Quick DASH Research Articles

Shoulder Pain in Policemen Due to Gun Hanging in Lahore, Pakistan

Objective: To assess the frequency of shoulder pain in policemen due to gun hanging in Lahore, Pakistan.
 Study Design: Cross-Sectional Study.
 Place and Duration: Police Stations in Lahore, including Johar town, Model Town, Faisal Town and Khyaban e Amin. Lahore Pakistan from Nov 2019 to May 2020.
 Methodology: The data were collected from the policemen of different police stations in Lahore. Inclusion criteria were work-related shoulder pain and no fracture or dislocation, and with no history of trauma or injury, and the age limit is 25 to 40 years of policemen. Data was collected using "Shortened disabilities of the arm, shoulder and hand questionnaire (Quick DASH)".
 Results: There were 100 study participants. The mean age of the participants was 32.48±4.49 years. Results of this study showed that 43% had no shoulder pain, and 57% had shoulder pain due to gun hanging. In addition, results showed that 21% participants had no difficulty, 18% had mild difficulty, 27% had moderate difficulty, 22% had severe difficulty, and 12% were unable to open the jar.
 Conclusion: The shoulder pain due to gun hanging is high among policemen Daily life activities such as sleeping patterns and recreational and social life activities were also disturbed due to shoulder pain.

Outcome of Volar Barton Fractures Treated with Locking Compression Plates: A Cross-Sectional Study

Volar Barton fracture is the fracture of distal radius bone associated with ventral displacement. It is an oblique intra-articular fracture. Objective: To investigate the results, both functional and radiological, of open reduction and internal fixation with locking compression plates of the volar Barton fracture. Methods: A total of fifteen patients were included in this study. All of the participants had volar fragment type B3 fractures of the wrist. All the patients underwent open reduction to treat the fracture. Internal fixation was done using a locking compression plate (LCP). Out of a total of 15 patients, 10 were male and 5 females. The most common cause, almost 67 %, of the fracture was a road traffic accident (RTA). The mean age of the patients was 33 years, ranging from 21 to 55 years. All the patients had their respective surgeries within 7 days of the fracture accident. Quick Dash score-, and Gartland and Werley score were used to assess the function of the hand and wrist. Results: All the fractures took the meantime of 8 weeks for the bone union. The mean Quick Dash score was 10, ranging from 0 to 60. According to Gartland and Werley’s score, 9 patients were excellent, 4 patients were good and 2 were fair. No postoperative complication occurred. Conclusions: Open reduction and internal fixation with locking compression plates of the volar Barton fracture is an effective treatment for functional and radiological restoration.

Treatment of Lateral Epicondylitis with Physiotherapy during a Clinical Trial: Comparison of Mobilization Technique and Shock Wave

Objective: The current study aimed to examine effect of ESWT vs. MWM in the management of tennis elbow. Methods: The study was conducted in the physiotherapy department at PAU. Sample of the study consisted of 22 patients aged between 20-50 years. Patients were selected in the orthopedic clinic and randomly separated into 2 groups. The ESWT group included (12) patients, whereas the MWM group included (10) patients. The first group underwent 3 sessions/week and the latter underwent 2 sessions/week for 4 weeks. The demographic data were assessed. VAS was used for pain intensity. A hand-held dynamometer was used for wrist strength and Quick DASH was used for a functional disability. Results: Inter-group analysis was done using t-test. Comparing pre-post treatments using VAS disclosed that there were not significant differences between groups, P= 0.25. Pre-post treatment for wrist strength uncovered that there wasn't a significant difference between groups, P= 0.47. Pre-post QUICK DASH scores, P=0.35. Therefore, there wasn't a statistically significant difference between groups with functional disabilities. Conclusion: The study found that ESWT and MWM were effective in all outcome measures.

