Session 4 : YODA Best Paper
13. November
11:00 - 12:00
Lokale: Sal A
Chair: Christian Bredgaard Jensen & Claus Varnum
Julie Hyldgaard Petersen1, Karen Vestergaard Andersen2, Line Kjeldgaard Pedersen1, Stine Fjendbo Galili3, Claus Sixtus Jensen3, 4, Marianne Lisby3, Bjarne Møller-Madsen1, Jan Duedal Rölfing1
1. Children’s Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark 2. The Emergency Department, Aarhus University Hospital, Aarhus Denmark 3. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus Denmark 4. Department of Paediatrics, Aarhus University Hospital, Denmark
Background: Virtual reality (VR) is a promising method to reduce procedural anxiety and pain in children without pre-procedural pain.
Aim: The primary aim of this pilot study was to investigate the effect of VR on pre- procedural anxiety in children experiencing acute pain in the setting of an Emergency Department (ED). In addition, this study aimed to test the feasibility of the study procedure.
Materials and Methods: In this pilot randomized controlled trial (RCT) twenty children aged 6-14 years were randomized to standard of care (SOC) or VR+SOC during their visit at the ED. Anxiety was assessed three times using modified Yale Preoperative Anxiety Scale (mYPAS); at baseline, after intervention immediately before the procedure (pre- procedure) and during the procedure. The pain level was at the same time assessed using Numerical Rating Scale (NRS).
Results: Twenty children, median age 11 (7-14) years, were randomized. VR significantly decreased the level of anxiety and pain from baseline to the pre-procedural measurement: -8.33 (95%CI [-15.28; -2.38]) points, p=0.0114 and -1.85 (95%CI [-2.29; -0.78]) points, p=0.0023. A high level of anxiety at baseline was found to be associated with a positive effect of VR to reduce pre-procedural anxiety, spearman’s rho: 0.988.
Interpretation / Conclusion: The preliminary results found an effect of VR on reducing pre-procedural anxiety and pain in children with acute pain. An association between anxiety at baseline and the effect of VR was found. This study has been profitable for structuring a large-scale study which, due to the limitation of a pilot study, is needed to confirm the findings.
1. Children’s Orthopaedics and Reconstruction, Aarhus University Hospital, Denmark 2. The Emergency Department, Aarhus University Hospital, Aarhus Denmark 3. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus Denmark 4. Department of Paediatrics, Aarhus University Hospital, Denmark
Background: Virtual reality (VR) is a promising method to reduce procedural anxiety and pain in children without pre-procedural pain.
Aim: The primary aim of this pilot study was to investigate the effect of VR on pre- procedural anxiety in children experiencing acute pain in the setting of an Emergency Department (ED). In addition, this study aimed to test the feasibility of the study procedure.
Materials and Methods: In this pilot randomized controlled trial (RCT) twenty children aged 6-14 years were randomized to standard of care (SOC) or VR+SOC during their visit at the ED. Anxiety was assessed three times using modified Yale Preoperative Anxiety Scale (mYPAS); at baseline, after intervention immediately before the procedure (pre- procedure) and during the procedure. The pain level was at the same time assessed using Numerical Rating Scale (NRS).
Results: Twenty children, median age 11 (7-14) years, were randomized. VR significantly decreased the level of anxiety and pain from baseline to the pre-procedural measurement: -8.33 (95%CI [-15.28; -2.38]) points, p=0.0114 and -1.85 (95%CI [-2.29; -0.78]) points, p=0.0023. A high level of anxiety at baseline was found to be associated with a positive effect of VR to reduce pre-procedural anxiety, spearman’s rho: 0.988.
Interpretation / Conclusion: The preliminary results found an effect of VR on reducing pre-procedural anxiety and pain in children with acute pain. An association between anxiety at baseline and the effect of VR was found. This study has been profitable for structuring a large-scale study which, due to the limitation of a pilot study, is needed to confirm the findings.
