Thirty-four years follow-up of a bilateral Mac Kee-Farrar arthroplasty without loosening or osteolysis

We report the case of a 93-year-old patient with bilateral Mac Kee-Farrar hip arthroplasties implanted 34 years ago. The patient was seen in 2005 for a type B1 periprosthetic fracture on the right prosthesis implanted in 1973. There was no loosening and the fracture was treated by plate fixation. Before the fracture, the Postel-Merle d'Aubigné (PMA) score was 16 on both sides, with a Devane activity score grade 2. At last follow-up, the PMA score was 13 for both hips, with a Devane activity score grade 1. Serum cobalt level was 1.36 microg/L (normal <1 microg/L). This exceptional case is to our knowledge the longest observed with this implant without clinical or radiographic signs of loosening. The serum cobalt level, rarely assayed after more than 30 years, was within the limits accepted for a metal-on-metal hip bilateral arthroplasty. We discuss the causes of failure and success of the Mac Kee-Farrar implant as reported in the literature and remark that long survival of the metal-on-metal bearing can occasionally be observed without signs of wear. Recent works on the metal-on-metal bearing merit attention.     

Isolated posterior malleolus fracture: a rare injury mechanism

Isolated posterior malleolus fractures of the ankle are very rare, especially those without any associated ligamentous injury. The mechanism of injury is unique, and treatment depends on the displacement of the fracture and associated injuries. We present the case of a 46-year-old female car driver who sustained this injury. Axial loading of the plantar flexed foot most likely caused this fracture pattern. The fracture healed in 6 weeks with non-operative treatment in a below-knee plaster cast.The authors declare that this case study complies with the current laws in the United Kingdom.     

Occipital condylar fractures. Review of the literature and case report

Fractures of the occipital condyle are rare. Their prompt diagnosis is crucial since there may be associated cranial nerve palsies and cervical spinal instability. The fracture is often not visible on a plain radiograph. We report the case of a 21-year-old man who sustained an occipital condylar fracture without any associated cranial nerve palsy or further injuries. We have also reviewed the literature on this type of injury, in order to assess the incidence, the mechanism and the association with head and cervical spinal injuries as well as classification systems, options for treatment and outcome.     

Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts

Background contextThe most common location for burst fractures occurs at the thoracolumbar junction, where the stiff thoracic spine meets the more flexible lumbar spine. With our current military conflicts in Iraq and Afghanistan, we have seen a disproportionate number of low lumbar burst fractures.PurposeTo report our institutional experience in the management of low lumbar burst fractures.Study designRetrospective review.MethodsWe performed a retrospective review of medical records and radiographs for all patients treated at our institution with combat-related injuries and thoracolumbar fractures. We included all patients who had sustained a burst fracture from T12 to L5 and had at least 1-year clinical follow-up.ResultsThirty-two patients sustained burst fractures. Nineteen patients (59.4%) had low lumbar (L3–L5) burst fractures, and 12 patients (37.5%) had thoracolumbar junction (T12–L2) burst fractures as their primary injury. Additionally, seven patients sustained less severe burst fractures at an additional level. One patient sustained burst fractures at both upper and lower lumbar levels. Of the low lumbar fractures, 52.6% had evidence of neurologic injury, two of which were complete. Similarly, in the upper lumbar group, 58.2% sustained a neurologic injury, two of which were complete. Twenty-two patients underwent surgical intervention, complicated by infection in 18%. At most recent follow-up, all but one patient with presenting neurologic injury had persistent deficits.ConclusionLow lumbar burst fractures are the predominant combat-related spine injury in our current military conflicts. The rigidity offered by current body armor may effectively lower the transition zone that normally occurs at the thoracolumbar junction, thereby, transferring forces into the lower lumbar spine. Increased awareness of this fracture pattern is warranted by all surgeons because of unique clinical challenges associated with its treatment. Although the incidence is increased in the military population, other surgeons may be involved with long-term care of these patients on completion of their military service.     

Three-level bilateral pediculolysis following osteoporotic lumbar compression fracture.