Anatomical, functional and pain hand assessment after transulnar artery access with ipsilateral RAO for percutaneous coronary interventions

Abstract Aims The purpose of our research comes from the increasing need for an alternative approach when the standard right radial is not accessible, most commonly due to the presence of RAO. The use of this approach is still controversial in the interventional community, due to lack of published studies. Our purpose was to prove its' safety and success. Material and methods In the period from September 2019 until April 2021, 103 consecutive patients underwent PCI through primarily chosen TUA with ipsilateral RAO. These patients were included in a prospective single center study of effectiveness and safety. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TUA. Anatomical, functional and pain assessment of the punctured arm was performed at baseline and after the procedure and at follow-up. Using pre-procedural UA angiography, we measured the diameter of the UA and the collateral circulation for the occluded RA by QCA (Quantitative angiography). Values of UA diameter were compared with previous angiographies before RAO. Additional functional assessment of the arm was performed using JAMAR dynamometer for hand strength and self-assessment with QUICK DASH questionnaire. VAS score was used for pain assessment. Clinical and duplex ultrasound evaluation for ulnar patency were examined. Results Mean age of patients was 62.9±9 years with 30% females. Previous TRA was present in all patients, 32% of patients had multiple previous TRA (>3), with 10 being the largest number. Procedural success through primary chosen TUA with ipsilateral RAO was 96.2%. In 4 (3.8%) patients we had an inability to puncture the right UA and were transferred to left TRA. Procedural success after UA puncture was 100%. Number of punctures of the UA was 1.6±0.9 (1–6 punctures). Access site bleeding complications were detected in 4% (EASY score >2). On duplex ultrasound follow up, there wasn't a single case of UAO detected. There were no clinical or ischemic hand complications seen during long-term follow up. Local bleeding complications were found to be related to larger number of punctures, time of puncture and longer procedural time (p<0.0001). QCA assessment showed an increasing of UA diameter after RAO of 0.28±0.35 mm (p<0.0001). Dynamometer values of arm strength showed a small decrease in values 12 hours after procedure (72.6±23 vs. 71.9p, p=0.029), but without changes in initial strength on 1, 6 and up to 1 year after procedure. QUICK DASH self-assessment showed no significant changes in the follow-up period. Conclusion Transulnar approach with ipsilateral RAO is safe and successful for PCI. The existence of appropriate collateral support for the occluded RA, allows for a safe TUA with ipsilateral RAO. Anatomical, functional and pain assessment of the punctured arm affirmed the safe use of this approach as the best alternative for right TRA and preservation of wrist access benefits. Funding Acknowledgement Type of funding sources: None.

Tendon Transfer Outcome in Radial Nerve Injury: Our Experience

Objective: The objective of the current study was evaluation of outcome of tendon transfers in high radial nerve palsy for restoration of power and function of wrist and hand in Karachi, Pakistan. Methodology: A descriptive case series with clinical data of 17 patients was analyzed at the Department of Orthopedics Surgery at the Dr. Ruth K.M. Pfau Civil Hospital at Dow University of Health Sciences in Karachi, Pakistan, from January 2018 to December 2021. Patients who were diagnosed with high and low RNP were registered. Those with multiple injuries which might have caused considerable disability (polytrauma patients) or those suffering from brachial plexus lesions were excluded. Results: Out of seventeen patients, 14 (85%) were male while 03 (15%) were femalewith mean age of 29.5 years. There were 65% right-sided injured patients. Mean of the Disabilities of the Arm, Shoulder and Hand (DASH) scores was 11.44 ± 3.35 with 94.1% patients in minimal disability category whereas 5.88% patients moderately disable.Motor power of wrist and finger extension was significantly improved between the preoperative period and three months post-operatively, between the pre-operative period and six months. Conclusion: Tendon transfers treating radial nerve palsy have positive functional outcomes in terms of wrist extension, finger extension, and handgrip strength, as well as positive patient satisfaction as measured by Quick DASH ratings. Tendon transfers help restoring nonfunctional dangling wrist and hand into functional powerful wrist and hand. Keywords: Radial nerve palsy, tendon transfers outcome, DASH scores

Morbidité et qualité de vie après reconstruction mammaire par lambeau de grand dorsal autologue, à épargne musculaire et perforant

