Wrist Function Research Articles

Conservative treatment of distal radial fractures

Distal fracture of the radius is common in all age groups. Under careful consideration of individual indications and contraindications, conservative treatment with reduction and immobilization can have significant advantages over the frequently applied surgical approach, particularly in older patients. Immobilization after closed reduction enables satisfactory wrist function to be achieved according to individual patient expectations. A.Patients with a. significant comorbidities, b. high surgical risk from an anesthesiology perspective (ASA > 3), c. low functional requirements, d. low cosmetic expectations regarding residual visible deformity. B.Young patients with an extension fracture and additional a.< 10° dorsal tilt in the case of extraarticular fractures after closed reduction, b.< 5 mm radial shortening after closed reduction, c.< 2 mm intraarticular displacement after closed reduction. A.Patient age < 65years with an extension fracture and additional a.> 10° dorsal tilt in the case of extraarticular fractures after closed reduction, b.> 5 mm radial shortening after closed reduction, c.> 2 mm intraarticular displacement after closed reduction. B.Flexion fracture for which ligamentotaxis for closed reduction is not possible. C.Open distal radial fracture. D.Fracture dislocations. E.Impairments of peripheral circulation, motor or sensory function of the hand after reduction. After puncturing the fracture hematoma and infiltrating the fracture gap with local anesthetic, the forearm is suspended using Chinese finger traps on the thumb and middle finger. Constant traction in the longitudinal axis of the forearm is ensured by a weight applied via a wide cushioned cuff to the distal upper arm. Reduction then is enabled with the additional reductive effect of ligamentotaxis. After minimal cushioning of the forearm with cotton wool and crepe bandage, a dorsal gypsum longuette is applied. After the plaster bandage has hardened, peripheral circulation, motor function, and sensitivity are checked. The reduction is controlled by X‑ray and documented. A.General procedures to reduce swelling; sufficient analgesics should be prescribed. B.The circular plaster cast is applied once swelling has subsided sufficiently, generally after 2-3days. C.The duration of cast wearing should be planned at 5weeks. A total of 73patients (55women and 18men) aged 65-88years were followed up for 12months to investigate functional outcomes after surgical and conservative therapy. While surgical patients had better functional scores up to 12weeks after treatment begin, there was no longer a significant difference in the 6‑ and 12-month follow-up results. The measured grip strength was consistently better in the surgically treated group. Clinically visible deformities were present in 78% of the conservatively treated patients; however, the patients were satisfied with the functional or cosmetic results. No deformities were seen in the surgically treated patients. All fractures were completely healed after 6months. The rate of complications was significantly higher in the surgery group, with 13complications compared to 5 in the conservative treatment group.

Combined approach versus single Henry approach for fixation of die-punch distal radius fractures: a retrospective study

BackgroundDistal radius fracture (DRF) is one of the most common orthopaedic-related traumas. DRF patients with die-punch fractures have a higher risk of loss of reduction, poorer functional outcomes, and increased risk of complications even after open reduction and internal fixation (ORIF). According to the three-column theory, the lunate fossa is an important part of the intermediate column for load bearing. When the distal radius fracture involves the lunate fossa, adequate anatomical reduction can have an important impact on the prognosis of wrist function. Herein, we used the combined volar and dorsal approach, and the dorsal approach was used to assist in bone grafting or dorsal plate fixation in reducing fractures. We compare the combined approach versus the Henry approach for the fixation of die-punch distal radius fractures.MethodsWe reviewed patients who were admitted for surgery for die-punch fractures from January 2016 to June 2021. The patients were followed-up after surgery to measure and evaluate their Gartland–Werley wrist score, wrist range of motion (ROM), and follow-up imaging data.ResultsThere were 21 patients in the volar locking plate (VLP) group and 10 patients in the combined approach group. The majority of fractures in the VLP and combined approach groups were AO B and C fractures, respectively. The cause of injury and AO fracture classification showed significant differences between the two groups, and there was no difference in age or sex between the two groups. There was no significant difference in ROM between the two groups, but the VLP group presented a better Gartland–Werley score and volar tilt angle, and the combined group presented better maintenance in radial height and articular congruity.ConclusionsReduction through the combined palmar and dorsal approach supplemented by bone grafting or dorsal plate fixation is an effective method for the treatment of die-punch distal radius fractures, which provides a new option for the treatment of die-punch fractures.

