Fractures Of Upper Limb Research Articles

A Cross-sectional Study on the Prescription Pattern of Undenatured Collagen-II in Bangladeshi Patients

Numerous clinical and experimental studies have shown that individuals with a variety of orthopedic diseases can get benefit from the undenatured form of type II collagen (UC-II). It has proved its efficacy and long lasting effectiveness for several orthopedic patients throughout different countries in the world. But in Bangladesh it is not frequently prescribed yet. Therefore, we made the decision to conduct a survey-based study to determine the number of patients prescribed with UC-II under which pathological conditions and to what extent they have got relief from their joint associated ailments. To conduct the study, we visited the orthopedic department of various hospitals in Bangladesh and with consent from patients we collected pictures of prescriptions as well as got overview regarding their complications. We gathered photographs of 252 prescriptions from orthopedic department patients, among which only 31 patients were prescribed with UC-II. According to this study, 40.47 , 32.54 , 15.47 , 9.12 and 2.38 % of patients were over the age group of 60 , 50 , 40 , 30 and 20 - years respectively. We found that a range of individuals with various orthopedic problems such as osteoarthritis, spondylosis, right tibial plateau, paresthesia in right upper limb and various bone fractures were advised with UC-II. However, we discovered only in 12.30% of prescriptions that the doctors prescribed UC-II, indicating this is a less common practice in Bangladesh in spite of its huge potential to recover joint pain associated complications. Bangladesh Pharmaceutical Journal 26(2): 157-161, 2023 (July)

Ultrasound guided suprascapular and supraclavicular nerve block in combination with continuous perineural brachial plexus block for operative management of upper limb multiple fractures: a case report

We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein the patient declined general anesthesia. Instead, we successfully administered anesthesia using ultrasound-guided supraclavicular and suprascapular nerve blocks, combined with continuous perineural brachial plexus block. The surgical procedure was successfully completed within six hours, and no complications were encountered.

Minimally invasive treatment of upper limb fractures

Minimally invasive treatment of upper limb fractures

Added value of waist circumference to body mass index for predicting fracture risk in obesity: a prospective study from the CARTaGENE cohort.

Waist circumference (WC) is a stronger risk factor of metabolic disorders than body mass index (BMI), but whether it holds true for fracture risk prediction remains unclear. We aimed to evaluate relationships between WC and fracture incidence within BMI categories and evaluate whether BMI modifies these relationships. Men and women aged 40-70years from the CARTaGENE cohort were divided by BMI category at baseline: normal weight, overweight, and obesity. Incident fractures were identified over 7years via linkage with healthcare administrative databases. Cox proportional hazard models estimated the relationships between WC and incident fractures at any site and by skeletal site within each BMI category. Results are reported as adjusted hazard ratios (95% confidence intervals) per 10cm increase in WC. Effect modification was evaluated qualitatively by comparing relationships between BMI categories. Of the 18 236 individuals included, 754 sustained a fracture. Significant relationships were found between WC and distal lower limb fractures in the normal (1.25 [1.08, 1.45]) and overweight (1.28 [1.07, 1.52]) BMI categories, but not in the obesity category. In the overweight category, we found an increased risk of distal upper limb fractures with increasing WC (1.49 [1.04, 2.15]). No significant relationship was observed regarding WC and fracture risk at any site or major osteoporotic fractures. An effect modification of BMI on the relationships between WC and distal lower limb fractures was observed. WC provides both independent and additive information to BMI for the identification of individuals at risk of obesity-related fractures.

Prevalence of Psychiatric Morbidity and Stress Burden among Patients with Limb Fracture.

