Explore the vast range of titles available.

The results of published novel research in a specific field of medicine are the basis for changing the existing, recognized diagnostic or therapeutic paradigm. Over the last 20–30 years, there have been many examples of such changes. Most often, no one misses them, because new forms of diagnosis and treatment are usually much more precise and effective. However, there are some treatments that have been abandoned despite having been used for many years with good results, and their fate was decided by the results of novel research showing that their effectiveness is similar to placebo. There are several examples of such therapies, including the use of regional intravenous blockades with guanethidine and free radical scavengers in the treatment of the acute phase of complex regional pain syndrome (CRPS), treatment of distal radial fractures by percutaneous fixation with K-wires, and conservative treatment of hand fractures. In this article, the authors recall these methods and discuss their advantages, despite the fact that evidence-based medicine (EBM) has considered them ineffective.

Manual of Orthopaedics, Seventh Edition provides you with quick access to the orthopaedic information needed to diagnose and treat musculoskeletal injuries and diseases with confidence. Your keys to excellence in your orthopaedic challenges… \\u00b7 Broad scope covers the full range musculoskeletal conditions, from the commonly encountered seen in primary care medicine to the catastrophic seen in the emergency rooms and orthopaedic clinics \\u00b7 User-friendly outline format provides quick access to essential facts on a variety of acute and chronic orthopaedic disorders \\u00b7 Treatment algorithms provide an initial approach to all musculoskeletal problems \\u00b7 Illustrations support the text offering visual guidance on common techniques - including placement of splints, use of casts, and injections New to the Seventh Edition… \\u00b7 All chapters have been updated with the most current information \\u00b7 New authors have been added to gain a fresh perspective and to update chapter outlines where indicated \\u00b7 Clear distinction has been made regarding what conditions are appropriately managed by primary care and emergent/urgent care providers and which need orthopaedic subspecialist care A must have resource for students, residents, primary care providers, emergent and urgent care providers and orthopaedic providers in all practice enviornments.

Background Severe angulation or shortening can be a surgical indication for fifth metacarpal neck fracture. In a previous meta-analysis, antegrade intramedullary pinning was shown to produce better hand function outcomes than percutaneous transverse pinning or miniplate fixation for treatment of fifth metacarpal neck fractures. However, the outcomes of retrograde intramedullary pinning, to our knowledge, have not been compared with those of antegrade intramedullary pinning. Questions/purposes We asked whether the clinical and radiographic outcomes of antegrade intramedullary pinning are different from those of percutaneous retrograde intramedullary pinning for treating patients with displaced fifth metacarpal neck fractures. Methods Forty-six patients with displaced fifth metacarpal neck fractures with an apex dorsal angulation greater than 30° were enrolled in our prospective study. Subjects were treated randomly by antegrade intramedullary pinning (antegrade group) or by percutaneous retrograde intramedullary pinning (retrograde group). Clinical evaluations, which included active ROM of the fifth metacarpophalangeal joint, VAS for pain, grip strength, and DASH score, were performed at 3 months and 6 months postoperatively. Radiographic evaluations of apex dorsal angulation and axial shortening were performed preoperatively and 6 months postoperatively. Results Patients in the antegrade group achieved better outcomes than patients in the retrograde group for all clinical parameters at 3 months postoperatively (ROM: antegrade median 80° [range, 57°–90°] versus retrograde 69° [range, 45°–90°], difference of medians 11°, p < 0.001; VAS: antegrade median of 2 [range, 0–5] versus retrograde 4 [range, 0–7], difference of medians 2, p < 0.001; grip strength: antegrade median 81% [range, 60%–100%] versus retrograde 71% [range, 49%–98%], differences of medians 10%, p < 0.001; DASH: antegrade median 4.3 [range, 0–15.8] versus retrograde 10.3 [range, 0–28.4], difference of medians 6, p < 0.001), but these differences, with the numbers available, were not observed at 6 months postoperatively for any clinical parameters (ROM: antegrade median 88° [range, 81°–90°] versus retrograde 87° [range, 80°–90°], difference of medians 1°, p = 0.35; VAS: antegrade median 1 [range, 0–2] versus retrograde 1[range, 0–3], difference of medians 0, p = 0.67; grip strength: antegrade median 93% [range, 78%–104%] versus retrograde 91% [range, 76%–101%], difference of medians 2%, p = 0.41; DASH: antegrade median 3 [range, 0–12.5] versus retrograde of 4.3 [range, 0–15.8], difference of medians 1.3, p = 0.48). At 6 months postoperatively, there also were no differences, with the numbers available, in radiographic parameters between the antegrade and retrograde fixation groups. Residual angulation was not different (antegrade median: 7° [range, 2°–11°], retrograde: 9° [range, 3°–13°], difference of medians 2°, p = 0.56). Shortening between the two groups also was not different (antegrade median: 1 mm [range, 0 mm–2 mm], retrograde median: 1 mm [range, 0 mm–2 mm], difference of medians 0, p = 0.78). Conclusion Our study findings suggest antegrade intramedullary pinning has some clinical advantages during the early recovery period over percutaneous retrograde intramedullary pinning for treatment of displaced fifth metacarpal neck fractures, but the advantages are not evident at 6 months postoperatively. In addition, our study showed no differences in radiographic outcomes between antegrade and retrograde techniques. For patients who require an early return of hand function, such as athletes, antegrade intramedullary pinning can be recommended. Otherwise, treatment could be decided according to the surgeon’s preference and patient status, and based on consideration of the need for an accessory procedure for pin removal after antegrade intramedullary pinning. Level of Evidence Level I, therapeutic study.