Morbidity following autologous latissimus dorsi flap (ALD), muscle sparing latissimus dorsi flap (MSLD) and thoracodorsal artery perforator flap (TAP) is controversial. The purpose of this study was to measure morbity using Quick Dash at 1month and 1year following breast reconstruction with one of these three flaps. The second objective was the evaluation of quality of life using Breast-Q. Thirty four consecutive patients who had undergone breast reconstruction were included in this monocentric and prospective study: 10patients in the ALD group, 12patients in the MSLD group and 12patients in the TAP group. At 1month and 1year following surgery, the variation of Quick Dash was 13,63and 2,38in the ALD group, 3,41and -1,13in the MSLD group and 5,69and 0in the TAP group. Satisfaction whith breasts, psychosocial, sexual and chest well-being were higher in the ALD group. Satisfaction with back was higher in the MSLD and TAP groups. Back and shoulder well-being was comparable regardless of the flap. Seroma occurrence was very rare in case of TAP, rare and not abundant in case of MSLD and frequent in case of ALD. This study appears to confirm that immediate morbidity is less important with MSLD or TAP than ALD. Hoewever at one year following surgery, morbity seems to be comparable with the 3flaps. Patients satisfaction seems to be higher with ALD except for the aspect of the back.

Clinical Outcomes of Arthroscopic One-Tunnel Triangular Fibrocartilage Complex Transosseous Suture Repair Are Not Diminished in Cases of Ulnar Styloid Process Fracture Nonunion

To determine whether clinical outcomes of arthroscopic one-tunnel wrist triangular fibrocartilage complex (TFCC) transosseous suture repair are not diminished in cases of ulnar styloid process fracture nonunion (USPFN). Patients who underwent arthroscopic 1-tunnel transosseous suture repair of Palmer 1B foveal TFCC tear (with/without superficial fiber tear; Atzei class 2 or 3 TFCC tear) from 2015 to 2020 were retrospectively reviewed. Group I was the TFCC foveal tear repair group with USPFN. Group II was the TFCC foveal tear repair group without USPFN. In group I, no additional treatment for USPFN was made. Functional preoperative and postoperative outcomes were compared by Modified Mayo Wrist Score (MMWS); Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score; grip strength; pain visual analog scale (VAS); and distal radioulnar joint (DRUJ) stability. Wrist posteroanterior, lateral, and both oblique views of the wrist were used to assess the ulnar styloid process before and after operation. This study consisted of 66 patients: group I (n= 22) and group II (n= 44). No differences were found between the 2 groups preoperatively in MMWS, Quick-DASH, grip strength, and VAS (MMWS: P= .94, Quick-DASH: P= .23, grip strength: P=.69, VAS: P= .45). No differences were found between the 2 groups with respect to outcome measures postoperatively in MMWS, Quick-DASH, grip strength, and VAS (MMWS: P= .59, Quick DASH: P= .82, grip strength: P= .15, VAS: P= .84). All of the enrolled patients achieved restored function with negative ballottement test and maintained DRUJ stability on follow-up. Of the 22 USPFN cases in group I, 11 (50%) showed spontaneous union after transosseous TFCC foveal repair without any additional USPFN treatment. The proportion of patients achieving a minimal clinically important difference for the Quick-DASH was similar between the 2 groups. Although this current study has insufficient statistical power, the available data suggest that patients with TFCC foveal tear combined with USPFNs treated with arthroscopic transosseous repair surgery could experience similar functional improvement compared with those with TFCC foveal tear without USPFNs. The presence of USPFN accompanied by Palmer 1B type TFCC foveal tear may not affect the clinical results, including MMWS, Quick-DASH, grip strength, VAS, and DRUJ stability of patients who undergo arthroscopic 1-tunnel transosseous suture repair. Level III, retrospective comparative study.

The influence of deltoid tensioning on functional outcomes following reverse shoulder arthroplasty

BackgroundWe aimed to investigate the relationship between functional outcomes and radiological and clinical measurements (based on deltoid moment arm length measurements) of reverse total shoulder arthroplasty (RTSA) performed in patients for irreparable rotator cuff tears. MethodsThirty-eight patients who underwent RTSA after irreparable rotator cuff tears between 2016 and 2019 were included in the study. Patients with primary osteoarthritis, rheumatoid arthritis, or post-traumatic RTSA were excluded from the study. The patients were evaluated functionally using the range of motion, Quick DASH, and Constant Scores (CS). Deltoid lengthening was measured both clinically by the difference in upper extremity length (dUEL) and radiologically by the acromiohumeral distance (AHD) and deltoid lever length (DLL). AHD was measured with true anteroposterior radiographs and ultrasound guidance. ResultsThe mean age of the patients was 66.39 ± 7.92 (range, 49–83) years. Of 38 patients, 31 (81.57%) were female and 7 (18.43%) were male. The mean follow-up durations were 26.43 ± 17.05 (range, 12–58) months. The mean active anterior elevation (AAE), abduction (AAB), and external rotation (AER) increased from 57.32°, 41.25°, and 22.32° preoperatively to 149°, 110°, and 34° at the last follow-up, respectively. Preoperatively, the mean QuickDASH score was 58.04, and at the last follow-up, it was 38.19. The mean Constant Score rose from 24.75 preoperatively to 60.64 at the last follow-up. The AHD, DLL, and dUEL mean values were 2.346, 1.89, and 1.746 cm, respectively. There was a significant relation between the DLL and the AAE (P < .01). ConclusionOptimizing deltoid tension plays an essential role in regaining function, and this study demonstrates that lengthening the deltoid increases the patient’s ability to elevate anteriorly, likely by recreating the force-length relationship of the deltoid muscle.