Yousef Hussein1, Afrim Iljazi1, Michala Sørensen1,2,4, Søren Overgaard3,4, Michael Petersen1,4
1. Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet 2. Department of Orthopedic Surgery, Zealand University Hospital 3. Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg-Frederiksberg 4. Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
Background: Dislocation is a major concern following total hip arthroplasty (THA) for osteoarthritis (OA). Both dual mobility cups (DMCs) and standard cups (SC) with large femoral heads are utilized to reduce the risk of dislocation.
Aim: We investigated whether DMCs are superior to SCs in reducing the two-year risk of dislocation in a propensity-matched sample from the Danish Hip Arthroplasty Register (DHR).
Materials and Methods: This population-based cohort study utilizing data from the DHR and the Danish National Patient Register. We included all patients undergoing primary THA for OA from 2010 to 2019 with either DMC or SC with metal-on- polyethylene or metal-on-ceramic articulations with a 36mm femoral head. The samples were propensity-score matched on patient and implant characteristics. The primary outcome was the difference in the absolute risk of dislocation within two years, with a secondary outcome of the difference in the absolute risk of revision surgery of any cause within the same timeframe. The cumulative incidence of dislocation was calculated using the Aalen-Johansen estimator, while the difference in absolute risk was estimated using absolute risk regression.
Results: We included 4,499 patients with DMC and 4,499 patients with SC after propensity score matching. Both groups had a mean age of 75 years, included approximately 60% females, and had a two-year survival of 95%. The DMC group was 80% less likely to dislocate within two years (ARR 0.20, CI 0.14-0.28, p<0.01) with no increased risk of revision surgery (ARR 1.15, CI 0.89-1.48, p<0.01).
Interpretation / Conclusion: DMCs are associated with a lower risk of dislocation within two years compared to SCs, with no increased risk of revision surgery.
1. Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet 2. Department of Orthopedic Surgery, Zealand University Hospital 3. Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg-Frederiksberg 4. Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
Background: Dislocation is a major concern following total hip arthroplasty (THA) for osteoarthritis (OA). Both dual mobility cups (DMCs) and standard cups (SC) with large femoral heads are utilized to reduce the risk of dislocation.
Aim: We investigated whether DMCs are superior to SCs in reducing the two-year risk of dislocation in a propensity-matched sample from the Danish Hip Arthroplasty Register (DHR).
Materials and Methods: This population-based cohort study utilizing data from the DHR and the Danish National Patient Register. We included all patients undergoing primary THA for OA from 2010 to 2019 with either DMC or SC with metal-on- polyethylene or metal-on-ceramic articulations with a 36mm femoral head. The samples were propensity-score matched on patient and implant characteristics. The primary outcome was the difference in the absolute risk of dislocation within two years, with a secondary outcome of the difference in the absolute risk of revision surgery of any cause within the same timeframe. The cumulative incidence of dislocation was calculated using the Aalen-Johansen estimator, while the difference in absolute risk was estimated using absolute risk regression.
Results: We included 4,499 patients with DMC and 4,499 patients with SC after propensity score matching. Both groups had a mean age of 75 years, included approximately 60% females, and had a two-year survival of 95%. The DMC group was 80% less likely to dislocate within two years (ARR 0.20, CI 0.14-0.28, p<0.01) with no increased risk of revision surgery (ARR 1.15, CI 0.89-1.48, p<0.01).
Interpretation / Conclusion: DMCs are associated with a lower risk of dislocation within two years compared to SCs, with no increased risk of revision surgery.
Marianne Frydendal Nielsen1, Søren Ege Quist1, Rasmus Elsoe2, Peter Larsen2,3, Bjarne Møller-Madsen1, Jan Duedal Rölfing1,4
1. Children’s Orthopaedics and Reconstruction, Aarhus University Hospital, Palle Juul- Jensens Boulevard 99, 8200 Aarhus N, Denmark 2. Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark 3. Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark 4. Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
Background: Gait analysis by technical means is more objective than clinical observation. Highly specialized 3D motion capture systems are the gold standard. An instrumented walkway system like GAITRite is a validated alternative. GAITRite is a portable carpet for automated measurement of spatiotemporal parameters of the footstep pattern. Inertial measurement units (IMUs) like Xsens are alternative options. IMUs register movement in space. They are portable, less expensive, and increasingly available compared to video-based systems.
