71 results on '"upper limb fracture"'
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2. Feasibility of the PERformance Guided Fracture Rehablitation Method-protocol (PERFoRM)
- Published
- 2023
3. Clinical application of upper limb fracture fixator in emergency treatment of upper limb fracture.
- Author
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Lianghao Xiong, Jintao Le, Chun Zhao, Rongxia Yuan, Mai Yang, and Hai Shen
- Abstract
Objective: To compare and analyze the curative effect of fracture upper limb fixator and traditional splint in emergency treatment of upper limb fracture. Methods: This is a prospective study. A total of 80 patients with upper limb fractures admitted to the Emergency Department of Sichuan Province Orthopedic Hospital from December 2021 to August 2022 were prospectively selected as subjects. They were divided into two groups according to the random number table method: Patients in the control group were treated with traditional splint, while those in the observation group were treated with medical adjustable upper limb fixator. The clinical efficacy, treatment time, pain, fitness, probability of secondary injury and complications were compared between the two groups. Results: After treatment, the excellent and good rate in the observation group (75.00%) was higher than that in the control group(52.50%). There was no statistically significant difference in the treatment time between the two groups. There was no significant difference in the probability of secondary injury between the two group. Statistically significant difference was observed in the comparison of pain conditions between the two groups. The total fitness rate of the observation group (97.50%) was higher than that of the control group (75.00%). The total incidence of complications in the observation group (2.50%) was lower than that in the control group (20.00%), with a statistically significant difference. Conclusion: Fracture upper limb fixator shows various benefits in first aid of upper limb fractures, such as improving the clinical efficacy of patients with upper limb fractures, ameliorating pain, improving fitness effect, and reducing the probability of complications. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
4. دگزمدتومیدین در کنار لیدوکائین در بلوک سوپراکالویکوالر در اعمال جراحی شکستگی اندام فوقانی: کارآزمایی بالینی شاهددار تصادفی.
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بهرام نادری نبی, عباس صدیقینژاد, مهران سلیمانها, سمانه غضنفر طهرا, زهرا عطرکار روشن, احمدرضا میربلوک, محمدرضا حبیبی, and محمد حقیقی
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LIDOCAINE , *DRUG efficacy , *SURGICAL therapeutics , *HAND injuries , *PAIN measurement , *ORTHOPEDIC surgery , *NERVE block , *ARM , *IMIDAZOLES , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *COMPARATIVE studies , *BLIND experiment , *DESCRIPTIVE statistics , *RESEARCH funding , *STATISTICAL sampling , *HEMODYNAMICS , *DATA analysis software , *BONE fractures , *PHYSIOLOGIC salines , *PHARMACODYNAMICS - Abstract
Background Various drugs are used as adjuvants to improve the quality of supraclavicular block method. Objective This study aims to investigate the effect of adding dexmedetomidine to lidocaine in the supraclavicular block method in patients candidate for upper extremity surgery. Methods This double-blind randomized controlled clinical trial was conducted on 61 patients candidate for upper extremity fracture surgery receiving the supraclavicular block method from 2017 to 2018. They were randomly divided into two groups of lidocaine-normal saline (30 mL of 1.5% lidocaine plus normal saline) and lidocaine-dexmedetomidine (30 mL of 1.5% lidocaine plus 1 μg/kg of dexmedetomidine). The supraclavicular block characteristics and intraoperative hemodynamic changes were measured. Results There was no statistically significant difference between the two groups regarding the demographic factors. The mean age of patients was 43.09±10.92 years, and most of them were male. The mean onset time of sensory-motor blockade was faster and the duration of sensory-motor blockade and analgesia were longer in the lidocaine-dexmedetomidine group than in the other group. These differences were statistically significant. There was significant differences in hemodynamic parameters among nine assessment times in each group and between the two groups. Conclusion Adding dexmedetomidine to lidocaine in the supraclavicular block method accelerates the blockade onset and increases the duration of blockade and analgesia after surgery without causing any considerable side effects. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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5. Does the surgical treatment of concomitant upper limb fractures affect the outcomes of hip fractures in the elderly population?
- Author
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Lee, Marcus Josef, Ng, Jingwen, Kok, Ta Wei Kevin, and Kwek, Beng Kee Ernest
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HIP fractures , *OLDER people , *HEMIARTHROPLASTY , *WRIST fractures , *ELBOW fractures , *HUMERAL fractures , *OLDER patients - Abstract
Introduction: Elderly patients with concomitant upper limb and hip fractures present a management dilemma because upper limb fractures potentially affect rehabilitation outcomes for the hip fracture. This study aims to evaluate whether the site of upper limb fractures and the decision to surgically treat such fractures affect the functional outcome of surgically treated hip fracture patients. Methodology: We retrospectively reviewed 1828 hip fracture patients treated at a single trauma centre over 3 years, of whom 42 with surgically treated hip fractures had concomitant upper limb fractures. Outcome measures, such as length of hospital stay, complications, mortality and readmission rates, were assessed, whilst the functional outcomes were evaluated using the Modified Barthel Index (MBI) on admission, post-operatively and at 6 and 12 months of follow-up. Results: Amongst the 42 patients with surgically treated hip fractures, 31.0% had proximal humerus fractures, 50.0% had wrist fractures, 16.7% had elbow fractures and 2.4% had forearm fractures. 50.0% of these upper limb fractures were treated surgically. There was no difference in complications, inpatient morbidity, readmission rates or the length of hospital stay for patients whose upper limb fractures were surgically treated as compared to those non-surgically treated. There was no difference in absolute MBI scores at 6 and 12 months based on the management of upper limb fractures. However, patients with surgically treated wrist fractures had statistically significant higher MBI scores at 6 months as compared to those treated non-surgically. Conclusion: Surgical treatment of concomitant upper limb fractures does not appear to change the outcomes of the hip fractures. Hip fracture patients with surgically treated wrist fractures had better functional outcomes at 6 months compared to those treated non-surgically; however, there was no difference at 12 months. Hip fracture patients with concomitant wrist fractures had better functional outcomes compared to hip fracture patients with proximal humerus fractures. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Combined use of minimal screw synthesis and external articulated fixation is effective for the management of supra-intercondyloid humeral fractures in the elderly? A retrospective study.
