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  • World Scientific Pub Co Pte Ltd  (3)
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  • World Scientific Pub Co Pte Ltd  (3)
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  • 1
    Online Resource
    Online Resource
    Retrospective Comparative Study of Clinical Outcomes and Cost-Effectiveness with Bone Substitutes on Volar Locking Plate Fixation of Unstable Distal Radial Fractures in the Elderly
    World Scientific Pub Co Pte Ltd ; 2023
    In:  The Journal of Hand Surgery (Asian-Pacific Volume) Vol. 28, No. 01 ( 2023-02), p. 61-68
    Details
    In: The Journal of Hand Surgery (Asian-Pacific Volume), World Scientific Pub Co Pte Ltd, Vol. 28, No. 01 ( 2023-02), p. 61-68
    Abstract: Background: This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly. Methods: The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015–2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients (n = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group. Results: After matching, the backgrounds of Groups VLA (n = 388) and VLS (n = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, p 〈 0.001). Conclusions: In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF. Level of Evidence: Level IV (Therapeutic)
    Type of Medium: Online Resource
    ISSN: 2424-8355 , 2424-8363
    URL: Article
    DOI: 10.1142/S2424835523500091
    Language: English
    Publisher: World Scientific Pub Co Pte Ltd
    Publication Date: 2023
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Locked Tension Band Wiring for Mayo IIA Olecranon Fractures: Modified Surgical Technique and Retrospective Comparative Study of Clinical Outcomes and Cost-effectiveness with Locking Plate
    World Scientific Pub Co Pte Ltd ; 2023
    In:  The Journal of Hand Surgery (Asian-Pacific Volume) Vol. 28, No. 02 ( 2023-04), p. 205-213
    Details
    In: The Journal of Hand Surgery (Asian-Pacific Volume), World Scientific Pub Co Pte Ltd, Vol. 28, No. 02 ( 2023-04), p. 205-213
    Abstract: Background: Tension band wiring (TBW) has traditionally been used for simple olecranon fractures, but due to its many complications, locking plate (LP) is increasingly being employed. To reduce the complications, we developed a modified technique for olecranon fracture repair, locked TBW (LTBW). The study aimed to compare (1) the frequency of complications and re-operations between LP and LTBW techniques, (2) clinical outcomes and the cost efficacy. Methods: We retrospectively evaluated data of 336 patients who underwent surgical treatment for simple and displaced olecranon fractures (Mayo Type ⅡA) in the hospitals of a trauma research group. We excluded open fractures and polytrauma. We investigated complication and re-operation rates as primary outcomes. As secondary outcomes, Mayo Elbow Performance Index (MEPI) and the total cost, including surgery, outpatients and re-operation, were examined between the two groups. Results: We identified 34 patients in the LP group and 29 patients in the LTBW group. The mean follow-up period was 14.2 ± 3.9 months. The complication rate in the LTBW group was comparable to that in the LP group (10.3% vs. 17.6%; p = 0.49). Re-operation and removal rates were not significantly different between the groups (6.9% vs. 8.8%; p = 1.000 and 41.4% vs. 58.8%; p = 1.00, respectively). Mean MEPI at 3 months was significantly lower in the LTBW group (69.7 vs. 82.6; p 〈 0.01), but mean MEPI at 6 and 12 months were not significantly different (90.6 vs. 85.2; p = 0.06, 93.9 vs. 95.2; p = 0.51, respectively). The mean cost/patient of the total cost in the LTBW group were significantly lower than those in the LP group ($5,249 vs. $6,138; p 〈 0.001). Conclusions: This study showed that LTBW achieved clinical outcomes equivalent to those of LP and was significantly more cost effective than LP in the retrospective cohort. Level of Evidence: Level III (Therapeutic)
    Type of Medium: Online Resource
    ISSN: 2424-8355 , 2424-8363
    URL: Article
    DOI: 10.1142/S2424835523500224
    Language: English
    Publisher: World Scientific Pub Co Pte Ltd
    Publication Date: 2023
    Location Call Number Limitation Availability
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Primary Radial Nerve Exploration Determined by Ultrasound in Pediatric Supracondylar Humerus Fracture: A Report of Two Cases
    World Scientific Pub Co Pte Ltd ; 2021
    In:  The Journal of Hand Surgery (Asian-Pacific Volume) Vol. 26, No. 02 ( 2021-06), p. 284-289
    Details
    In: The Journal of Hand Surgery (Asian-Pacific Volume), World Scientific Pub Co Pte Ltd, Vol. 26, No. 02 ( 2021-06), p. 284-289
    Abstract: We report two pediatric cases of radial nerve palsy caused by supracondylar fracture of the humerus requiring nerve exploration. The children had comparable conditions, palsy types (complete motor and partial sensory) and radiographic findings. The fracture in the first case was managed conservatively with closed reduction and percutaneous pinning but, while the patient eventually recovered from the partial sensory palsy, her motor palsy remained unchanged. In the second case, ultrasound assessment of the nerve prior to fixation indicated that surgical exploration was needed as it revealed tethering on the edge of the proximal fracture fragment. The nerve was released during an open reduction and the patient subsequently recovered from both sensory and motor palsies. Ultrasonography proved essential in the initial clinical assessment by determining how to proceed. We recommend primary nerve exploration when ultrasound findings show entrapment or tethering of the radial nerve.
    Type of Medium: Online Resource
    ISSN: 2424-8355 , 2424-8363
    URL: Article
    DOI: 10.1142/S2424835521720097
    Language: English
    Publisher: World Scientific Pub Co Pte Ltd
    Publication Date: 2021
    Location Call Number Limitation Availability
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    Online Resource
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