Mirror therapy combined with contralaterally controlled functional electrical stimulation for the upper limb motor function after stroke: a randomized controlled trial

Purpose In this study, we investigated the effects of mirror therapy (MT) combined with contralaterally controlled functional electrical stimulation (CCFES) on upper limb motor function, activities of daily life, and corticospinal excitability in post-stroke patients. Methods Sixty post-stroke patients were randomly divided into four groups: CCFES, MT, MT combined with CCFES, and control. All the patients underwent routine rehabilitation. Those in the MT, CCFES, MT combined with CCFES, and control groups received MT, CCFES, MT combined with CCFES, and routine rehabilitation alone, respectively. Upper limb motor function, activities of daily living, and corticospinal excitability were evaluated before and after a 3-week intervention period. Results MT combined with CCFES demonstrated a significantly greater therapeutic effect on motor function of the paretic wrist than CCFES, MT, or routine rehabilitation alone. However, there was no significant difference in the overall motor function of the affected upper limb, activities of daily life, or corticospinal excitability between the MT combined with CCFES group and the other three groups. Conclusion MT combined with CCFES may be a potential adjuvant therapy to promote motor function in paretic wrist after stroke.

A Novel Technique Using the Dorsal Capsule of the Distal Radioulnar Joint for Extensor Carpi Ulnaris Tendon Subsheath Reconstruction.

Background Ulnar-sided wrist pain is a common problem encountered by hand surgeons. Symptomatic recurrent subluxation of the extensor carpi ulnaris (ECU) tendon has become increasingly recognized as one of the pathological conditions leading to ulnar-sided wrist pain. Surgical reconstruction of the subsheath is usually needed. ECU tendon subsheath reconstruction with the periosteal flap was first described by Schlesinger in 1907. Since then, various other techniques have been widely used. We describe a technique of ECU subsheath reconstruction using the dorsal capsule of the distal radioulnar joint (DRUJ). Description of Technique Two hand surgeons performed the surgeries with the same steps taken each time. A detailed description of our surgical technique, with the dorsal capsule of the DRUJ used to reconstruct the ECU tendon subsheath, is illustrated. Patient and Methods Patients who presented with symptomatic ECU instability despite conservative treatment or who have failed primary subsheath repair were offered this surgical option. Patients were followed up postoperatively for an average duration of 6.7 months in our outpatient clinics for assessment of wrist function. The surgical outcomes were reviewed and graded with the Modified Mayo Wrist Score (MMWS). Results All but one of the seven patients had an overall improvement in their range of movement of the wrist, grip strength, and pain scores. Four patients had excellent outcomes on the MMWS, one of whom had an asymptomatic recurrence seen on dynamic ultrasound. Two patients required subsequent surgeries: one had an excellent outcome and the other had a poor outcome on the MMWS. Conclusion We present our first seven cases of ECU subsheath reconstruction with the dorsal capsule of the DRUJ. Our results in the short term have been satisfactory. The technique does not disrupt the integrity of the extensor retinaculum, which is essential for optimal extensor tendon function, and can also be considered as an option to salvage failed procedures.

Predictive value of bone morphogenetic protein-7, thromboxane A2, and osteoprotegerin for prognosis of patients with distal radius fractures.

This study aims to investigate the predictive value of bone morphogenetic protein-7 (BMP-7), thromboxane A2 (TXA2), and osteoprotegerin (OPG) for the prognosis of patients with distal radius fractures. Between January 2021 and January 2022, a total of 124 patients (71 males, 53 females; mean age: 49.8±5.1 years; range, 34 to 68 years) with distal radius fractures were included in the fracture group. Healthy volunteers receiving physical examination in our hospital in the same period were included in the control group (n=50; 29 males, 21 females; mean age: 50.1±5.4 years; range, 35 to 68 years). The expressions of BMP-7, TXA2, and OPG in the peripheral blood were detected. In the fracture group, 124 patients underwent internal fixation after inclusion and followed for six months. The prognosis was evaluated based on the Gartland & Werley scoring system for wrist joint function. The factors influencing prognosis were analyzed, and the predictive values of BMP-7, TXA2, and OPG were calculated. Age, fracture classification, early loss of palmar tilt, late loss of palmar tilt, time to return to exercise after surgery, BMP-7, TXA2, and OPG were all factors influencing the prognosis (p<0.05). For predicting the prognosis, the area under the ROC curve of BMP-7 + TXA2 + OPG (0.928) was significantly larger than those of BMP-7 (0.810), TXA2 (0.856) and OPG (0.823) alone, and BMP-7 + TXA2 + OPG had the highest predictive efficiency. The BMP-7 was negatively correlated with TXA2 (r=-0.471), but positively correlated with OPG (r=0.437). The combined detection of BMP-7, OPG, and TXA2 is highly valuable for predicting the prognosis of patients with distal radius fractures.

