann-Whitney test results showed significant difference for the PRWE and DASH scores and the grip strength for the two examined groups. Patients with distal radius fracture with associated intrinsic ligament injury had worse outcomes than did patients without associated ligamentous injury. Associated injuries of the SL and LT ligament should be considered when treating distal radius fractures, and wrist arthroscopy should be incorporated into the operative protocol.