- Author
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Bienati, Fabrizio, Isola, Alessandro, Ortu, Sebastiano, Bonini, Luca, Sirianni, Rossella, Capone, Antonio, and Manca, Mario
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SUPINATION ,RANGE of motion of joints ,MINIMALLY invasive procedures ,PRONATION ,BONE screws ,OPEN reduction internal fixation ,RETROSPECTIVE studies ,GERIATRIC assessment ,EXTERNAL fixators ,EARLY ambulation (Rehabilitation) ,TREATMENT effectiveness ,QUESTIONNAIRES ,DESCRIPTIVE statistics - Abstract
Fractures of the distal humerus are relatively rare and can be a source of disabling outcomes especially if not properly treated. Therefore, the objective of the treatment must be to obtain a stable synthesis that allows early mobilization, avoiding complications such as muscular hypotonotrophy, joint rigidity or delays in consolidation that may be due to prolonged immobilization of this joint. Although ORIF treatment of these fractures may intuitively appear to be the gold standard, there is still no consensus in the literature on which type of treatment is most suitable. We report in this retrospective case series analysis our experience on 31 elder patients (more than 65 years old), affected by a supra-intercondyloid humerus fracture, treated using a minimal internal fixation with cannulated screws combined with the use of an external articulated elbow fixator. This methodology is less invasive but allows a stable synthesis and an early mobilization. Clinical and radiographic examinations were performed for each patient at 1, 2, 3 and 6 months after surgery. At 6 months the residual joint excursion was evaluated and the data were collected. In addition, at 6 months, each patient underwent three different functional capacity assessment questionnaires: MAYO Elbow Performance score, The Disability of the ARM, Shoulder and Hand Score (QuickDASH) and Oxford Elbow Score. The healing rate was 100% with no cases of non-union, despite the old age of our patients. The average range of motions obtained at 6 months from the surgery was 111° in flexion-extension and 157° in pronation-supination for the patient with an extra-articular fracture, 88° in flexion-extension and 153° in pronation-supination for the patients with a partial articular fracture and 85° in flexion-extension and 149° in pronation-supination for the patients with a complete articular fracture. Our results in the recovery of an arc of motion in flexion-extension are slightly less performing than the results obtained with an ORIF treatment. Indeed, according to literature the mean postoperative flexion arc in an ORIF treatment of distal humerus fractures in adults is 110°. The functional results obtained were satisfactory, with an average score at 6 months from the surgery of 95/100 (Mayo score) for the patients with an extra-articular fracture, 83.3/100 for the patients with a partial articular fracture and 79/100 for the patients with a complete articular fracture. The results obtained, in terms of range of motions, function, pain and healing and complications rate lead us to affirm that, in selected patients, this technique can represent a valid treatment and therefore a valid option that could be considered. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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7. Concurrent uper limb and hip fracture in the elderly: experience at our centre.
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Del Baño-Barragán L, Martínez-García Á, Garríguez-Pérez D, Mora-Fernández J, García-Coiradas J, Valle-Cruz JA, and Marco F
- Abstract
Introduction: The incidence of hip fracture in the elderly is on the rise, occasionally accompanied by concurrent upper limb fractures. Our investigation aims to determine whether these patients experience poorer functional outcomes, prolonged hospitalization, or higher mortality rates when compared to those with isolated hip fracture., Material and Methods: We retrospectively reviewed 1,088 elderly patients admitted to our centre with hip fracture between January 2017 and March 2020. We recorded the presence of concomitant fractures and their treatment. We analyzed the duration of hospital stay, in-hospital mortality and function., Results: We identified 63 patients with concomitant upper limb fracture (5.6%). Among them, 93.7% were women, and the average age was 86.4 years. 80.9% of the upper limb fractures were distal radius or proximal humerus. Patients with concomitant fracture had increased length of stay (mean, 19.6 vs, 12.8, p=0.002), decreased proportion of patients returning to their own home at discharge (23.6% vs, 26.3%, p=0.042) and increased in-hospital mortality rate (9.5% vs, 5.9%, p=0.003)., Conclusions: Patients with concomitant upper limb fracture require a longer length of stay and exhibit an elevated in-hospital mortality rate. Furthermore, this condition is associated with a reduced short-term functional recovery, thereby decreasing the chances of the patient returning home upon hospital discharge., (Publicado por Elsevier España, S.L.U.)
- Published
- 2024
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8. The Relationship between the Dominant Hand and the Occurrence of the Supracondylar Humerus Fracture in Pediatric Orthopedics.
- Author
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Herdea, Alexandru, Ulici, Alexandru, Toma, Alexandra, Voicu, Bogdan, and Charkaoui, Adham
- Subjects
HUMERUS ,BONE fractures ,PEDIATRIC orthopedics ,PRESCHOOL children ,HANDEDNESS - Abstract
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 1-3 years group, no statistical significance was found between hand dominance and the side of fracture (p = 0.7315). During preschool years (4-6 years old), the non-dominant hand is more often involved (p = 0.03, odds ratio: 3.5). In the 7-14 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. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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9. Clinical application of upper limb fracture fixator in emergency treatment of upper limb fracture.
- Author
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Xiong L, Le J, Zhao C, Yuan R, Yang M, and Shen H
- Abstract
Objective: To compare and analyze the curative effect of fracture upper limb fixator and traditional splint in emergency treatment of upper limb fracture., Methods: This is a prospective study. A total of 80 patients with upper limb fractures admitted to the Emergency Department of Sichuan Province Orthopedic Hospital from December 2021 to August 2022 were prospectively selected as subjects. They were divided into two groups according to the random number table method: Patients in the control group were treated with traditional splint, while those in the observation group were treated with medical adjustable upper limb fixator. The clinical efficacy, treatment time, pain, fitness, probability of secondary injury and complications were compared between the two groups., Results: After treatment, the excellent and good rate in the observation group (75.00%) was higher than that in the control group(52.50%). There was no statistically significant difference in the treatment time between the two groups. There was no significant difference in the probability of secondary injury between the two group. Statistically significant difference was observed in the comparison of pain conditions between the two groups. The total fitness rate of the observation group (97.50%) was higher than that of the control group (75.00%). The total incidence of complications in the observation group (2.50%) was lower than that in the control group (20.00%), with a statistically significant difference., Conclusion: Fracture upper limb fixator shows various benefits in first aid of upper limb fractures, such as improving the clinical efficacy of patients with upper limb fractures, ameliorating pain, improving fitness effect, and reducing the probability of complications., Competing Interests: Conflicts of interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)
- Published
- 2023
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10. Reduced gait and postural stability under challenging conditions in fallers with upper limb fracture.
