Search

Fractures of the distal radius are the most common upper limb fracture and account for over a sixth of all fractures seen in emergency departments. Although most of these fractures are managed non-operatively, a significant number of complex injuries undergo operative management. This educational review of up to date guidelines discusses the perioperative management of distal radius fractures and provides readers with continuing professional development activities.

Background: Adolescents are most likely to suffer from injuries, which are the leading cause of morbidity and mortality. Fractures have been identified as a major consequence of injuries and fractures of the limbs significantly limit their functional capacity. It can lead to reduced productivity and quality of life of adolescent. As adolescents are among the most economically productive age groups, preventing adolescent-related injuries is an investment for a country. During the first three months after treatment, 59.5 percent of upper limb fracture patients admitted to the National Hospital in Sri Lanka struggled to conduct daily activities. Objective: To evaluate the functional outcomes of adolescents aged 10 to 19 years after receiving first treatment for upper limb fractures at government hospitals in Colombo district in Sri Lanka. Methodology: A follow-up research was conducted on 400 randomly selected adolescent victims who had upper limb fractures as a result of their injuries. After initial treatment, they were recruited from six main hospitals in Colombo district and followed up for six weeks. At six weeks, while attending follow-up clinics at their respective hospitals or at their homes, a validated and culturally accepted new tool was employed to measure their functional outcomes using a Likert scale. Results: After six weeks of treatment, 33.2 percent of 400 sufferers had good functional outcomes. Adolescents' highest mean score was for performing specific activities, such as playing, sports or recreational activities, or sewing, and this was their primary functional disability (Mean score 865.5 with standard deviation of 23.97). Conclusions and Recommendations: Adolescent fracture sufferers' rehabilitation care must be improved for them to recover quickly, as they are the country's future generation.

Background Trauma theatre time is valuable and previous studies reported cost of £24.77/minute. BSUH Children’s emergency department (CED) guidelines were implemented in December 2016, allowing reduction of forearm and distal radius (DR) fractures in CED using 70% nitrous (N2O) sedation. Due to COVID-19 pandemic and the risks associated with aerosol generating procedures as well as staffing levels, CED shifted to using 50%N2O with or without intranasal fentanyl. Method Relevant fractures presenting to CED from Feb-Dec 2020 were identified and compared to previous years. Demographics, treatment modality, timings, and outcomes were reviewed for 275 patients. Results In 2017-2018, 56% were manipulated in CED under 70%N2O (compared to only 3% in 2016). The main barrier identified was shortage of doctors trained in sedation to supervise use of 70%N20. In 2020, 101 patients were suitable for manipulation in CED. 64 had DR fractures, 37 midshaft fractures, 65 were male. Mean age: 10 years. 92 patients (91%) were manipulated in CED/fracture clinic. One was under 70%N2O; the rest used 50%N2O with or without intranasal fentanyl. 8 (9%) had manipulation under GA. Of those manipulated in CED, 3 were re-manipulated in clinic for cast problems. A typical MUA takes 30minutes indicating a saving of £743 per case; therefore, £68,356 over the study period. Conclusions Paediatric upper limb fracture manipulation in CED under N2O is effective and provides significant cost savings. Due to changes related to COVID-19 pandemic, considerably more patients in 2020 were safely treated in CED/clinic. Using 50%N2O improves uptake due to lower staffing requirements.

In malunion cases, restoration of anatomy is a key factor in obtaining a good functional outcome, but this can be technically very challenging. Three-dimensional printed bone models can further improve understanding of the malunion pattern. The use of three-dimensional (3D) computer planning, and the assembly of patient-specific instruments and implants, especially in complex deformities of the upper limb, allow accurate correction while reducing operation time, blood loss volume and radiation exposure during surgery. One of the major disadvantages of the 3D technique is the additional cost because it requires specific computer software, a dedicated clinical engineer, and a 3D printer. Further technical developments and clinical investigations are necessary to better define the added value and cost/benefit relationship of 3D in the treatment of complex fractures, non-unions, and malunions. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180074