Delayed open surgery for distal radius epiphyseal plate fracture in children

ObjectivesThis study assessed the feasibility of open surgery and determined outcome predictors for late management of epiphyseal plate fracture of the distal radius in children. MethodsThis retrospective study included 25 patients (22 male, 3 female) who underwent open surgery for late management of epiphyseal plate fracture of the distal radius. Wrist function was evaluated on Cooney score. Potential predictors comprised age, gender, fracture type, days after injury (DAI), degree of violence (DOV), and dorsal angulation before surgery (DABS). ResultsOverall, wrist function after surgery was classified as excellent for 16 patients (64%), good for 6 (24%), and fair for 3 (12%). The rate of excellent wrist function was 86.7% (13/15) in children older than 10 years but only 40% (4/10) for those aged under 10 years (p = 0.0280). Cooney score correlated positively with age, but there was no correlation with gender, fracture type, DAI, DOV or DABS. ConclusionOpen reduction surgery for late management of distal radius epiphyseal fracture yielded good results in patients aged over 10 years. Level of evidenceIII.

Open Volar STT Ligament Reconstruction to Augment the Mathoulin's Arthroscopic Dorsal Capsuloligamentous Reconstruction: Technique Description and Case Reports.

Background The results of Mathoulin's arthroscopic dorsal capsuloligamentous reconstruction (ADCLR) are excellent in many patients with scapholunate instability, though less consistently good in higher grade instabilities. The purpose of this article is to describe a novel technique of volar scaphotrapeziotrapezoid (STT) reconstruction which may be used to augment rotational control of the scaphoid, in conjunction with the ADCLR, for use in European Wrist Arthroscopy Society (EWAS) grade IV/V instabilities. Description of Technique Following completion of ADCLR, the STT joint is approached through the flexor carpi radialis sheath. The palmaris longus tendon is harvested. Fluoroscopy is used to site guide wires for tunnel placement in the distal scaphoid and the proximal trapezium; 3.5-mm tunnels are overdrilled in both bones, to a depth of 8 mm. The palmaris graft is then anchored in the scaphoid tunnel with a mini-DX SwiveLock anchor. The graft is tensioned, then anchored in the trapezium tunnel with another anchor. Patients and Methods We retrospectively selected two young men heavy manual workers who had this procedure more than 12 months previously for scapholunate instability, with static radiographic abnormalities and a drive through sign (EWAS grade V). The patients were reviewed after 12 months, for assessment of visual analog scale, quick disabilities of the arm, shoulder, and hand, and patient-rated wrist/hand evaluation scores, range of motion, and grip strength. Results Both patients had marked improvements of wrist comfort and function at 1 year, and were able to return to their normal duties at work and complete all activities of daily living with minimal symptoms. Conclusion This volar STT reconstruction may expand the success of the Mathoulin's ADCLR into higher grade instabilities.

Outcomes of an exercise program in patients with dorsal or volar midcarpal laxity: a cohort study of 213 patients

Purpose Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI). Materials and methods This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results. Results PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36–30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery. Conclusions We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI.

To Compare Mean Dash Score at 12 Weeks in Distal Radius Fracture Patients Treated Operatively (ORIF Group) Versus Those Treated Non-Operatively (CAST Group)

