Radius Fractures Research Articles

"Dr. AI Will See You Now": How Do ChatGPT-4 Treatment Recommendations Align With Orthopaedic Clinical Practice Guidelines?

Artificial intelligence (AI) is engineered to emulate tasks that have historically required human interaction and intellect, including learning, pattern recognition, decision-making, and problem-solving. Although AI models like ChatGPT-4 have demonstrated satisfactory performance on medical licensing exams, suggesting a potential for supporting medical diagnostics and decision-making, no study of which we are aware has evaluated the ability of these tools to make treatment recommendations when given clinical vignettes and representative medical imaging of common orthopaedic conditions. As AI continues to advance, a thorough understanding of its strengths and limitations is necessary to inform safe and helpful integration into medical practice. (1) What is the concordance between ChatGPT-4-generated treatment recommendations for common orthopaedic conditions with both the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines (CPGs) and an orthopaedic attending physician's treatment plan? (2) In what specific areas do the ChatGPT-4-generated treatment recommendations diverge from the AAOS CPGs? Ten common orthopaedic conditions with associated AAOS CPGs were identified: carpal tunnel syndrome, distal radius fracture, glenohumeral joint osteoarthritis, rotator cuff injury, clavicle fracture, hip fracture, hip osteoarthritis, knee osteoarthritis, ACL injury, and acute Achilles rupture. For each condition, the medical records of 10 deidentified patients managed at our facility were used to construct clinical vignettes that each had an isolated, single diagnosis with adequate clarity. The vignettes also encompassed a range of diagnostic severity to evaluate more thoroughly adherence to the treatment guidelines outlined by the AAOS. These clinical vignettes were presented alongside representative radiographic imaging. The model was prompted to provide a single treatment plan recommendation. Each treatment plan was compared with established AAOS CPGs and to the treatment plan documented by the attending orthopaedic surgeon treating the specific patient. Vignettes where ChatGPT-4 recommendations diverged from CPGs were reviewed to identify patterns of error and summarized. ChatGPT-4 provided treatment recommendations in accordance with the AAOS CPGs in 90% (90 of 100) of clinical vignettes. Concordance between ChatGPT-generated plans and the plan recommended by the treating orthopaedic attending physician was 78% (78 of 100). One hundred percent (30 of 30) of ChatGPT-4 recommendations for fracture vignettes and hip and knee arthritis vignettes matched with CPG recommendations, whereas the model struggled most with recommendations for carpal tunnel syndrome (3 of 10 instances demonstrated discordance). ChatGPT-4 recommendations diverged from AAOS CPGs for three carpal tunnel syndrome vignettes; two ACL injury, rotator cuff injury, and glenohumeral joint osteoarthritis vignettes; as well as one acute Achilles rupture vignette. In these situations, ChatGPT-4 most often struggled to correctly interpret injury severity and progression, incorporate patient factors (such as lifestyle or comorbidities) into decision-making, and recognize a contraindication to surgery. ChatGPT-4 can generate accurate treatment plans aligned with CPGs but can also make mistakes when it is required to integrate multiple patient factors into decision-making and understand disease severity and progression. Physicians must critically assess the full clinical picture when using AI tools to support their decision-making. ChatGPT-4 may be used as an on-demand diagnostic companion, but patient-centered decision-making should continue to remain in the hands of the physician.

Postoperative ileus in obstetric and gynecological practice: a prospective solution to the problem

Proton pump inhibitors (PPIs) are the undisputed leaders in the treatment of acid-related diseases. In actual clinical practice, the use of PPIs has been growing exponentially in recent decades. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines and reviews and meta-analyses of the current decade on the safety of PPI use note that when prescribing PPIs in large doses for a long period, the possibility of developing numerous side effects should be taken into account. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to 12/01/2023. The review addresses issues of drug interactions between PPIs and chemotherapeutic drugs, which should certainly be taken into account in real clinical practice. In addition, recent reviews and meta-analyses have examined side effects of long-term PPI use, such as increased risk of infection (Clostridium difficile infection, community-acquired pneumonia), electrolyte disturbances, kidney damage, increased risk of hip, wrist and spine fractures; increased cardiovascular risk and a number of others, which can also have an adverse effect on the prognosis of cancer patients. The risk of developing gastric cancer with long-term PPI therapy can be considered as a likely side effect, since their association with PPI use is not denied or questioned in recent reviews and meta-analyses. There is still uncertainty regarding the increased risk of other cancers, since there are publications that do not confirm their association with PPI use. However, the presented review, despite a number of contradictions, allows us to conclude that the increased cancer risk with long-term use of PPIs is real and must be taken into account when prescribing PPIs for a long term.