Patient-reported outcomes after initial conservative fracture treatment in primary healthcare – a survey study

BackgroundPrimary healthcare in Norway has first-line responsibility for medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care. However, some municipalities have X-ray facilities and handle minor fractures locally. We investigated patient-reported outcome measures after initial treatment of radiologically diagnosed fractures of the wrist, collarbone, and ankle at a primary healthcare centre in a rural municipality with a large ski resort. The patients’ general satisfaction with the treatment was also investigated.MethodsValidated questionnaires were sent to patients with fractures of the wrist or collarbone (Quick DASH—Disability of Arm, Shoulder and Hand) or the ankle (FAOS -The Foot and Ankle Outcome Score). Patients with wrist and collarbone fractures also answered the Quality-of-life questions that are a subscale of the FAOS questionnaire for ankle fractures. Patient satisfaction was measured for all fracture groups. The Quick DASH scale ranges from 0 (no disability at all) to 100 (great disability), while for FAOS a score of 100 indicates no symptoms and 0 indicates extreme disabilities.ResultsA total of 148 of 238 patients answered the questionnaire (62% response rate). Patients with distal radius fractures had a mean Quick DASH score of 5.1 (median 0, range 0–77), and scores were significantly lower for males (p = 0.013) and increased with age (p = 0.024). Patients with collarbone fractures had a mean Quick DASH score of 2.1 (median 0, range 0–32) with no significant age or gender differences. Patients with ankle fractures had the following mean subscale-scores: Pain, 93.8; Symptoms, 71.4; Activities of daily living, 97.4; Sport, 90.0; and Quality of life, 92.1. The scores did not differ significantly by specialization of the physician. A total of 88% of the patients were highly or very highly satisfied with the handling of their fracture.ConclusionsThe patients reported low rates of functional disability and high rates of satisfaction after initial radiological diagnosis and treatment of their fracture at the primary healthcare centre. Specialisation of the treating physician was not associated with the outcome in any of the fracture types.

Translation, cross-cultural adaptation and psychometric properties of Urdu version of upper limb functional index; a validity and reliability study

BackgroundThe upper limb functional index is broadly used outcome measure for musculoskeletal disorders of the upper limb. The main objective of the study was to translate and validate the upper limb functional index (ULFI) outcome measure in the Urdu language.MethodsUpper limb functional index was translated into Urdu language using Beaton et al. guidelines through forward and backward translation along with the expert committee reviews. Two fifty (n = 250) Urdu-speaking patients with sub-acute or chronic conditions of upper limb musculoskeletal disorders were included in the study. The mean age was 32.33 ± 4.67 years. The data were collected from the physical therapy department of The University of Lahore Teaching hospital. All participants completed the upper limb functional index-Urdu (ULFI-U), Numeric pain rating scale (NPRS), Quick Disability of arm, shoulder, and hand (QuickDash), and (health survey) SF-12 at baseline while only ULFI-U at day three. Reliability was assessed through internal consistency by Cronbach’s alpha and test-retest reliability by intra-class correlation (ICC). Content validity was measured by Lynn and Lawshee method. Spearman’s correlation has been used to measure criterion validity. The construct validity was measured through hypothesis testing. The structural validity has been explained through factor analysis by exploratory factor analysis (EFA) using Maximum likelihood extraction (MLE) with Promax rotation.ResultsThe English version of ULFI was translated into the Urdu language with minor alterations. The Urdu version ULFI has demonstrated high levels of reliability with intra-class correlation (ICC2,1= 0.91) and Cronbach’s alpha (α = 0.94). The content validity index found as 0.808, the criterion validity for ULFI-U correlating with quick Dash was found excellent (r = 0.845) and ULFI-U established strong correlation with 6 domains of SF-12(r = 0.697 to 0.767) and weak correlation with its 2 domains and NPRS(r = 0.520). A two-factor structure was obtained using EFA.ConclusionsThe ULFI-U is a valid and reliable patient-reported outcome (PRO) that can be used to assess upper limb musculoskeletal disorders in Urdu-speaking patients.Trial registrationThis study was registered in the U. S National Library on clinicaltrial.gov under registration no. NCT05088096. (Date: 21/10/2021).