RESUMO Objetivo Descrever o perfil sociodemográfico e analisar o desempenho ocupacional de usuários de um serviço especializado em reabilitação, de acordo com o modelo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Materiais e Métodos Estudo documental e exploratório, com análise dos prontuários de 97 pacientes atendidos entre 2013 a 2015, avaliados pela Medida Canadense de Desempenho Ocupacional (COPM). Resultados A idade variou de 14 e 83 anos (média de 48,4 anos); sendo a maioria mulheres (57,7%), casados (43,3%) e aposentados (39,2%). A maioria tinha menos de oito anos de estudo (42,3%); 80,4% eram sedentários; 12,4% tabagistas e 19,6% consumiam bebida alcoólica regularmente. Síndrome do manguito rotador, acidente vascular encefálico e fraturas de membro superior foram os diagnósticos mais frequentes. A média do desempenho foi 4,28 pontos (DP=1,84) e da satisfação com o desempenho foi 4,43 pontos (DP=2,41). Verificou-se dificuldades em atividades de autocui-dado; mobilidade funcional; atividades produtivas e atividades de lazer e recreação. Em relação aos componentes da CIF, o domínio Mobilidade obteve maior número de categorias citadas pelos usuários, enquanto que o domínio Cuidado Pessoal obtive o maior número de queixas. Conclusão O desempenho ocupacional dos pacientes apresentou mais limitações em atividades de autocuidado e produtivas. A aplicação da CIF para classificar as atividades identificou demandas específicas em cinco domínios, sendo mobilidade e cuidado pessoal os mais frequentes. Estes resultados permitem direcionar as ações de saúde às reais necessidades dos pacientes e estruturar a prática profissional. ABSTRACT Objective To describe the socio-demographic profile and analyze the occupational performance of users of a specialized rehabilitation service according to the International Classification of Functioning, Disability, and Health (ICF) model. Materials and Methods Documentary and exploratory study, in which the medical records from 97 patients treated between 2013 and 2015, were assessed using the Canadian Occupational Performance Measure (COPM). Results The age range of the patients was 14-83 years (average of 48.4 years), the majority being women (57.7%), married (43.3%), and retired (39.2%). Most patients had less than eight years of schooling (42.3%); 80.4% were sedentary; 12.4% smokers and 19.6% regularly consumed alcoholic beverages. Rotator cuff syndrome, stroke, and upper limb fracture were the most frequent diagnoses. The mean of occupational performance was 4.28 points (SD=1.84), and performance satisfaction was 4.43 points (SD=2.41). There were difficulties in self-care activities, functional mobility, productive activities and leisure and recreational activities. Regarding the components of the ICF, the Mobility domain obtained the highest number of categories cited by the users. In contrast, the Personal Care domain received the highest number of complaints. Conclusion The occupational performance of the patients presented more limitations in self-care and productive activities. The application of ICF to classify activities identified specific demands in five domains, Mobility, and Personal care being the most frequent. These results allow directing health actions towards the real needs of the patients and structuring professional practice. RESUMEN Objetivo Describir el perfil socio demográfico y analizar el desempeño ocupacional de los usuarios de un servicio de rehabilitación de acuerdo con el Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). Materiales y Métodos Estudio documental, exploratorio, con análisis de prontuarios de 97 pacientes atendidos entre 2013 a 2015, evaluados por la Medida Canadiense de Desempeño Ocupacional (COPM). Resultados La edad varía de 14 y 83 años (promedio de 48,4 años); la mayoría mujeres (57,7%), casados (43,3%) y retirados (39,2%). La mayoría tenía menos de ocho años de estudio (42,3%); 80,4% eran sedentarios; 12,4% eran fumadores y 19,6% consumían bebidas alcohólicas regularmente. Síndrome del manguito rotador, accidente vascular encefálico y fracturas de miembro superior fueron los diagnósticos más frecuentes. La media del rendimiento fue 4,28 puntos (DP = 1,84) y la satisfacción con el rendimiento fue 4,43 puntos (DP = 2,41). Se verificó dificultades en actividades de autocuidado; movilidad funcional; actividades productivas y actividades de ocio y recreación. En relación a la CIF, el dominio Movilidad obtuvo mayor número de categorías citadas por los usuarios, mientras que el dominio Cuidado personal obtuve el mayor número de quejas. Conclusión El desempeño ocupacional de los pacientes presentó más limitaciones en actividades de autocuidado y productivas. La aplicación de la CIF para clasificar las actividades identificó demandas específicas en cinco áreas, siendo movilidad y cuidado personal los más frecuentes. Estos resultados permiten orientar las acciones de salud a las reales necesidades de los pacientes y estructurar la práctica profesional.