Aim: To compare wrist function by mean of DASH score at 12 weeks in distal radial fracture patients treated operatively (ORIF group) versus those treated non-operatively (CAST group). Methodology: The randomized controlled trial was conducted at The Indus Hospital Karachi, which is a tertiary care hospital from 1st January 2017 to 30th June 2017 and the 12 weeks follow up was taken after the recruitment of the last patient and 96 patients were enrolled. Patients in the operative group were treated with a volar locking plate. Reduction and stabilization of fracture were done with the application of 2.7mm volar locking titanium distal radius anatomically contoured implants. Non-operative Treatment Protocol was that All patients were complete a six weeks immobilization in a splint. One repeated manipulation if needed was accepted in the first 3 weeks. Passive and active finger motion from the starting was encouraged. Formal physiotherapy in this group was started 6 weeks after the removal of the cast. In the twelfth week, the functional assessment was examined by a physiotherapist or orthopaedic resident in both the Cast group and ORIF. Results: Thirty (31.3%) were in operative and 66(68.8%) were in non-operative group. No significant difference were found in age, height, weight, and BMI between both the groups (Mean: 42.7 vs 41.6 years, p=0.644; 156.5 vs 156.4 cm, p=0.962, 61.0 vs 59.5 kg, p=0.557, 24.9 vs 24.5, p=0.395 respectively). Moreover, distribution of gender, dominant hand, and injured hand was also similar in both the groups (p=0.427, p=0.587, and p= 0.673). DASH score were found to be significantly lower in operative group as compared to non-operative cast group (median 17.5 vs 28.8, p&lt;0.0001, mean 16.6 vs 27.9, p&lt;0.0001). Conclusion: At 12 weeks volar locking plates significantly produced better clinical and functional outcomes as compared with the treatment by Cast. The significantly anatomical reduction was more possible to be conserved in the operating group, but in the operative group, early mobilization achieved is the key to better achieving functional outcomes. Keywords: Distal radius extra-articular fractures, DASH score, Wrist function

Clinical Results of Nonvascularized Metatarsal Articular Bone Grafting for Osteochondral Defects of the Radiocarpal and Distal Radioulnar Joint.

Background Treatment of post-traumatic osteochondral defects in the radiocarpal and distal radioulnar joint with nonvascularized metatarsal articular bone grafting is an option to restore the joint (cartilage) surface and wrist function. Purpose To evaluate the clinical midterm results of 10 consecutive patients who were treated with a nonvascularized metatarsal bone graft for cartilage bone defects of the lunate facet, scaphoid facet, sigmoid notch, or the radial part of the ulnar head. Patients and Methods Patients with isolated osteochondral defects of the lunate facet, scaphoid facet, sigmoid notch, or radial part of the ulnar head, respectively, as a result of wrist trauma were retrospectively identified in a prospectively collected database. The patients symptoms were limited wrist motion and/or pain. Clinical results and complications were extracted from patient's medical files and two questionnaires consisting of the Patient-Rated Wrist Evaluation and additional questions regarding patient satisfaction and return to work and/or hobby. Results Minor complications occurred in three cases and required surgery. In five cases an acceptable donor site foot morbidity was seen at 1 year. One patient was not satisfied due to persistent wrist pain despite adequate range of motion. One patient could not return to its prior work. Another patient could not resume its hobby. Conclusion Retrospective evaluation of 10 cases with resurfacing of the scaphoid facet, sigmoid notch, and/or lunate facet, or radial part of the ulnar head has shown that osseointegration was possible without a vascular pedicle to the graft in all cases with a (mean) follow-up of 5 years. This technique may become an alternative treatment when implants become less available. Level of Evidence Level III.

Surface electromyographic characteristics of forearm muscles after ulnar and radius fracture inchildren.

To evaluate the characteristics of forearm muscle activity in children with ulnar and radius fractures during different follow-up periods by surface electromyography. A retrospective analysis was performed on 20 children with ulnar and radius fractures treated with an elastic intramedullary nail from October 2020 to December 2021. All children were treated with transcubital casts after surgery. At 2 months and before taking out the elastic intramedullary nail, surface electromyographic signals were collected on the flexor/extension of the wrist and the maximum arbitrary isometric contraction of the grip strength in the forearm flexor and extensor muscles of the forearm. The root-mean-square values and integrated EMG values of the superficial flexor and extensor digitalis of the healthy side and the affected side were collected at the last follow-up and 2 months after surgery, and the co-systolic ratio was calculated. The root-mean-square values and co-systolic ratio were compared and analyzed, and the Mayo wrist function score was evaluated. The mean follow-up time was (8.4 ± 2.85) months. Mayo scores were (87.42 ± 13.01) and (97.69 ± 4.50) points at the last follow-up and two months after surgery, respectively (p < 0.05). In the test of grip strength, 2 months after surgery, the grip strength of the affected side was lower than that of the healthy side (p < 0.05), and the maximum and mean values of the superficial flexor of the affected side were lower than those of the healthy side (p < 0.05). At the last follow-up, there was no difference in the grip strength between the affected side and the healthy side (p > 0.05), and no difference in the maximum RMS, mean RMS and cooperative contraction ratio of the superficial flexor and digital extensor muscles between the affected side and the healthy side (p > 0.05). Satisfactory results can be obtained after elastic intramedullary napping in children with ulnar and radius fractures. However, 2 months after surgery, the grip strength of the affected side is small, and the electrical activity of the forearm muscle is low during flexion and extension activities of the wrist joint, which has not returned to normal, suggesting that children orthopaedic clinicians should remind children to conduct timely and effective rehabilitation training after the removal of the cast.

