Hassan Abbaszadegan

Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year

Background and purpose Promising results have been reported after volar locked plating of unstable dorsally displaced distal radius fractures. We investigated whether volar locked plating results in better patient-perceived, objective functional and radiographic outcomes compared to the less invasive external fixation. Patients and methods 63 patients under 70 years of age, with an unstable extra-articular or non-comminuted intra-articular dorsally displaced distal radius fracture, were randomized to volar locked plating (n = 33) or bridging external fixation. Patient-perceived outcome was assessed with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Patient-Rated Wrist Evaluation (PRWE) questionnaire. Results At 3 and 6 months, the volar plate group had better DASH and PRWE scores but at 12 months the scores were similar. Objective function, measured as grip strength and range of movement, was superior in the volar plate group but the differences diminished and were small at 12 months. Axial length and volar tilt were retained slightly better in the volar plate group. Interpretation Volar plate fixation is more advantageous than external fixation, in the early rehabilitation period.

Evaluation of a Swedish version of the patient-rated wrist evaluation outcome questionnaire: Good responsiveness, validity, and reliability, in 99 patients recovering from a fracture of the distal radius

The patient-rated wrist evaluation (PRWE) form is an established outcome questionnaire designed to measure wrist pain and disabilities in activities of daily living. We translated and validated this score for use in Sweden. The original PRWE score was translated forwards and backwards, and then the responsiveness, validity, and reliability of the Swedish version were tested in 99 patients who were recovering from a fracture of the distal radius. The patients completed the PRWE questionnaire 7 weeks and 4 to 6 months after the injury. Responsiveness was assessed by Standard Response Mean and Effect Size. Content validity was evaluated by examining the proportion of best and worse possible scores. Construct validity was assessed by comparing scores twice after the injury and by comparing patients with fractures of different severity. Criterion validity was evaluated by correlating the PRWE with another upper extremity score: the disability of the arm, shoulder, and hand (DASH) score. Reliability was evaluated with a test-retest and by internal consistency. Responsiveness was excellent (SRM = 1.4–1.7, ES = 1.3). Five patients reported the best possible result after 4 to 6 months but none at 7 weeks, and no patient reported the worst score at any time. The PRWE score corresponded well with improvement and showed good correlation with severity of fracture. The PRWE showed a strong correlation with DASH score (Spearmans rank coefficient = 0.86). Intraobserver reliability of the test-retest and internal consistency was good (Kendall W coefficient = 0.79, Spearmans rank coefficient = 0.99, Cronbachs α = 0.94–0.97). We found this Swedish version of the PRWE to be responsive, valid, and reliable for evaluating the patient-rated outcome after a fracture of the distal radius.

The Bankart repair versus the Putti-Platt procedure: A randomized study with WOSI score at 10-year follow-up in 62 patients

Background and purpose This randomized study compared clinical results after surgery for posttraumatic shoulder instability with either an anatomical repair or an older, less anatomical but commonly used method. The less anatomical procedure has been considered quicker and less demanding, but it has been questioned regarding the clinical result. We therefore wanted to compare the clinical outcome of the two different procedures. Our hypothesis was that the anatomical repair would give less residual impairment postoperatively. Methods Patients with anterior posttraumatic shoulder instability were consecutively randomized on the day before surgery to either a Bankart repair using Mitek GI/GII anchors combined with capsular imbrication (B) (n = 33) or a Putti-Platt procedure (P) (n = 33). Follow-up was performed by examination at 2 years and using a self-evaluation score at 10 years. Results At the 2-year follow-up, we found no difference in muscle strength between patients treated with the two surgical methods and there were no statistically significant differences in the Rowe scores (mean 90 units for both groups). Compared to preoperatively, the decrease in external rotation 2 years after surgery was 10 degrees in the P group and 3 degrees in the B group (p = 0.03). 10 years after surgery, 62 of 66 patients replied to a questionnaire sent by mail. It included a self-evaluating quality of life score for shoulder instability (WOSI) for evaluation of their shoulder function. In the P group 15 patients and in the B group 19 patients reported they had experienced either a redislocation or a subluxation with a new feeling of shoulder instability. Mean WOSI score was similar in the P and B groups: 80% and 83%, respectively. The WOSI score was 87% for patients with stable shoulders (n = 28) and 77% for those with unstable shoulders (n =34) (p = 0.005). Interpretation With assessment of pain and general shoulder function, only a small difference was found between the two methods. The WOSI scores for stable shoulders indicated that some shoulders still had impaired function even though the shoulders had become stable.

Atraumatic shoulder instability Discussion of classification and results after capsular imbrication

This study consists of 27 shoulders in 24 patients whose atraumatic shoulder instability was treated with the imbrication procedure described by Rockwood. Follow‐up after 2 years or more showed the following results: 37% excellent, 30% good, 15% fair and 18% poor (Rowe score). No statistically significant differences in the results were observed between the dominant and non‐dominant arm, nor in post‐operative return to sports activities. Those with voluntary instability had more laxity at follow‐up and tended to have poorer results. Those with unidirectional laxity had only good or excellent results and showed no post‐operative laxity. We found no other reliable indication of the results of surgery. The difficulties of classifying shoulder instability by such factors as trauma, laxity and direction of instability are discussed. Overall, we consider capsular imbrication to be a good treatment for involuntary atraumatic shoulder instability.