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Langeard, Antoine, Pothier, Kristell, Chastan, Nathalie, Marcelli, Christian, Chavoix, Chantal, and Bessot, Nicolas
- Abstract
Background: While most fractures are caused by falls, not all falls result in fractures. Risk factors for falls are well established, but only weak associations have been demonstrated for risk factors for fractures. Conflicting results on the implication of bone mineral density (BMD) suggest that other risk factors should be studied, such as gait and balance disorders. Aims: Gait and postural stability in challenging conditions were, therefore, compared between fallers with and without fracture. Methods: We enrolled 80 adults aged 55 and older who fell in the previous year. We compared gait and posture after obstacle crossing between fallers with an upper-limb fracture (n = 38), and fallers without fracture (n = 42). Data on BMD, body mass index, handgrip strength, fear of falling, number of comorbidities, number of falls, global cognition, executive functioning and education level were collected. Results: Compared to fallers without fracture, fallers with fracture had significant lower gait velocity (Likelihood-Ratio = 4.93; P = 0.03) and lower postural stability during stabilization after obstacle crossing (Likelihood-Ratio = 10.99; P < 0.001). In addition, fallers with fracture had lower handgrip strength (Likelihood-Ratio = 9.92; P = 0.002), lower education level (Likelihood-Ratio = 8.32; P = 0.004), poorer executive functions (Likelihood-Ratio = 5.81; P = 0.02, higher fear of falling (Likelihood-Ratio = 5.55; P = 0.02) and were more likely women (Likelihood-Ratio = 17.55; P < 0.001), compared to fallers without fracture. Discussion: This study demonstrated that the main difference between fallers with upper-limb fracture and fallers without fracture is mobility in dynamic condition. Poor executive function and low muscular strength could also be involved. Conclusions: These factors should be taken into account when assessing risk factors for fracture and implementing preventive programs. Clinical trial registration: clinicaltrials.gov. NCT02292316 [ABSTRACT FROM AUTHOR]
- Published
- 2019
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11. The Relationship between the Dominant Hand and the Occurrence of the Supracondylar Humerus Fracture in Pediatric Orthopedics
- Author
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Alexandru Herdea, Alexandru Ulici, Alexandra Toma, Bogdan Voicu, and Adham Charkaoui
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supracondylar humerus fracture ,pediatric ,humerus fracture ,upper limb fracture ,fracture laterality ,handedness ,Pediatrics ,RJ1-570 - Abstract
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 1–3 years group, no statistical significance was found between hand dominance and the side of fracture (p = 0.7315). During preschool years (4–6 years old), the non-dominant hand is more often involved (p = 0.03, odds ratio: 3.5). In the 7–14 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.
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- 2021
- Full Text
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12. Bone Development and Disease in Infants.
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Pavone, Vito and Pavone, Vito
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Medicine ,CTEV ,Cervical Vertebral Maturation ,DDH ,DDH prevention ,Dimeglio score ,Ewing's sarcoma ,Herring lateral pillar classification ,Legg-Calvé-Perthes disease ,Pirani score ,SARS-Co-V-2 ,Stulberg classification ,Waldenström stage ,bone tumors ,bracing ,children ,chronological age ,clubfoot ,cognitive behavioral therapy ,complex regional pain syndrome ,composite prosthesis ,congenital talipes equinovarus ,conservative ,developmental dysplasia of the hip ,douple diapering ,drugs ,duration ,dynamic splint ,fracture laterality ,growing age ,handedness ,hemophilia ,high-impact sports ,hip adduction ,hip extension ,hip positioning ,humerus fracture ,infants ,interobserver reliability ,lockdown ,multidisciplinary ,n/a ,neonatal hip ,occupational therapy ,pandemic ,pediatric ,pediatric orthopedics ,pharmacological treatment ,physical activity ,physical therapy ,ponseti method ,prophylaxis ,psychological wellness ,reflex sympathetic dystrophy ,skeletal maturity ,sport ,sport activity level ,sport practice ,static splint ,supracondylar humerus fracture ,trauma ,treatment ,upper limb fracture ,young athletes - Abstract
Summary: Children's bone growth is continuous, and remodelling is always extensive. Growth proceeds from a vulnerable part of the bone, the growth plate. In remodelling, old bone tissue is gradually replaced by new tissue. Many bone disorders arise from the changes that occur in a growing child's musculoskeletal system, and these disorders can positively or negatively impact bone development. Other bone disorders may be inherited or occur in childhood for unknown reasons.Bone disorders in children can result from factors that affect people of all ages, including injury, infection (osteomyelitis), cancer, and metabolic diseases. Causes of bone disorders can involve the gradual misalignment of bones and stress on growth plates during growth. Congenital deformities such as clubfoot or developmental dysplasia of the hip can lead to important alterations of bone development, causing severe dysfunction. Certain rare connective tissue disorders can also affect the bones, such as Marfan syndrome, osteogenesis imperfecta, and osteochondrodysplasias.Many specialists are involved in the management of bone development disorders in children and adolescents, such as neurosurgeons, plastic surgeons, general surgeons, ORL surgeons, maxillofacial surgeons, orthopaedics, radiologists, and pediatric intensive care physicians.The aim of this Special Issue is to present the latest research on the etiology, physiopathology, diagnosis and screening, management, and rehabilitation related to bone development and disease in infants, focusing on congenital, developmental, post-traumatic, and post-infective disorders.
13. Clinical assessment of patients with isolated hip fractures associated with an upper limb fracture.
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Gómez-Álvarez, J., González-Escobar, S., and Gil-Garay, E.