Fifth metacarpal neck fracture fixation: antegrade intramedullary pinning with two K-wires or percutaneous retrograde crossed pinning

Objective: The present study aimed to compare clinical and radiological outcomes in patients with displaced fifth metacarpal neck fractures after treatment with antegrade intramedullary pinning with two K-wires or percutaneous retrograde crossed pinning. Material Method: While seventeen patients were treated with antegrade intramedullary pinning (Group ), 14 were treated with percutaneous retrograde crossed pinning (Group 2). Clinical and radiological outcomes included Quick Dash, active range of motion (ROM), VAS, and dorsal angulation loss at weeks four and twelve and in the final follow-up. Results: The findings revealed that the groups had mean ages of 29.41±8.15 years and 27.78±7.42 years, res-pectively. While ROM was better in Group 2 at weeks four and twelve, we could not find a significant difference between the groups by active ROM in the final follow-up. Moreover, Group 1 had a better Dash score in the fourth week and twelth week , but both groups had similar Dash scores in the final follow-up. Finally, the groups had no preoperative and postoperative differences radiologically. Conclusion: The present findings uncovered that treatment of a displaced fifth metacarpal neck fracture by anteg-rade intramedullary pinning yielded a better in the first three months improvement in active ROM and Quick Dash than percutaneous retrograde crossed pinning.

Clinical effects of proprioceptive thumb exercise for individuals with carpometacarpal joint osteoarthritis: A randomized controlled trial

Study DesignRandomized Control Trial. IntroductionThumb CMC joint OA is a common diagnosis. Currently there is no evidence available to under if proprioceptive neuromuscular training is an effective intervention for this population. Purpose of the studyTo establish the effectiveness of a proprioceptive training program as a complementary therapy for patients with thumb CMC joint OA. MethodsStandard conservative thumb CMC joint OA treatments were received by both the control (n = 26) and experimental groups (n = 26) for a period of 12 weeks. The experimental group received a proprioceptive training program during the same intervention period. Outcome measures included severity of pain with activity according to the numerical rating scale (NRS), QuickDASH, Canadian Occupational Performance Measure (COPM), and proprioception via joint position sense (JPS). ResultsFifty-two females participated in the study. Both the experimental and control group made both clinically and statistically significant changes in the mean VAS and COPM scores over time. Only the experimental group achieved a statistically and clinically significant change in JPS error score over time. DiscussionExperimental group achieved a statistically significant change in JPS over time in concordance with previous investigations. Changes in pain scores differed from prior investigations and the between-group comparison was not statistically significant. Changes in the Quick DASH was similar to previous findings. ConclusionProprioceptive training in addition to a traditional rehabilitation program decreased error scores on the joint position sense test.

IS LOCKED COMPRESSION PLATE BETTER THAN LIMITED CONTACT DYNAMIC COMPRESSION PLATE IN TREATMENT OF CLOSED MIDDLE THIRD RADIUS AND ULNAR FRACTURES IN ADULTS: A SHORT-TERM COMPARATIVE STUDY