Artificial intelligence as an adjunctive tool in hand and wrist surgery: a review

Artificial intelligence (AI) is currently utilized across numerous medical disciplines. Nevertheless, despite its promising advancements, AI’s integration in hand surgery remains in its early stages and has not yet been widely implemented, necessitating continued research to validate its efficacy and ensure its safety. Therefore, this review aims to provide an overview of the utilization of AI in hand surgery, emphasizing its current application in clinical practice, along with its potential benefits and associated challenges. A comprehensive literature search was conducted across PubMed, Embase, Medline, and Cochrane libraries, adhering to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The search focused on identifying articles related to the application of AI in hand surgery, utilizing multiple relevant keywords. Each identified article was assessed based on its title, abstract, and full text. The primary search identified 1,228 articles; after the application of inclusion/exclusion criteria and manual bibliography search of included articles, a total of 98 articles were covered in this review. AI’s primary application in hand and wrist surgery is diagnostic, which includes hand and wrist fracture detection, carpal tunnel syndrome (CTS), avascular necrosis (AVN), and osteoporosis screening. Other applications include residents’ training, patient-doctor communication, surgical assistance, and outcome prediction. Consequently, AI is a very promising tool that has numerous applications in hand and wrist surgery, though further research is necessary to fully integrate it into clinical practice.

Assessing the severity of carpal tunnel syndrome during physical examination by measuring two-point discrimination: Post-hoc analysis of prospectively collected data

IntroductionCarpal tunnel syndrome (CTS) commonly presents after distal radius fractures. Assessing its degree of severity is essential to therapeutic decision-making - i.e. operative vs. conservative treatment. The role of the two-point discrimination (2PD) has not yet been evaluated as a potential indicator of severity during physical examination. Therefore, in our cross-sectional study, we aimed to find a correlation between 2PD values and disease severity, based on the gold-standard electromyography and electroneurography (EMG-ENG) and ultrasonography findings. MethodsWe conducted a post-hoc analysis of prospectively assessed CTS patients for 2PD values. We analyzed the correlation between 2PD and EMG-ENG measurement results, patient characteristics, nerve ultrasonography, and relevant CTS questionnaires. CTS severity was determined by EMG-ENG results. The Pearson correlation was calculated between variables. ResultsThe study included 81 patients. The three pre-determined EMG-ENG severity categories showed a significant correlation between both 2PD values and 2PD severity categories (r= 0.29 [0.07–0.48] and r= 0.26 [0.03–0.45]). Distal sensory latency and conduction velocity values correlated significantly with 2PD categories. However, the correlation coefficients (r= 0.25 [0.02–0.46] and r=-0.24 [-0.37–0.07]) were low. The 2PD severity categories showed no significant correlation with the severity assessed by nerve ultrasound (r=-0.07 [-0.38–0.25]). The 2PD values showed a significant correlation between the values of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (r= 0.3 [0.06–0.51]). We concluded that the best cut-off value for differentiating severe from non-severe CTS was at the 9.5 mm 2PD cut-off value (sensitivity = 0.65 [0.45–0.81], specificity = 0.71[0.58–0.82], AUC = 0.71 [0.59–0.83]). ConclusionThere is a significant correlation between 2PD values and the severity of carpal tunnel syndrome as determined by EMG-ENG; however, they are not interchangeable. Based on the results of our study, we propose that measuring two-point discrimination may be a quick and easy, reliable and cost-effective screening method to assess the severity of carpal tunnel syndrome following distal radius fractures.