Primary Cooperative Application of a LARS® Tube and 3D‐Printed Prosthesis for Reconstruction of the Distal Radius after en bloc Resection of Giant Cell Tumor of Bone: A Comparative Retrospective Study

Using a fibula autograft (FA) to reconstruct defects after en bloc resection of giant cell tumor of bone (GCTB) in the distal radius is classic but has high complication rates. We describe a novel reconstruction method employing the cooperative application of LARS® and a 3D-printed prosthesis (L-P) and investigate whether it improves postoperative outcomes. From April 2015 to August 2022, 14 patients who underwent the cooperative L-P reconstruction method after en bloc resection of distal radial GCTBs and 31 patients who received FA reconstruction were enrolled as two retrospective cohorts in this comparative study. The properties of the implants and critical surgical techniques were elaborated in the L-P group. Preoperative function, intraoperative data, and postoperative clinical, functional, and radiographic outcomes of all patients were recorded and compared between the two groups. The grip strength and range of wrist motion, including extension, flexion, radial deviation, and ulnar deviation, were measured. The Mayo modified wrist and Musculoskeletal Tumor Society scores were chosen to assess wrist function and surgical functional outcomes, respectively. Kaplan-Meier curves were generated to analyze the significant differences in complication rates and implant survival between the two groups. In both groups, all 45 patients underwent the operation without complication with similar average osteotomy lengths and bleeding volumes, while a shorter operative duration was achieved in the L-P group (201.43 ± 22.87 min vs. 230.16 ± 51.44 min, P=0.015). At a mean follow-up of 40.42 ± 18.43months (range, 14-72months), both reconstruction methods effectively ameliorated postoperative function. Patients who received L-P showed higher postoperative modified Mayo wrist scores (81.43 ± 5.49 vs. 71.13 ± 16.10, P=0.003), Musculoskeletal Tumor Society scores (27.64 ± 1.34 vs. 25.06 ± 2.95, P=0.004), and grip strength on the normal side (68.71% ± 8.00% vs. 57.81% ± 12.31%, P=0.005) than the FA group. Better wrist extension (63.21° ± 8.99° vs. 45.32° ± 14.53°, P < 0.001) and flexion (45.36° ± 7.90° vs. 30.48° ± 12.07°, P < 0.001) were also observed in the L-P group. The complication rate was significantly higher in the FA group (29/31, 93.55%) than in the L-P group (1/14 7.14%, P < 0.001). The L-P group showed higher implant survival than the FA group, but the difference was not statistically significant. The cooperative application of LARS® and 3D-printed prostheses is an effective modality for reconstructing musculoskeletal defects after en bloc resection of distal radial GCTBs, which can improve functional outcomes, diminish complication rates, and promote wrist joint stability and motion.

Determination of immune factor levels in serum and local hematoma samples of osteoporotic fracture patients and clinical study of the effect of active vitamin D3 treatment on immune factor levels

ObjectiveThe aim of this study was to investigate changes in systemic and local immune factors, namely, interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α, in patients with and without osteoporotic fractures and to explore the effects of active vitamin D3 treatment on immune function and fracture prognosis in patients with osteoporotic fractures.MethodThe mRNA expression levels of IL-1β, IL-6 and TNF-α were measured before the operation. After the operation, the patients in the control group were treated with conventional fracture treatment and calcium supplementation, and the patients in the treatment group were treated with calcium plus active vitamin D3 in addition to conventional fracture treatment. The serum of each patient was collected on the seventh day after the operation.ResultsThe expression levels of the three immune factors (IL-1β, IL-6 and TNF-α) in the fracture end hematoma samples were significantly positively correlated with those in the serum samples (P < 0.05). The mean values of the serums of IL-1β, IL-6 and TNF-α in the osteoporosis group were significantly higher than those in the non-osteoporosis group (P < 0.05). The average number of hematomas in the osteoporosis group was significantly higher than that in the non-osteoporosis group (P < 0.05). The results for the active vitamin D3 treatment group were significantly lower than those for the control group (P < 0.05). The mean wrist function score of the active vitamin D3 treatment group was significantly better than that of the control group (P < 0.05). The average fracture healing time of the treatment group was significantly shorter than that of the control group (P < 0.05).ConclusionThe relative expression of IL-1β, IL-6, and TNF-α in the fracture end hematoma samples was positively correlated with the corresponding levels of these immune factors in the serum samples. The levels of IL-1β, IL-6 and TNF-α in the serum and fracture end hematoma samples of the osteoporotic fracture patients were higher than those of the non-osteoporotic fracture patients. Active vitamin D3 treatment promoted fracture healing by affecting the levels of these immune factors.