Aim: The aim of the study was to evaluate the interrater reliability between Xsens and GAITRite assessing spatiotemporal gait parameters in healthy adults.
Materials and Methods: 42 healthy adults volunteered to participate. Two clinicians examined all participants within one session using the Xsens and the GAITRite gait analyses simultaneously. The spatiotemporal gait parameters were compared with interclass correlation coefficient (ICC) analysis. ICC estimates and their 95% confident intervals (95%-CI) were calculated in Python. We analysed ICC (2, k) and ICC (3, k) to assess both absolute agreement and consistency of the measurements.
Results: The strongest absolute agreements were for cadence, step length, cycle time and stride length. ICC (2, k) ranged from 0.97 [95%-CI: 0.22, 0.99] to 0.98 [95%-CI: 0.88, 0.99]. ICC (3, k) ranged from 0.86 [95%-CI: 0.72, 0.93] to 1.00 [95%-CI: 0.99, 1.00], indicating good to excellent reliability considering a systematic difference. Swing time, stance time and single support time measurements showed insignificant ICC (2, k) values, but significant ICC (3, k) values with good to excellent reliability. There was a systematic difference between duration and step count because of the experimental setup. Distance and percentage measurements (swing, stance, and single support) were not correlated. Neither was bilateral differences between step time, step length or cycle time.
Interpretation / Conclusion: The interrater reliability between GAITRite and Xsens is moderate to excellent for selected gait parameters. For these, both systems may be used interchangeably for gait analysis in healthy adults.
1. Children’s Orthopaedics and Reconstruction, Aarhus University Hospital, Palle Juul- Jensens Boulevard 99, 8200 Aarhus N, Denmark 2. Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark 3. Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark 4. Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
Background: Gait analysis by technical means is more objective than clinical observation. Highly specialized 3D motion capture systems are the gold standard. An instrumented walkway system like GAITRite is a validated alternative. GAITRite is a portable carpet for automated measurement of spatiotemporal parameters of the footstep pattern. Inertial measurement units (IMUs) like Xsens are alternative options. IMUs register movement in space. They are portable, less expensive, and increasingly available compared to video-based systems.
Aim: The aim of the study was to evaluate the interrater reliability between Xsens and GAITRite assessing spatiotemporal gait parameters in healthy adults.
Materials and Methods: 42 healthy adults volunteered to participate. Two clinicians examined all participants within one session using the Xsens and the GAITRite gait analyses simultaneously. The spatiotemporal gait parameters were compared with interclass correlation coefficient (ICC) analysis. ICC estimates and their 95% confident intervals (95%-CI) were calculated in Python. We analysed ICC (2, k) and ICC (3, k) to assess both absolute agreement and consistency of the measurements.
Results: The strongest absolute agreements were for cadence, step length, cycle time and stride length. ICC (2, k) ranged from 0.97 [95%-CI: 0.22, 0.99] to 0.98 [95%-CI: 0.88, 0.99]. ICC (3, k) ranged from 0.86 [95%-CI: 0.72, 0.93] to 1.00 [95%-CI: 0.99, 1.00], indicating good to excellent reliability considering a systematic difference. Swing time, stance time and single support time measurements showed insignificant ICC (2, k) values, but significant ICC (3, k) values with good to excellent reliability. There was a systematic difference between duration and step count because of the experimental setup. Distance and percentage measurements (swing, stance, and single support) were not correlated. Neither was bilateral differences between step time, step length or cycle time.
Interpretation / Conclusion: The interrater reliability between GAITRite and Xsens is moderate to excellent for selected gait parameters. For these, both systems may be used interchangeably for gait analysis in healthy adults.