To assess the prevalence of psychiatric morbidity and stress burden among the patients with limb fractures and compare them with age and gender matched control group. The cross-sectional study was conducted on 25 patients each of lower and upper limb fractures, presenting 2 weeks or more after the fracture to orthopedics OPD of Dayanand Medical College and Hospital. Psychiatric manifestations and stress burden were assessed using Mini International Neuropsychiatric Interview (M.I.N.I.), perceived stress scale (PSS), and impact of event scale-revised (IES-R) on the patients. It was compared to an equal number of age and gender matched normal control group. Majority of the patients with limb fractures were male (70%). The upper limb fracture was in age group of 18-30 years (52%), and those with lower limb fracture were >50 years of age (48%). Most common psychiatric morbidity seen in patients was major depressive disorder (52%) which was statistically significant in comparison with control group. The impact of trauma on patients resulted in avoidance and hyperarousal symptoms significantly in lower limb fracture patients than upper limb ones (P < 0.05). The long bone injuries in patient cause significant psychiatric morbidity which increases the stress burden in such patients due to immobility and pain.

FUNCTIONAL RECOVERY OF DISTAL RADIUS FRACTURE: AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS

Distal Radius Fracture (DRF) is the most common upper limb fracture, which reduces independence in daily living activities. This study explored the functional recovery of distal radius fracture six months post-injury. We conducted a qualitative study using an Interpretive Phenomenological Analysis (IPA). 11 adults aged 18 and 59 with DRF participated in face-to face, semi-structured, and in-depth interviews recorded digitally. In addition, transcribed recordings were analysed thematically. Four themes emerged from the analysis: (i) I could do or could not do, (ii) How I live my life, (iii) What I feel like, and (iv) Something is wrong with my hand. Following over six months of injury, all participants experienced physical limitations where most participants reported reduced daily activities performance. Consequently, some participants developed adaptive strategies to enhance their daily activities’ ability. DRF also affected their psychological aspects. Overall, DRF affects individuals’ functioning in daily living activities, work and leisure for over six months post-injury. This study highlights that occupational therapists need to maintain or strengthen functional recovery and support individuals with DRF even for over six months post-injury.

The Natural History of Symptomatic Fractures in Children and Adolescents with Osteogenesis Imperfecta Type 1: A Cohort Study from Western Australia.

The fracture experience of children and adolescents with osteogenesis imperfecta (OI) type 1 is not well described in the literature. We present data on symptomatic long bones and axial skeleton fractures of all patients aged 0 to 18 years with OI type 1 seen at a specialized bone clinic in Western Australia in the period 2008 to 2020 using a retrospective chart review method. The cohort consisted of 44 patients (21 males, 23 females). Median (interquartile range [IQR]) age was 11.3 (6.2 to 17) years, giving a total of 520 patient-years in the study during which 197 fractures were experienced. The mean fracture rate was 379 fractures per 1000 patient-years (95% confidence interval [CI]: 310 to 440); however, the experience for fractures varied from ≤1 fracture in 23% (n = 10) to two to 20 in 77% (n = 34) of the cohort. Twenty-one patients (48.5%) received bisphosphonates during the study period. In logistic regression, age, but not sex or family history of OI, was a significant predictor of fracture risk. The highest total fracture rate was observed in the age group 0 to <3 years at 469 fractures/1000 patient-years, which declined to 140 fractures/1000 patient-years in the age group 15 to 18 years. The lower limbs were the site of 49.7% of all fractures. The highest rate for lower limb fracture was in the age group 0 to <3 years at 331 fractures/1000 patient-years, decreasing to 0 fractures/1000 patient-years in the age group 15 to 18 years. Upper limb fracture rates increased from 100 fractures/1000 patient-years in the 0 to <3 years age group to 307 fractures/1000 patient-years in the 9 to <12 years age group and then declining to 70 fractures/1000 years in the 15 to 18 years age group. In pediatric patients with OI type 1, fracture risk is highest in early life, especially in the lower limbs. Multidisciplinary care of children with OI should have a particular focus on strategies to prevent these fractures. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Preoperative estimation of humerus intramedullary nail length using clinical landmarks

