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In an open-label, multicenter, randomized trial, point-of-care ultrasonography was noninferior to radiography in children and adolescents with an isolated distal forearm injury, without a visible deformity.

Pediatric wrist fractures are common skeletal injuries in clinical practice; however, due to the ongoing development of children’s bones, fracture characteristics are complex and often prone to misdiagnosis or missed diagnosis. Moreover, traditional diagnostic methods rely heavily on the physician’s experience, which may compromise efficiency and accuracy, especially in environments with limited medical resources. To address this issue, this study proposes an improved deep learning detection method based on YOLO11s, named Kid-YOLO, for the automatic detection of pediatric wrist fractures in X-ray images. By introducing the C3k2-WTConv module and Focaler-MPDIoU loss function, the model was improved in terms of multi-scale feature extraction, target box localization accuracy optimization, and addressing the class imbalance problem. The C3k2-WTConv module, which combines wavelet transform and convolution operations, effectively enhances the model’s ability to detect subtle fractures and complex patterns. The Focaler-MPDIoU loss function improves performance in detecting rare targets by dynamically adjusting sample weight distribution and optimizing prediction box positioning. Experiments were conducted on the publicly available GRAZPEDWRI-DX dataset after data cleaning, The results show that, compared with the YOLO11 model, the improved model achieves a 3.2% increase in precision, a 1.6% increase in recall, a 1.8% improvement in mAP@50, and a 3.2% improvement in mAP@50–95. Furthermore, this study developed an AI-assisted diagnostic system with an integrated graphical user interface, capable of efficiently performing image loading, fracture detection, and result visualization, thereby providing physicians with a reliable diagnostic tool. In the future, this method is expected to be applied to a broader range of medical imaging analysis tasks, offering new technical support for precision medicine.

Background Currently, non- or minimally displaced distal radius fractures are treated by 3 to 5 weeks of cast immobilisation. Many patients with a distal radius fracture suffer from long-term functional restrictions, which might be related to stiffness due to cast immobilisation. Current literature indicates that 1 week of immobilisation might be safe; however, no level 1 evidence is available. This trial aims to compare 1 week of brace immobilisation with 3 weeks of cast immobilisation in patients with distal radius fractures that do not need reduction. Methods The aim of this trial is to evaluate the non-inferiority of 1 week of brace immobilisation in patients with non- or minimally displaced distal radius fractures. A two-armed single blinded multicentre randomised clinical trial will be conducted in three hospitals. Adult patients, between 18 and 50 years old, independent for activities of daily living, with a non- or minimally displaced distal radius fracture can be included in this study. The intervention group is treated with 1 week of brace immobilisation, and the control group with 3 weeks of cast immobilisation. Primary outcome is the patient-reported outcome measured by the Patient-Related Wrist Evaluation score (PRWE) at 6 months. Secondary outcomes are patient-reported outcome measured by the Quick Disabilities of the Arm, Shoulder and Hand score at 6 weeks and 6 months, PRWE at 6 weeks, range of motion, patient-reported pain score measured by VAS score, radiological outcome (dorsal/volar tilt, radial height, ulnar variance, presence of intra-articular step off), complications and cost-effectiveness measured by the EuroQol 5 Dimension questionnaire, Medical Consumption Questionnaire and Productivity Cost Questionnaire. Discussion This study will provide evidence on the optimal period of immobilisation in non-operatively treated displaced and reduced distal radius fractures. Both treatment options are accepted treatment protocols and both treatment options have a low risk of complications. Follow-up will be according to the current treatment protocol. This study will provide level 1 evidence on the optimal period and way of immobilisation for non- or minimally displaced distal radius fractures in adult patients. Trial registration ABR 81638 | NL81638.029.22 | www.toetsingonline.nl . 18th of October 2023

