The Journal of hand surgery
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Review Comparative Study
A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly.
As the population in developed countries continues to age, the incidence of osteoporotic distal radius fractures (DRFs) will increase as well. Treatment of DRF in the elderly population is controversial. We systematically reviewed the existing literature for the management of DRFs in patients aged 60 and over with 5 common techniques: the volar locking plate system, nonbridging external fixation, bridging external fixation, percutaneous Kirschner wire fixation, and cast immobilization (CI). ⋯ This systematic review suggests that despite worse radiographic outcomes associated with CI, functional outcomes were no different from those of surgically treated groups for patients age 60 and over. Prospective comparative outcomes studies are necessary to evaluate the rate of functional recovery, cost, and outcomes associated with these 5 treatment methods.
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To evaluate measurement properties of 2 brief outcome measures for carpal tunnel syndrome: the 6-item carpal tunnel symptoms scale (CTS-6) and the 2-item palmar pain scale (measuring severity of pain in the scar/palm and pain-related activity limitation). Our hypothesis was that the CTS-6 is responsive to change in symptoms after surgical treatment and the pain scale is a valid measure of surgery-related pain. ⋯ The CTS-6 is highly responsive to change in symptoms, and the palmar pain scale is a valid measure of surgery-related pain. These brief scales can be appropriate primary and secondary outcomes measures in clinical trials studying carpal tunnel syndrome.
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Comparative Study
Nonunion of operatively treated capitellum and trochlear fractures.
To test the hypothesis that comminuted fractures of the capitellum and trochlea with posterior comminution (Dubberley type 3B) have a greater risk of nonunion than other types of capitellum and trochlea fractures. ⋯ Fractures of the capitellum and trochlea are prone to nonunion when they create multiple articular fragments and there is posterior comminution (Dubberley type 3B).
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The FasT-Fix device (Smith and Nephew Endoscopy, Andover, MA), initially developed for knee meniscal tears, is described for all-arthroscopic triangular fibrocartilage complex (TFCC) repairs. Potential benefits of this technique are ease of use, the lack of prominent suture knots, and strength of repair. This case series evaluates the early clinical outcomes of this technique. ⋯ At mean 1-year follow-up, 11 out of 12 patients achieved excellent subjective outcomes based on QuickDASH and PRWE questionnaires. Although range of motion and grip strength were slightly decreased compared to prior case series reports, the short-term results indicate that the FasT-Fix all-arthroscopic, all-inside technique is a safe and effective technique for repair of Palmer type 1B TFCC tears.