Validity and Reliability of Modified Sphygmomanometer Versus Jamar Dynamometer in Measuring Hand Grip Strength for Patients with Distal Radius Fractures

Validity and Reliability of Modified Sphygmomanometer Versus Jamar Dynamometer in Measuring Hand Grip Strength for Patients with Distal Radius Fractures

Epidemiology of American Football-Related Fractures in the United States 2002-2021.

American football is the most popular sport in the United States, with over 5.6 million people >6 years old playing the sport. Fractures in American football athletes are significant, as they compromise an athlete's performance and can also lead to prolonged recovery periods, affecting team dynamics and player careers. Analyzing these injuries is critical to evaluate preventive measures and tailor rehabilitation strategies to ensure the well-being and sustained peak performance of football athletes on and off the field. To analyze the trend of American football fractures by body site, sex, and age in amateur athletes over a 20-year period between 2002 and 2021. Descriptive epidemiology study. The National Electronic Injury Surveillance System (NEISS) database was queried to characterize football-related fractures and injuries from 2002 to 2021 in patients aged 0-99 years old. National injury estimates were calculated using sample weights. Chi-square analysis and one-way ANOVA were performed to compare categorical variables. Of 56,809 cases of American football-related fractures over 20 years, patients aged 10 to 14 years had the highest incidence of fractures, composing 41.2% of all fractures (n = 23,389), and patients aged <18 years represented 88.8% of all fractures (n = 50,457). The median age of players when fractures occurred was 13 years. Upper extremity fractures (n = 41,863 [73.7%]) were the most common fracture reported compared with lower extremity and head, neck, and trunk fractures. Among upper extremity fractures, finger fractures had the highest prevalence (35.6%), followed by lower arm fractures (19.9%) and wrist fractures (13%). While most cases resulted in release after treatment (93.1%), 5.9% resulted in treatment and hospitalization. When analyzing trends in American football-related fractures over time, we observed the largest number of fractures in 2006 (n = 3664), while the smallest number of fractures occurred in 2020 (n = 1313). Also, a downward trend was found in American football-related fractures since 2006, with a mean of 101 fewer fractures each year. Our analysis showed that American football-related fractures diagnosed in the emergency department in the United States were most likely to occur in pediatric patients (10-18 years old). In addition, patients experiencing American football-related fractures were most likely to have an upper extremity fracture and not require hospitalization. The trend in American football-related fractures has been decreasing since 2006.

Distal Radioulnar Joint Instability.

The distal radioulnar joint (DRUJ) is vital to the stability and function of the wrist and forearm. The osseous morphology is variable and provides little stability. A complex of confluent soft tissues is the primary stabilizer; however, the contribution of each component has yet to be elucidated. It has become increasingly clear that the anatomic fixation of distal radius fractures restores DRUJ stability, obviating the need for additional DRUJ stabilization. This review will describe the anatomy and biomechanics of the DRUJ and discuss injury patterns, treatments, and clinical results.

Functional Outcome of Intra-Articular Distal End Radius Fracture Treated Surgically by Volar Locking Plate: A Prospective Study

Background. Unstable distal end intra-articular fractures of the radius pose a greater risk of reduction loss, potentially resulting in malunion and poor functional outcomes. Therefore, the amount of reduction and the technique of fracture fixation play a crucial role in achieving improved functional outcomes and ensuring patient satisfaction.Material and methods. This is a study of prospectively enrolled 27 patients with displaced intra-articular distal end radius fractures treated surgically by volar locking plate through modified Henry’s approach in the department of orthopedics at a tertiary care center. Patients were post-operatively evaluated for functional outcome and complications. Results. Out of the 27 patients 26 came for regular follow up, ranging from 3 months to 18 months and one patient was lost to follow-up. The functional outcome was investigated with the Mayo wrist score. Excellent scores were noted in 34.6%, good in 53.8% and satisfactory in 11.5% of the patients. Conclusion. Irrespective of the direction and degree of displacement, the volar locking plate as a treatment for an intraarticular distal end radius fracture is a good option as it provides stable fixation, and good to excellent outcomes with less complications.