Background With roughly 45,000 adult patients each year, distal radius fractures are one of the most common fractures in the emergency department. Approximately 60% of all these fractures are displaced and require surgery. The current guidelines advise to perform closed reduction of these fractures awaiting surgery, as it may lead to post-reduction pain relief and release tension of the surrounding neurovascular structures. Recent studies have shown that successful reduction does not warrant conservative treatment, while patients find it painful or even traumatizing. The aim of this study is to determine whether closed reduction can be safely abandoned in these patients. Methods In this multicenter randomized clinical trial, we will randomize between closed reduction followed by plaster casting and only plaster casting. Patients aged 18 to 75 years, presenting at the emergency department with a displaced distal radial fracture and requiring surgery according to the attending surgeon, are eligible for inclusion. Primary outcome is pain assessed with daily VAS scores from the visit to the emergency department until surgery. Secondary outcomes are function assessed by PRWHE, length of stay at the emergency department, length of surgery, return to work, patient satisfaction, and complications. A total of 134 patients will be included in this study with follow-up of 1 year. Discussion If our study shows that patients who did not receive closed reduction experience no significant drawbacks, we might be able to reorganize the initial care for distal radial fractures in the emergency department. If surgery is warranted, the patient can be sent home with a plaster cast to await the call for admission, decreasing the time spend in the emergency room drastically. Trial registration This trial was registered on January 27, 2023.

Purpose To evaluate the rate of missed scaphoid fractures on follow-up computed tomography (CT) for suspected occult scaphoid fracture after normal radiography with residual radial-sided wrist pain. Methods In a retrospective analysis, wrist CT during a five-year period was analyzed. The CT examinations and radiological reports were re-evaluated. Available clinical findings and radiologic follow-up performed during a period of a minimum of three years served as outcome reference. Results In total, 178 examinations had been performed on 174 patients for suspect scaphoid fracture, 67 men and 107 women, showing 15 and 6 scaphoid fractures, respectively; a statistically significant sex difference ( p  = 0.0024). In 157 examinations, no scaphoid fracture was detected on CT, instead 29 other wrist or carpal bone fractures were found. On follow-up, no missed scaphoid fractures were found. Before CT, 124 of the 157 patients had been treated with a cast. After CT, 35 patients continued with cast treatment for a median of 14 days. Conclusions CT appears to be a reliable method for evaluating suspect scaphoid fracture as part of a diagnosis-treatment regimen including pain immobilization with a plaster cast.

Pediatric wrist fracture detection is diagnostically challenging due to subtle fracture morphologies and growth plate obscuration. To address this, we propose FracDet-v11, a specialized real-time framework based on YOLOv11s. We introduce a series of architectural enhancements to optimize feature representation and detection robustness: (1) a reconstructed backbone integrating Haar Wavelet Downsampling (HWD) and PKI-CAA to effectively preserve high-frequency details, complemented by a Dual-branch Channel Attention Module (DCAM); (2) a lightweight Slim-Neck for efficient feature fusion; and (3) a detection head incorporating Deformable Convolution v4 (DCNv4) and Focaler-CIoU loss to adapt to geometric deformations and prioritize hard samples. Benchmarking on the GRAZPEDWRI-DX dataset demonstrates that FracDet-v11 achieves a precision of 73.9% and mAP50 of 64.8%, surpassing the baseline by 3.8% and 3.1%, respectively. Furthermore, the model exhibits robust generalization on the external FracAtlas dataset with an mAP50 of 47.9%, confirming its potential as a reliable assistive tool for clinical diagnosis. The code for this work is available on GitHub at https://github.com/boboji1233/FracDet-v11.

IntroductionDistal radius fractures (DRFs) are common injuries, especially in older adults due to age-related frailty. Most DRFs in patients aged 60 and older are treated non-operatively since surgery offers no clinically important benefits. Although anatomical alignment has traditionally been the goal of the treatment, evidence suggests that in older populations, radiographic outcomes do not reliably correlate with functional outcomes. Current evidence, including one randomised trial, shows no functional benefit of closed reduction compared with casting alone, calling into question the routine use of the procedure in older patients. The primary objective is to evaluate whether no reduction is equivalent to closed reduction in patients aged 65 years or older with a displaced DRF, based on wrist-related pain and disability measured by the Patient-Rated Wrist Evaluation (PRWE) score at 12 months.Methods and analysisThis is a multi-centre, randomised controlled, equivalence trial conducted in hospitals in Finland, Denmark, Sweden and Estonia. We aim to enrol 532 patients aged ≥65 years with a displaced DRF (AO/OTA 23A/23C). Participants will be randomised (1:1) to receive either a dorsal cast without reduction (experimental intervention) or closed reduction followed by casting (control comparator). The primary endpoint is the difference between groups assessed using the PRWE outcome score at 12 months. The equivalence margin will be set at 6 PRWE points. Key secondary endpoints will include the Numeric Rating Scale for pain, patient satisfaction, quality of life (EQ-5D-5L Index) and serious adverse events at 3 months and 12 months and cosmesis at 3 months. Our main analyses will follow an intention-to-treat principle, analysed using repeated measures mixed model.Ethics and disseminationEthical approval has been granted by the Ethics Committee of Tampere University Hospital (R25001). Results of the trial will be disseminated through peer-reviewed journals.Protocol version6 July 2025, v1.0.Trial registration numberNCT07042139.