Aims Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture. Methods A total of 744 adults with an isolated fracture of the proximal humerus, elbow, or distal radius completed PROMs. Due to multicollinearity of patient engagement and psychosocial variables, we generated a single variable combining measures of engagement and psychosocial factors using factor analysis. We then performed multivariable analysis with p < 0.10 on bivariate analysis. Results Patient engagement and psychosocial factors combined to form a single factor (factor 1) accounting for 20% (QuickDASH, semi-partial R2 = 0.20) and 14% (PROMIS UE PF, semi-partial R2 = 0.14) of the variation in limitations six to nine months after fracture. Factor 1 also accounted for 17% (NRS-C, semi-partial R2 = 0.17) of variation in satisfaction with care, and 21% (NRS-S, semi-partial R2 = 0.21) of variation in satisfaction with services. Demographic factors (age, sex, work status) and measures of greater pathophysiology (type of fracture, high-energy injury, post-surgical complications), accounted for much less variation. Conclusion Patients who actively manage their health and demonstrate effective emotional and social functioning share a common underlying trait. They have fewer limitations and greater satisfaction with care during recovery from upper limb fractures. Future efforts should focus on evaluating initiatives that optimize patient engagement, such as patient education, coaching, and a communication strategy for healthcare professionals. Cite this article: Bone Joint J 2020;102-B(1):42–47

Introduction: Upper limb fractures are one of the common fractures presentingin Accident and Emergency departments. Some of the upper limb fractures need openreduction and internal fixation. Use of suction drains after upper limb surgery is still debatableissue. Some surgeons routinely use, others never use and few occasionally use. Objectives:Aim of this study was to compare the results of upper limb fracture surgery by using or not usingthe suction drains. Design: Quasi Experimental Design. Settings: Orthopedic department AzizBhatti Shaheed Teaching Hospital Gujrart. Period: From December 2015 to November 2016.Method & Material: Total 120 patients were selected as per selection criteria. In 60 patients weused suction drain post-operatively & remaining 60 patients without Suction drain. Results:In our study we selected 120 patients .Patients divided in two groups. In group A 60 patientsincluded in the study. We did not use suction drain in these patients. In group B we also selected60 patients of upper limb fractures. We used suction drain in these patients. We compared theresults of both groups on the basis of superficial wound infection and pain. In group A, sixpatients developed superficial wound infection while four patients developed superficial woundinfection in group. There was no difference in severity of pain in both groups. Conclusion:We concluded from our study that there is no added advantage of suction drain in upper limbfracture surgery.

Introduction: Upper limb fractures are one of the common fractures presentingin Accident and Emergency departments. Some of the upper limb fractures need openreduction and internal fixation. Use of suction drains after upper limb surgery is still debatableissue. Some surgeons routinely use, others never use and few occasionally use. Objectives:Aim of this study was to compare the results of upper limb fracture surgery by using or not usingthe suction drains. Design: Quasi Experimental Design. Settings: Orthopedic department AzizBhatti Shaheed Teaching Hospital Gujrart. Period: From December 2015 to November 2016.Method & Material: Total 120 patients were selected as per selection criteria. In 60 patients weused suction drain post-operatively & remaining 60 patients without Suction drain. Results:In our study we selected 120 patients .Patients divided in two groups. In group A 60 patientsincluded in the study. We did not use suction drain in these patients. In group B we also selected60 patients of upper limb fractures. We used suction drain in these patients. We compared theresults of both groups on the basis of superficial wound infection and pain. In group A, sixpatients developed superficial wound infection while four patients developed superficial woundinfection in group. There was no difference in severity of pain in both groups. Conclusion:We concluded from our study that there is no added advantage of suction drain in upper limbfracture surgery.

Introduction Some patients with a hip fracture also present a concomitant upper limb fracture. We want to know whether these patients have a worse functional level and whether they have any differences in various clinical parameters compared with patients with an isolated hip fracture. Material and methods We retrospectively reviewed 1061 discharge reports from the Orthogeriatrics Unit. We collected information on several clinical parameters of the fractures. Subsequently, we performed a statistical analysis of the data by comparing the associated fracture group with the isolated fracture group. Results We detected 44 patients with associated upper limb fracture, 90.9% were women (40) and the average age was 84.45 years. Eighty-one point eight percent of the upper limb fractures were distal radius or proximal humerus. Pertrochanteric fractures were the most common (none of them were subtrochanteric fractures). Surgical delay was 2.60 days and the average hospital stay was 12.30 days. Sixty-four point three percent were nail surgery and 31% arthroplasty. The mean Barthel Index score was 84.88 (P = .021). Fifty-two point 5% of the patients in the study group were referred to a functional support unit (P = .03). The in-hospital mortality rate was 4.2%, with no differences between groups. Conclusions Patients with an associated fracture have a higher previous functional capacity and they are more independent. Nevertheless, after the fracture they need more help from the healthcare system for optimal functional recovery.