Epidemiology of High-Energy Distal Radius Fractures.

Background: High-energy distal radius fractures have not been as well studied as the more common osteoporotic fractures. Differences between these two groups of fractures have implications on the prevention and clinical management of such injuries. Methods: A retrospective review was conducted of all patients in our institution who presented with distal radius fractures within the period of a year. Demographic data, injury mechanism, fracture classification, associated injuries and work-related status were obtained and analysed. Results: High energy fractures made up 27.1% of the cases. Falls from height were the most common cause, followed by motor vehicle accidents. These high-energy fractures were more commonly seen in males, younger patients (average age 41 vs. 61 years), and in workplace accidents. These injuries were also more likely to be bilateral and associated with an additional ipsilateral upper extremity injury. The high-energy group was also more likely to have an AO type B fracture. Conclusions: A substantial proportion of distal radius fractures seen in our population are high-energy injuries. Their contrasting patient and injury profiles suggest that they should be considered separately from osteoporotic fractures. Level of Evidence: Level IV (Therapeutic).

Effect of ultrasound-guided nerve blocks on anesthesia and pulmonary function in patients undergoing distal radius fracture surgery.

This study aimed to assess the impact of ultrasound (US)-guided nerve blocks (NBs) on anesthesia and their protective effect on pulmonary function (PF) in patients undergoing distal radius fracture (DRF) surgery. A total of 122 patients undergoing DRF surgery between April 2020 and June 2023 were included. According to the type of peripheral NB technique, these patients were randomized into a control group (CG; n = 60) receiving brachial plexus block (BPB) using blinded techniques, and an observation group (OG; n = 62) receiving US-guided supraclavicular BPB. Anesthetic effects, BPB-related indexes, adverse events, PF parameters (forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow), and serum biochemical indexes (interleukin [IL]-6/10) were compared. The OG showed a relatively higher proportion of good anesthetic effects, shorter onset and completion times of block, and longer block duration compared to the CG, with a lower AE rate. Despite reductions in PF parameters and IL-10 levels after intervention, the OG maintained higher values than the CG. IL-6 levels increased significantly in the OG but remained lower than in the CG. In conclusion, US-guided NBs demonstrated significant anesthetic efficacy and apparently reduced anesthesia adverse events while also exerting a protective effect on PF in DRF surgery patients.

Fear of Childbirth After Major Orthopedic Traumas: A Nationwide Multi-Register Analysis.

The aim of this study was to evaluate the association between previous major traumas and the prevalence of fear of childbirth (FOC) and the subsequent effects of FOC on the intended mode of delivery. In this nationwide retrospective register-based cohort study, data from the Care Register for Health Care were linked with the National Medical Birth Register (MBR) to evaluate the prevalence of FOC after major traumas. A total of 18,573 pregnancies met the inclusion criteria. A multivariable logistic regression model was used to assess the effects of FOC on the intended mode of delivery. Women with major traumas before pregnancy were compared to individuals with wrist fractures. Adjusted odds ratios (aORs) with 95% CIs between the groups were compared. Of those pregnancies that occurred after major traumas, 785 (6.2%) women were diagnosed with FOC after traumatic brain injury (TBI), 111 (6.1%) women after spine fracture, 38 (5.0%) women after pelvic fracture, 22 (3.2%) women after hip or thigh fracture, and 399 (5.2%) women in the control group. Among those women diagnosed with FOC, the adjusted odds for elective CB as an intended mode of delivery were highest among women with previous spine fractures (aOR 2.28, CI 1.45-3.60) when compared to the control group. We found no evidence of differences in maternal FOC in patients with preceding major traumas when compared to the control group. Therefore, it seems highly likely that the major trauma itself is the explanatory factor for the increased rate of elective CB.

Intraoperative fluoroscopy skills in distal radius fracture surgery: valid and reliable assessment on a novel immersive virtual reality simulator.

