QuickDASH Score Research Articles

Paper 16: What Happens to Youth Baseball Players Diagnosed with Little League Shoulder and Little League Elbow?

Objectives: Little League elbow (LLE) and Little League shoulder (LLS) are frequent diagnoses encountered in youth baseball players. To date, limited data exists as to how these athletes fare as they progress in their baseball careers. The purpose of the current study was to evaluate the career progression and patient reported outcomes in a series of youth baseball players 5 years after being diagnosed with LLE and LLS. Methods: The electronic medical record from a single pediatric hospital was searched for all patients receiving a diagnosis of LLE or LLS sustained from playing baseball between 2014 and 2018. Baseline data at the time of diagnosis was documented including age, primary position, months played per year, duration of symptoms, and treatment. Patients were then interviewed with a standardized questionnaire including several validated outcomes tools and baseball specific questions at a minimum of 3 years post-diagnosis. Suboptimal outcome was defined as symptom recurrence or a SANE score less than previously published patient acceptable symptom state (PASS) of 75.5. Statistical analysis was then performed to compare outcome groups. Results: In total, 61 athletes were contacted (17 LLS, 44 LLE). All patients were male and the mean age at diagnosis was 13±2 years. While 95% returned to baseball post-diagnosis, at 4.8±1.5 years follow-up, 48% of the cohort was still playing with 18% attributing persistent arm pain as a reason for quitting. Symptom recurrence was present in 25% occurring at an average of 9 months post-diagnosis. Players changing position was not uncommon (26%). In the elbow group, no patient went on to require a UCL reconstruction, whereas one patient in the shoulder group ultimately underwent surgery. The mean QuickDASH, ASES, and Kerlan Jobe scores were 2±5, 96±10, and 90±11, respectively. There were no differences between LLE and LLS groups with respect to these scores (p>0.05). No differences were observed between groups in terms of demographics or play characteristics, however those with recurrence were less likely to be still playing ball and had lower outcome scores (<0.05). Conclusions: While arm pain is frequently encountered in youth baseball players, receiving a diagnosis of LLE or LLS appears to have a good prognosis for these athletes with many patients continuing to remain active in competitive baseball even up to 5 years post-diagnosis. Rates of future arm pain requiring surgical intervention were negligible. This data is important for counseling patients about the long-term prognosis of their arm injuries.

Paper 15: 5 Year Radiographic and Functional Outcomes of Non-Operative Treatment of Completely Displaced Clavicle Fractures in Teenagers, A Prospective Study

Objectives: Optimal treatment for displaced clavicle fractures in adolescents remains controversial, with many surgeons favoring operative reduction and fixation. To prospectively assess patient reported outcomes (PROs) in teenagers undergoing non-operative treatment of a completely displaced clavicle fracture ≥ 5 years post-injury. Furthermore, bilateral clavicle imaging was used to determine the association between these outcomes and the presence or absence of bony remodeling. Methods: This study used a subset of patients previously enrolled in a multicenter study looking at adolescent clavicle fractures. Patients from a single institution and ≥ 13 years at the time of injury, with non-operatively treated completely displaced clavicle fractures who were ≥5 years out from their initial injury were able to participate in the study. Patients were clinically evaluated for evidence of scapular dyskinesia, strength deficits, and cosmetic concerns. Bilateral clavicle imaging was used to assess residual shortening, displacement, and angulation. PROs included: ASES, QuickDASH, Marx Shoulder Activity Scale, and return to sport data. Results: Twenty-four patients were available for follow-up, of whom 17 (71%) consented to the additional imaging. The mean age at the time of injury was 14.5±1.1 years with 89% being male. At a mean follow-up of 6.1 years, all fractures healed and no interventions were necessary (Figure 1). Significant remodeling was observed across all measurements with improvements of 70% in mean shortening (22.8 mm to 6.8 mm, p<0.001), 73% in superior displacement (13.4 mm to 3.6 mm, p<0.001), and 83% in angulation (10.4˚ to 1.8˚, p<0.001) (Figure 2). Thirteen patients (72%) had initial shortening > 2 cm and all remodeled to < 2 cm. PROs were almost universally excellent with no patients reporting shoulder pain and mean ASES, quickDASH, and Marx activity scores of99±3, 1±3, and 20±1, respectively, with 79% of patients reporting perfect scores in all 3 domains. Majority (58%) were completely satisfied with the appearance of their shoulder, 38% were more satisfied than not, one patient (4%) was neither satisfied nor dissatisfied, and no patients were dissatisfied. All patients except 1 returned to sporting activities if interested. No PROs were associated with bony remodeling (p>0.05). Conclusions: Teenage patients with completely displaced clavicle fractures can expect excellent radiographic and clinical outcomes 5 years post-injury if treated non-operatively. This study further supports the role of non-operative treatment for teenagers, with nearly perfect outcomes reported bringing into question the role of acute operative management of these fractures given its associated risks and costs.