Background Fifth metacarpal fractures are the most common fractures of the hand. These fractures are generally treated with conservative methods. The aim of this study was to compare the radiological and clinical outcomes of two conservative treatment methods, functional metacarpal splint(FMS) and ulnar gutter splint(UGS), for the treatment of fifth metacarpal neck fractures. Methods A prospective comparative study was designed to assess the conservative treatment of isolated and closed stable fractures of the fifth metacarpal neck. In total, 58 patients were included in the study and were treated with FMS or UGS after fracture reduction in a consecutive order. Angulation, shortening and functional outcome ( Quick DASH scores and grip strengths) were evaluated at the 2nd and 6th months. Results Forty patients returned for follow-up. Twenty-two patients were treated with FMS, and 18 patients were treated with UGS. The average age was 28 years (SD ± 12, range;18–43) in the FMS group and 30 years (SD ± 14, range;18–58) in the UGS group. After reduction, significant correction was achieved in both groups, but the average angulation was lower in the FMS group(16 ± 7) compared with the UGS group (21 ± 8)( p  = 0.043). However, this better initial reduction in FMS group(16 ± 7) could not be maintained in the 1st month follow-up (21 ± 5) ( p  = 0.009). In the FMS group, the improvement in Quick DASH scores between the 2nd and 6th month follow-up was significant ( p  = 0.003) but not in the UGS group( p  = 0.075). When the expected grip strengths were calculated, the FMS group reached the expected strength values at the 2nd month follow-up, whereas the UGS group still exhibited significantly lower grip strength at the 2nd month follow-up( p  = 0.008). However, at the end of the 6th month follow-up, both groups exhibited similar reduction, Quick DASH and grip strength values. Conclusions In stable 5th metacarpal neck fractures, FMS is adequate to prevent loss of reduction and yields faster improvement in clinical scores with earlier gain of normal grip strength compared with UGS. However, in the long term, both FMS and UGS methods yield similar radiological and clinical outcomes. Patient comfort and compliance may be better with FMS due to less joint restriction, and these findings should be considered when deciding the treatment method. Trial registration ISRCTN79534571 The date of registration: 01/04/2019 Type of study/level of evidence: Therapeutic, II.

Prolonged immobilization of joints after distal radius fracture (DRF) causes cerebral disuse-dependent plasticity (DDP) and deterioration of upper extremity function. Action observation therapy (AOT) can improve DDP. This nonrandomized controlled trial (UMIN 000039973) tested the hypothesis that AOT improves hand-use difficulties during activities of daily living in patients with DRF. Right-handed women with volar locking plate fixation for DRF were divided into AOT and Non-AOT groups for a 12-week intervention. The primary outcome was difficulty in using the fractured hand, assessed with the Japanese version of the Patient-related Wrist Evaluation (PRWE). The secondary outcomes were range of motion (ROM) of the injured side and gap between measured ROM and patient-estimated ROM. The survey was administered immediately post operation and at postoperative weeks 4, 8, and 12. The AOT group used a head-mounted display and three-dimensional video during ROM exercises. The Non-AOT group used active ROM exercises alone. A generalized linear model (GLM) was used to confirm interactions and main effects by group and time period, and multiple comparisons were performed. Thirty-five patients were assigned to the AOT group (n = 18, median age, 74 years) or the Non-AOT group (n = 17, median age, 70 years). In the GLM, PRWE Total, PRWE Specific, and PRWE Usual scores revealed interactions between groups and periods. The post-hoc test revealed that the PRWE Specific scores (z = 3.43, p = 0.02) and PRWE Usual scores (z = 7.53, p<0.01) were significantly lower in the AOT group than in the Non-AOT group at 4 weeks postoperatively, whereas PRWE Total scores (z = 3.29, p = 0.04) were lower at 8 weeks postoperatively. These results suggested that AOT can improve hand-use difficulties in right-handed women after DRF surgery. AOT positively affects the motor imagery of patients with DRF and can reverse the patient's perceived difficulty in using the fractured hand during rehabilitation.

