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Treatment with a variable angle locking plate can, in theory, maintain near anatomic reduction of intra-articular distal radius fractures, but it is unknown to what extent reduction is maintained as measured by computed tomography. We assessed changes in radiographic fracture position 1 year post-operatively. We included 73 patients of whom 66 patients (90%) had radiographs available for review at 1 year post-operatively. We found a small (less than 2 mm or 2°) but statistically significant change in several measures. Accounting for inter-observer variability, this is probably within measurement error. We found no difference in change in fracture position or range of motion, grip strength or patient-reported outcome between the use of one or two distal rows of screws. Our results show that minimal changes in reduction can be expected after volar plate fixation in most patients. We recommend using only one screw row routinely, limiting costs, surgical time and the risk of misplacement of screws., Level of Evidence: IV.

Introduction: We aimed to evaluate the results of offering patients optional follow-up for simple upper extremity fractures. Specifically this study tested if there is a difference in (1) upper extremity disability, (2) return to work, and (3) satisfaction with delivered care at 2-6 months after enrollment between patients who choose and do not choose a return visit for an adequately aligned metacarpal, distal radius, or radial head fracture. Additionally we assessed if there was a difference in overall evaluation of the visit at enrollment between those patients and what factors were associated with returning after initially choosing not to schedule a follow-up visit., Patients and Methods: We prospectively enrolled all adult patients (n=120) with adequately aligned metacarpal fractures, non-or minimally displaced distal radius fractures, and isolated non- or minimally displaced radial head fractures of whom 82 (68%) were available at 2-6 months after enrollment. Subjects chose to have a scheduled (n=56) or optional (n=64) return visit. Subsequently, we recorded patient demographics and overall evaluation of the visit. Between two and six months after enrollment we measured QuickDASH, satisfaction with care, and current employment status., Results: Accounting for potential differences in baseline characteristics by multivariable analysis, return choice was not associated with QuickDASH (β regression coefficient [β] -0.53, 95% confidence interval [CI] -7.4 to 6.4, standard error [SE] 3.5, P=0.88), return to work (odds ratio [OR] -1.3, 95%CI -3.5 to 0.95, SE 1.1, P=0.26), satisfaction with care (β -0.084, 95%CI -0.51 to 0.35, SE 0.22, P=0.70), or overall evaluation of the initial visit (β 0.18, 95%CI -0.38 to 0.73, SE 0.28, P=0.53). Of the 64 people choosing optional follow-up, 11 patients returned (17%). The only factor independently associated with returning after initially not choosing to return was greater disability at enrollment (OR 1.05, 95%CI 1.0050-1.098, SE 0.024, P=0.029)., Conclusions: A majority of patients prefer optional follow-up for simple upper extremity fractures with a good prognosis. Hand surgeons can consider offering patients with low-risk hand fractures an optional second visit. Eliminating unnecessary visits, tests and imaging could lower the cost of care., Level of Evidence: Therapeutic level II., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Endoprosthetic reconstruction, intramedullary nailing, and open reduction internal fixation (ORIF) are the most commonly practiced surgical strategies for treatment of metastatic proximal femoral fractures. This review describes functional outcome, local, and systemic complications. All three surgical strategies result in reasonable function on average; however, wide ranges indicate that both poor and good functional levels are obtained. We found that the overall reoperation rate was comparable for endoprosthesis and intramedullary nailing, but was higher for ORIF. J. Surg. Oncol. 2016;114:507-519. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objectives: To identify demographic, injury-related, or psychologic factors associated with finger stiffness at suture removal and 6 weeks after distal radius fracture surgery. We hypothesize that there are no factors associated with distance to palmar crease at suture removal., Design: Prospective cohort study., Setting: Level I Academic Urban Trauma Center., Patients: One hundred sixteen adult patients underwent open reduction and internal fixation of their distal radius fractures; 96 of whom were also available 6 weeks after surgery., Intervention: None., Main Outcome Measurements: At suture removal, we recorded patients' demographics, AO fracture type, carpal tunnel release at the time of surgery, pain catastrophizing scale, Whiteley Index, Patient Health Questionnaire-9, and disabilities of the arm, shoulder, and hand questionnaire, 11-point ordinal measure of pain intensity, distance to palmar crease, and active flexion of the thumb through the small finger. At 6 weeks after surgery, we measured motion, disabilities of the arm, shoulder, and hand, and pain intensity. Prereduction and postsurgery radiographic fracture characteristics were assessed., Results: Female sex, being married, specific surgeons, carpal tunnel release, AO type C fractures, and greater catastrophic thinking were associated with increased distance to palmar crease at suture removal. At 6 weeks, greater catastrophic thinking was the only factor associated with increased distance to palmar crease., Conclusions: Catastrophic thinking was a consistent and major determinant of finger stiffness at suture removal and 6 weeks after injury. Future research should assess if treatments that ameliorate catastrophic thinking can facilitate recovery of finger motion after operative treatment of a distal radius fracture., Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Purpose: This systematic review aims to provide an overview of functional outcome and complications after surgery for metastatic humerus fractures., Methods: A literature search was performed in September 2013 using the Pubmed, Embase and Cochrane database. We included 23 studies reporting on 29 treatment arms: intramedullary nailing (19 studies, 596 cases), plate-screw fixation (five studies, 150 cases), endoprosthetic reconstruction (three studies, 81 cases), and diaphysis prosthesis (two studies, 82 cases), totalling 909 fractures. There were 414 pathological and 56 impending fractures. In 439 cases the type of fracture was not specified. Four studies reported functional outcome., Results: Average Musculoskeletal Tumor Society score ranged from 64 to 79 (three studies, 100 patients) after intramedullary nailing, was 90 (one study, 24 patients) after plate-screw fixation, and 73 (one study, 30 patients) after endoprosthetic reconstruction. Re-operation rate varied from 0 to 10 % after intramedullary nailing (overall 4.4 %), 5-14 % after plate-screw fixation (overall 9.3 %), 14-16 % after diaphysis prosthesis (overall 14.6 %), and 0-6 % after endoprosthetic reconstruction (overall 2.5 %). Systemic complication rate varied between 0 and 26 % after intramedullary nailing (overall 2.2 %), between 0 and 6 % after plate-screw fixation (overall 4.8 %), was 0 % after endoprosthetic reconstruction, and varied between 0 and 16 % after diaphysis prosthesis (overall 9.7 %)., Conclusions: Reported complication rates help surgeons inform their patients and could aid in surgical decision making. Functional outcome, pain and quality of life were poorly reported. Patient reported outcomes are therefore an important direction for future research.