Effects of deprivation, ethnicity, gender and age on distal radius fracture incidence and surgical intervention rate.

INTRODUCTION: Social deprivation has been shown to be associated with increased incidence of many types of fracture but the causes for this have not been established. The aim of this study was to establish if distal radius fracture was associated with deprivation and investigate reasons for this. METHOD: Data was reviewed of 4463 adult patients who attended our Emergency Department over a four year period. The Index of Multiple Deprivation was used to measure deprivation for each patient. Modelling techniques were used to investigate the relationship between fracture rate and deprivation, gender, ethnicity and age. RESULTS: Distal radius fracture rate was higher for patients in more deprived quintiles. Mean age in the most deprived two quintiles was 54.4 years compared to 60.1 years in the least deprived three quintiles. Modelling showed important differences between ethnic groups. Deprivation was an independent risk factor for distal radius fracture only in white patients. Deprived white women had a lower second metacarpal cortical index than women of other ethnicities suggesting increased bone fragility. Being male is a risk factor for fracture when deprivation, ethnicity and age are taken into account. Incidence rate ratio of the least deprived quintile compared to the most deprived was 0.33 (95% CI: 0.30-0.37) for white men and 0.47 (95% CI: 0.44-0.49) for white women. CONCLUSION: Effective interventions exist to prevent further fragility fracture and this work allows geographical areas at risk to be identified. Presentation with a distal radius fracture provides an opportunity to implement interventions. In the current economic climate resources are scarce and must be used prudently. Resources should be targeted to those at risk patients from deprived areas and preventative strategies put in place.

The inter-rater reliability of the modified finger goniometer for measuring forearm rotation.

STUDY DESIGN: Prospective cohort study. PURPOSE OF THE STUDY: To compare the inter-rater reliability of using a modified finger goniometer (MFG) for the measurement of isolated forearm rotation for patients with distal radius fractures to the currently accepted technique for isolated forearm measurement. INTRODUCTION: The currently accepted method of forearm measurement requires the assessor to visually estimate vertical for the stationary arm and placement of the moveable arm while placing a straight edge along a curved surface. Inter-rater reliability may be limited as assessors may estimate the placement of the goniometer arms differently depending on their experience, posture, and even their positioning relative to the patient. Rather than continue to place a straight edge on a round surface, we evaluate a new technique using an MFG for measuring isolated forearm rotation. METHODS: Patients with clinically healed distal radius fractures were enrolled in the study. Measurement of active forearm pronation and supination was recorded using 2 separate measurement techniques. These measurements were taken by 2 separate hand therapists with more than 10 years of clinical experience in a tertiary care setting at the beginning and end of hand therapy sessions for 3 consecutive weekly visits. Intraclass correlation coefficients (ICCs), standard error of measurement, and minimal detectable change were calculated for each technique. RESULTS: The point estimates for the MFG method demonstrated a slightly higher ICC than the standard method for pronation (0.86 vs 0.82). For supination, both measurement techniques displayed equally high pooled ICCs (0.95). The standard error of measurements for the MFG were 2.1 for pronation and 1.2 for supination compared with 2.9 (pronation) and 1.2 (supination) for the standard technique. These translate into 90% minimal detectable changes of 5° and 3° for the MFG pronation/supination compared with 7° (pronation) and 3° (supination) for the standard technique, respectively. DISCUSSION: Although the point estimates for the ICCs of the MFG method are equal or higher than the standard method, the confidence intervals for the ICCs overlap, indicating that the MFG is at least equivalent to the standard method in terms of inter-rater reliability. LEVEL OF EVIDENCE: 2b.

Bone mineral density and vitamin D status among African American children with forearm fractures.

OBJECTIVE: To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level ≤ 20 ng/mL) compared with fracture-free control patients. METHODS: This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. RESULTS: The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio 0.38 [0.20-0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09-10.94]). CONCLUSIONS: These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits.

Ethnic disparities in recovery following distal radial fracture.

BACKGROUND: Ethnic disparities have been demonstrated in the treatment of chronic diseases, such as diabetes and heart disease. It is unclear if similar ethnic disparities appear with respect to recovery following fracture care. METHODS: We retrospectively reviewed 496 individuals (253 whites, 100 blacks, and 143 Latinos) with a fracture of the distal part of the radius. Assessment of physical function and pain was conducted at three, six, and twelve months following treatment. The Disabilities of the Arm, Shoulder and Hand (DASH) score was used to assess physical function, and a visual analog scale was used to assess pain. Multiple linear regression was used to model physical function and pain across ethnicity while controlling for age, sex, mechanism of injury, level of education, type of fracture, type of treatment (operative or nonoperative), and Workers' Compensation status. RESULTS: Both blacks and Latinos exhibited poorer physical function and greater pain than whites did at most follow-up points. Latinos reported more pain at each follow-up point in comparison with blacks and whites (p < 0.001 at three, six, and twelve months). These significant differences remained after controlling for Workers' Compensation status, which was also strongly associated with both pain and function. CONCLUSIONS: These findings suggest that recovery is different between ethnic groups following a fracture of the distal part of the radius. These ethnic disparities may result from multifactorial sociodemographic factors that are present both before and after fracture treatment.

Concurrent fractures of the hip and wrist: a matched analysis of elderly patients.

INTRODUCTION: Osteoporotic fractures involving the hip and wrist are common in the elderly. The incidence of coincident hip and wrist fractures in the same patient is small but may represent a unique subpopulation of elderly with osteoporotic fragility fractures and little information has been published about these patients. MATERIALS AND METHODS: We performed a retrospective review studying a series of 33 elderly patients who were admitted with concurrent hip and wrist fractures and matched them with patients of similar age, race, gender and co-morbidities with isolated hip fractures analysing their pre-morbid functional status, degree of osteoporosis by the Singh's index, length of stay and re-admission rate. RESULTS: In our cohort of 33 matched pairs, location of fall in the study group consisted of 21 at home and 26 in the control group. The median duration of stay in hospital was 23 days versus 18 days in the control group. Bone density assessment of our study group revealed 18 patients with severe osteoporosis with Singh's index and 21 severe osteoporosis in the control group. The 1-year re-admission rate for the patients in the study group was 7 and 12 in the control group. Ambulatory status at discharge in the study group was 12 and in the control group 21. DISCUSSION AND CONCLUSION: Our study population demonstrated a higher proportion of community ambulators with fewer 1-year re-admission rates and a high cervical:trochanteric ratio of 2.7, all of which signify that they belong to a physiologically younger and more active cohort than our control group of isolated hip fractures. Patients with concurrent hip and wrist fractures were not significantly more osteoporotic, and showed a trend toward longer stay in hospital and incurred a higher cost of stay. The confluent upper limb injury was the likely reason for their post-discharge impaired ambulatory status. The most common location of injury in both groups of patients is at home.

Consideraciones en el tratamiento quirúrgico en fractura de cépula radial / Considerations in radial head elbow fractures

Se presenta la experiencia de 3 años relacionada a fracturas de la cúpula radial y su tratamiento en nuestra Cátedra-Servicio. Haciendo hincapié en las secuelas que ocasiona la cupulectomía en el posterior dolor en la muñeca y la posibilidad de que algunas fracturas de la cúpula puedan ser tratadas con síntesis. Igualmente se desglosa las diferentes clasificaciones y el enfoque quirúrgico