Anne Marie Holt1, Frederik Hammer1, Thea Saabye1, Ales Jurca5,6, Andreas Balslev-Clausen1, Steen Harsted3,4, Christian Wong1,2
1. Department of Orthopedic Surgery, Copenhagen University Hospital; Rigshospitalet 2. Department of Orthopedic Surgery, Copenhagen University Hospital; Hvidovre Hospital 3. Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark 4. Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark 5. Volumental AB, Stockholm, Sweden 6. Jozef Stefan International Postgraduate School
Background: Accurate data collection on children's foot size and shape is crucial due to potential impacts on functionality, pain, and quality of life. The advent of 3D scanning technology offers a novel approach to assessing foot dimensions and deformities.
Aim: This study aims to explore the correlation, agreement, and reliability between manual measurements and 3D scans, along with assessing intra-rater reproducibility for each method.
Materials and Methods: In a cross-sectional design, 3D scans and manual measurements were collected from 496 children aged 6-16 years as part of the PANIC Feet study, covering foot length AND width, hallux valgus angle (HVA), and arch height. Correlations were assessed using Pearson's correlation coefficient, reliability through the intraclass correlation coefficient (ICC), and agreement with limits of agreement (LoA). Intra- rater reliability was examined using re-test data to evaluate correlation, agreement, and reliability for both methods, respectively.
Results: For most subjects, the 3D-scanner measures higher values for foot length and width compared to manual measurements. Between-method reliability was excellent for foot length (ICC>0,99), good for foot width (ICC>0,83), and poor for HVA measurements (ICC>0,42). While there was a correlation for arch height measurements between methods (r > 0,61), a direct comparison was not possible. Between- session reliability was excellent for both methods (ICC>0,97) for foot length measurements. In general, the 3D-scan measurements had a higher between-session reliability than the manual measurements. The between-session reliability for the 3D-scan measurements was excellent (ICC>0,98) for foot width, moderate (ICC>0,68) for HVA measurements, and good (ICC>0,81) for arch height measurements. However, the between-session reliability for the manual measurements was good (ICC>0,76) for foot width, poor (ICC>0,48) for HVA measurements, and poor (ICC>0,28) for arch height measurements.
Interpretation / Conclusion: 3D scanning has higher between-session reliability than manual measurements for assessing children's foot dimensions. However, this study does not address the validity of 3D measurements, highlighting the need for further research in this area.
1. Department of Orthopedic Surgery, Copenhagen University Hospital; Rigshospitalet 2. Department of Orthopedic Surgery, Copenhagen University Hospital; Hvidovre Hospital 3. Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark 4. Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark 5. Volumental AB, Stockholm, Sweden 6. Jozef Stefan International Postgraduate School
Background: Accurate data collection on children's foot size and shape is crucial due to potential impacts on functionality, pain, and quality of life. The advent of 3D scanning technology offers a novel approach to assessing foot dimensions and deformities.
Aim: This study aims to explore the correlation, agreement, and reliability between manual measurements and 3D scans, along with assessing intra-rater reproducibility for each method.
Materials and Methods: In a cross-sectional design, 3D scans and manual measurements were collected from 496 children aged 6-16 years as part of the PANIC Feet study, covering foot length AND width, hallux valgus angle (HVA), and arch height. Correlations were assessed using Pearson's correlation coefficient, reliability through the intraclass correlation coefficient (ICC), and agreement with limits of agreement (LoA). Intra- rater reliability was examined using re-test data to evaluate correlation, agreement, and reliability for both methods, respectively.
Results: For most subjects, the 3D-scanner measures higher values for foot length and width compared to manual measurements. Between-method reliability was excellent for foot length (ICC>0,99), good for foot width (ICC>0,83), and poor for HVA measurements (ICC>0,42). While there was a correlation for arch height measurements between methods (r > 0,61), a direct comparison was not possible. Between- session reliability was excellent for both methods (ICC>0,97) for foot length measurements. In general, the 3D-scan measurements had a higher between-session reliability than the manual measurements. The between-session reliability for the 3D-scan measurements was excellent (ICC>0,98) for foot width, moderate (ICC>0,68) for HVA measurements, and good (ICC>0,81) for arch height measurements. However, the between-session reliability for the manual measurements was good (ICC>0,76) for foot width, poor (ICC>0,48) for HVA measurements, and poor (ICC>0,28) for arch height measurements.