PurposeIntramedullary interlocking nailing is one of the accepted methods of treating humerus diaphyseal fractures. Appropriate nail length and diameter are of paramount importance to achieve a stable fracture fixation. Estimating the nail length can be as challenging in certain cases as it is important. This study aims to provide an easy-to-use formula utilizing clinical measurements from contra lateral arm to accurately estimate humeral nail length. MethodsThis descriptive cross-sectional study was conducted at 3 tertiary care hospitals in Mangalore, India. Patients above the age of 18 years coming to the outpatient department with elbow, shoulder or arm complaints requiring radiological investigation from July 2021 to July 2022 were included. Patients with fractures or dislocations of upper limbs, malunited or non-united fractures of upper limbs, congenital or developmental deformities and patients with open growth plates were excluded. Patients’ variables (like age and gender), radiological humerus length and contralateral arm clinical measurements were recorded. An independent samples t-test was used for univariate analysis, and linear regression analysis was done to estimate the desired nail length using the clinical measurement of the humerus (cm) in both genders separately. The significance level was set at p < 0.05. ResultsOur study included 204 participants of which 108 were male and 96 were female. The formula for predicting humeral nail length in males is (−2.029) + (0.883 × clinical measurement). The formula for females is 1.862 + (0.741 × clinical measurement). A simplified formula to determine humeral nail length is 0.9 clinical length – 2 cm (in males) and 0.7 × clinical length + 2 cm (in females). ConclusionTo improve the stability of fixation with intramedullary nails it is imperative to select the appropriate nail length. There have been studies that devised reliable methods of determining nail lengths in the tibia and femur using preoperative clinical measurements. A similar clinical method of determining humeral nail length is lacking in the literature. Our study was able to correlate radiological lengths of the humerus medullary canal with clinical measurements performed using anatomical landmarks to arrive at a formula. This allows for a reliable and easy nail length determination preoperatively.

Clinical efficacy of comprehensive rehabilitation therapy for postoperative elbow joint dysfunction in upper limb fracture.

Clinical efficacy of comprehensive rehabilitation therapy for postoperative elbow joint dysfunction in upper limb fracture.

Ultrasound-guided supraclavicular block versus Bier block for emergency reduction of upper limb injuries: a protocol for an open-label, non-inferiority, randomised controlled trial

BackgroundClosed reduction of upper limb fractures and/or dislocations are common in the emergency department (ED), which involves physically re-aligning the injured part prior to immobilisation. As this is painful, numerous techniques are available to provide regional anaesthesia to ensure patient tolerance. A Bier block (BB) is typically performed as part of routine care. An alternative technique gaining interest in the ED is ultrasound-guided supraclavicular block (UGSCB), which involves injecting local anaesthetic around the brachial plexus at the supraclavicular fossa under ultrasound guidance. It is unclear whether UGSCB is effective and safe when performed in the ED.MethodsSUPERB (SUPraclavicular block for Emergency Reduction versus Bier block) is a prospective open-label, non-inferiority randomised controlled trial that compares the effectiveness of UGSCB versus BB for closed reduction of upper limb fractures and/or dislocations. Adult patients presenting with an upper limb fracture and/or dislocation that requires emergent closed reduction in the ED will be eligible. After screening, participants will be randomised to either UGSCB or BB. Once regional anaesthesia is obtained, closed reduction of the injured part will be performed and appropriately immobilised. The primary outcome is maximal pain experienced during closed reduction measured via a visual analogue scale (VAS). Secondary outcomes include baseline and post-reduction pain, patient satisfaction, total opioid requirement in ED, ED length of stay, adverse events and regional anaesthesia failure.DiscussionExisting evidence suggests UGSCB is effective when performed in the operating theatre by trained anaesthetists. SUPERB will be the first randomised controlled trial to elucidate the effectiveness and safety of UGSCB in the ED. The findings have the potential to provide an alternative safe and effective option for the management of upper extremity emergencies in the ED.Trial registrationThis trial has been registered on 21 October 2022 with Australia and New Zealand Clinical Trials Registry (ACTRN12622001356752).