BACKGROUND CONTEXT: Osteoporotic compression fractures frequently occur at the thoracolumbar junction as a result of anterior column failure. Fractures of the pedicles are much less common and are not known to be associated with a prior compression fracture. Bilateral pedicle fractures over several consecutive lumbar levels in an osteoporotic elderly patient have not been previously reported. PURPOSE: To draw attention to this unusual case and to review the relevant literature. STUDY DESIGN: A clinical case report of bilateral fractures of the pedicles from L3 through L5 in an 83-year-old male 2 years after an osteoporotic L3 compression fracture presenting with low back pain. METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall. He had another minor fall and his radiographic workup revealed bilateral fractures of the pedicles of the L3, L4, and L5 vertebrae. The patient was treated nonoperatively. RESULTS: The patient's symptoms improved without surgical intervention. Subsequent radiographic evaluation with plain films, computed tomography, and bone scan demonstrated union of the fractured pedicles. CONCLUSIONS: In this uncommon case of bilateral lumbar pedicle fractures over three consecutive levels, isolated failure of the posterior rather than the anterior column occurred. This unusual fracture pattern may have been precipitated by the previous vertebral compression fracture. Nonsurgical management may result in acceptable clinical outcome.     

The Hyperplantarflexion Ankle Fracture Variant

Various patterns of ankle fractures that are not accounted for by common classification systems have been the subject of case reports. The first difficulty with these variant patterns is recognizing all associated pathology, followed by the successful application of stable fixation. The purpose of this study was to describe the common morphologic features and ligamentous injuries of a unique variant fracture pattern, as well as the surgical treatment technique and the short-term functional and radiographic outcomes. Of 121 consecutive unstable ankle fractures over a 2-year period, 7 patients were found to have a similar constellation of injuries around the ankle. A vertical shear fracture of the posteromedial tibial rim was the main feature. Six of the 7 also had a fracture of the posterior malleolus. On magnetic resonance imaging, the deltoid and posterior tibiofibular ligaments were intact in all cases. Fractures were treated with open anatomic reduction of the posteromedial and posterior fragments with antiglide plate fixation. All fractures healed at 2 months without loss of reduction, fixation failure, or surgical complications. The average American Academy of Orthopaedic Surgeons lower extremity score was 79 at an average of 8 months' follow-up. The common radiographic and morphologic features associated with this posteromedial fracture indicate that it likely occurs through a common mechanism that involves hyperplantarflexion. The characteristics of this fracture pattern have not been fully described previously, but this ankle fracture variant may occur in up to 6% of cases. Unstable ankle fractures should be evaluated carefully for evidence of posteromedial involvement so appropriate treatment may proceed.     

An Unusual Monteggia Equivalent: A Case Report with Literature Review

Monteggia fracture dislocations are uncommon in childhood. Over a period of time, various equivalents of this entity have been described. These fractures with concomitant elbow injuries are exceedingly rare in young children. We present a case of a 6-year-old boy who sustained a fracture of proximal ulna with ipsilateral supracondylar fracture humerus. We suggest that the fracture pattern can be included under type I Monteggia equivalent on the basis of its characteristics, biomechanics and the mode of injury.     

Importance of greenstick lamina fractures in low lumbar burst fractures

Lumbar burst fractures (L3-L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32-110 months). The male to female ratio was 21:5 and the mean age was 37 years (17-64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2-L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted.     

Flexion-valgus unicondylar tibial plateau depression fracture pattern: Classification and treatment

PurposeThe authors have identified a subset of unicondylar tibial plateau depression fracture patterns caused by a flexion-valgus force. The purpose of this study was to describe this fracture pattern and suggest a modified lateral approach that may allow for improved reduction and stabilization.MethodsThe preoperative radiographs and CT scans of 102 patients who sustained unicondylar tibial plateau fractures (OTA 41B) were reviewed. Twenty-six fracture patients had posterolateral (PL) tibial plateau depression fractures. By medical record review and telephone follow-up, the injury mechanism of the 22 unicondylar tibial plateau fractures was confirmed as a flexion-valgus force. The radiographic features of those cases were analyzed and measured. To address this specific fracture pattern, a modified approach combined with a novel intra-articular osteotomy was applied.ResultsAccording to the morphological characteristics, this tibial plateau fracture pattern could be divided into two subtypes: type A was a confined, basin-like articular surface depression fracture located in the PL quadrant, and type B was a cancellous fracture involving the PL tibial plateau resulting in a decrease in the posterior slope. One radiographic hallmark of this fracture pattern is an anatomically or a mechanically intact posterior column wall. The novel approach was applied to both types. The postoperative radiographic measurements revealed excellent reduction quality. On axial scans, the distance between the most posterior rafting screw and the tangent line of the tibial plateau rim was 3.0 ± 2.07 mm (from −1.9 to 4.3), and the angulation between them was 8.9 ± 3.02° (from −7.3 to 15.6). These results indicated excellent PL quadrant coverage from the rafting screws.ConclusionFlexion-valgus force-induced unicondylar tibial plateau depression fracture is a unique injury pattern. We suggest a novel surgical approach to address this injury’s key features, which may facilitate exposure and enhance fixation strength.     

Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability?

In the management of a pelvic fracture prompt recognition of an unstable fracture pattern is important in reducing mortality and morbidity. It is believed that a fracture of the transverse process of L5 is a predictor of pelvic fracture instability. However, there is little evidence in the literature to support this view. The aim of this study was to determine whether a fracture of the transverse process of L5 is a reliable predictor of pelvic fracture instability. We reviewed our hospital trauma database and identified 80 patients who sustained a pelvic fracture between 2006 and 2010. There were 32 women and 48 men with a mean age of 40 years (10 to 96). Most patients were injured in a road traffic accident or as a result of a fall from a height. A total of 41 patients (51%) had associated injuries. The pelvic fractures were categorised according to the Burgess and Young classification. There were 45 stable and 35 unstable fractures. An associated fracture of the transverse process of L5 was present in 17 patients; 14 (40%) of whom had an unstable fracture pattern. The odds ratio for an unstable fracture of the pelvis in the presence of a fracture of the transverse process of L5 was 9.3 and the relative risk was 2.5. A fracture of the transverse process of L5 in the presence of a pelvic fracture is associated with an increased risk of instability of the pelvic fracture. Its presence should alert the attending staff to this possibility.     

Osteoporosis of the spine: correlation between vertebral deformity and bone mineral density in postmenopausal women

The purpose of this study is to evaluate the relation of bone mineral density (BMD) or the age-matched z score and osteoporotic vertebral fractures. The radiographs and spinal bone mineral density of 131 consecutive postmenopausal patients were retrospectively reviewed. The vertebral fractures between T4 and L4 were graded. Sixty-two patients had no fractures, and 69 had 1 or more fractures. In the nonfracture group, the mean age was 62.6 years, BMD was 0.88 g/cm2, and the z score was -1.00. In the fracture group, the mean age was 69.6 years, BMD was 0.788 g/cm2, and the z score was -1.26. Patients with 2 and 3 or more fractures had a lower mean BMD than that of the nonfracture group (P < .01). The z score (adjusted for age) was significantly lower only in patients with 3+ fractures (P < .05). Patients with grade 2 and grade 3 of any fracture type had significantly lower BMD (P < .01). The z score was lower only in those with grade 3 fracture (P < .05). Our study indicates that the clinical use of BMD z score adjusted for age is a better predictor of severity of vertebral fractures than is BMD alone.     

Bilateral fracture of the tibial shaft with intact fibulae

We report the case history, treatment, and follow-up of a 16-year-old girl who sustained symmetrical fractures of the right and left tibia without fractures of the fibulae. Although a fracture of the tibia with an intact fibula is not an uncommon fracture pattern, a bilateral fracture of this type is quite rare, and we have been unable to find such a reported case in our review of the literature. The management of a fracture of the tibia with an intact fibula is controversial, with potential complications of delayed union and varus malunion. For this reason, as well as the bilateral nature of the injury, we felt operative treatment to be indicated.     