Question What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures? Design Systematic review of controlled trials. Participants Adults following an upper limb fracture. Intervention Any exercise therapy program, including trials where exercise was delivered to both groups provided that the groups received different amounts of exercise. Outcome measures Impairments of body structure and function, activity limitations and participation restrictions. Results Twenty-two trials were identified that evaluated 1299 participants with an upper limb fracture. There was insufficient evidence from 13 trials to support or refute the effectiveness of home exercise therapy compared with therapist-supervised exercise or therapy that included exercise following distal radius or proximal humeral fractures. There was insufficient evidence from three trials to support or refute the effectiveness of exercise therapy compared with advice/no exercise intervention following distal radius fracture. There was moderate evidence from five trials (one examining distal radius fracture, one radial head fracture, and three proximal humeral fracture) to support commencing exercise early and reducing immobilisation in improving activity during upper limb rehabilitation compared with delayed exercise and mobilisation. There was preliminary evidence from one trial that exercise to the non-injured arm during immobilisation might lead to short-term benefits on increasing grip strength and range of movement following distal radius fracture. Less than 40% of included trials reported adequate exercise program descriptions to allow replication according to the TIDieR checklist. Conclusion There is emerging evidence that current prescribed exercise regimens may not be effective in reducing impairments and improving activity following an upper limb fracture. Starting exercise early combined with a shorter immobilisation period is more effective than starting exercise after a longer immobilisation period. Registration CRD42016041818. [Bruder AM, Shields N, Dodd KJ, Taylor NF (2017) Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. Journal of Physiotherapy 63: 205–220]

Background In Afghanistan, Medecins Sans Frontieres provided specialised trauma care in Kunduz Trauma Centre (KTC), including physiotherapy. In this study, we describe the development of an adapted functional score for patient outcome monitoring, and document the rehabilitation care provided and patient outcomes in relation to this functional score. Methods A descriptive cohort study was done, including all patients admitted in the KTC inpatient department (IPD) between January and June 2015. The adapted functional score was collected at four points in time: admission and discharge from both IPD and outpatient department (OPD). Results Out of the 1528 admitted patients, 92.3% (n = 1410) received at least one physiotherapy session. A total of 1022 patients sustained either lower limb fracture, upper limb fracture, traumatic brain injury or multiple injury. Among them, 966 patients received physiotherapy in IPD, of whom 596 (61.7%) received IPD sessions within 2 days of admission; 696 patients received physiotherapy in OPD. Functional independence increased over time; among patients having a functional score taken at admission and discharge from IPD, 32.2% (172/535) were independent at discharge, and among patients having a functional score at OPD admission and discharge, 79% (75/95) were independent at discharge. Conclusions The provision of physiotherapy was feasible in this humanitarian setting, and the tailored functional score appeared to be relevant.

The study evaluates the serum levels of Trimethylamine N-Oxide (TMAO), a gut microbial metabolite, in 286 postmenopausal women with hip fracture. From January 1, 2018 to December 31, 2018, eligible patients were included. Same women without fracture mated age were enrolled. TMAO serum levels were tested by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). The serum levels of TMAO were significantly higher in patients with hip fracture than in those controls (P

It is known that during a fall, a child would rather protect their dominant hand by using the non-dominant one, although the role of handedness in upper limb fractures has not been studied in-depth. We carried out a retrospective, cross-sectional cohort study, including pediatric patients who presented to the emergency room with a supracondylar humerus fracture following an injury by falling from the same height. In total, 245 patients were selected and grouped according to age. In the 1&ndash, 3 years group, no statistical significance was found between hand dominance and the side of fracture (p = 0.7315). During preschool years (4&ndash, 6 years old), the non-dominant hand is more often involved (p = 0.03, odds ratio: 3.5). In the 7&ndash, 14 years group this trend was maintained and actually increased (p = 0.052, odds ratio: 3.8). We might conclude that children tend to protect their dominant hand by falling on their non-dominant one. The main objective of this study is to highlight a link between handedness and the side of the body where the hand fracture will be identified in the pediatric population, regarding supracondylar humerus fracture.