Background: Forearm bone fracture is a commonly encountered fracture. The inception of locking compression plate (LCP) has revolutionized fracture management. With their dramatic success for articular fractures, there is a speculation that they might be more appropriate for diaphyseal fractures as well. Objective: To compare internal fixation of closed, middle third forearm fractures with LCP and limited contact dynamic compression plate (LC-DCP) in adults with respect to union rate, implant failure, functional outcome, and infection rate. Methods: Twenty-two patients with closed, middle third fractures of both the forearm bones were involved in this prospective, randomized, controlled study, which took place between February 2019 to January 2021. They were segregated into two groups based on open reduction and internal fixation with LCP (n=11) and with LC-DCP (n=11). Postoperative follow-up intervals of 1, 2, 6 weeks and 3, 6 months. The patients were assessed for implant failure, fracture union and function outcome of Andersons’ criteria to assess union, forearm rotation, and wrist flexion-extension, and disabilities of the arm, shoulder and hand (DASH) score for patient related outcome at the latest follow up. Results: The mean age of the patients was 30.9 years (range 19-47 years) with mean follow up about of 2 years. The union rate in LCP group was (100%) whereas in LC-DCP was (81.8%), the p value was (0.4), which is not statistically significant. The p value for Quick DASH score and Anderson’ criteria were (0.8 and 0.43), respectively which is also not statistically significant. No incidence of implant failure in both groups. Conclusion: Although LCP is an effective treatment alternative and may have a subtle edge over LC-DCP in the management of these fractures, their supremacy could not be certified. We deduce that surgical planning and expertise rather than the choice of implant are more pivotal for outstanding results. Keywords: Limited contact dynamic compression plate, locking compression plate, closed, middle third fractures, both bones of forearm Citation: Chhaily ZA, Joda AI, Abd Ali AS, Ali ZH. Is locked compression plate better than limited contact dynamic compression plate in treatment of closed middle third radius and ulnar fractures in adults: A short-term comparative study. Iraqi JMS. 2022; 20(1): 146-153. doi: 10.22578/IJMS.20.1.19

Functional and radiological outcome of C-shaped intercondylar fractures in children.

The aim of this study was to retrospectively evaluate the clinical, functional, and radiographic outcomes of displaced C-shaped intercondylar fractures of the humerus in children and adolescents, and evaluate upper-extremity function with the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). We retrospectively reviewed the data of nine children with displaced C-intercondylar fractures that were treated surgically. Age, sex, laterality, mechanism of injury, amount of displacement, type of treatment, fixation method, and outcome were recorded. The outcome of C-shaped fractures was compared with that of T-intercondylar fractures published by the same surgeons in a previous study. A total of nine consecutive patients (median age, 12 years; range, 9-14 years) with displaced C-intercondylar fractures of the humerus (3 females) were included; in six cases (67%), the left side was affected. Median follow-up was 2 years (range, 2-6). All patients underwent open reduction and internal fixation by screws ( n = 5), Kirschner-wires ( n = 3), or both ( n = 1). Overall, four out of nine patients developed a total of five complications (55.5%): one case of secondary displacement, one case of fishtail deformity, two cases extension deficit, and one case of limited flexion/extension requiring release. The median Quick DASH score at last follow-up visit was 0 (range, 0-4.5). C-intercondylar fractures should be added as a class to complete the Tnoniolo and Wilkin's classification. The prognosis is similar to that of T-intercondylar fractures because, in both cases, fractures are intra-articular and require open reduction and internal fixation.

Trapeziometacarpal External Fixation under Local Anesthesia for the Treatment of Comminuted Intra-Articular Thumb Metacarpal Fractures: Evaluation of Clinical Results and Long-Term Patient Satisfaction.

Background A variety of internal and external fixation techniques have been described for the treatment of Rolando fractures, but the optimal fixation method has not been clearly defined. Purpose The aim of the study was to describe the results and the long-term functional outcome of the application, under local anesthesia, of an external fixation system for the treatment of Rolando fractures. Patients and Methods In total, 22 consecutive patients (16 men) underwent surgical treatment for Rolando fractures by using two pairs of pins external fixator. All procedures were performed under local anesthesia (Xylocaine 2%) and an image intensifier. Patients were evaluated at regular intervals postoperatively and contacted by phone for long-term follow-up. Functional outcome was assessed using the validated Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) tool. Results The mean age was 39.8 ± 14.2 years. The mean time from injury to surgery was 4.1 ± 2 days. The mean operative time was 16.3 ± 2.6 minutes. All fractures were healed and no loss of fracture reduction was observed postoperatively. One patient developed wound erythema at the proximal pins, without requiring early removal of the implant, and another one experienced temporary numbness at the distribution of the superficial radial nerve. In total, 20 out of the 22 patients who were available for long-term follow-up did not report any complaints and could perform the daily activities without restriction. The average follow-up was 6.5 ± 1.2 years, and the mean Quick DASH score was 1.8 ± 3. Conclusion The two pairs of pins external fixator is a valuable option for the treatment of Rolando fractures and can be easily, quickly, and effectively applied under local anesthesia.