Can elderly patients regain their preoperative functional level after distal radius fracture type A? Results from a fracture register study using PROM.

Although distal radius fractures (DRFs) are the most common fractures of the human body, there are still ongoing debates concerning the treatment for type A fractures, especially in elderly patients. In spite of good clinical outcomes, it remains unclear whether elderly patients, especially, could regain the preoperative functional level of the wrist. Therefore, we have quantified wrist function within a retrospective study design using patient-reported outcome measures (PROM) and we have analyzed the influence of age between control and patient collective and young vs. old, respectively. The retrospective study included all patients with a surgically treated DRF type A and a control group of healthy patients, age and gender matched. The function of the wrist was examined by using a self-assessment questionnaire called the Munich Wrist Questionnaire (MWQ) according to the patient-related outcome measurements PROM. We could enroll 110 patients and controls, and the average follow-up was 66 months. Subgroup matching induced similar age group distribution: in both groups, 7 individuals <30 years, 67 between 31 and 64 years, 29 between 65 and 79 years, and 7 individuals >80 years, were enrolled, respectively. In the fracture group, women were significantly older than men (59 ± 15 vs. 47 ± 17 (M ± SD). There was no significant difference between the control and the patient groups (96 ± 6 vs. 95 ± 7). The function was significantly different between controls and patients <30 years (100 ± 1 vs. 98 ± 2). In the control group, there was a functional difference in the age group <30 compared with 65-79 and >80 and in the age group 30-64 compared with 65-79 and >80. In the control group, the function was found to be significantly decreasing with advancing age, whereas in the patient group, this influence was absent. A correlation analysis showed a worse function with increasing age in the control group and therefore a negative correlation. In the fracture group, a similar result could not be obtained. Age has a relevant influence on wrist function. Although the wrist function decreases significantly with aging, in the patient group, this influence is absent, and the functional results after surgery are excellent. Even elderly patients can regain their preoperative functional level.

Can specific virtual reality combined with conventional rehabilitation improve poststroke hand motor function? A randomized clinical trial

Trial objectiveTo verify whether conventional rehabilitation combined with specific virtual reality is more effective than conventional therapy alone in restoring hand motor function and muscle tone after stroke.Trial designThis prospective single-blind randomized controlled trial compared conventional rehabilitation based on physiotherapy and occupational therapy (control group) with the combination of conventional rehabilitation and specific virtual reality technology (experimental group). Participants were allocated to these groups in a ratio of 1:1. The conventional rehabilitation therapists were blinded to the study, but neither the participants nor the therapist who applied the virtual reality–based therapy could be blinded to the intervention.ParticipantsForty-six patients (43 of whom completed the intervention period and follow-up evaluation) were recruited from the Neurology and Rehabilitation units of the Hospital General Universitario of Talavera de la Reina, Spain.InterventionEach participant completed 15 treatment sessions lasting 150 min/session; the sessions took place five consecutive days/week over the course of three weeks. The experimental group received conventional upper-limb strength and motor training (100 min/session) combined with specific virtual reality technology devices (50 min/session); the control group received only conventional training (150 min/session).ResultsAs measured by the Ashworth Scale, a decrease in wrist muscle tone was observed in both groups (control and experimental), with a notably larger decrease in the experimental group (baseline mean/postintervention mean: 1.22/0.39; difference between baseline and follow-up: 0.78; 95% confidence interval: 0.38–1.18; effect size = 0.206). Fugl-Meyer Assessment scores were observed to increase in both groups, with a notably larger increase in the experimental group (total motor function: effect size = 0.300; mean: − 35.5; 95% confidence interval: − 38.9 to − 32.0; wrist: effect size = 0.290; mean: − 5.6; 95% confidence interval: − 6.4 to − 4.8; hand: effect size = 0.299; mean: − -8.9; 95% confidence interval: − 10.1 to − 7.6). On the Action Research Arm Test, the experimental group quadrupled its score after the combined intervention (effect size = 0.321; mean: − 32.8; 95% confidence interval: − 40.1 to − 25.5).ConclusionThe outcomes of the study suggest that conventional rehabilitation combined with a specific virtual reality technology system can be more effective than conventional programs alone in improving hand motor function and voluntary movement and in normalizing muscle tone in subacute stroke patients. With combined treatment, hand and wrist functionality and motion increase; resistance to movement (spasticity) decreases and remains at a reduced level.Trials Registry: International Clinical Trials Registry Platform: ISRCTN27760662 (15/06/2020; retrospectively registered).