- Abstract
Copyright of Revista Española de Cirugía Ortopédica y Traumatologia (English Edition) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2018
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14. CEREBRAL NEURODYNAMICS IN PATIENTS WITH STROKE AND UPPER LIMB INJURIES DURING REHABILITATION
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B. I. Vakhitov, I. S. Raginov, and I. Kh. Vakhitov
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Medicine (General) ,R5-920 ,upper limb fracture ,delta rhythm ,neurodynamics ,theta rhythm ,stroke ,diffuse electroencephalogram ,dynamic and static exercises - Abstract
The problem of rehabilitation therapy after ischemic strokes is one of the most relevant in current neurology [4, 7]. Neurophysiological research is currently leading in the evaluation and control of brain plasticity. Approximately 80% of all injuries are the injuries to the musculoskeletal system; almost half of them are upper limb traumas. Treatment efficacy depends on the quality of first aid. Conservative treatment methods are effective in 13%–60% of patients, whereas with surgical methods, the efficacy is between 10% and 70%. Moreover, patients with radius fractures usually lose their ability to work for 6 to 8 months; 10% of them have to change their profession after it; 6% to 17% of patients become disabled. Rehabilitation of such patients should include dynamic electroencephalographic (EEG) monitoring, since the information about the functional state of cerebral structures is necessary for organizing an effective rehabilitation program, predicting and assessing treatment outcomes.We have examined 26 patients with cerebral stroke (14 men and 12 women aged 42–65 years) in the early stages with the leading neurological syndrome manifesting as spastic hemiparesis and 27 patients with extension fractures of the distal radial physis (after manual reposition and plaster splint removal) at different stages of their rehabilitation with a week interval.We found that changes in brain electric activity (from similar leads of the contralateral hemisphere) were more significant in patients with acute stroke, which can be associated with specific changes in the cerebral rhythms after stroke, since deep location of the alteration focus results in more diffused EEG symptoms due to conducting paths. Positive dynamics in the reduction of slow-wave activity above the affected area in the late rehabilitation period was more pronounced in patients who performed dynamic and static exercises. Normalization of electrogenesis was more effective in patients performing static exercises than in those performing dynamic exercises.
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- 2020
15. [Minimally invasive treatment of upper limb fractures].
- Author
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Xu SG
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- Humans, Fracture Fixation, Internal, Upper Extremity surgery, Treatment Outcome, Minimally Invasive Surgical Procedures, Fractures, Bone surgery, Fracture Fixation, Intramedullary
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- 2023
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16. Perioperative management of distal radius fractures
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George Sylvestor, Jiang An Lim, Bryan Lc Loh, Wasim S. Khan, Lim, Jiang An [0000-0003-1610-7956], Loh, Bryan Lc [0000-0002-8140-3965], and Apollo - University of Cambridge Repository
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medicine.medical_specialty ,Upper Limb Fracture ,Colles' Fracture ,Review ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Colles’ fractures ,Perioperative management ,medicine ,Wrist fractures ,Humans ,Distal radius fractures ,Continuing Professional Development activities ,030222 orthopedics ,business.industry ,General surgery ,Radius ,Smith’s fractures ,Medical–Surgical Nursing ,Anesthesiology and Pain Medicine ,Continuing professional development ,Surgery ,Emergency Service, Hospital ,Radius Fractures ,business - Abstract
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.
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- 2020
17. Study on Functional Outcomes of Adolescents after Initial Treatment of Upper Limb Fractures in a Selected District in Sri Lanka
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Upul Senarath, Samitha Siritunga, Hemali Jayasekera, and Paramjit Gill
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medicine.medical_specialty ,Activities of daily living ,business.industry ,Upper Limb Fracture ,Rehabilitation care ,Likert scale ,medicine.anatomical_structure ,Quality of life (healthcare) ,medicine ,Physical therapy ,Upper limb ,Initial treatment ,Sri lanka ,business - Abstract
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.
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- 2021
18. 1569 Paediatric Upper Limb Fracture Manipulation in A Children’s Emergency Department: Practice Changes During The COVID-19 Pandemic
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T Crompton, M Derias, N Morrissey, J Porter, G Alexander-Harvey, Kyle James, J Amen, and S Maripuri
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Emergency medicine ,Pandemic ,Upper Limb Fracture ,medicine ,Surgery ,Emergency department ,business - Abstract
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.
- Published
- 2021
19. Serum of 25-Hydroxyvitamin D and Intact Parathyroid Hormone Levels in Postmenopausal Women with Hip and Upper Limb Fractures.
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Lv, Jiang‐Tao, Zhang, Ying‐Ying, Tian, Shao‐Qi, and Sun, Kang
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ELDER care , *BONE injuries , *RISK factors of fractures , *CONFIDENCE intervals , *DISEASES , *HYPERPARATHYROIDISM , *QUESTIONNAIRES , *STATISTICS , *T-test (Statistics) , *VITAMIN D deficiency , *DATA analysis , *POSTMENOPAUSE , *RECEIVER operating characteristic curves , *DATA analysis software , *DESCRIPTIVE statistics , *ODDS ratio , *MANN Whitney U Test , *DISEASE complications - Abstract
Objectives To assess the serum of 25-hydroxyvitamin D (25( OH)D) and intact parathyroid hormone ( iPTH) levels in postmenopausal women from northern China with hip and upper limb fractures. Design Case-control. Setting Affiliated Hospital of Qingdao University. Participants Postmenopausal women diagnosed with hip fracture (n = 335) and matched controls without fracture (n = 335). Measurements Between 2011 and 2013, fasting venous samples were analyzed for 25( OH)D, iPTH, alkaline phosphatase ( ALP), calcium, and phosphorus. All women completed a standardized questionnaire designed to document putative risk factors for fractures. Results Eight percent of participants had vitamin D deficiency, and 66.0% had secondary hyperparathyroidism. Serum 25( OH)D levels were significantly ( P < .001) lower in women with hip fracture than in controls. Multivariate logistic regression analysis adjusted for common risk factors showed that serum 25( OH)D of 20 ng/mL or less was an independent indicator of hip fracture (odds ratio ( OR) = 2.98, 95% confidence interval ( CI) = 2.11-4.20) and concomitant upper limb fracture in those with existing hip fractures ( OR = 4.77, 95% CI = 1.60-10.12). The area under the receiver operating characteristic curve of 25( OH)D was 0.77 (95% CI = 0.68-0.84) for hip fracture and 0.80 (95% CI = 0.72-0.89) for hip and upper limb fractures. Conclusion Vitamin D insufficiency and secondary hyperparathyroidism were a common problem in postmenopausal women who presented with concomitant hip and upper limb fractures, suggesting that they might contribute to the pathophysiology of fractures in postmenopausal women. [ABSTRACT FROM AUTHOR]
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- 2016
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20. Low 25(OH) D serum levels are related with hip fracture in postmenopausal women: a matched case-control study.
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Xing-Mao Fu, Shao-Guang Fan, Shu-Liang Li, Yi-Sheng Chen, Hai Wu, Yan-Long Guo, Fu, Xing-Mao, Fan, Shao-Guang, Li, Shu-Liang, Chen, Yi-Sheng, Wu, Hai, and Guo, Yan-Long
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POSTMENOPAUSE , *VITAMIN D deficiency , *DISEASE prevalence , *HIP joint abnormalities , *PARATHYROID hormone , *BLOOD sampling , *BONE fractures , *HIP joint injuries , *VITAMIN D , *CASE-control method - Abstract
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 < 0.0001) lower in hip fracture patients than in the controls [37.0 (interquartile range [IQR] 28.0-48.0) nmol/L vs. 41.3 (IQR 32.0-54.5) nmol/L; P < 0.0001], and the iPTH levels were significantly higher in the former group [10.2 (IQR 6.3-14.9) pmol/L vs. 5.8 (IQR 4.1-6.6) pmol/L; P < 0.0001]. Further, a 25(OH) D level ≤50 nmol/L was found to independently indicate the occurrence of hip fracture [odds ratio (OR), 3.023; 95 % confidence interval (CI) 2.154-4.298], as well as hip fracture with concomitant upper limb fracture (OR 4.473; 95 % CI 2.984-10.532). Similarly, a serum iPTH level ≥6.8 pmol/L independently indicated the development of hip fracture (OR 2.498; 95 % CI 1.764-3.942), as well as hip fracture with concomitant upper limb fracture (OR 3.254; 95 % CI 1.998-7.984).Conclusions: Vitamin D insufficiency and secondary hyperparathyroidism were found to be common problems in the sample of postmenopausal women who had experienced hip fracture. Monitoring the alterations in the serum levels of 25(OH) D and iPTH could be applied clinically as independent risk factors for hip fracture. [ABSTRACT FROM AUTHOR]- Published
- 2015
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21. Use of three-dimensional technology for complications of upper limb fracture treatment
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Annemieke Van Haver, Matthias Vanhees, Frederik Verstreken, Roger P. van Riet, and Maartje Michielsen
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Orthodontics ,030222 orthopedics ,business.industry ,Upper Limb Fracture ,medicine.disease ,03 medical and health sciences ,Instructional Lecture: Trauma ,0302 clinical medicine ,3D technology ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Human medicine ,030212 general & internal medicine ,Malunion ,business ,application ,fracture complications - Abstract
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
- Published
- 2019
22. Desempenho ocupacional e aplicação da Classificação Internacional de Funcionalidade (CIF) em um serviço de reabilitação
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Mariana Thereza Alves, Ivânia Garavello, Fabiana Caetano Martins Silva e Dutra, Alessandra Cavalcanti, and Edinara Kososki
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servicios de rehabilitación ,medicine.medical_specialty ,serviços de reabilitação ,disability evaluation ,medicine.medical_treatment ,Upper Limb Fracture ,Clasificación internacional del funcionamiento ,Exploratory research ,evaluación de la discapacidad ,rehabilitation centers ,Classificação internacional de funcionalidade ,DeCS, BIREME) [terapia ocupacional (fonte] ,MeSH, NLM) [occupational therapy (source] ,03 medical and health sciences ,0302 clinical medicine ,International Classification of Functioning, Disability and Health ,medicine ,avaliação da deficiência ,030212 general & internal medicine ,Medical diagnosis ,Stroke ,International classification of functioning ,Personal care ,Rehabilitation ,business.industry ,Medical record ,Public Health, Environmental and Occupational Health ,DeCS, BIREME) [terapia ocupacional (fuente] ,medicine.disease ,disability and health ,Physical therapy ,de la discapacidad y de la salud ,incapacidade e saúde ,business ,030217 neurology & neurosurgery - Abstract
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.
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- 2019
23. The impact of a patient's engagement in their health on the magnitude of limitations and experience following upper limb fractures
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Mark A. Williams, David Ring, Stephen Gwilym, Prakash Jayakumar, Ana-Maria Vranceanu, Sarah E Lamb, and Teun Teunis
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Patient Activation ,Adult ,Male ,medicine.medical_specialty ,Humeral Fractures ,Intra-Articular Fractures ,Upper Limb Fracture ,Health Behavior ,Patient engagement ,Health Promotion ,03 medical and health sciences ,Fractures, Bone ,Young Adult ,0302 clinical medicine ,Physical medicine and rehabilitation ,Surveys and Questionnaires ,Health care ,Activities of Daily Living ,Adaptation, Psychological ,Elbow Joint ,Medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Patient Reported Outcome Measures ,Prospective Studies ,Aged ,Patient Activation Measure ,Aged, 80 and over ,business.industry ,Middle Aged ,Self Efficacy ,medicine.anatomical_structure ,Socioeconomic Factors ,Patient Satisfaction ,Upper limb ,Surgery ,Female ,Patient Participation ,business ,Radius Fractures ,Elbow Injuries ,030217 neurology & neurosurgery - Abstract
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
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- 2020
24. UPPER LIMB FRACTURE
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Basharat Manzoor, Ali Amjad, and Sajjad Rasool
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Suction (medicine) ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Upper Limb Fracture ,Orthopedic department ,Teaching hospital ,Surgery ,Upper limb surgery ,medicine.anatomical_structure ,Suction drain ,medicine ,Internal fixation ,Upper limb ,business - Abstract
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.
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- 2018
25. UPPER LIMB FRACTURE
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Ali Amjad, Sajjad Rasool, and Basharat Manzoor
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medicine.medical_specialty ,business.industry ,Suction drain ,Upper Limb Fracture ,Medicine ,Post operative ,business ,Surgery - Abstract
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.
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- 2018
26. Clinical assessment of patients with isolated hip fractures associated with an upper limb fracture
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E. Gil-Garay, S. González-Escobar, and J. Gómez-Álvarez
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030222 orthopedics ,medicine.medical_specialty ,Hip fracture ,Barthel index ,business.industry ,medicine.medical_treatment ,Mortality rate ,Upper Limb Fracture ,medicine.disease ,Arthroplasty ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Concomitant ,medicine ,Fracture (geology) ,Upper limb ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,business - Abstract
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.
- Published
- 2018
27. Application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures
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Wen-Kai Wang, Wen-Bin Guo, and Huang Liu
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Sevoflurane ,Inflammatory stress response ,Brachial plexus block ,lcsh:R ,Upper limb fracture ,lcsh:Medicine - Abstract
Objective: To study the application value of sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block for children with upper limb fractures. Methods: Children who underwent upper limb fracture surgery in the First Women and Children's Hospital of Huizhou between June 2014 and April 2017 were selected as the research subjects and randomly divided into the combined group who accepted sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block and the control group who accepted sevoflurane light general anesthesia via laryngeal mask airway. The contents of inflammatory cytokines IL-1β, TNF-α, CRP, IL-10 and TGF-β as well as stress hormones FC, Ins, NE and E in serum were determined the same day and 3 days after operation. Results: The same day and 3 days after operation, the contents of IL-1β, TNF-α, CRP, IL-10, TGF-β, FC, Ins, NE and E in serum of combined group were significantly lower than those of control group. Conclusion: Sevoflurane light general anesthesia via laryngeal mask airway combined with brachial plexus block is more effective than sevoflurane light general anesthesia via laryngeal mask airway to suppress the inflammatory stress response in children with upper limb fracture surgery.
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- 2018
28. Exercise reduces impairment and improves activity in people after some upper limb fractures: a systematic review.
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Bruder, Andrea, Taylor, Nicholas F., Dodd, Karen J., and Shields, Nora
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ARM fractures ,RANDOMIZED controlled trials ,PHYSIOLOGICAL therapeutics ,PHYSICAL therapy ,CLINICAL trials ,TREATMENT effectiveness - Abstract
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. [Copyright &y& Elsevier]
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- 2011
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29. Children’s daily living activities during immobilization of upper-limb fractures with an above- or below-elbow cast.
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Aviv, Barak, Bar-On, Elhanan, Weigl, Daniel, Becker, Tal, and Katz, Kalman
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The purpose of this prospective study was to assess the impact of cast immobilization on the activities of daily living in children with fractured upper limbs. Using the Activities Scale for Kids (ASK), 52 consecutive children (17 girls, 35 boys), aged 5–15 years (mean, 9 years), with upper limb fractures treated by means of above- or below-elbow casts were assessed. The files were reviewed for background and fracture-related data. Mean score of the above-elbow group was 65.4 ± 15.5 points on the ASK capability domain (ASK-c) (with cast) and 98.7 ± 3 points on the ASK-performance domain (without cast). Corresponding scores for the below-cast group were 89.8 ± 13 and 99.5 ± 2. Factors that positively affected overall function were older age, male sex, shorter duration of pain, and less displacement. On multivariate analysis, only age proved to be a potential predictive factor. Cast position and hand dominance had no effect. The specific activities affected were personal hygiene, dressing, making a snack, and reaching high objects. To ease their children’s adjustment to forearm cast immobilization after fractures, parents should be educated in the areas of daily living that may be affected. This is particularly true for younger children with more displaced fractures that cause more pain. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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30. Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review
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Karen J Dodd, Nora Shields, Nicholas F. Taylor, and Andrea M Bruder
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medicine.medical_specialty ,medicine.medical_treatment ,Upper Limb Fracture ,Physical Therapy, Sports Therapy and Rehabilitation ,Upper Extremity ,Fractures, Bone ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,Humans ,030212 general & internal medicine ,Upper limb ,Exercise ,Rehabilitation ,business.industry ,lcsh:RM1-950 ,Exercise therapy ,Exercise Therapy ,Treatment Outcome ,Fracture ,lcsh:Therapeutics. Pharmacology ,Humeral fracture ,medicine.anatomical_structure ,Systematic review ,Physical therapy ,Home exercise ,Radial head fracture ,business ,030217 neurology & neurosurgery - Abstract
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]
- Published
- 2017
31. Early physical and functional rehabilitation of trauma patients in the Médecins Sans Frontières trauma centre in Kunduz, Afghanistan: luxury or necessity?
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Rafael Van den Bergh, Peter Skelton, Engy Ali, Erin Schillberg, Eric Weerts, Catherine Van Overloop, Bérangère Gohy, Sophia Cheréstal, Miguel Trelles, Masood Nasim, Muhammad Mahmood Naimi, and Pauline Falipou
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Male ,Health (social science) ,medicine.medical_treatment ,International Cooperation ,Upper Limb Fracture ,Outcome monitoring ,Cohort Studies ,Outcome measure ,Fractures, Bone ,0302 clinical medicine ,Trauma Centers ,Activities of Daily Living ,Brain Injuries, Traumatic ,Outpatient clinic ,030212 general & internal medicine ,Function ,Child ,Functional rehabilitation ,Rehabilitation ,Afghan Campaign 2001 ,General Medicine ,Middle Aged ,Hospitalization ,Child, Preschool ,Female ,Cohort study ,Adult ,medicine.medical_specialty ,Adolescent ,Traumatic brain injury ,Operational Research ,Trauma ,03 medical and health sciences ,Young Adult ,MSF ,medicine ,Trauma centre ,Humans ,Physical Therapy Modalities ,Aged ,business.industry ,Public Health, Environmental and Occupational Health ,Afghanistan ,030208 emergency & critical care medicine ,Original Articles ,medicine.disease ,Altruism ,Physical therapy ,Wounds and Injuries ,business - Abstract
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.
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- 2016
32. The pucker sign in children with an upper limb fracture: A case-series
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Nobuaki Inoue, Satoshi Shimomura, Osamu Nomura, and Norikazu Ota
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Orthodontics ,030222 orthopedics ,Series (stratigraphy) ,business.industry ,Bone pathology ,Upper Limb Fracture ,Retrospective cohort study ,General Medicine ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,medicine.anatomical_structure ,Emergency Medicine ,Fracture (geology) ,medicine ,Upper limb ,business ,030217 neurology & neurosurgery - Published
- 2018
33. Gut microbiota-dependent Trimethylamine N-Oxide are related with hip fracture in postmenopausal women: a matched case-control study
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Meng Shan, Liu Yakun, Yang Li, Hua Gao, Yan-Long Guo, Shao-Guang Fan, Shao-Bin Jin, and Li-Juan Sui
- Subjects
Aging ,medicine.medical_specialty ,Osteoporosis ,Upper Limb Fracture ,Trimethylamine ,postmenopausal women ,Trimethylamine N-oxide ,Gut flora ,Gastroenterology ,chemistry.chemical_compound ,Methylamines ,Risk Factors ,Tandem Mass Spectrometry ,Internal medicine ,medicine ,Humans ,Aged ,Hip fracture ,Postmenopausal women ,Chinese ,biology ,business.industry ,Hip Fractures ,Case-control study ,Cell Biology ,Middle Aged ,biology.organism_classification ,medicine.disease ,Trimethylamine N-Oxide ,Gastrointestinal Microbiome ,Postmenopause ,chemistry ,hip fracture ,Case-Control Studies ,Female ,business ,Osteoporotic Fractures ,Research Paper - Abstract
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
- Published
- 2019
34. Research and Development of Methods and Tools for Rapid Digital Simulation and Design of Personalized Orthoses
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Yavor Sofronov, Iliya Savov, Konstantin Kamberov, and Georgi Todorov
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Rapid prototyping ,Reverse engineering ,Workflow ,Development (topology) ,Computer science ,business.industry ,Upper Limb Fracture ,Parametric model ,CAD ,computer.software_genre ,Software engineering ,business ,computer - Abstract
The presented work covers the definition of three different methods for designing orthoses produced by the methods of rapid prototyping of polymer structures. The stages of design and production of orthoses are defined. The methods are illustrated, by way of example, of an orthosis for upper limb fracture. The use of parametric modeling facilitates easier and faster preparation of CAD models. In the production of orthoses, the use of an automated approach by adapting a parametric model leads to a number of advantages. Besides shortening the required workflow time, there are opportunities to track the effectiveness and performance of the end products and adjust the relevant parametric models in the catalog in order to improve them and embed the resulting know-how in the model. The creation of a workflow to facilitate easier CAD modeling in combination with reverse engineering technology and rapid prototyping technologies offers excellent opportunities to improve the resulting orthoses for the patients in need.
- Published
- 2019
35. Characteristic of Musculoskeletal Trauma Patients Admitted to a Trauma Center in Central Java-Indonesia
- Author
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Harry Jonathan, Ilham Suryo Wibowo Antono, and Syafiq Basalamah
- Subjects
medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Trauma center ,Upper Limb Fracture ,Developing country ,medicine.disease ,Epidemiology ,medicine ,Trauma centre ,Medical emergency ,Day to day ,business ,Musculoskeletal trauma - Abstract
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.
- Published
- 2020
36. An Intelligent Flexbar for Upper-Limb Rehabilitation based on Wireless Sensor Network
- Author
-
Yu-Heng Lin, Mong-Fong Horng, Chin-Hsin Kao, Chn-Shiuh Shieh, and Sheng-Che Weng
- Subjects
Rehabilitation ,business.industry ,Computer science ,medicine.medical_treatment ,Upper Limb Fracture ,Human–computer interaction ,medicine ,Disconnection ,User interface ,Duration (project management) ,Upper limb rehabilitation ,business ,Wireless sensor network ,Graphical user interface - Abstract
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.
- Published
- 2018
37. Biomechanical Response of Upper Limb Fracture in Real-World Truck-to-Pedestrian Accident Using THUMS (Version 4.0)
- Author
-
Kui Li, Zhi Yong Yin, Sen Su, Sheng Xiong Liu, and Fu Ping Wang
- Subjects
Truck ,Engineering ,business.industry ,Upper Limb Fracture ,Biomechanics ,General Medicine ,Structural engineering ,Pedestrian accident ,Road traffic accident ,medicine.anatomical_structure ,medicine ,Upper limb ,business ,human activities - Abstract
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.
- Published
- 2013
38. Supracondylar Fractures of the Humerus in Children: Review of Management and Controversies
- Author
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John Dabis, Yael Gelfer, and Karen Daly
- Subjects
Long term complications ,medicine.medical_specialty ,business.industry ,Upper Limb Fracture ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Extremity fractures ,Cubitus varus ,Epidemiology ,medicine ,Humerus ,business ,Clinical evaluation - Abstract
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.
- Published
- 2016
39. Low 25(OH) D serum levels are related with hip fracture in postmenopausal women: a matched case–control study
- Author
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Hai Wu, Shu-Liang Li, Shao-Guang Fan, Yi-Sheng Chen, Yan-Long Guo, and Xing-Mao Fu
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Intact parathyroid hormone ,North china ,Upper limb fracture ,25-Hydroxyvitamin D ,Gastroenterology ,General Biochemistry, Genetics and Molecular Biology ,vitamin D deficiency ,Hip fracture ,Chinese han population ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Vitamin D ,Medicine(all) ,Postmenopausal women ,business.industry ,Biochemistry, Genetics and Molecular Biology(all) ,Hip Fractures ,Research ,Case-control study ,General Medicine ,Middle Aged ,medicine.disease ,Postmenopause ,Endocrinology ,Case-Control Studies ,Female ,business - Abstract
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
- Published
- 2015
40. Exercise reduces impairment and improves activity in people after some upper limb fractures: a systematic review
- Author
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Nicholas F. Taylor, Nora Shields, Andrea M Bruder, and Karen J Dodd
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Upper Limb Fracture ,Upper limb fracture ,Physical Therapy, Sports Therapy and Rehabilitation ,Wrist ,Fractures, Bone ,Physical medicine and rehabilitation ,Intervention (counseling) ,medicine ,Humans ,Exercise ,Physiotherapy ,Physical Therapy Modalities ,Randomized Controlled Trials as Topic ,Rehabilitation ,business.industry ,Exercise therapy ,Exercise Therapy ,Humeral fracture ,medicine.anatomical_structure ,Arm ,Home exercise ,Physical therapy ,Upper limb ,business - Abstract
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.
- Published
- 2011
- Full Text
- View/download PDF
41. What is the real impact of upper limb cast immobilisation on activity-related energy expenditure in children?
- Author
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Xavier Martin, Cécile Delhumeau, Albane B.R. Maggio, Dimitri Ceroni, and Anne Tabard-Fougère
- Subjects
Upper extremity ,Upper Limb Fracture ,Physical activity ,physical activity ,030209 endocrinology & metabolism ,Physical Therapy, Sports Therapy and Rehabilitation ,03 medical and health sciences ,0302 clinical medicine ,energy expenditure ,upper extremity ,medicine ,Orthopedics and Sports Medicine ,Prospective cohort study ,Balance (ability) ,First episode ,030222 orthopedics ,ddc:618 ,business.industry ,Positive energy ,Fracture ,medicine.anatomical_structure ,Energy expenditure ,fracture ,Anesthesia ,Upper limb ,Original Article ,business - Abstract
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).
- Published
- 2018
42. The impact of a patient's engagement in their health on the magnitude of limitations and experience following upper limb fractures.
- Author
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Jayakumar P, Teunis T, Vranceanu AM, Williams M, Lamb S, Ring D, and Gwilym S
- Subjects
- Activities of Daily Living, Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Elbow Joint surgery, Female, Fractures, Bone, Health Promotion, Humans, Humeral Fractures psychology, Intra-Articular Fractures psychology, Male, Middle Aged, Patient Reported Outcome Measures, Patient Satisfaction, Prospective Studies, Radius Fractures psychology, Self Efficacy, Socioeconomic Factors, Surveys and Questionnaires, Young Adult, Health Behavior, Humeral Fractures surgery, Intra-Articular Fractures surgery, Patient Participation, Radius Fractures surgery, Elbow Injuries
- Abstract
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 R
2 = 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.- Published
- 2020
- Full Text
- View/download PDF
43. Does degree of adiposity influence upper limb fracture site in children?
- Author
-
Rebecca J Moon, Megan Farmer, Cyrus Cooper, Adelynn Lim, Nicholas C. Harvey, Nicholas Clarke, Justin H Davies, Avinash Segaran, and Elaine M. Dennison
- Subjects
Orthodontics ,business.industry ,Upper Limb Fracture ,Medicine ,General Medicine ,business ,Degree (temperature) - Published
- 2015
44. Differences in childhood adiposity influence upper limb fracture site
- Author
-
Adelynn Lim, Justin H Davies, Nicholas Clarke, Nicholas C. Harvey, Avinash Segaran, Megan Farmer, Cyrus Cooper, Elaine M. Dennison, and Rebecca J Moon
- Subjects
Fracture risk ,Male ,medicine.medical_specialty ,Histology ,Adolescent ,Physiology ,Endocrinology, Diabetes and Metabolism ,Upper Limb Fracture ,Fracture site ,Overweight ,Article ,Body Mass Index ,Upper Extremity ,Fractures, Bone ,Sex Factors ,Prevalence ,Medicine ,Humans ,Obesity ,Child ,Adiposity ,business.industry ,medicine.disease ,United Kingdom ,Increased risk ,Child, Preschool ,Physical therapy ,Fracture (geology) ,Female ,medicine.symptom ,business ,Body mass index - Abstract
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
- Published
- 2015
45. Audit of upper limb fracture management in an accident and emergency department
- Author
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D P Jenkins, E E Glucksman, and M W Cooke
- Subjects
medicine.medical_specialty ,Referral ,Upper Limb Fracture ,Audit ,Critical Care and Intensive Care Medicine ,Teaching hospital ,Fractures, Bone ,London ,Humans ,Medicine ,Hospitals, Teaching ,Referral and Consultation ,Fracture clinic ,Arm Injuries ,Medical Audit ,business.industry ,Accident and emergency ,General Medicine ,Confidence interval ,medicine.anatomical_structure ,Practice Guidelines as Topic ,Emergency medicine ,Emergency Medicine ,Upper limb ,Emergency Service, Hospital ,business ,Research Article - Abstract
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.
- Published
- 1994
46. 1201 Safe handling of oral chemotherapeutic agents in clinical practice at Saudi hospitals
- Author
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Y. Al Ghawaa, M. Al Ghalbi, Nagwa Abdel Rahman Ibrahim, A. Al Eid, and A. Al Alwan
- Subjects
Cancer Research ,medicine.medical_specialty ,Pediatrics ,business.industry ,education ,Upper Limb Fracture ,Pediatric age ,Emergency department ,medicine.disease ,Safe handling ,Surgery ,Clinical Practice ,Falling (accident) ,Oncology ,Closed head injury ,medicine ,medicine.symptom ,business ,Developed country - Abstract
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.
- Published
- 2015
47. Common fall-related injuries in children at King Abdul Aziz Medical City, Riyadh – Kingdom of Saudi Arabia
- Author
-
Yara Al Goraini, Rana F. Kattan, Manar AlGhamdi, and Manal Bawazeer
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,education ,Upper Limb Fracture ,Public Health, Environmental and Occupational Health ,Pediatric age ,COHORT ANALYTIC STUDY ,General Medicine ,Emergency department ,medicine.disease ,Middle childhood ,Infectious Diseases ,Falling (accident) ,Closed head injury ,medicine ,Optometry ,medicine.symptom ,business ,Developed country - Abstract
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.
- Published
- 2015
48. Out on a limb: risk factors for arm fracture in playground equipment falls
- Author
-
Raphael H Grzebieta, George Rechnitzer, Shauna Sherker, and Joan Ozanne-Smith
- Subjects
Male ,medicine.medical_specialty ,Victoria ,Upper Limb Fracture ,education ,Poison control ,Impact test ,Occupational safety and health ,Fractures, Bone ,Risk Factors ,Injury prevention ,Medicine ,Humans ,Child ,Surface depth ,Arm Injuries ,business.industry ,Public Health, Environmental and Occupational Health ,Arm Fracture ,Equipment Design ,Anthropometry ,Methodologic Issues ,Surgery ,Play and Playthings ,Case-Control Studies ,Physical therapy ,Accidental Falls ,Environment Design ,Female ,Stress, Mechanical ,business ,human activities - Abstract
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
- Published
- 2005
49. The epidemiology of multifocal upper limb fractures
- Author
-
M. R. Broadbent, O. Quaba, C. Hadjucka, and M. M. McQueen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Humeral Fractures ,Proximal humerus ,Adolescent ,Upper Limb Fracture ,Population ,Poison control ,Upper Extremity ,03 medical and health sciences ,Fractures, Bone ,0302 clinical medicine ,Epidemiology ,medicine ,Humans ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Multiple Trauma ,Incidence (epidemiology) ,Middle Aged ,medicine.disease ,Ulna Fractures ,Surgery ,medicine.anatomical_structure ,Olecranon fracture ,Scotland ,030220 oncology & carcinogenesis ,Upper limb ,030211 gastroenterology & hepatology ,business ,Radius Fractures - Abstract
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.
- Published
- 2003
50. Neurological status documentation in upper limb fracture patients
- Author
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U.K. Choudhuri, R.W. Trickett, E.S. Uppin, and A. Khurana
- Subjects
medicine.medical_specialty ,Documentation ,business.industry ,Neurological status ,Upper Limb Fracture ,Emergency Medicine ,Physical therapy ,medicine ,Surgery ,Orthopedics and Sports Medicine ,business - Published
- 2011
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