Predictive Value of the (Quick)DASH Tool for Upper Extremity Dysfunction Following Percutaneous Coronary Intervention.

PurposeThe use of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and its shortened version, the QuickDASH, have been used to assess upper extremity function following a transradial percutaneous coronary intervention (TR-PCI). However, the use of these scores has not yet been validated for TR-PCI induced complications in the upper extremity. The aim of this study was to establish the validity of the DASH and the QuickDASH, for the assessment of upper extremity dysfunction following a transradial percutaneous coronary intervention (TR-PCI).Patients and MethodsThis study was a diagnostic retrospective analysis of the ARCUS study, of whom 440 underwent TR-PCI and 62 control patients were treated via the transfemoral approach. All participants completed the DASH and QuickDASH questionnaire prior to the procedure and at each follow-up visit up to six months of follow-up. Receiver operating characteristics (ROC) were constructed to determine the validity of the questionnaires, using physical examinations to determine the occurrence of upper extremity dysfunction, according to the ARCUS study.ResultsAt each follow-up moment, the area under the curve (AUC) showed a poor ability of the DASH and QuickDASH to discriminate between patients with and without upper extremity dysfunction (AUC: 0.565–0.586). There was no significant difference between the questionnaires (p > 0.05).ConclusionThe DASH and QuickDASH questionnaires are both equally incapable of discriminating between patients with and without upper extremity dysfunction following a TR-PCI. Study results suggest that the DASH and QuickDASH questionnaires are incapable of discerning changes in upper extremity function as a result of procedural complications following a TR-PCI vs cardiac induced activity cessation.

Terrible triad injury of the elbow: A PROCESS-compliant surgical case series from Eastern Morocco

IntroductionThe terrible triad of the elbow (TTE) is a lesion associating a dislocation of the elbow, a fracture of the radial head, and a fracture of the coronoid process, with a high potential of complication. The treatment is based on the restoration of bone lesions and external capsular ligament repair. The systematic repair of the medial collateral ligament (MCL) is still debated in the literature. The aim of this study is to evaluate the clinical and functional results of the surgical treatment in a real-world series from Easter Morocco. Patients and methodsThis was a retrospective study of 6 cases of TTE operated by isolated external approach or combined approach (internal or anterior) of the elbow in the department of Traumatology-Orthopedics of the Mohammed VI University Hospital (Oujda Morocco), over a period of 7 years from 2013 to 2020. Radial head and coronoid process fractures were classified according to the Mason and Morrey-Regan classifications, respectively. The following clinical parameters were evaluated: Mayo Clinic Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analog Scale (VAS), and arc of mobility in flexion-extension and prono-supination. Results6 male patients treated between May 2013 and December 2020 were included. The median follow-up was 48 months. All patients had frontal and lateral standard X-ray of over and under joints, and computed tomography (CT)-scan was delivered for 5 cases. The elbow dislocation was posterolateral in five cases, and posteromedial in only one patient. Radial head fractures were classified as type I in one case, type II in two cases, and type III in three cases. Coronoid fractures were type I in three cases, type II in one case, and type III in two cases. At the last follow up, the mean MEPS, Quick DASH, and VAS was 81, 28, 0.8, respectively. The mean arc of mobility in flexion was 120° and it was deficient by 20° in extension. In addition, the mean arc of mobility in protonation was 80°, while in supination it was 75°. Regarding complications, we noticed an instability of the elbow on valgus in a single case, elbow stiffness with heterotopic ossification in a single case, ulnar nerve damage in a single case during medial collateral ligament anchoring, and elbow hygroma in one single case. ConclusionThe surgical management of TTE can provide good and long-term functional results after restoration of the stabilization of bone structures and the lateral ligament complex, without the need to repair the medial collateral ligament.