Introduction: Musculoskeletal trauma becomes a serious problem in developing countries such as Indonesia. Increasing cases of musculoskeletal trauma from day to day not in spite of increased mobility, motorization and the growing of industrialization in Indonesia. There are lack of studies that been published about musculoskeletal trauma pattern in Indonesia before. The purpose of this study is to provide an overview of the epidemiological parameters related to musculoskeletal trauma cases admitted to the trauma center in Banyumas, Central Java, Indonesia. Methods: Our study conduct a descriptive cross-sectional study at the trauma centre of Siaga Medika Hospital in Banyumas regency, Central Java. During 1-year period (January 2016 to December 2016), a total of 2183 patients were taken from the patients register. A detailed information of all patients was done with regards to age, sex, and the location of injury. Results: Predominant Injuries occur in the age group of 15-30 years. Males experienced more injury with male to female ratio of 3:1. Lower limb fracture ranks first as the location of the most common musculoskeletal trauma (41.8%), followed by upper limb fracture in the next sequence (40.3%). The predominant incidence of musculoskeletal trauma occurs from August to December 2016, where the highest incidence is in August with 299 cases. Conclusions: Even though we already have the traffic rules and standard operating procedures of any work that went well, but still need firmness in practice. Change in attitude of the people towards the traffic rules and road safety, and the standard operational procedure of any works should be brought about. This study expected to provide an overview of musculoskeletal trauma pattern in Indonesia in order to assist in arranging strategy to any trauma center providing service for musculoskeletal trauma based on these epidemiological trends.

The Intelligent Flexbar (I-FLEXBAR) is an innovative system which can assist patients with upper-limb fractures to have a safe, effective, and convenient rehabilitation, either within a hospital or at home. In addition, the I-FLEXBAR has received the personal treatment of rehabilitation specialists in determining the strength, rep count and duration in training. This presented system improves the defects of the Traditional Flexbar (TF) such as disconnection with network, less user interface and no guidance for users. The stress signal of a micro gauge embedded in I-FLEXBAR is fetched to measure and analyze the user operations. I-FLEXBAR offers various beneficial functionalities for rehabilitation patients. I-FLEXBAR will warn users with improper usage, to protect their safety. Furthermore, The friendly user-interface guides the users through a graphic user interface (GUI) and games. I-FLEXBAR could effectively and efficiently help patients who have an upper-limb fracture to safely rehabilitate the functions of upper limbs.

Upper limb fracture is easily found in the truck-to-pedestrian road traffic accident. And it is important to understand and elucidate the biomechanics of upper limb fractures caused by the frontal structure of the truck. Finite element (FE) analysis could potentially help in the understanding the biomechanical response mechanism of upper limb fracture. In this study, THUMS (Total Human Model for Safety) was applied to reconstruct the upper limb fracture in a real-world truck-to-pedestrian accident. Totally two FE simulations were conducted to find out the most likely scenario in this case. Analyzing the simulations of two possible scenarios clearly demonstrated that the simulation result of collision-to-left scenario was consistent with the autopsy finding, and bending mechanism could explain how the upper limb fracture occurs. Then we drew a conclusion that FE analysis is a valuable method for us to understand the biomechanical mechanism of upper limb fracture in the forensic practice.

Upper extremity fractures account for up to 90% of pediatric fractures. Among these fractures Supracondylar Humerus fractures are one of the commonest requiring surgical intervention and have a high prevalence of associated short term complications such as nerve injuries and long term complications such as cubitus varus. The epidemiology, classifications, clinical evaluation and complications of this fracture is hereby comprehensively reviewed along with controversies in management and available guidelines.

Purpose There is limited information on the prevalence of vitamin D deficiency among patients diagnosed with hip fracture in the Chinese Han population. Therefore, the aim of this study was to assess the effects of change in the serum levels of 25-hydroxyvitamin D [25(OH) D] and intact parathyroid hormone (iPTH) among postmenopausal women in North China with confirmed hip fracture. Methods This study was done from May 1, 2012 to April 30, 2014. Three hundred and forty-nine postmenopausal women who were diagnosed with first-ever hip fracture and 349 matched controls without fracture were used for this study. The 25(OH) D, iPTH, alkaline phosphatase, calcium, and phosphorus levels were measured in fasting venous blood samples collected from the subjects. A predesigned questionnaire was used to collect information on covariates for multivariate analyses to evaluate the hypothesized relationship between vitamin D deficiency and fracture risk. Results The serum 25(OH) D levels were found to be significantly (P

Question What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures? Design Systematic review of controlled trials. Participants Adults following an upper limb fracture. Intervention Any exercise therapy program, including trials where exercise was delivered to both groups providing there was an expectation of different amounts of exercise. Outcome measures Body structure and function, and activity limitations. Results 13 relevant trials involving 781 participants with an upper limb fracture were identified. 12 of the 13 trials included exercise of different duration and administration in both intervention and comparison groups. In support of the role of exercise there is evidence that: exercise and advice compared to no intervention reduce pain and improve upper limb activity in the short term after distal radius fracture; starting exercise earlier after conservatively managed proximal humeral fractures can reduce pain and improve shoulder activity; and physiotherapy that included supervised exercise and home exercise increased wrist movement after distal radius fracture when compared to home exercise alone. There is contrary evidence from two trials one after distal radius fracture and one after proximal humeral fracture that a home exercise program was superior to a supervised plus home exercise program. Only a single meta-analysis was conducted due to clinical heterogeneity and a lack of common outcome measures among the included trials. Conclusion There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures.