Application of phased game-based education model in children with upper limb fractures

Application of phased game-based education model in children with upper limb fractures

Autologous drill dust bone graft a novel technique of bone graft harvesting

This paper, describes a novel technique of graft harvest from the drill site during plate osteosynthesis of fractures of upper limb. The grafts harvested are corticocancellous chips which we prefer to name as 'Drill dust'. This drill dust usually goes wasted as surgeons tend to ignore to collect the drilled out bone which is usually washed out during or after the procedure. We decided to collect these drilled out bone in a meticulous and systematic manner and found that they form a significant amount of bone to be used as a graft at the fracture site which can potentially enhance fracture union. We did a study utilising our technique assessing clinical and radiological union in a subset of patients undergoing upper limb fracture plate osteosynthesis between July 2018 to Jun 2019. We found that there was an enhanced radiological and clinical union in all 28 of our cases where this technique was used. There were no complications noted with the procedure.

Intraarticular Distal End Radius Fractures Treated with Volar Locking Plate Variations.

"Distal end radius fractures" account for almost 16% of all fractures and are the most common kind of upper limb fractures treated in hospital emergency departments. "Distal end radial fractures" occur more often in younger people due to high-energy trauma than in older people due to low-energy trauma. When comparing women and men of the same age, proximal end radii fracture are more prevalent in women than men owing to significant osteoporosis and a higher tendency for accidents in older women. This was a prospective interventional study in which participants were divided in to two groups. Both groups in the study had comparable range of motion, with the exception of the forearm", where the "variable angle volar locking plate" excelled. The risk of complications was low in both approaches. Thus we conclude that when it comes to treating "displaced intra-articular distal end radius" fractures, the variable angle volar locking plate is superior than the Ellis locking plate.

A comparative study of outcome of tension band wiring and hook plating in fracture olecranon

Background: Olecranon fractures are common upper limb fracture accounting for 40% of the fractures around elbow. Anatomic reduction and restoration of the joint surface is required for good outcome and to prevent post-traumatic arthritis. This study was directed towards the functional results and complications of surgical management of olecranon fracture treated with hook plate fixation and tension band wiring. Methods: This prospective comparative study was done at a tertiary care centre from 2019 to 2022. This study consisted of 30 patients of fracture olecranon of which 15 were treated with tension band wiring and 15 with hook plate. All patients were followed up with minimum follow up of six months and evaluated for their functional outcome using Mayo elbow performance score. Results: In this study, the average age was 34 years in TBW group and 37 years in hook plate group. The mean Mayo elbow performance score after 6 months in TBW group was 88.33 (excellent) and in plate group was 90 (excellent). Superficial infection was present in 2 patients of the TBW group. Elbow stiffness was present in 2 patients of TBW group. Hardware impingement was present in one patient in each of TBW group and plate group. Conclusions: To achieve early movements and to prevent complications like traumatic arthritis and joint stiffness we need a perfect anatomical reduction in intra-articular fractures of the olecranon. This study showed no significant difference in functional outcome with both the techniques, but the complications are more with TBW.

The health benefits of bicycling to school among adolescents in China: A propensity score matching study.

A large number of high-income countries are now promoting active commuting to school as an opportunity for adolescents to increase physical activity (PA) and improve their health. Few studies have examined the multiple benefits of active travel to school among adolescents in developing countries, especially in China. Hence, this study aims to estimate the effects of bicycling to school on adolescents' subjective health, physical health, and sickness absence. Self-reported and cross-sectional data from 6,353 school-aged children (12-19 years old) in the 2014-2015 China Education Panel Survey (CEPS2014-2015) were used. The independent variable was a binary, self-reported indicator of whether children bicycled to school. The dependent variables included subjective health (self-reported health, mental stress), physical health (BMI, kidney disease, lung disease, heart disease, brain disease, upper limb fracture, lower limb fracture, and sickness frequency), and sickness absence. Propensity score matching (PSM) was used to estimate the causal effects of bicycling to school on adolescents' health. Bicycling to school positively affects both subjective and physical health. Those students who biked to school were associated with a higher self-rated health status, a healthier weight, a lower level of mental stress, and a lower risk of developing brain diseases. No significant relation is found between bicycling and sickness frequency, and sickness absence. Moreover, we separately compared the bicycling group with the walking group and the non-active travel group. There is still evidence that cycling is beneficial for students. Compared with walking to school, cycling to school resulted in a higher self-rated health score and a lower mental stress score. Physically, students who bicycled to school were less likely to be absent from school and suffer from kidney and brain diseases than students who walked to school. However, we do not find a significant difference in health outcomes from cycling compared to non-active modes of transportation. Further, differentiation of the health effects of bicycling across living areas shows that health effects are more pronounced for those living in edge and rural areas. These findings provide evidence of the value of promoting bicycling to school in improving various adolescents' health outcomes in transitional China.