Orthopedic trainees must be able to perform intraoperative fluoroscopy imaging to assess the surgical result after volar locking plate surgeries of distal radius fractures. Guided by Messick's contemporary validity framework, the aim of our study was to gather evidence of validity for a test of proficiency for intraoperative imaging of a distal radius fracture using a novel immersive virtual reality simulator. 11 novices and 9 experienced surgeons employed at orthopedic departments completed 2 individual simulator sessions. At each session the participants performed 3 repetitions of an intraoperative fluoroscopic control of a distal radius fracture, consisting of 5 different fluoroscopic views. Several performance metrics were automatically recorded by the simulator and compared between the 2 groups. Simulator metrics for 3 of the 5 fluoroscopic views could discriminate between novices and experienced surgeons. An estimated composite score based on these 3 views showed good test-retest reliability, ICC = 0.82 (confidence interval 0.65-0.92; P < 0.001). A discriminatory standard was set at a composite score of 6.15 points resulting in 1 false positive (i.e., novice scoring better than the standard), and 1 false negative (i.e., experienced surgeon scoring worse than the standard). This study provided validity evidence from all 5 sources of Messick's contemporary validity framework (content, response process, internal structure, relationship with other variables, and consequences) for a simulation-based test of proficiency in intraoperative fluoroscopic control of a distal radius fracture fixated by a volar locking plate.

Distal Radius Osteotomies for Kienbock's Disease—A Minimally Invasive Approach

Abstract Background Negative ulnar variance is a recognized predisposing factor for Kienbock's disease (KD). Radial shortening osteotomy (RSO) reduces radial height, thereby alleviating stress on the lunate. Conversely, radial closed wedge osteotomy (RCWO) involves removing a distal radius wedge to not only decrease radial height but also reduce radial inclination, thereby enhancing lunate coverage. Description This article outlines a straightforward and minimally invasive approach to RSO utilizing a single cut and stabilization with a single screw. Additionally, it introduces a technique for RCWO comprising two cuts, wedge removal from the distal radius, and fixation using a single headless screw. Literature Review Traditionally, RSO and RCWO procedures include a volar approach consistent with distal radius fracture fixation techniques. However, the reliance on “free-hand” cuts may necessitate larger hardware for stabilization. Overcorrection poses risks of suboptimal outcomes and often mandates subsequent hardware removal procedures. Clinical Relevance Both RSO and RCWO techniques offer minimally invasive solutions, which preserve the periosteum, and maintain stability. These techniques only require a single screw and a removable splint. RSO is indicated for KD wrists with negative ulnar variance, while RCWO is preferable for cases with negative ulnar variance and increased radial inclination.

Study on automatic and rapid diagnosis of distal radius fracture by X-ray

This article aims to combine deep learning with image analysis technology and propose an effective classification method for distal radius fracture types. Firstly, an extended U-Net three-layer cascaded segmentation network was used to accurately segment the most important joint surface and non joint surface areas for identifying fractures. Then, the images of the joint surface area and non joint surface area separately were classified and trained to distinguish fractures. Finally, based on the classification results of the two images, the normal or ABC fracture classification results could be comprehensively determined. The accuracy rates of normal, A-type, B-type, and C-type fracture on the test set were 0.99, 0.92, 0.91, and 0.82, respectively. For orthopedic medical experts, the average recognition accuracy rates were 0.98, 0.90, 0.87, and 0.81, respectively. The proposed automatic recognition method is generally better than experts, and can be used for preliminary auxiliary diagnosis of distal radius fractures in scenarios without expert participation.