TO EVALUATE THE FUNCTIONAL OUTCOME OF VOLAR PLATING IN DISTAL END RADIUS FRACTURES

Introduction: Most frequent bone injuries seen in orthopaedic practice is distal end radius fractures.[1] It occurs most frequently in adult patients after the fourth decade of life and comprises around 10% to 20% of all the fractures attended as emergencies.[2] The causes of the injury are fall on outstretched hand/work related accidents/car accidents/sports injuries. The importance of fixation of the distal radius (DR) fractures have evolved over the past two decades. Cast immobilization was the initial method, followed by K-wire fixation and then internal fixation with a variety of plates.[4] After using a variety of the available volar locking plates to fix intra-articular fractures, a significant improvement in wrist function was observed. In addition, surgical technique has improved, resulting in less disfigurement. The purpose of this study was to evaluate the outcome of a fracture of the distal radius (DR) treated surgically by ORIF (open reduction and internal fixation) with a volar plate, and to prospectively follow the degree of recovery of wrist range of motion and patient functional outcomes. Result: The present study was conducted on patients presenting with fracture of the distal end of radius, who were treated with open reduction and internal fixation with volar plating. The results of the study are summarized as below: ? Majority of the patients were in age group 21-30 and 31-40 years with a mean age of 35.90 ± 12.21 years. The youngest patient was 18 years old and oldest one was 58 years old. ? Majority of the patients were males. ? In majority of the patients, left side involvement was seen in comparison to right side involvement. ? Coronary artery disease, diabetes mellitus type-2 and hypertension were seen in 1 patient each in our study. Rest of the patients had no comorbidities. The reason for not having significant comorbidities was that majority of the patients in our study were young. ? All these patients underwent open reduction and internal fixation with volar plating. Majority of the patients (77.4%) achieved fracture union within 1-2 months, while 19.4% achieved it within 3 months. 1 patient (3.2%) was able to achieve the union within a month of surgical intervention. The fracture union was achieved in a short time. The wrist function was assessed using Gartland and Werley score. The mean Gartland and Werley score showed significant improvement from 1 month to 6 months in all the patients. ? At 6 months, 87.1% patients had excellent outcome and 12.9% patients had good outcome. ? Complications were seen in 4 patients. Of them 1 patient complained of complex regional pain syndrome and 3 patients complained of wrist stiffness Conclusion: We found that open reduction and internal fixation with volar plating provided excellent to good wrist outcome in patients with distal end radius fractures with minimal complications. Volar plating provides stable fixation for early mobilization, leading to early resumption to pre-trauma functional level. Although we obtained excellent to good results with open reduction and internal fixation with volar plating in distal end radius fractures, the results cannot be extrapolated to the general population as the sample size was small. Hence, we recommend that large multi- centric studies be performed before generalizing the results.

Precision shaping of elastic stable intramedullary nail for the treatment of metaphyseal diaphysis junction fracture of the distal radius in children: a preliminary report in two centers