全髋关节置换术后股骨假体周围Vancouver B型骨折治疗的随访研究

目的 探讨全髋关节置换术后股骨假体周围Vancouver B型骨折治疗方法的选择,总结同种异体皮质骨板移植重建股骨假体周围骨折的临床效果.方法 22例全髋关节置换术后股骨假体周围骨折患者,男7例,女15例;年龄平均65岁(53～75岁).Vancouver分类B1型5例,B2型4例,B3型13例.B1型骨折采用异体皮质骨板移植加钢丝环扎治疗;B2型骨折选择加长股骨柄翻修;B3型骨折选择骨水泥柄翻修,加同种异体皮质骨板移植和钢丝环扎同定.所有患者均获得随访,随访时间平均67个月(37～95个月).采用Harris髋关节功能评分、X线片、外周血T淋巴细胞亚群、抗体免疫复合物检测 和核素骨显像对治疗结果进行评价.结果 22例患者骨折全部愈合,21例患者能自由行走,1例需要助 行器帮助.末次随访Harris评分平均89分(79～93分).患者未发生免疫排斥反应;术后3个月,骨折愈合,术后12个月,移植骨板与宿主骨骨性愈合,股骨皮质厚度增加3～5mm;核素骨显像骨板移植区放射性核素分布较对侧浓集.3例患者移植骨板出现部分吸收现象.术后2年.骨板与宿主骨融合,移植骨板吸收停止.结论 针对股骨假体周围骨折不同类型分别采取不同方法治疗能够取得较好疗效,同种异体皮质骨板移植在维持骨折稳定性、促进骨折愈合、增加局部骨量和改善骨强度方面有较好疗效.     

椎板重建在腰椎滑脱症手术治疗中的应用

目的:探讨椎管减压椎弓根钉复位固定椎间植骨加椎板重建术治疗腰椎滑脱症的临床疗效。方法:自2007年8月至2008年8月,选择32例腰椎滑脱症患者行全椎板切除椎管减压椎弓根钉复位固定椎间植骨术,然后在椎板切除减压区硬膜外植微粒骨重建椎板,其中26例获得1年以上随访,男16例,女10例;年龄55～76岁,平均62.5岁;病程2～10年。所有病例术前有不同程度的腰痛,一侧或双下肢麻木、疼痛、间歇性跛行等。影像学检查为L3、L4或L5的Ⅰ-Ⅲ度前滑脱,其中退行性滑脱18例,峡部裂性滑脱8例。术后3个月及末次随访时从临床症状体征改善程度、滑脱椎体复位情况、植骨融合情况及椎管狭窄情况等方面对疗效进行评定。结果:26例患者平均随访时间为1年8个月(1～3年)。术后切口均愈合良好,无并发症发生。临床改善情况按JOA下腰痛评分标准,术前为(5.2±1.5)分,术后3个月为(23.1±1.9)分,优20例,良5例,可1例;末次随访评分(22.9±2.4)分,优19例,良5例,可2例。术后3个月和末次随访JOA评分较术前有明显改善(P=0.00),术后3个月和末次随访时疗效无明显差异(P>0.05)。滑脱椎体复位情况:Ⅰ度滑脱的17例完全复位;Ⅱ度滑脱的7例中5例完全复位,2例改善为Ⅰ度;Ⅲ度滑脱的2例改善为Ⅰ度。植骨融合情况:术后3个月20例融合,末次随访时全部融合,重建椎板骨质大片融合形成替代椎板。椎管狭窄情况:术后3个月及末次随访时CT检查示椎管无狭窄,神经根、硬膜囊无压迫。结论:椎管减压椎弓根钉复位固定椎间植骨加椎板重建术治疗腰椎滑脱症可以同时达到椎体复位、充分减压和脊柱生物力学稳定,能有效预防术后腰椎不稳以及瘢痕压迫、粘连等形成的医源性椎管狭窄,早期及中期疗效满意,为腰椎滑脱症的治疗提供了另外思路。     

The isolated posterior malleolar fracture and syndesmotic instability: A case report and review of the literature

IntroductionAnkle fractures are among the most common type of fractures in the lower extremity. A posterior malleolar fracture is frequently part of a more complex ankle fracture and only in rare cases it occurs as isolated injury. Posterior malleolar fractures often occur with associated injuries, such as a Maisonneuve fracture or with bi- or trimalleolar ligamentous injuries. Knowledge about these associated injuries is essential to prevent missed diagnoses. The aim of this article is to describe the isolated posterior malleolar fracture, the possible associated injuries, the diagnostic work-up and therapeutic consequences.Presentation of caseWe present a case of a 26-year-old male patient who sustained an isolated posterior malleolar fracture with 4.5 years follow-up.DiscussionIsolated fractures of the posterior malleolus are uncommon injuries. Diagnosis, treatment and outcome can seldom be extracted from large series. However, several cases have been described in literature, which we have summarized.ConclusionThis case report and literature review shows that isolated posterior malleolar fractures might occur as part of a more complex ankle injury, in combination with a fracture of the lower leg or after high energy trauma. Physicians should be aware of these associated injuries. Diagnostic work-up should include X-rays of the knee and lower leg and a CT scan of the ankle. If diagnosed and treated properly, isolated posterior malleolar fractures have a good long-term functional outcome.     