Background Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. Methods We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Results We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. Conclusions This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.

Background Distal radius fractures (DRFs) are a global public health issue and represent the second most common type of fracture among the elderly. There remains controversy in the orthopedic community regarding the optimal treatment strategy for DRFs. Methods We will conduct a multicenter, randomized, single-blind, controlled trial to assess the efficacy of surgical versus conservative treatment for distal radius fractures in elderly patients. Sample size calculations are based on the PRWE score, aiming to randomize 456 participants in a 1:1 ratio. Once randomized, patients will be followed for 24 months post-treatment. The primary outcome will be wrist function reported by patients within the first year post-injury. Secondary outcomes include QUICKDASH scores, VAS scores, EQ-5D-3L scores, range of wrist motion, grip strength, complications, and patient satisfaction. Additionally, the study will evaluate the economic and social benefits using statistical methods. Discussion There is no definitive answer as to whether elderly patients with displaced distal radius fractures universally benefit from surgery. However, current literature suggests that surgery does not provide significant advantages. Through this study, we aim to provide the highest quality evidence to determine the optimal treatment strategy for distal radius fractures in patients aged 60 and above, thereby enhancing post-trauma recovery for the elderly. Trial registration This study had been registered in the Chinese Clinical Trials Registry. Registration number: ChiCTR2400080223 on January 24, 2024. https://www.chictr.org.cn .

Purposes The objective of this study was to investigate intra-articular distal radius fractures, aiming to provide a comprehensive analysis of fracture patterns and discuss the corresponding treatment strategies for each pattern. Methods 294 cases of intra-articular distal radius fractures lines were collected and clustered thorough K-means and hierarchical clustering algorithm. The demographic data of patients and the clinical treatment outcomes were recorded. For functional evaluation, quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS) pain score, range of motion (ROM) of the wrist joint and the percentage of the grip strength relative to the healthy wrist at 12 months follow-up were evaluated and recorded; For radiographic parameters of volar tilt (VT), radial inclination (RI), and ulnar variance (UV) were obtained; The occurrence of complications was carefully assessed and documented. Results Totally 294 patients were included and divided into the volar side affected group and the dorsal side affected groups. And each group was further categorized into three types: type I, with two parts fractures with either one volar/dorsal side intact; type II, with three parts fractures with  volar/dorsal side simply affected; and type III, with four parts fractures with volar/dorsal side communited affected. The volar plate fixation was performed as the standard treatment, while the combined plate fixation was used for comminuted dorsal bone defects of the metaphysis and impaction. There were no differences in the postoperative radiograph parameters, functional outcomes and incidences of complications for each type of volar side group and dorsal side group except that the 3.2 type DRFs showed less range of flexion (75.56±7.48)° and extension (61.65±9.9)° than other dorsal types. Conclusions A new intra-articular distal radius fractures classification was proposed based on the affection condition of volar or dorsal side. The volar plate fixation is an effective treatment for the intra-articular distal radius fractures, while combined plate fixation can be considered as an alternative treatment for dorsal side comminuted fractures. Level of evidence III a

The objective of the present study was to evaluate effectiveness, complications and cost-effectiveness of any surgical or non-surgical treatment for radius or ulna fractures in elderly patients. Secondary objectives were to analyze present treatment traditions of distal radius fractures (DRF) in Sweden and to calculate resource usage for its treatment. The assessment contains a systematic review of clinical and health economic studies comparing treatment options for radius or ulna fractures. The results regarding the effectiveness of the treatments are summarized in meta-analyses. In addition, the assessment contains a cost analysis for different treatment options commonly used for DRF care, and an analysis of registry data on the incidence and treatment of DRF. In total 31 randomized controlled trials were included in meta-analyses. When comparing functional outcome for plate fixation versus non-surgical treatment for DRF, there were no clinically important differences at one-year follow-up (mean difference [MD], -3.29, 95% CI, -7.03; 0.44). Similar results were found when comparing plating and percutaneous methods with respect to functional outcome (standardized mean difference [SMD], -0.07, 95% CI, -0.21; 0.07) and grip strength (MD, -3.47, 95% CI, -11.21; 4.28). There were no differences for minor complications, (risk difference [RD], -0.01, 95% CI, -0.07; 0.05) whereas major complications were less common for the percutaneous group, (RD, 0.02, 95% CI, 0.02; 0.03). Given the low number of studies, the evidence above was rated as moderate certainty. The cost for plate fixation versus plaster cast was estimated to 1698 compared to 137 US dollars. For DRF, plate fixation increased in Sweden between 2005 and 2013, and was the most common surgical method in 2013. Surgical treatment of moderately displaced distal radius fractures in elderly patients offers no clear benefit compared to non-surgical treatment. Plating procedures have become more common during the second millennium and involve higher costs and higher risk of major complications than percutaneous options.