Gunshot Injuries: Patterns, Presentations, and Outcomes of Civilian Hospital Experiences in a Developing Country Setting

Background: Gunshot injuries are considered a health burden as well as one of the intricate emergencies in civilian medical practice. In this study, we aim to determine the pattern of presentation and management outcome in a general hospital setting in a sub-Saharan African country.Methods: This is a retrospective, hospital-based study conducted between January 2015 and December 2019 in a general teaching hospital to review the clinical presentation and management outcome of gunshot injuries. All patients’ records were reviewed during the study period.Results: The total number of patients involved in the study was 157 with 83% male predominant. About 50% were from the age group 20–29 years that were most affected. The commonest anatomical site affected in the study was the lower limb (41.4%) and upper limb (22.9%), and most of the patients had been diagnosed with limb fractures (49.7%) and soft tissue injuries (28.7%). Wound debridement is the commonest procedure performed for 91 (58.0%) patients. The site of the pullet has a significant relation to the management outcome with a P-value of 0.002. Additionally, about 45% (72 patients) have stayed more than 20 days and it was affected significantly by the types of treatment provided, which has a significant relation to a hospital stay with a P-value of 0.00.Conclusion: Most of the patients in this study were young males. Upper and lower limb fractures were the most common presentations. Wound debridement, bone fixation, and laparotomy were the most common treatments with significant success rates, despite prolonged hospital stays.

The 2015 Nepal Earthquake: An Overview of the Orthopedic Experience in 192 Admitted Casualties

Introduction: On 25 April 2015, a massive 7.6 magnitude earthquake struck Nepal followed by dozens of aftershocks including a 7.3 magnitude on 22 May 2015 killing over 9000 people’s and injuring more than 23,000. This study aimed to provide an overview on type of injuries and the procedures carried out among admitted casualties. Methods: Patients who required admission for treatment were included. Retrospective analysis of records of 192 earthquake victims for demographic data, type of injuries and procedure performed were reviewed. Results: Total patients received were over 2843; 192 were admitted for orthopedic procedures. Total 205 surgeries were performed on 170 patients out of which, 8, 87 and 110 for spine, upper limb and lower limb fractures respectively. 13 patients required debridement and external fixation. One patient required nail revision and two limb amputations were performed. No mortality occurred in the hospital while 9 dead bodies were received. Conclusion: Well-planned categorization of casualties with timely and appropriate surgical intervention by orthopedic team can not only save the injured limb but also prevents unnecessary morbidity and mortality

Horse and Cattle-Related Trauma: A Retrospective Review of Injuries and Management in a Regional Queensland Hospital.

Horse and cattle-related trauma is a common presentation to regional hospitals in Australia. We review local incidence and patterns of injuries relating to horse and cattle trauma over a three-year period at the Toowoomba Base Hospital within the Darling Downs region in Queensland, an area rich in cattle farming and equestrian recreation. We conducted a single-centre retrospective cohort study. The inclusion criteria were all patients presenting with injuries following cattle or horse-related incidents between January 2018 and April 2021. Primary outcomes were the mechanism of trauma, confirmed injuries, and the need for admission, operative intervention, or inter-hospital transfer. A total of 1002 individuals (55% female; mean age 34 years; median Injury Severity Score (ISS) 2) were identified during the study period. Presentations relating to horses (81%) were more frequent than cattle (19%). The most common mechanism of injury was "falling" for horse incidents (68%)and "trampling" for cattle incidents (40%). Horse incidents often resulted in soft tissue injury (55%), upper limb fracture (19%), or lower limb fracture (9%). Cattle incidents often resulted in soft tissue injury (57%), upper limb fracture (15%), and rib fracture (15%). Overall, 14% required admission, 13% required operative intervention, and 1% required inter-hospital transfer. This local series demonstrates a high volume of cattle and horse-related trauma in our region. Whilst most patients are managed locally without operative intervention, the high frequency of injuries observed necessitates further development of preventative measures and safety advocacy.