Standardization of palmar plate osteosynthesis in order to consequently achieve physiologic anatomy of the distal radius end. Unstable dorsally displaced distal radius fractures or fractures that should be treated functionally. Severe intraarticular joint depression that cannot be reduced with either a palmar or arthroscopic assisted approach. Patient in supine position with the forearm supinated on arm table. Radiopalmar incision along the radial border of the flexor carpi radialis tendon. Detachment of the pronator quadratus muscle from radial to ulnar. Gross reduction with eventual correction of a dorsal or radial shift. Placement of the angular stable plate and preliminary fixation with a nonangular stable cortical screw in the long hole at the radius shaft. Fluoroscopic control of axial alignment in the anteroposterior view and of correct distal position of the plate in the lateral view under reduction condition. Placement of one or two angular stable screws at the shaft. Under subtle reduction with flexion, ulnar deviation and axial traction placement of two K‑wires via the holes at the distal edge of the plate. These wires mostly keep reduction maintained while reduction maneuver can be paused. Fluoroscopic control in two planes. Replacement of the wires by distal angular stable screws with the help of the wires as an orientation. In case of insufficient reduction, reduction maneuver can be repeated while the first angular stable screw is locked. Final fluoroscopic control in two planes and ulnar deviation, eventually also in tangential view and clinical testing for stability of the distal radioulnar joint. Wound closure only by skin suture. Application of a sterile dressing and a palmar cast. Arm consequently in upright position and active and complete movement of fingers. Palmar below-elbow cast for 2 weeks, then movement of wrist without exertion. After regular radiographic control 4-5 weeks postoperatively, increase of axial load to normal and, if needed, physiotherapy. Clinical control for irritation of tendons by plate or screws after 1 year and eventual plate removal.

Background Delayed extensor pollicis longus (EPL) rupture is a known complication of distal radius fractures (DRF). Identifying predictive imaging findings could aid in early risk stratification. This study aims to evaluate the association between floating fat signs in patients with DRF and delayed EPL rupture. Methods In this retrospective study, we included 352 consecutive patients with DRF from a single institution. Of these patients, 12 experienced an EPL rupture, while 340 had no tendon-associated complications. We evaluated the preoperative CT scans of patients with DRF. For the second and third extensor compartments, we visually graded the floating fat sign on a semi-quantitative Likert scale (0–2). We assessed the presence of bone fragments, Lister’s tubercle fracture type, fracture gap, intra-articular fracture, and articular step-off in intra-articular fractures. Results The sum of floating fat sign scores in the second and third compartments was significantly correlated with the rate of EPL rupture in all patients ( p  < 0.001), as well as in the subgroup analysis of conservative treatment and volar plating groups ( p  = 0.009 and 0.001, respectively). Univariate analysis showed significant differences between the EPL rupture and non-rupture groups regarding the treatment choice ( p  = 0.001) and the sum of the floating fat sign scores ( p  < 0.001). Conservative treatment and sum of floating fat sign scores of 3 and 4 were independent predictive indicators of EPL rupture ( p  = 0.001, Odds ratio [OR] = 0.04; p  = 0.006, OR = 38.22; and p  = 0.022, OR = 25.54, respectively). Conclusion The floating fat sign in DRF is associated with EPL rupture and could help predict delayed EPL rupture.