Novel Technique in Late Stage Avascular Necrosis of Lunate: Tendon Interposition and Ligament Reconstruction with ECRL Tendon– A Case Report

Aim: To evaluate clinical and functional results of extensor carpi radialis longus tendon ball interposition for treatment of late stage avascular necrosis of lunate (kienbock’s disease).&#x0D; Materials and Methods: Patient with stage 4 kienbock’s disease was treated with excision of lunate and ecrl tendon interposition to fill the cavity of the excised lunate bone. Tendon was split. One half was left in situ and the other was used to fill the cavity by passing it to the scaphoid and triquetrum. This also helps to maintain intercarpal stability. Functions were assessed using grip strength, range of movement of wrist, quick dash and visual analogue score. Radiological examination was performed to assess carpal height ratio and progression of arthritis.&#x0D; Results: Long and bulky ecrl tendon acts as a spacer to fill the excised lunate. it also provides scapho lunate and lunate triquetral ligament reconstruction for inter carpal stability.&#x0D; Conclusion: ECRL tendon used for interposition with reconstruction seems to be an effective treatment modality for late stage of kienbock’s disease.

Olecranon With Concomitant Radial Head Fracture: A Case Series of Fifteen Patients.

IntroductionSimultaneous olecranon and radial head fractures are rare injuries and due to this factor, the outcome of the selected therapy is not widely studied. The aim of this study is to report and evaluate the functional outcome of the surgical treatment of simultaneous olecranon and radial head fractures.Materials and MethodsThis is a retrospective study of fifteen patients with concomitant olecranon and radial head fractures presenting to our orthopedic department between 2015 and 2020. Olecranon fractures were classified by Mayo classification and radial head fractures by Mason classification and were managed appropriately. Main outcome measures include range of elbow extension-flexion, pronation-supination, Broberg and Morrey rating system score, and quickDASH score.ResultsOur study included 6 females and 9 males with a mean age of 50 (r, 25–73). The mean of follow-up was 31 months (r, 3–51). Olecranon fractures were fixed with tension band with K-Wires or intramedullary compression screw or locking plate. Radial head fractures were fixed with headless compression screws or mini plate or replaced (radial head arthroplasty). Postoperatively, an average 115° extension-flexion arc and 135° pronation-supination arc was noted. The mean Broberg and Morrey rating system score was 78 and the mean quick DASH score was 25, indicating a good result. Two cases of heterotopic ossification were present and no nonunion was noted.ConclusionSurgical management of concomitant olecranon and radial head fractures with appropriate technique can result in the restoration of a functional movement arc and a satisfactory outcome.

Treatment of avascular necrosis of the humeral head \u2013 Postoperative results and a proposed modification of the classification

BackgroundAvascular necrosis of the humeral head after proximal humeral fracture i.e. type 1 fracture sequelae (FS) according to the Boileau classification is a rare, often painful condition and treatment still remains a challenge. This study evaluates the treatment of FS type 1 with anatomic and reverse shoulder arthroplasty and a new subclassification is proposed.MethodsThis single-center, retrospective, comparative study, included all consecutive patients with a proximal humeral FS type 1 treated surgically in a four-year period. All patients were classified according to the proposed 3 different subtypes.Constant score (CS), Quick DASH score, subjective shoulder value (SSV) as well as revision and complication rate were analyzed. In the preoperative radiographs the acromio-humeral interval (AHI) and greater tuberosity resorption were examined.ResultsOf 27 with a FS type 1, 17 patients (63%) with a mean age of 64 ± 11 years were available for follow-up at 24 ± 10 months. 7 patients were treated with anatomic and 10 with reverse shoulder arthroplasty. CS improved significantly from 16 ± 7 points to 61 ± 19 points (p < 0.0001). At final follow-up the mean Quick DASH Score was 21 ± 21 and the mean SSV was 73 ± 21 points. The mean preoperative AHI was 9 ± 3 mm, however, 8 cases presented an AHI < 7 mm. 4 cases had complete greater tuberosity resorption.The complication and revision rate was 19%; implant survival was 88%.ConclusionBy using the adequate surgical technique good clinical short-term results with a relatively low complication rate can be achieved in FS type 1. The Boileau classification should be extended for fracture sequelae type 1 and the general recommendation for treatment with hemiarthroplasty or total shoulder arthroplasty has to be relativized. Special attention should be paid to a decreased AHI and/or resorption of the greater tuberosity as indirect signs for dysfunction of the rotator cuff. To facilitate the choice of the adequate prosthetic treatment method the suggested subclassification system should be applied.