Interpretation / Conclusion: 3D scanning has higher between-session reliability than manual measurements for assessing children's foot dimensions. However, this study does not address the validity of 3D measurements, highlighting the need for further research in this area.
Johanne Frost Teilmann1, Emil Toft Petersen1,2,3, Theis Muncholm Thillemann2,3, Chalotte Hemmingsen1, Josephine Olsen Kipp1,2, Thomas Falstie-Jensen3, Maiken Stilling1,2,3
1. AutoRSA Research Group, Orthopedic Research Unit, Aarhus University Hospital. 2. Department of Clinical Medicine, Aarhus University. 3. Department of Orthopedic Surgery, Aarhus University Hospital.
Background: Radial head arthroplasty (RHA) is used in the treatment of complex elbow fracture dislocations with a risk of overlengthening the radius. Overlengthening of the radius has been associated with elbow joint stiffness and decreased range of motion, but little is known about the detailed kinematics of the elbow joint with an overlengthened radius following RHA.
Aim: This experimental study aimed to evaluate the elbow kinematics following increasing radial head arthroplasty overlengthening by use of dynamic radiostereometry.
Materials and Methods: Eight human donor arms were examined with dynamic radiostereometry during a motor-controlled elbow flexion with the forearm in unloaded neutral position, and in supinated- and pronated position without and with 1kg of either varus or valgus load, respectively. The elbows were examined before and after RHA with stem lengths of anatomical size, +2 mm, and +4 mm length. The ligaments were kept intact using a step- cut humerus osteotomy for repeated RHA exchange. Bone models were obtained from computed tomography and AutoRSA software was used to match the bone models with dynamic radiostereometric analysis recordings. To describe elbow kinematics, anatomic coordinate systems were applied to the humerus, the ulna, and the radius.
Results: The greatest kinematic changes in the elbows were observed with the +4 mm implant imposing: 1) Joint distraction of 2.8 mm (CI 95% 1.6; 4.0) in the radiohumeral joint and of 1.1 mm (CI 95% 0.4; 1.7) in the ulnohumeral joint. 2) Increased varus angle up to 2.4° for both the radius (CI 95% 0.0; 4.8) and the ulna (CI 95% 0.2; 4.5). 3) Radial shift of 2 mm (CI 95% 0.2; 3.1) in the ulnar direction and ulnar shift of 1.0 mm (CI 95% 0.3; 1.6) in the posterior direction.
Interpretation / Conclusion: The kinematics of the elbow joint deviated increasingly from the native joint kinematics with a +2 mm to a +4 mm radial overlengthening. This might affect several other factors, like the joint contact pressure, interosseus membrane tension, and distal radioulnar joint stability and congruency. This study supports the importance of restoring the anatomical radial length in RHA surgery.
1. AutoRSA Research Group, Orthopedic Research Unit, Aarhus University Hospital. 2. Department of Clinical Medicine, Aarhus University. 3. Department of Orthopedic Surgery, Aarhus University Hospital.
Background: Radial head arthroplasty (RHA) is used in the treatment of complex elbow fracture dislocations with a risk of overlengthening the radius. Overlengthening of the radius has been associated with elbow joint stiffness and decreased range of motion, but little is known about the detailed kinematics of the elbow joint with an overlengthened radius following RHA.
Aim: This experimental study aimed to evaluate the elbow kinematics following increasing radial head arthroplasty overlengthening by use of dynamic radiostereometry.