Functional Outcome of Intra-articular Distal Radius Fractures Treated with Volar Variable Angled Locking Compression Plate at a Tertiary Care Center

Abstract Context: Distal radius fractures (DRFs) are the most prevalent fractures involving the upper extremity, accounting for nearly 18% of all fractures treated by orthopedic surgeons. Although numerous treatments have been established for the management of DRF, the “gold standard” treatment for intra-articular DRF is still debated. Aims: This study aimed to assess the functional and radiological outcome of intra-articular DRF treated with volar variable angled locking compression plate (LCP) at a tertiary care center with a follow-up of 2 years. Settings and Design: This was a retrospective observational study. Subjects and Methods: Thirty patients with intra-articular DRF who underwent volar variable angled LCP stabilization were included in the study and followed up for 2 years after surgery. Three-column classification was used to classify the included individuals. Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Modified Mayo Wrist Score (MMWS), and the Visual Analog Scale (VAS) were utilized to assess the functional outcome. The follow-up radiographs were analyzed using the Batra anatomical score. Statistical Analysis Used: IBM SPSS (Version 20.0, Armonk, NY: IBM Corp, USA) was used for statistical analysis. Results: Thirty patients with a mean age of 44 years (34–59 years) were included in the study. Eighteen individuals had all three columns affected and 12 had two-columnar intra-articular DRF. At 2-year follow-up, the median QuickDASH Score was 2.3, MMWS was 85, VAS was 1, and the median Batra score was 90. Handgrip of the operated limb was comparable to the uninjured limb. Conclusions: Volar variable angled LCPs restore the articular architecture allowing for an excellent range of motion, good grip strength, and early functional mobility with minimal complications. Hence, LCPs appear to be superior to existing treatment techniques for DRF.

Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature.

Background Dorsal bridge plating (DP) of the distal radius is used as a definitive method of stabilization in complex fracture configurations and polytrauma patients. Questions/Purposes This review aims to summarize the current understanding of DP and evaluate surgical outcomes. Methods Four databases were searched following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered with PROSPERO. Papers presenting outcome or complication data for DP were included. These were reviewed using the National Institutes of Health Quality Assessment and Methodological Index for Non-Randomised Studies tools. Results were collated and compared to a local cohort of DP patients. Results Literature review identified 416 patients with a pooled complication rate of 17% requiring additional intervention. The most prevalent complications were infection/wound healing issues, arthrosis, and hardware failure. Average range of motion was flexion 46.5 degrees, extension 50.7 degrees, ulnar deviation 21.4 degrees, radial deviation 17.3 degrees, pronation 75.8 degrees, and supination 72.9 degrees. On average, DP removal occurred at 3.8 months. Quality assessment showed varied results. There were 19 cases in our local cohort. Ten displayed similar results to the systematic review in terms of range of motion and radiographic parameters. Higher QuickDASH scores and complication rates were noted. Local DP showed earlier plate removal at 2.9 months compared to previous studies. Conclusion DP is a valid and useful technique for treating complex distal radius fractures. It displays a lower risk of infection and pain compared to external fixation which is commonly used to treat similar injuries. Patients can recover well following treatment both in function and range of motion. Further high-quality studies are required to fully evaluate the technique.