BackgroundUpper limb fractures and subsequent cast immobilisation constitute a potential cause of reduction in childhood levels of physical activity (PA), with subsequent decrease of energy consumption. The main objective of this study was thus to quantify the decrease of activity-related energy expenditure (AEE) due to upper limb cast immobilisation .MethodsWe conducted a longitudinal matched case-control study that included 35 children and teenagers with a first episode of upper limb fracture and 35 healthy cases. PA was assessed during cast immobilisation by accelerometer. AEE was the calculated using an equation based on the total counts per day measured by accelerometers.ResultsAEE in children and teenagers with upper limb fractures was estimated to be 7.4 % lower than healthy controls. The mean difference corresponded to 1.35 kcal/kg per mean valid recorded time (750 min), that is, the waking hours. When converted in kcal per mean subjects’ weight, the difference in AEE amounted 63.5 kcal/day, which corresponds approximately to 26 min of walking at a speed of 4 km/hours. In comparison with the mean AEE in healthy controls (18.2 kcal/kg), the noted decrease (1.35 kcal/kg) represents only 7.4 % of AEE.ConclusionReduction of AEE in children and teenagers with upper limb fractures may lead to a slight positive energy balance, as there is usually no compensatory reduction of energy intake. An increase of light PA has to be counselled in this situation or patients should be advised to reduce their energy intake during the immobilisation period.Level of evidenceLevel I: high-quality prospective study (all patients were enrolled at the same point in their disease with ≥80 % follow-up of enrolled patients).

Introduction: although it has been suggested that overweight and obese children have an increased risk of fracture, recent studies in post-menopausal women have shown that the relationship between obesity and fracture risk varies by fracture site. We therefore assessed whether adiposity and overweight/obesity prevalence differed by upper limb fracture site in children.Methods: height, weight, BMI, triceps and subscapular skinfold thickness (SFT) were measured in children aged 3–18 years with an acute upper limb fracture. Data was compared across three fracture sites (hand, forearm and upper arm/shoulder [UA]), and to published reference data.Results: 401 children (67.1% male, median age 11.71 years, range 3.54–17.27 years) participated. 34.2%, 50.6% and 15.2% had fractures of the hand, forearm and UA, respectively. Children with forearm fractures had higher weight, BMI, subscapular SFT and fat percentage z-scores than those with UA fractures (p < 0.05 for all). SFT and fat percentage z-scores were also higher in children with forearm fractures compared to hand fractures, but children with hand and UA fractures did not differ. Overweight and obesity prevalence was higher in children with forearm fractures (37.6%) than those with UA fractures (19.0%, p = 0.009). This prevalence was also higher than the published United Kingdom population prevalence (27.9%, p = 0.003), whereas that of children with either UA (p = 0.13) or hand fractures (29.1%, p = 0.76) did not differ. These differences in anthropometry and overweight/obesity prevalence by fracture site were evident in boys, but not present in girls.Conclusion: measurements of adiposity and the prevalence of overweight/obesity differ by fracture site in children, and in particular boys, with upper limb fractures

The objective of this study was to audit the initial management of patients with upper limb fractures, and to determine whether the accident and emergency (A&E) management of fractures is improved by using guidelines for treatment and referral. This was achieved by comparing the standard of treatment, as determined by fracture clinic doctors, before and after the introduction of fracture treatment guidelines in the A&E department of a London teaching hospital. A total of 326 patients seen in the department and referred to the fracture clinic over two 2-month periods were included in the audit. The first audit revealed some error in 69/215 (32.1%) referrals and 51/215 (23.7%) of these were potentially liable to increased morbidity. After introducing the guidelines the total errors fell to 14/111 (12.6%) patients referred, of which only eight patients (7.2%) were at risk of increased morbidity. This represents an overall improvement of 19.5% [95% confidence interval (CI) 12.3 to 29.7%] and a 16.5% (95% CI 9.1 to 23.9%) reduction in the potentially more significant errors. Hence, the use of audit and implementation of simple guidelines for fracture management in an A&E department improves the standard of treatment.