BackgroundThis study introduces a novel retrograde precision shaping elastic stable intramedullary nailing (ESIN-RPS) technique and reports clinical outcomes in pediatric distal radius metaphyseal diaphysis junction (DRMDJ) fracture.MethodsData about DRMDJs were collected from February 1, 2020, to April 31, 2022 at two hospitals, retrospectively. All patients were treated with closed reduction and ESIN-RPS fixation. The operation time, blood loss, fluoroscopy times, alignment, and residual angulation on X-ray were recorded. At the last follow-up, the function of wrist and forearm rotation were evaluated.ResultsTotally, 23 patients were recruited. The mean time of follow-up was 11 months and the minimum was 6 months. The mean operation time was 52 min, and the mean fluoroscopies pulses were 6 times. The postoperative anterioposterior (AP) alignment was 93 ± 4% and the lateral alignment was 95 ± 3%. The postoperative AP angulation was (4 ± 1)°, and the lateral angulation was (3 ± 1)°. At the last follow-up, the evaluation of the Gartland and Werley demerit criteria of wrist revealed 22 excellent cases and 1 good case. The forearm rotation and thumb dorsiflexion functions were not limited.ConclusionThe ESIN-RPS is a novel, safe, and effective method for the treatment of pediatric DRMDJ fracture.

Treatment of distal radius fracture by MIPO technique at Thu Duc City Hospital

Objective: To assess the possibility of anatomical correction when treating fractures of the distal radius fracture with a locking plate through a minimally invasive incision and evaluate the possibility of early recovery of wrist function after treatment of the distal radius fracture with minimally invasive incision preserving the pronator quadratus (PQ) muscle. Subject and method: Acute distal radius fracture patients aged 18 to 65 years old, who came for examination and treatment at the Orthopedic and Trauma Department of Thu Duc City Hospital from October 2020 to May 2021. Classification of the distal radius fracture according to AO: A2, A3, B3, C1 and C2. Result: The result of anatomical reduction included VT 6.22o, RI 22.0o, and UV 0.81 mm. X-ray grading gave 75.0% excellent and 25.0% good results, with 100% bone healing after 12 weeks. At 12 weeks, the mean GRIP Strength score was 71.3%, the VAS score was 1.7 points, the Q-DASH score was 18.1 good function points, and the MAYO score was 74. The average time to return to normal activities was 7 weeks. Conclusion: minimally invasive plate osteosynthesis (MIPO) is a method that gives good results for some fracture types in treating distal radius fractures, by indirect reduction with small incisions to help preserve the PQ muscle and early return the wrist function.

Evaluation of treatment results of perilunate dislocation by open reduction and repair of the scapholunate ligament

The study aims to evaluate the treatment results of perilunate dislocations treated with open reduction and scapholunate ligament (SLL) repair. The results showed that the majority of patients had no pain and wrist function was restored well. After surgery, the majority of patients (29 out of 32) had relief from pain. The average wrist motion was 77.93o extensions, 73.69o flexions, and the mean grip strength was 41.35±5.15 kg. which was 93.56% of the normal side. There was 26 excellent, 1 good, and 5 satisfactory results. The average follow-up time was 32.35 months. Surgical procedures included open reduction and SLL repair. The average functional score is 81.30 (very good). Thus, open reduction and SLL repair gave satisfactory results to subacute and acute perilunate dislocations of the wrist. This technique achieved a relatively pain-free wrist with good grip strength and average SL distance.

Efficiency of low-intensity laser therapy in the treatment of lateral epicondylitis

Aim: Lateral epicondylitis is the most common cause of lateral elbow pain and dysfunction, mainly caused by repetitive gripping or wrist extension during various activities. Although also known as tennis elbow, lateral epicondylitis often develops as a work-related condition and therefore poses an important public health concern. The aim of this study was to investigate the efficacy of laser in the treatment of patients diagnosed with lateral epicondylitis.&#x0D; Material and Method: Patients who received low-intensity laser therapy (LILT) treatment and patients who received placebo LILT while waiting for extracorporeal shock wave therapy (ESWT) treatment with the same diagnosis were included in the study. A total of 60 patients in two groups of 30 were included in the study. The patients who received LILT treatment constituted the treatment group (n=30), and the patients receiving placebo LILT constituted the control group (n=30). VAS for resting and resisted wrist extension, HAQ, PRTEE-T pain, function, and total scales were used to measure patients' pain status and response to treatment. Results were compared by analyzing patient files and recorded data.&#x0D; Results: A total of 48 (80%) subjects were female and 12 (20%) were male. The mean age of the control group was 47.8±7.4 years, and the mean age of the treatment group was 45.7±8.5 years. There was no significant difference between the two groups in terms of age, gender, and occupational distribution (p&gt;0.05). In our study, the group treated with LILT showed statistically significant improvement in all parameters (VAS, HAQ, PRTEE) we investigated compared to the control group (p