Active commuting reduces the risk of wrist fractures in middle-aged women—the UFO study

Summary

Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus.

Introduction

Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture.

Methods

The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case–control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3?±?5.8 years, and mean age at fracture was 60.3?±?5.8 years.

Results

Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27–0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk.

Conclusion

This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.     

Bilateral Moore hemiarthroplasty: 36 years of good tolerance without loosening or osteolysis

We report an illustrative case of bilateral Moore arthroplasty with the clinical and radiographic results at 36 years follow-up. The femoral prostheses were implanted for necrosis of the femoral head when the patient was 46 years old. At implantation the patient's physical activity level was high (Devane 4) and remained so until retirement at age 65 years. His activity level remained high (Devane 3) to the age of 82 years when the patient suffered a Vancouver B1 periprosthetic fracture on the left. At this date, both arthroplasties were free of loosening an osteolysis. Plate fixation with wiring led to fracture healing. The Postel Merle d'Aubigné score was 17 before the fracture and 16 at healing (with a pain score of 6 both before and after). Radiographically, acetabular cartilage tolerance was excellent. This case illustrates the excellent clinical outcome obtained with the Moore hemiarthroplasty at more than 35 years despite less than satisfactory initial fixation and the absence of resurfacing. The fact that this prosthesis does not have a polyethylene element prevented the development of osteolysis which could have been expected with such a long postoperative period in this a highly active patient. Favorable factors (good abductor lever arm, adapted head diameter, resistance of the acetabular cartilage in a young subject with femoral head necrosis) may have played a role in this particular case since the excellent and sustained outcome was observed on both sides. This exceptional longevity provides useful information for better determining precise indications for head cups for the treatment of necrosis of the femoral head.     

Femoral cortical thickness influences the pattern of proximal femoral periprosthetic fractures with a cemented stem

Introduction

Periprosthetic fractures of the proximal femur place a significant burden on the patients who endure them, as well as the medical health system that supports them. The purpose of this study was to determine whether femoral cortical thickness, as an absolute measurement, is a predictor of periprosthetic fracture pattern.

Method

A cohort of 102 patients who had sustained a periprosthetic hip fracture were retrospectively identified. This included 58 males and 44 females with a mean age of 79.8 years. The femoral periprosthetic fracture pattern was classified based on the Vancouver classification system. Stem fixation was recorded and femoral cortical thickness measured. Patients were grouped into cemented and cementless stems. The relationship between cortical thickness and periprosthetic fracture pattern was assessed using the primary stem fixation method. Receiver operating characteristic (ROC) curve analysis was used to identify a threshold in the cortical thickness that predicted fracture pattern. Multinomial logistic regression analysis was used to adjust for confounding variables to assess the independent influence of cortical thickness on the risk of sustaining a Vancouver type A, B or C.

Results

There were 65 (63.7%) patients in the cemented group and 37 (36.3%) in the cementless group. The pattern of periprosthetic fractures around cemented stems was significantly (p < 0.001) influenced by the femoral cortical thickness, with a thinner cortical thickness associated with a type A fracture pattern. In contrast, no association between femoral cortical thickness and fracture pattern assessment was demonstrated in the cementless group (p = 0.82 Chi square). Comparing the rate of type A fracture patterns between the groups illustrated a significantly decreased risk in the cemented group with a cortical thickness of > 7 mm (odds ratio 0.03, p < 0.001). ROC curve analysis of the cemented group demonstrated a threshold value of 6.3 mm, offering a sensitivity of 83.3% and a specificity of 78.9% in predicting an A type fracture. Using this threshold, patients with a cortical thickness of 6.3 mm or less were significantly more likely to sustain a Vancouver type A fracture (OR 18.9, 95% CI 2.0–166.7, p < 0.001) when compared to patients with a cortical thickness of > 6.3 mm. In contrast, the ROC curve analysis did not find cortical thickness to be a predictor of fracture pattern in the cementless group. When adjusting for confounding variables, multinomial logistic regression demonstrated a cortical thickness of 6.3 mm or less was a significant predictor of a type A fracture (OR 3.28, 95% CI 1.06–10.16, p = 0.04) relative to those sustaining a type B fracture.