All-cause mortality and suicide after pediatric traumatic brain injury: a 20-year nationwide study in Finland

ObjectivesTo assess all-cause mortality and suicides after pediatric traumatic brain injury (pTBI). Study designWe conducted population-based historical cohort study using three nationwide registers from 1998 to 2018 in Finland. All patients that were the age of 0–17 at the time of the pTBI were included. The reference group consisted of children with ankle or wrist fractures. We used Kaplan–Meier and restricted mean survival time (RMST) analysis with 95% confidence intervals (CI) to compare all-cause mortality and suicides between groups. ResultsAfter 20 years of follow-up, there were 479 deaths in the pTBI group (0.67% of 71,963) and 306 deaths in the reference group (0.47% of 64,848). In the pTBI group, 28.6% of the deaths occurred after the first follow-up year, compared to 2.6% in the reference group. In all-cause mortality, survival time was slightly less in the pTBI group with age and gender adjustment throughout the follow-up period [20-year RMST ratio: 0.995; CI (0.994–0.996)]. The leading manners of death were suicides (pTBI group = 28.4%; reference group = 45.5%) and traffic collisions (pTBI group = 37.4%; reference group = 20.8%). Age and gender-adjusted survival time was slightly less for those with suicide as a manner of death in the pTBI group [10-year RMST ratio: 0.999; CI (0.999–0.999); 20-year RMST ratio: 0.999; CI (0.998–0.999)]. ConclusionsChildren and adolescents who sustained a TBI have slightly lower long-term survival time for all-cause mortality, most of which occurs during the first year following injury. There is no clinically meaningful difference in deaths by suicide between the two injury groups.

Multidisciplinary approach to repair of intra-articular fractures of the distal radius in a complicated setting (prehabilitation)

Introduction Treatment of malunited periarticular fracture of the distal metaepiphysis of the radius in a complicated setting is challenging and involved orthopaedic care and related specialties of neurologists, neurosurgeons and rehabilitation specialists. New methods are offered for repair of the distal radius fractures but the results obtained to date cannot be considered satisfactory, since the treatment is aimed at the restoration of the anatomical relationships and the hand function.The objective was to demonstrate the role of prehabilitation preparing patients for elective reconstructive surgery, to present a multidisciplinary approach to the treatment of malunited radius fracture complicated by posttraumatic compression ischemic multineuropathy.Material and methods The medical history of a 56-year-old patient with distal radius malunion complicated by posttraumatic compression ischemic multineuropathy was reviewed. Outcome criteria included absence of complaints and restored function of the hand and the wrist.Results A positive functional outcome was recorded after prehabilitation and surgery. Early postop, the DASH scored 35, palmar flexion measured 64° with dorsiflexion of 61° and dynamometry of 30 kg seen with the left involved hand. A faster recovery of the hand function occurred due to regression of neurological disorders.Discussion Treatment of the distal radius malunion in a complicated setting suggests the involvement of related specialists including neurologists, neurosurgeons, professionals in functional and diagnostic radiology, rehabilitation specialists so that the approach must be multidisciplinary. A preoperative course of prehabilitation supervised by a neurologist and a rehabilitation specialist is essential for the patient to achieve a higher basic level of functionality. Surgical treatment must be a stage of multi-stage multidisciplinary treatment of distal radius malunion in a complicated setting.Conclusion The clinical case showed an effective multidisciplinary approach in the treatment of distal radius malunion in a complicated setting. Preoperative preparation (prehabilitation) had a positive effect on the postoperative recovery and functional results.

Solute transport in stochastic discrete fracture-matrix systems: Impact of network structure

Obtaining a comprehensive understanding of solute transport in fractured rocks is crucial for various geoengineering applications, including waste disposal and construction of geo-energy infrastructure. It was realized that solute transport in fractured rocks is controlled by stochastic discrete fracture-matrix systems. However, the impacts and specific uncertainty caused by fracture network structures on solute transport in discrete fracture-matrix systems have yet not been fully understood. In this article, we aim to investigate the influence of fracture network structure on solute transport in stochastic discrete fracture-matrix systems. The fluid flow and solute transport are simulated using a three-dimensional discrete fracture matrix model with considering various values of fracture density and size (i.e., radius). The obtained results reveal that as the fracture density or minimum fracture radius increases, the corresponding fluid flow and solute transport channels increase, and the solute concentration distribution range expands in the matrix. This phenomenon, attributed to the enhanced connectivity of the fracture network, leads to a rise in the effluent solute concentration mean value from 0.422 to 0.704, or from 0.496 to 0.689. Furthermore, when solute transport reached a steady state, the coefficient of variation of effluent concentration decreases with the increasing fracture density or minimum fracture radius in different scenarios, indicating an improvement in the homogeneity of solute transport results. The presented analysis results of solute transport in stochastic discrete fracture-matrix systems can be helpful for uncertainty management in the geological disposal of high-level radioactive waste.