The Outcomes of Intra-Medullary Square Nail for Adult Both Bone Forearm Shaft Fractures

Background: Forearm shaft fractures are common in developing countries. Anatomical reduction of these fractures using plates and screws is considered an accepted treatment mode. Like other shaft fractures, this can be treated with intramedullary nails like square nails, Rush nails, and interlocking nails. This study evaluates radiological and functional treatment results using square nailing.
 Methods: A prospective study was conducted on 100 adult patients with diaphyseal forearm fractures over 3 years. Out of 100 patients, 68 were men, and 32 were women. Patients were followed up at 2 weeks, 6 weeks, 8 weeks, and then every 3 months till 1 to 1.5 years. We have used criteria described by Anderson et al. and the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score for functional evaluation of the patients.
 Results: Out of 100 patients, the union was achieved in 88 patients, while the rest 12 patients required re-surgery. 4 patients had delayed union, 4 patients developed an infection at the ulnar entry site, and 3 patients developed bursitis of olecranon bursa.
 Conclusion: Intramedullary nailing of both bone forearm shaft fractures using square nails can give satisfactory results in most cases, comparable with treatment by plates and screws, and provides an alternative, cost-effective treatment of both bone forearm shafts fractures with good cosmesis owing to small incisions.

Influence of surgical performance on clinical outcome after osteosynthesis of distal radius fracture

IntroductionClinical outcome after surgery depends on the surgeon's level of expertise or performance. The present study of minimally invasive plate osteosynthesis (MIPO) with anterior plate for distal radius fracture assessed whether clinical outcome correlated with surgeon performance. MethodsThe series included 30 distal radius fractures: 15 operated on by 4 level III surgeons (Group 1) and 15 by 4 level V surgeons (Group 2), utilizing the MIPO technique. The surgical performance of all 8 surgeons was assessed using the OSATS global rating scale. Clinical outcomes were assessed at 3 months’ follow-up using the modified Mayo score (MMS), in 4 grades: 0–64 (poor), 65–79 (moderate), 80–89 (good), and 90–100 (excellent). The QuickDASH score (QDASH) was also calculated, and complications were recorded. ResultsMedian MMS was better for level V (75 = fair result) than level III surgeons (62 = poor result). Median QDASH score likewise was better in group 2 (9.1) than group 1 (22.7). In group 1, there were 2 paresthesias in the median nerve territory, 1 type-1 complex regional pain syndrome, and 1 hypoesthesia in the scar area. Mean correlation between the 2 scores was –0.68. Group 1 patients were on average 7 years older. The number of patients, number of surgeons and distribution of OA A and C fractures were almost identical in the two groups. On MMS, the overall result of the two groups was moderate (70.5), which can be explained by short mean follow-up. DiscussionQuality of the clinical outcome on MMS and QDASH increased with surgical performance, with fewer complications. In the patients' interest, protocols for improving surgical performance should be implemented, for example, through deliberate practice.

Limb Salvage Surgery in Large and Fungating Giant Cell Tumors of Distal Radius: A Case Series

Introduction: A Giant Cell Tumor (GCT) is a benign tumor, but often aggressive with recurrence or metastasis tendency. Often, distal radius GCT is presented in relatively small or medium sizes. Large and fungating distal radius GCT is characterized by its higher ability to infiltrate, destruct, and compromise its surrounding tissue. Therefore, it increases the risk of complications including amputation. The treatment requires more complex surgery and reconstruction than usual GCT. In this case series, we prefer to perform the limb salvage surgery with wide en bloc resection, followed by reconstruction of the bone and soft tissue, instead of amputation. Case Presentation: We report 4 patients with massive GCT at the distal radius. All complained about pain and a lump in the wrist. The tumors are large in dimension with the size of 12 x 8 x 6 cm, 10 x 10 x 8 cm, 11 x 9 x 9 cm, and 17 x 14 x 8 cm respectively, fungating and compromised surrounding soft tissue. Limb salvage procedures are performed with wide en-bloc resection, bone cement spacer insertion, K-wire fixation, dissection, and tendon reconstructions followed by soft tissue defect closure using distant flap and primary suture. Follow-up post-surgery was variable within 2 to 36 months. All patients had a reduced scale of VAS, increased functional outcome measured with quick DASH score, no major complications, and no sign of recurrence or metastasis during the follow-up period. Conclusion: Large and fungating GCT of distal radius managed by limb salvage surgery and complex reconstruction deliver a good result. Thus, it can give other options other than amputation.