Conclusion

Cortical thickness was found to influence the periprosthetic fracture pattern around cemented femoral stems, but this was not observed with cementless stems. Type A fracture patterns were significantly more likely to occur with a cortical thickness of 6.3 mm or less around cemented stems.

     

Vertebral fracture risk (VFR) score for fracture prediction in postmenopausal women

Summary

Early prognosis of osteoporosis risk is not only important to individual patients but is also a key factor when screening for osteoporosis drug trial populations. We present an osteoporosis fracture risk score based on vertebral heights. The score separated individuals who sustained fractures (by follow-up after 6.3?years) from healthy controls at baseline.

Introduction

This case?Ccontrol study was designed to assess the ability of three novel fracture risk scoring methods to predict first incident lumbar vertebral fractures in postmenopausal women matched for classical risk factors such as BMD, BMI, and age.

Methods

This was a case?Ccontrol study of 126 postmenopausal women, 25 of whom sustained at least one incident lumbar fracture and 101 controls that maintained skeletal integrity over a 6.3-year period. Three methods for fracture risk assessment were developed and tested. They are based on anterior, middle, and posterior vertebral heights measured from vertebrae T12-L5 in lumbar radiographs at baseline. Each score??s fracture prediction potential was investigated in two variants using (1) measurements from the single most deformed vertebra or (2) average measurements across vertebrae T12-L5. Emphasis was given to the vertebral fracture risk (VFR) score.

Results

All scoring methods demonstrated significant separation of cases from controls at baseline. Specifically, for the VFR score, cases and controls were significantly different (0.67?±?0.04 vs. 0.35?±?0.03, p?<?10?^?6) with an AUC of 0.82. Dividing the VFR scores into tertiles, the fracture odds ratio for the highest versus lowest tertile was 35 (p?<?0.001). Sorting the combined case?Ccontrol group according to VFR score resulted in 90% of cases in the top half.

Conclusion

At baseline, the three scores separated cases from controls and, especially, the VFR score appears to be predictive of fractures. Control experiments, however also, indicate that VFR-based fracture prediction is operator/annotator dependent and high-quality annotations are needed for good fracture prediction     

Predictors of functional outcomes after surgical treatment of distal radius fractures

PURPOSE: Identifying predictors of outcomes is important in anticipating and treating patients with underlying factors that may affect recovery. The predictors of functional outcomes after distal radius fracture (DRF) treatment have not been well defined in the past. METHODS: This was a prospective cohort study designed to identify predictors of hand outcomes after DRF treatment. The study included consecutive patients with inadequately reduced DRFs who had open reduction and internal fixation with volar plating. Demographic and socioeconomic data were collected at the time of the initial treatment. Outcome data were collected 3, 6, and 12 months after surgery. Outcome evaluation consisted of radiographic measurements and the Michigan Hand Outcomes Questionnaire (MHQ). We hypothesized that the following factors are important predictors of functional outcomes: (1) age, (2) socioeconomic status, (3) severity of fracture pattern, and (4) postsurgical radiographic measurements. Regression models were developed using the overall MHQ score as the outcome variable at 3 months and 1 year after surgery. RESULTS: Sixty-six patients had data available at 3 months and 49 patients had data available at 1 year. At 3 months after surgery, radiographic incongruity (step + gap) was a significant predictor after controlling for age, fracture type, dorsal-volar tilt angulation, and income. Patients with increased incongruity reported lower MHQ scores (worse functional outcomes). At 1 year after surgery, however, only age and income were significant predictors after controlling for fracture type. Increased age and decreased income were associated with lower MHQ scores. CONCLUSIONS: After successful surgery and hand therapy, only age and income were significantly associated with long-term outcomes 1 year after surgery. Precise anatomic reduction enhances short-term functional outcomes in DRF treatment. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level I.