Background: Falls can be an everyday occurrence in all pediatric age groups and both genders. Falling is the common leading cause of nonfatal and unintentional injuries in many developed countries. We identified the common types of injuries associated with falling down in Saudi and non-Saudi children up to 17-years-old and determined the relationship between the types of injuries and patient outcomes. This is the first nationally representative study in Saudi Arabia. Methods: We conducted a cohort analytic study of all children from 0 to 17 years of age who presented to the Emergency Department (ED) at King Abdul Aziz Medical city (KAMC) in Riyadh during 2001 to 2014 with fall-related injuries. Patient outcomes in relation to the falls were assessed. Results: A total of 1639 children were treated in the KAMC ED for fall-related injuries. Boys experienced significantly higher fall rates than did girls. Upper limb fracture was the most common type of injury overall (40.6%). In males, the skull and face were the most commonly affected (80.6%); in females, the neck and vertebra were the most frequently injured (40.0%). Middle childhood was the most common age group that experienced fallrelated injuries. Of these patients, 95.2% were hospitalized for less than 12 days, whereas 4.7% of the patients were hospitalized for 12 days or more. The majority of the patients presented to the ED were released home or transferred (99.5%). Closed head injury was the commonest injury associated with death (2.1%). Conclusion: Childhood fall-related injuries could contribute significant morbidity and mortality in Saudi Arabia if we do not take appropriate action.

Background: Falls can be an everyday occurrence in all pediatric age groups and both genders. Falling is the common leading cause of nonfatal and unintentional injuries in many developed countries. We identified the common types of injuries associated with falling down in Saudi and non-Saudi children up to 17-years-old and determined the relationship between the types of injuries and patient outcomes. This is the first nationally representative study in Saudi Arabia. Methods: We conducted a cohort analytic study of all children from 0 to 17 years of age who presented to the Emergency Department (ED) at King Abdul Aziz Medical city (KAMC) in Riyadh during 2001 to 2014 with fall-related injuries. Patient outcomes in relation to the falls were assessed. Results: A total of 1639 children were treated in the KAMC ED for fall-related injuries. Boys experienced significantly higher fall rates than did girls. Upper limb fracture was the most common type of injury overall (40.6%). In males, the skull and face were the most commonly affected (80.6%); in females, the neck and vertebra were the most frequently injured (40.0%). Middle childhood was the most common age group that experienced fallrelated injuries. Of these patients, 95.2% were hospitalized for less than 12 days, whereas 4.7% of the patients were hospitalized for 12 days or more. The majority of the patients presented to the ED were released home or transferred (99.5%). Closed head injury was the commonest injury associated with death (2.1%). Conclusion: Childhood fall-related injuries could contribute significant morbidity and mortality in Saudi Arabia if we do not take appropriate action.

Objectives: To investigate and quantify fall height, surface depth, and surface impact attenuation as risk factors for arm fracture in children who fall from playground equipment. Design: Unmatched case control study. Setting: Five case hospitals and 78 randomly selected control schools. Participants: Children aged less than 13 years in Victoria, Australia who fell from school playground equipment and landed on their arm. Cases sustained an upper limb fracture and controls had minor or no injury. A total of 402 cases and 283 controls were included. Interventions: Children were interviewed in the playground as soon as possible after their fall. Main outcome measures: Falls were recreated on site using two validated impact test devices: a headform (measuring peak G and HIC) and a novel anthropometric arm load dummy. Equipment and fall heights, as well as surface depth and substrate were measured. Results: Arm fracture risk was greatest for critical equipment heights above 1.5 m (OR 2.39, 95% CI 1.49 to 3.84, p

Aim: The aim of this study is to identify the epidemiology of multifocal upper limb fractures and define any commonly occurring patterns. Patients: Patients included were those over the age of 13 years who presented to one orthopaedic trauma unit, in an eight-year period, and who sustained a multifocal upper limb fracture. Results: There were 83 patients with 171 multifocal upper limb fractures. Mean age 60 years; range 13 to 92 years. 78 patients had bifocal fractures and 5 had trifocal. The most common pairing of fourteen different combinations was distal radius and proximal humerus. All but nine patients had involvement of the proximal humerus or distal radius. The most common injuries were the two-part proximal humerus fracture, the simple intra-articular olecranon fracture and the extra-articular fracture of the distal radius with metaphyseal comminution. Conclusion: This study has shown that multifocal fractures of the upper limb are most likely to occur in the middle aged to elderly women who have had a fall from standing height. As previously demonstrated osteopenic fractures are increasing in incidence in developed countries, where the population is ageing, which implies that the incidence of multifocal fractures of the upper limb is likely to increase.

a Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland b Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland c Department of Preventive Medicine, University of Tennessee Health Science Center, USA d Endocrine Centre, Heidelberg Repatriation Hospital, Austin Health/Department of Medicine, University of Melbourne, Australia e Department of Medical Rehabilitation, Oulu University Hospital and Institute of Health Sciences, University of Oulu, Oulu, Finland

Upper limb fractures in the elderly, usually managed by immobilisation of the arm, limit activities to an unknown extent. Fifty-one patients in Middlesbrough, aged over 60 years and who had upper limb fractures, were interviewed in the fracture clinic. Most patients had difficulty in performing various activities of daily living (ADL) following their injury. Difficulties with ADL were significantly associated with shoulder immobilisation (P = 0.03) and age (P = 0.01) but not with life satisfaction (P = 0.18) or existing poor health (P = 0.39). Relatives and friends provided most of the necessary help, the contribution of the health and social services being relatively small. Patients received more help with activities like shopping, laundry and housework than personal activities such as bathing, using the toilet and dressing. The injury increased demands on the GPs, meals on wheels, home help, nursing and warden services. Unmet demand was mostly for chiropodists, bath attendants and physiotherapists. Most patients (95%) were satisfied with the help they received from their relatives and friends. Despite difficulty with the activities of daily living most patients coped well with support following their fracture. Demographic changes and the increasing incidence of fractures mean that the burden on both carers and health and social services will increase.

Purpose To examine the base rate of falls for a group of community-living elderly people in Hong Kong. Methods This was a retrospective cross-sectional study of 554 elderly people aged 65 years or above living in various geographical regions of Hong Kong, who had completed assessments at a community centre over a period of 4 months. Participants were recruited by convenience sampling and stratified by age range according to the distribution in Hong Kong population. They were asked to report on their fall history for a period of the 12 months before joining the study. Results Of all the participants, 111 reported having fallen during the preceding 12 months. The fall rate was 29%, and the 1 -year prevalence of falls was 20%, dropping to 6.3% for two or more falls. Of all the falls, 47.7% occurred indoors whereas 52.3% occurred outdoors. Results showed female gender, Timed Up & Go Test, self-reported history of upper limb fracture, an intake of four or more types of medication, receiving rehabilitation services, and living with a couple only were independent predictors for fallers with at least one fall. There were no significant differences between the number of near-miss experienced by fallers and nonfallers in the past 12 months. Conclusion We determined the base rate of falls for a group of community-living elderly people of Hong Kong. Retrospective methods, which ask elderly people living in a community to recall their falls, may be used to identify risks preceding falls and to facilitate early intervention.

The authors utilized the principle of functional bracing in the management of 307 fractures and/or dislocations of the upper limb. There were 29 humeral fractures, 111 fracture-dislocations around the elbow, 32 fractures of the forearm, and 135 fractures of the distal radius. The average follow-up was 9 months. The results showed that more than 95% of the patients regained good range of motion and power. The details of the technique and the protocols are described. The conclusion drawn from an analysis of the results is that functional bracing is a safe and effective method in the management of upper limb fracture dislocations.

Background: Motocross is a form of motorcycle racing held on established off-road circuits and has been a recreational and competitive sport across the world for over 100 years. In the UK alone, motocross has grown into a phenomenally ambitious and popular franchise. There are over 200 motocross clubs across the country, permitting over 900 events annually. Method: Data were collected prospectively over 4 years (from 2010 to 2014) at our unit. All injuries caused by motocross biking that were referred to our trauma and orthopaedic department were included in this study, regardless of whether the rider was performing the sport competitively or recreationally. Results: During the period studied (4 years), 423 patients were included with a total of 485 injuries, ranging from 1 to 6 injuries per patient. The patient's age range was from 4 to 73 years, with most of the injuries being sustained within the early spring and summer months representing the start of the motocross season. Conclusions: We present the first epidemiological study of motocross injuries in the UK. Within the growing culture of ‘adrenaline sports’, motocross has become an exhilarating and extremely fashionable pastime. This study has identified and categorised the spectrum of injuries from upper limb fracture dislocations to life-threatening head and chest injuries, some of which are serious and may cause significant morbidity and possible mortality. These injuries could have significant resource implications, especially for smaller rural hospitals.