Relationships between Obesity and Incidence of Fractures in a Middle-Aged Population: A Study from the CARTaGENE Cohort.

The association between obesity and fracture risk is complex and may vary by definition of obesity, skeletal site, and sex. We aimed to evaluate the relationships between obesity, defined using body mass index (BMI) or waist circumference (WC), and fracture incidence at any site and by skeletal site (i.e., major osteoporotic fractures [MOFs], distal lower limb fractures [tibia, ankle, feet], and distal upper limb fractures [forearm/elbow, wrist]). The secondary aim was to assess the aforementioned relationships by sex. We used CARTaGENE, a large population-based cohort of individuals aged 40-70 years from Quebec, Canada, who were assessed in 2009-2010. Incident fractures were identified via linkage with healthcare administrative databases over a 7-year period. Cox proportional hazard models adjusted for several potential confounders were used to estimate the relationships, with exposures treated as continuous variables. Results are reported as adjusted hazard ratios (aHRs) and 95% confidence intervals. We identified 19 357 individuals (mean ± standard deviation: age 54 ± 8 years, BMI 27 ± 5 kg/m2, WC 94 ± 14 cm; 51.6% women). During follow-up, 497 women and 323 men sustained a fracture. There was a linear relationship between fracture incidence and WC, while cubic splines best fitted the relationship for BMI. Greater WC was associated with an increased risk of fracture at the distal lower limbs in the whole cohort and in the subgroup of women: aHR for each 10 cm increased in WC of 1.12 (1.03, 1.21) and 1.12 (1.01, 1.24), respectively. In men, WC was not significantly associated with any fracture outcome. Higher BMI was also significantly associated with distal lower limb fracture risk in the whole cohort (p=0.018). No significant relationships were found between either WC or BMI and the risk of any fracture, MOFs, and distal upper limb fractures. In middle-aged individuals, obesity, and mainly abdominal obesity, was associated with distal lower limb fracture risk. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Impact of urinary calcium excretion on kidney, bone, and cardiovascular systems in patients with bone biopsy proven osteoporosis: a longitudinal long-term follow-up study.

Hypercalciuria is common in patients with osteoporosis. However, the long-term effect of urinary calcium excretion (UCaE) on patients' health is not well-examined. The current study aims to assess the impact of UCaE on kidney, bone, and cardiovascular outcomes in patients with bone biopsy proven osteoporosis. Longitudinal study of all patients with osteoporosis who underwent bone biopsy and 24-h urine collection between 2008 and 2015 in the University of Kentucky. DXA scans, serum markers, kidney function, and cardiovascular events were recorded until last clinic visit in 2021. Exclusion criteria were secondary osteoporosis or conditions that might substantially impact UCaE. The significant results in univariate analysis were confirmed in multi-variable regression models involving clinically important covariates that might impact patients' outcomes. Study included 230 patients with mean follow-up of 7.2 ± 2.9 years. The mean age was 61 years, and the mean eGFR at baseline was 85 ± 19 ml/min/1.73 m2. Low bone turnover (LBT) was present in 57% and high bone turnover (HBT) in 43% of patients. Hypercalciuria was found in one-third of patients with no difference between LTB and HTB. UCaE correlated positively with eGFR but did not affect the rate of eGFR decline over time. Higher UCaE predicted kidney stones development. We observed U-shaped effect of UCaE on bone health. Hypercalciuria predicted loss of BMD at all sites, but also hypocalciuria was associated with higher loss in total hip BMD. Upper limb fractures were the most observed fractures, and their incidence was higher in patients with hyper- or hypo-calciuria. Lower UCaE independently predicted development of major adverse cardiac events (MACE) and cardiovascular disease (CVD). UCaE correlated with eGFR but it did not affect the change of eGFR over time. Patients with normal UCaE had lower incidence of upper limb fractures and less reduction in BMD. Low UCaE predicted MACE and CVD.