Variation in Treatment of Young Adult Distal Radius Fractures by Pediatric and Adult Orthopaedic Surgeons.

There remains a lack of consensus on the optimal treatment of isolated distal radius fractures in young adults. The primary aim of this study was to identify differences in treatment of isolated distal radius fractures in patients aged 17 to 21 years treated by adult versus pediatric orthopaedic surgeons. The secondary aim was to identify whether there is a variation in utilization of open reduction and internal fixation (ORIF) versus closed reduction and percutaneous pinning when treated surgically by adult versus pediatric orthopaedic surgeons. Patients aged 17 to 21 years with isolated distal radius fractures who were treated by adult or pediatric orthopaedic surgeons at 1 of 3 hospitals were identified through retrospective chart review. 72 patients in the pediatric surgeon cohort and 64 patients in the adult surgeon cohort were included. Demographic details were recorded, and radiographs from the initial clinic visit and final follow-up were obtained. Bivariate analysis was used to evaluate for primary and secondary aims. 40 of 136 patients were treated surgically. Bivariate analysis showed that factors associated with surgical treatment were treatment by an adult orthopaedic surgeon, higher body mass index, radiographic severity, AO classification, intraarticular involvement, distal radial-ulnar joint involvement, and meeting AAOS clinical practice guideline surgical criteria. Factors associated with ORIF compared with closed reduction and percutaneous pinning included treatment by an adult orthopaedic surgeon, older age, higher body mass index, and greater articular step-off. In comparable cohorts of young adult patients with distal radius fractures with similar fracture characteristics, there was notable variation in treatment between adult and pediatric orthopaedic surgeons. Surgical treatment was used more by adult surgeons, and when treated surgically, ORIF was used more by adult surgeons. Variation among surgeons illustrates the persistent lack of consensus on the optimal treatment in this population and highlights the need for additional research on this topic to guide management. Level IV.

Intra-articular fracture reduction: a comparative observational study of clinical results after the surgical treatment of distal radius fractures

Purpose: This study compared the outcomes of intra-articular fracture reduction for distal radius fractures. Methods: Among 180 patients who underwent open reduction and plate fixation, the exclusion criteria were as follows: non-acute fracture (&gt;1 month), an accompanying ulnar neck fracture, a distal ulnar fracture requiring fixation, fixation through the dorsal approach, other accompanying hand fractures, the absence of preoperative or postoperative computed tomography (CT), and follow-up for &lt;1 year. Intra-articular fractures were evaluated through CT. Forty-eight patients with intra-articular fractures were studied. Displaced intra-articular fractures were defined as: (1) articular step-off ≥1 mm, (2) fracture gap ≥2 mm, or (3) gross incongruence. Reduction was classified as good (n=23) or poor (n=25) based on postoperative CT. The pain visual analogue scale (pVAS), the quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and range of motion of the wrist joint were compared between both groups.Results: No significant between-group differences were found in the preoperative demographic data and the postoperative pVAS and quick DASH scores (pVAS: 0.6 vs. 0.8 and quick DASH: 9.4 vs. 10.2 in the good vs. poor reduction groups, respectively). However, the flexion-extension arc was significantly restricted in the poor reduction group (162° in the good reduction group vs. 146° in the poor reduction group, p&lt;0.001).Conclusion: The reduction of the articular surface was not related to pain and functional results at the mid-term follow-up after the surgical treatment of intra-articular distal radius fractures. However, insufficient fracture reduction affected the postoperative range of motion.

Three-Dimensional Morphometric Analysis of the Volar Cortical Shape of the Lunate Facet of the Distal Radius.

In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar-dorsal distance, radial-ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation.