Clinical outcomes in patients with scaphoid non-union treated with the vascularized medial femoral condyle technique a case series.

INTRODUCTION: Non-union is a prevalent complication of scaphoid fractures. Late diagnosis is common and has a clinical impact due to functional limitations for the patient. Multiple treatments have been proposed to manage this complication, ranging from conservative (i.e., orthopedic) to surgical treatment. The vascularized medial femoral condyle technique has shown satisfactory clinical and paraclinical results, mainly in presence of avascular necrosis of the proximal pole but data regarding functional outcomes and patient satisfaction is scarce. This case series aims to describe the clinical and patient-reported outcomes in a consecutive series of patients with non-union of the proximal third of the scaphoid treated with vascularized medial femoral condyle technique. METHODS: Case series reporting results for a consecutive - initial cohort of patients who presented with a non united fracture of the proximal pole of the scaphoid, avascular necrosis of the proximal pole was documented by CT od MRI imaging preoperatively in all patients. Measurement instruments include the q-DASH and PRWE questionnaires, radiographic images, goniometry, and assessment of grip strength. RESULTS: Twelve consecutive patients are included and they represent the initial cases for all surgeons involved; bone union was obtained in 10 patients (83%) after a mean follow-up time of 31 months (6-72), successful improvement in the range of motion and grip strength was documented. A high rate of satisfaction expressed by the patient was obtained, with an average score in Q-DASH of 17.3 and 20.1 in PRWE. CONCLUSIONS: The vascularized medial condyle technique in cases of nonunion of scaphoid fracture is a reproducible treatment in clinical terms, both in imaging and functional terms, and in patient satisfaction. The learning curve is flat for a dedicated multi surgeon team.

Casting Without Reduction Versus Closed Reduction With or Without Fixation in the Treatment of Distal Radius Fractures in Children: Protocol for a Randomized Noninferiority Trial.

BACKGROUND: Acute treatment for distal radius fractures, the most frequent fractures in the pediatric population, represents a challenge to the orthopedic surgeon. Deciding on surgical restoration of the alignment or cast immobilization without reducing the fracture is a complex concern given the remodeling potential of bones in children. In addition, the lack of evidence-based safe boundaries of shortening and angulation, that will not jeopardize upper-extremity functionality in the future, further complicates this decision. OBJECTIVE: The authors aim to measure functional outcomes, assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Physical Function v2.0 instrument. The authors hypothesize that outcomes will not be worse in children treated with cast immobilization in situ compared with those treated with closed reduction with or without percutaneous fixation. The authors also aim to compare the following as secondary outcomes: ulnar variance and fracture alignment in the sagittal and coronal planes, range of motion, pressure ulcers, pain control, radius osteotomy due to deformity, pseudoarthrosis cure, and remanipulation. METHODS: This is the protocol of a randomized noninferiority trial comparing upper-extremity functionality in children aged 5 to 10 years, after sustaining a distal radius fracture, treated with either cast immobilization in situ or closed reduction with or without fixation in a single orthopedic hospital. Functional follow-up is projected at 6 months, while clinical and radiographic follow-up will occur at 2 weeks, 3 months, and 9 months. RESULTS: Recruitment commenced in July 2021. As of January 2022, 23 children have been randomized. Authors expect an average of 5 patients to be recruited monthly; therefore, recruitment and analysis should be complete by October 2024. CONCLUSIONS: This experimental design that addresses upper-extremity functionality after cast immobilization in situ in children who have sustained a distal fracture of the radius may yield compelling information that could aid the clinician in deciding on the most suitable orthopedic treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT05008029; https://clinicaltrials.gov/ct2/show/NCT05008029. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34576.

Traduccion, adaptacion cultural y validacion de una escala de funcion del miembro superior: DASH / Translation, cultural adaptation and validation of the DASH - upper extremity functional scale

Introducción El objetivo del estudio fue realizar la traducción, adaptación cultural y validación de una escala de función del miembro superior, denominada DASH, por sus siglas en inglés (discapacidad del brazo, el hombro y la mano). Materiales y métodos Se realizó un estudio metodológico de validación de escalas: traducción (constó de traducciones inglés-español, comité de expertos inicial, dos contratraducciones, un segundo comité de expertos y una traducción definitiva); evaluación de confiabilidad (pruebas de coherencia interna, test-retest y cambio mínimo detectable); respuesta al cambio (mediciones en pacientes antes y después de tratamiento), y estudio de validez (se hicieron pruebas de validez de apariencia, de constructo y de criterio). Resultados La prueba traducida fue aplicada a 338 pacientes con enfermedades de mano y hombro, 311 fueron utilizables. La consistencia interna, mediante alfa de Cronbach, se estimó > 0,96; el resultado del coeficiente de concordancia de Lin fue 0,86. El cambio mínimo detectable fue 15,88, la capacidad de respuesta al cambio mediante la prueba de la t de Student aplicada sobre la diferencia en la puntuación arrojó una p < 0,001; adicionalmente se corrió una correlación no paramétrica de Spearman entre la diferencia en la puntuación DASH y la diferencia en la escala visual analógica de cambio en estado de salud (EVA SALUD) y se obtuvo un r = 0,62 (p < 0,001). Discusión La escala DASH traducida y adaptada al español demostró una buena fiabilidad, estabilidad y capacidad de respuesta al cambio, logró discriminar entre diferentes enfermedades y tiene una validez estimada buena en cuanto a contenido, constructo y criterio.

Introduction The objective of the study was to perform translation, cultural adaptation and validation of a function scale of the upper limb, called DASH, for its acronyms in English (disability of the arm, shoulder and hand). Materials and methods A methodological study of scale validation was performed: translation (consisting of English-Spanish translations, initial expert committee, two backtranslations, a second committee of experts and a definitive translation); reliability assessment (internal consistency tests, test-retest and minimum detectable change); response to change (measurements in patients before and after treatment), and validity study (validity tests of appearance, construct and criteria were performed). Results The translated test was applied to 338 patients with hand and shoulder diseases, 311 were usable. The internal consistency, using Cronbach's alpha, was estimated to be > 0.96; The result of the Lin coefficient of agreement was 0.86. The minimum detectable change was 15.88, the ability to respond to change using the Student t test applied on the difference in score yielded a p <0.001; A nonparametric Spearman correlation was recorded between the difference in the DASH score and the difference in the visual analogue scale of change in health status (EVA HEALTH) with r = 0.62 (p <0.001). Discussion The DASH scale, translated and adapted to Spanish demonstrated good reliability, stability and responsiveness to change, managed to discriminate between different diseases and has an estimated validity in terms of content, construct and criteria.