Clavicular Hook Plate versus Dog-Bone Technique for Acute High-Grade Acromioclavicular Joint Dislocation – A Retrospective Cohort Study Comparing Clinical Outcome Scores, Complications and Costs

Abstract Background Arthroscopically assisted coracoclavicular (CC) ligament fixation techniques have been promoted as providing superior outcomes for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocations. Nevertheless, there is a lack of high-level evidence for clinically relevant benefits. At our institute, orthopaedic surgeons use an arthroscopically assisted coracoclavicular ligament fixation technique (DB), while general trauma surgeons use a clavicular hook plate (cHP) technique. Aims The aim of the study was to compare clinical outcomes, complication rates and costs between the two groups. Methods The hospital database was searched for patients treated for acute traumatic high-grade (Rockwood Typ ≥III) ACJ dislocation using either a cHP or arthroscopically assisted DB technique between 2010 and 2019. Seventy-nine patients could be included (56 patients in the cHP group and 23 in the DB group). QuickDASH scores, subjective shoulder value (SSV) scores, pain scores (numerical pain rating scale 10) and complication rates were retrospectively collected through phone interviews and by screening patient charts as well as surgical reports. Costs per patient were obtained from the hospital's accounting system. Results Mean follow-up was 54±33.7 and 45±21.7 months in the cHP and DB group, respectively. QuickDASH and SSV scores did not differ but patients in the cHP group reported significantly lower pain scores (p=0.033). More patients reported hypertrophic or disturbing scars (p=0.49) and sensibility disturbances (p=0.007) in the cHP group. Three patients suffered from a frozen shoulder in the DB group (p=0.023). Conclusions Patient-reported outcomes are excellent after long-term follow up for both techniques. There are no clinically relevant differences in clinical outcome scores based on our results and a review of the literature. Both techniques certainly have their benefits regarding secondary outcome measures.

Functional Outcome for Fragment-Specific Fixation of Distal Radius Fracture – An Observational Study

Introduction: Fractures of the distal radius account for 14% of all fractures to the extremities and 17% of all fractures treated in emergency departments. Materials and Methods: An observational study was done with 62 cases of distal radius fracture from July 2021 to June 2022, where all patients with distal radius fracture more than 18 years of age with the physical fitness of surgery of both genders were included in this study. Patients with neurovascular injury and comatose patients were excluded from the study. All cases were fixed with fragment-specific fixation. The data collection instruments used were Constant–Murley score and QuickDASH score and were followed up for 12 months. Results: The mean age of the study participants was 39.90 ± 10.84 years. Around 45.2% were female and 54.8% were male. Around 74.2% had road traffic accident and 25.8% had slip and falls. Mean palmar flexion in degrees was 56.77 ± 3.51, mean dorsiflexion in degrees was 62.90 ± 3.21, mean radial flexion in degrees was 17.39 ± 3.11, and mean ulnar deviation in degrees was 23.77 ± 3.76. Around 71% had excellent results and 29% had good results. Conclusion: The use of distal radius plating in the treatment of fractures of the distal radius fractures of the wrist has been established as a good and acceptable treatment option.

Comparaison des différentes ancres dans les réinsertions transosseuses de tendons fléchisseurs profonds en zone I

Transosseous reinsertion has been used to complement the Bunnell pull-out technique in the repair of zone I deep flexor tendon injuries. The aim of this study is to compare the different devices on the market in terms of complication, functional recovery and ease of use. This is a single-center study including all patients who underwent transosseous anchor reinsertion from 2010 to 2021 with a minimum of 6 months of follow-up. Twenty-seven patients were included. The anchors used were of different types: Microfix® Quickanchor plus® and Miniquick anchor® from DePuy Mitek; Juggerknot® Soft Anchor 1.0mm from Zimmer-Biomet; or Kerifix® 4.0 from KeriMedical. We analyzed intraoperative data, complications and functional recovery by quickDASH score. The average age was 38.6 years (±16.1), the demographic characteristics were identical in the different groups. There was a significant difference in the number of anchors used intraoperatively before definitive placement (P=0.02), to the disadvantage of the Juggerknot® anchors. There was no significant difference in terms of complications and functional recovery evaluated by the quickDASH. Our study did not find significant differences between the different anchors in terms of complications and functional recovery. Some anchors seem to have a better grip during placement than others.

Social determinants of outcomes in nonoperatively treated proximal humerus fractures

Proximal humerus fractures (PHFs) are common fractures especially in the elderly, with most fractures being managed nonoperatively. Traditional biomedical factors such as radiological alignment have not been able to meaningfully predict comfort and capability after PHFs. Conversely, recent literature has increasingly recognized the role of psychological factors in determining comfort and capability after PHFs. Nonetheless, less is known about the impact of social factors. Additional study of these potentially modifiable social factors as targets for enhancing recovery from injury is merited. Among people recovering from a nonoperatively- treated proximal humerus fracture (PHF) we studied the social factors associated with patient-reported outcomes at 6 months and 1 year. One hundred seventy-one patients who received nonoperative management of a PHF completed baseline measures of sociodemographic characteristics (age, gender, race, employment status, household income, educational level, presence of domestic workers, housing type, and smoking status). Six and 12 months after fracture, participants completed the Oxford Shoulder Score (OSS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and EuroQol-5-Dimensions (EQ5D) measures of comfort and capability. The relationship between capability and social factors was assessed using linear regression modelling, accounting for potential confounding from age, fracture severity assessed using Neer classification, premorbid comorbidities measured by Charlson Comorbidity Index, and premorbid functional status measured by Parker Mobility Index and Barthel Index. Lower capability (higher QuickDASH scores) 6 months and 1 year after fracture were associated with being unemployed (coef:-5.02 [95% CI:-9.96 to-0.07]; P=.047) and having domestic workers at home (coef: 8.63 [95% CI: 1.39 to 15.86]; P=.020), but not with Neer classification. Both greater shoulder discomfort and magnitude of incapability (lower OSS scores) and worse general quality of life (lower EQ5D scores) were associated with having domestic workers (coef:-4.07 [95% CI:-6.62 to-1.53]; P=.002 and coef:-0.18 [95% CI:-0.29 to-0.07]; P=.001 respectively) or living in an assisted care facility (coef:-14.82 [95% CI:-22.24 to-7.39]; P<.001 and coef:-0.59 [95% CI:-0.90 to-0.29] P<.001). The finding that people recovering from PHF experience less incapability in proportion to their social independence (employment, absence of a caregiver such as domestic workers at home and living outside care facilities) emphasizes the important associations of social factors to musculoskeletal health, and the utility of accounting for social factors in the development and assessment of care strategies.

Outcomes After Acute Versus Delayed Total Elbow Arthroplasty for the Treatment of Distal Humerus Fractures

Compare outcomes of acute versus delayed total elbow arthroplasty (TEA) following distal humerus fractures (DHF). This retrospective study included 39 patients who underwent primary TEA with semiconstrained implants for DHF, either within 4 weeks of their injury or after failing initial open reduction and internal fixation (ORIF) or nonsurgical management, between June 1, 2003 and February 1, 2018 with minimum 1-year follow-up. Our outcome measures included QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score, complications, reoperations, and range of motion (ROM). Demographics, clinical variables, and outcomes were compared using the Student's t-test, Mann-Whitney U test, and Fisher's exact test as appropriate. Kaplan-Meier curves for mortality, implant survivorship, and reoperation were created. Our patients were categorized into acute TEA (n= 22), ORIF to TEA (n= 10), and nonsurgical to TEA (n= 7) treatment groups. Additional analysis was performed comparing acute to delayed TEA, which combined data from failed ORIF and nonsurgical cohorts. The median follow-up, average age, and median Charlson comorbility index were similar between groups. The most common fracture pattern was AO13C. At median follow-up of 5.8 years, QuickDASH differed between cohorts: mean of 31 (SD 19) in acute TEA and 52 (SD 27) in delayed TEA, which further subdivided to 44.2 (SD 25) in failed ORIF and 76 (SD 23) in failed nonsurgical management. Poorer QuickDASH scores at final follow-up were associated with delayed TEA, initial nonsurgical management, and depression. Surgical complications were associated with delayed TEA. Higher Charlson comorbidity index was associated with death. No variables were associated significantly with ROM, revision, or reoperation. Comminuted DHFs are difficult to treat in the elderly with high rates of complication and poor function after surgery. Our study suggests TEA performed acutely result in satisfactory outcomes and should be a consideration for patients at high risk of failing ORIF or nonsurgical management. Therapeutic, III.

All-Inside Versus Outside-in Repair of Triangular Fibrocartilage Complex Peripheral Tears

Triangular fibrocartilage complex (TFCC) peripheral tears with persistent wrist pain can be treated with arthroscopic surgical repair owing to vascularization of the peripheral region. The safety and efficacy of all-inside repair has been shown in prior case series. The purpose of this study was to compare two methods of arthroscopic peripheral TFCC repair: all-inside vertical mattress and outside-in horizontal mattress. A 5-year retrospective review was performed on patients treated from 2016 to 2021 with wrist arthroscopy and TFCC repair for Palmer 1B tears. Patients with ulnar extrinsic ligament repair, distal radioulnar joint instability, concomitant ulnar shortening osteotomy, and extensor carpi ulnaris instability were excluded. Patient therapy and office visit records were reviewed. Outcomes including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); range of motion; grip strength; immobilization time; complications; and need for revision procedures were compared. Fifty-two patients were included in the study, 32 in the outside-in group and 20 in the all-inside group. The average follow-up length was 24.8 weeks, with similar range of motion and strength in both groups. The average postoperative QuickDASH score was 13 in the outside-in group and 9 in the all-inside group at 43.5 months, compared with the preoperative QuickDASH scores of 47 and 50, respectively. Mean immobilization time was longer for outside-in than for all-inside (5.25 vs 2.0 weeks, respectively). All-inside arthroscopic peripheral TFCC repair showed range of motion, grip strength, complications, revisions, and postoperative improvement in QuickDASH scores similar to those with the outside-in technique. Therapeutic IV; retrospective comparative study.

Does age affect outcome in children with clavicle fracture treated conservatively? QuickDash and MRC evaluation of 131 consecutive cases.

Non-operative treatment with immobilization is the gold-standard for paediatric clavicular fractures. Purpose of this study is to evaluate functional outcomes and efficacy of non-operative treatment of clavicular fractures in a succession of 131 children. Between 2006 and 2012, we treated non-surgically 131 children for a clavicular fracture. All fractures have been classified according to Robinson classification. Clavicle shortening, range of movements and muscular strength through the Medical Research Council (MRC) Scale were evaluated. To assess the outcomes, QuickDASH questionnaire, dividing the sample in 3 age-related group, was administered. The average follow-up was 26 months (8-84 months). Clavicle shortening at the time of injury occurred in 18 cases. All fractures reached union. Average time to union was 34 days. Mean time return to activity was 12.6 weeks. No cases of nonunion or delayed union were reported. Complications occurred in 21 cases. A shortening persisted in 2 cases. Only one patient had a slight functional restriction. Average QuickDASH Score was 6.2±1.1 (range 4.3-9.4). All patients recovered to an MRC Score of 5, except for one patient with a score of 4. Best QuickDASH Scores were observed in the group aged under 8 years and in non-comminuted and lateral third fractures of the clavicle. Observing results, clavicle fractures have a satisfactory clinical healing as shown by the good scores at QuickDASH and MRC Scale. Younger children under 8 years can achieve the best results with a conservative treatment in terms of bone healing and activity level.

Immediate Proximal Row Carpectomy for Severe Perilunate Dislocation Injuries: A Minimum 5-Year Follow-Up.

Background: In patients with perilunate injuries (PLI) with multiple ligamentous and bony injuries involving the proximal carpal row, open reduction and internal fixation (ORIF) can be difficult and lead to poor functional outcomes. Proximal row carpectomy (PRC) is an alternative procedure that has been used for severely comminuted fractures. The aim of our study is to evaluate the long-term functional outcome (minimum 5 years) of patients that underwent an emergency PRC for PLI. Methods: We conducted a retrospective study of patients who underwent PRC at our centre between 2001 and 2016. Only patients with follow-up data of more than 5 years were included in the study. We evaluated range of motion, grip strength, Mayo Modified Wrist Score (MMWS) and Quick Disabilities of Arm, Shoulder and Hand (Quick-DASH). Radiographic analyses were performed to assess the presence of radiocarpal osteoarthritis and the space between the radius and capitate. Results: Thirteen patients were included, with an average follow-up of 78.07 months (6.5 years). The MMWS was 65 points (four excellent and good, four fair and five poor results) and the Quick-DASH score was 30 points. X-ray analysis reported only 15.3% of patients with radiocarpal arthrosis and an average radio-capitate joint space of 1.92 mm. Conclusions: The outcomes of PRC in the management of PLI are comparable to the results reported in literature for conventional ORIF. PRC is a simpler procedure that minimises the need for re-intervention. Level of Evidence: Level IV (Therapeutic).

Evaluating the Performance of an Automated Patient-Reported Outcomes Collection Platform in a Postoperative Hand Surgery Population

Reliable collection of postoperative patient-reported outcome measures (PROMs) is critical to understanding surgical outcomes and the value of care. Automated PROMs collection, triggered by the electronic medical record at the 1-year postoperative anniversary, may provide a simple way to acquire outcomes for patients who have been discharged from clinic. The purposes of this study were to (1) evaluate the percentage of responses with an automated PROMs collection platform and (2) identify whether such a system may introduce selection bias by comparing responders with nonresponders. Adult patients (aged ≥18 years) undergoing hand and upper-extremity surgeries between August 2017 and January 2019 were included. Preoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were collected using tablet computer. Postoperative QuickDASH scores were collected using a single electronic survey request 1 year after surgery via an email with a personalized REDCap link. Univariate and multivariable regression analyses were performed to identify factors that differed between responders and nonresponders. A response rate of 27% (269 of 1010) was observed for the eligible postoperative patients. On multivariable analysis, the following were associated with greater odds of response: older age, Caucasian race (vs unknown), longer surgery duration, attending the first postoperative visit, and responding to the preoperative QuickDASH. The poor response rate that was observed highlights that an automated single email postoperative contact for PROMs collection is insufficient-active follow-up via reminder emails and/or telephone calls is needed. Outcome researchers and clinicians must be aware of potential selection biases, such as age and race, that may exist with automated PROMs collection. Single email postoperative contact to obtain postoperative PROMs is insufficient.

Reconstruction of the Irreparable Proximal Scaphoid with Costo-Osteochondral Graft (Rib Graft)

Abstract Background Irreparable proximal pole fractures of the scaphoid remain a real challenge for the treating handsurgeon. Standard salvage options include 4-corner fusion or proximal row carpectomy. These procedures limit the range of motion and have a high rate of conversion to total wrist fusion. The two current biological reconstructive options are the rib graft or the vascularized femoral trochlea osteocartilaginous free flap. In addition, there is the prosthetic semi-replacement arthroplasty using the pyrocarbon adaptive proximal scaphoid implant (APSI). Aims To present our series of patients with non-reconstructable proximal scaphoid nonunion/fracture (not suitable for conventional bone graft reconstruction) who were treated by the rib graft technique. Methods Our case series of 21 patients treated between March 2013 and January 2019 will been presented (median follow-up 29 months). The surgical technique will be described and crucial technical steps explained. The mean age at surgery was 26 years (SD 5.8) and the median time between injury and rib graft surgery was 2 years (IQR 1.7–3.6). The median postoperative follow-up was 29 months (IQR 19.5–42.4). Results All patients returned to their pre-surgical occupation. Significant differences were found in active wrist movements, grip strength, QuickDASH and PRWE pain scores. Union was seen in all 21 patients. The postoperative capitolunate angles were within normal limits. 17/21 patients showed no progessive postoperative osteoarthritic changes, while 4/21 showed slight progression. Progressive ossification of the graft was noted in 14 /21 patients. No donor site complication occurred. One patient failed and underwent excision of the scaphoid and fourcorner fusion 9 months after the rib graft. At the time of revision, the graft was clinically united. We found statistically significant improvements in QuickDASH and PRWE. Conclusions Our results suggest that reconstruction of the irreparable proximal pole scaphoid nonunion with costo-osteochondral graft reconstruction (rib graft) is a reliable and straightforward procedure in this challenging problem.

Patient Experiences after Open Trigger Finger Release in Patients with Type 1 and Type 2 Diabetes-A Retrospective Study Using Patient-reported Outcome Measures.

Data included patient-reported outcome measures (PROMs) from all OTFRs performed between 2010 and 2020 registered in the Swedish national registry for hand surgery in individuals over 18 years cross-linked with the Swedish National Diabetes Register (NDR). PROMs included QuickDASH and HQ8, a questionnaire designed for national registry for hand surgery, preoperative and at 3 and 12 months postoperative. HQ8 included pain on load, pain on motion without load, and stiffness. Outcome was calculated using linear-mixed models and presented as means adjusted for age and stratified by sex. In total, 6242 OTFRs were included, whereof 496 had T1D (332, 67% women) and 869 had T2D (451, 52% women). Women with T1D reported more symptoms of stiffness (P < 0.001), and women with T2D reported more pain on load (P < 0.05), motion without load (P < 0.01), and worse overall result at 3 months. At 12 months, however, no differences were found in any of the HQ-8 PROMs among men or women. Women with T2D had slightly higher QuickDASH scores at 3 and 12 months. Patients with T1D and T2D can expect the same results after OTFR as individuals without DM, although the improvement might take longer especially among women with T2D.

Comparing the Efficacy of Intra-articular Platelet-Rich Plasma and Corticosteroid Injections in the Management of Frozen Shoulder: A Randomized Controlled Trial.

Introduction Periarthritis of the shoulder, or frozen shoulder (FS), is a common, painful, and disabling condition with varied treatment strategies. Intra-articular (IA) corticosteroid (CS) injections are a popular treatment option, but their efficacy is often temporary. Platelet-rich plasma (PRP) has emerged as an alternative therapy for adhesive capsulitis, but the literature on its effectiveness is limited. This study aimed to compare the efficacy of IA PRP and CS injections in managing FS. Methods In this prospective, randomized study, 68 patients who met the inclusion criteria were enrolled and randomized using a computer-generated table into two groups: Group 1 (IA PRP) received 4 ml PRP, and Group 2 (IA CS) received 2 ml (80 mg) of methylprednisolone acetate mixed with 2 ml normal saline (for a total of 4 ml) as a CS injection in the IA area of the shoulder. Outcome measures included pain; shoulder range of motion (ROM); the condensed version of the disabling conditions of the arm, shoulder, and hand (QuickDASH) score; and the shoulder pain and disability index (SPADI) score. Participants were monitored via follow-up for 24 weeks, with pain and function assessed at each evaluation using the visual analog scale (VAS) score, the SPADI score, and the QuickDASH score. Results The IA PRP injections demonstrated better long-term outcomes than the IA CS injections, significantly improving pain, shoulder ROM, and daily activity performance. After 24 weeks, the mean VAS score in the PRP and methylprednisolone acetate groups was 1.00 (1.0 to 1.0) and 2.00 (2.0 to 2.0), respectively (P≤0.001). The mean QuickDASH score was 41.83 ± 6.33 in the PRP group and 48.76 ± 5.08 in the methylprednisolone acetate group (P≤0.001). The mean SPADI score was 53.32 ± 7.49 in the PRP group and 59.24 ± 5.80 in the methylprednisolone acetate group (P≤0.001), indicating a significant improvement in the PRP group's pain and disability scores after 24 weeks. The rate of complications was similar between the two groups. Conclusions Our findings suggest that IA PRP injections provide better long-term results than IA CS injections for managing FS. Platelet-rich plasma can be used as a treatment modality for better outcomes, particularly when the patient is contraindicated or refuses CS treatment. Further research is needed to evaluate the efficacy of these treatment modalities at different stages of FS and explore the potential benefits of ultrasound-guided injections.

Disparities in Hand Surgery Exist in Unexpected Populations.

Background The purpose of our study is to investigate disparities in the patient populations and outcomes of carpal tunnel release (CTR) and trigger finger release (TFR). Methods A retrospective review of 777 CTR and 395 TFR patients from May 2021 to August 2022 was completed. The shortened form of the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (QuickDASH) was recorded to evaluate physical function preoperatively and at one and three months postoperatively. This study was deemed institutional review board-exempt by the institutional clinical research committee. Results Compared to CTR, TFR patients resided in zip codes with higher levels of social vulnerability across dimensions of 'household composition and disability' (p=0.018) and 'minority status and language' (p=0.043). When analyzing QuickDASH scores by demographics and procedure, preoperative scores were statistically significantly higher for non-married (p=0.002), White (p=0.003), and female sex (p=0.001) CTR patients. Further, one-month postoperative scores were statistically higher for White and non-married CTR patients (0.016 and 0.015, respectively). At three months postoperatively, female and non-married patients had statistically significant higher scores (0.010 and 0.037, respectively). In TFR patients, one-month postoperative QuickDASH scores for White and female patients were statistically significantly higher (0.018 and 0.007, respectively). There were no significant differences in QuickDASH scores between rural and non-rural patients, household income (HHI) above or below the median, or the Social Vulnerability Index (SVI) dimensions. Conclusion Our study found marital status, sex, and race were associated with disparities in pre-and postoperative physical function in patients undergoing carpal tunnel or trigger finger release. However, future studies are warranted to confirm and develop solutions to disparities within this population.