Materials and Methods: Eight human donor arms were examined with dynamic radiostereometry during a motor-controlled elbow flexion with the forearm in unloaded neutral position, and in supinated- and pronated position without and with 1kg of either varus or valgus load, respectively. The elbows were examined before and after RHA with stem lengths of anatomical size, +2 mm, and +4 mm length. The ligaments were kept intact using a step- cut humerus osteotomy for repeated RHA exchange. Bone models were obtained from computed tomography and AutoRSA software was used to match the bone models with dynamic radiostereometric analysis recordings. To describe elbow kinematics, anatomic coordinate systems were applied to the humerus, the ulna, and the radius.
Results: The greatest kinematic changes in the elbows were observed with the +4 mm implant imposing: 1) Joint distraction of 2.8 mm (CI 95% 1.6; 4.0) in the radiohumeral joint and of 1.1 mm (CI 95% 0.4; 1.7) in the ulnohumeral joint. 2) Increased varus angle up to 2.4° for both the radius (CI 95% 0.0; 4.8) and the ulna (CI 95% 0.2; 4.5). 3) Radial shift of 2 mm (CI 95% 0.2; 3.1) in the ulnar direction and ulnar shift of 1.0 mm (CI 95% 0.3; 1.6) in the posterior direction.
Interpretation / Conclusion: The kinematics of the elbow joint deviated increasingly from the native joint kinematics with a +2 mm to a +4 mm radial overlengthening. This might affect several other factors, like the joint contact pressure, interosseus membrane tension, and distal radioulnar joint stability and congruency. This study supports the importance of restoring the anatomical radial length in RHA surgery.
Dilay Kesgin Fener1, Emil Østergaard Nielsen 2, Ottilia Wyon Steenholdt1, Ali Abdel-Hadi Toma 1, Stig Brorson 3, Dennis Winge Hallager1,3
1. Department of Orthopaedic Surgery, Zealand University Hospital, Køge 2. Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager- Hvidovre 3. Center for Evidence-Based Orthopaedics, Zealand University Hospital and Department of Clinical Medicin, University of Copenhagen.
Background: Based on randomized trials and guidelines, non- surgical treatment is recommended for elderly patients with dorsally displaced distal radius fractures (DDDRF). Practice at our institution underwent evaluation in 2020. Using the CEBO model led to a new local guideline favoring non- surgical treatment in patients aged 60 years or older.
Aim: The aim of this retrospective quality assessment study was to investigate whether there has been an increased rate of complications or secondary surgeries following the change in clinical practice.
Materials and Methods: All patients aged 60 years or older treated at our institution for a forearm fracture between February 1, 2019, and January 31, 2020, and between February 1, 2022, and January 31, 2023, were screened for inclusion. Patients with DDDRFs were included. They were stratified based on the practice change in a before (group 1) and an after (group 2) cohort. The diagnosis was confirmed on radiographs. Exclusion criteria were high energy or open fractures, neurovascular compromise, previous fracture on the same side, other fractures, and patients relying on a walking aid in the injured hand or rejected use of data for quality assessment. Data were managed in Redcap according to a predefined protocol. Rates of complications and secondary surgeries within one year were compared between groups using Pearson’s Chi squared test.
Results: 689 patients were screened, 213 were included for analysis. Group 1 included 98 patients with a median age of 72 years (range 60-96), 88% female. Group 2 included 115 patients, with a median age of 76 years (range 60-93), 94% female. Surgical treatment was received by 78% in group 1 and 11% in group 2. In group 1, 12% (12 of 98) had at least one complication compared to 13% (15 of 115) in group 2 (p=0.9). In group 1, 4% (4 of 98) had secondary surgery within one year, compared to 6% (7 of 115) in group 2 (p=0.5). Carpal tunnel syndrome was the predominant indication in both groups.
Interpretation / Conclusion: We found no statistically significant difference in rates of complications and secondary surgery within one year of treatment before and after the practice change favoring non-surgical treatment in elderly patients with a DDDRF.
1. Department of Orthopaedic Surgery, Zealand University Hospital, Køge 2. Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager- Hvidovre 3. Center for Evidence-Based Orthopaedics, Zealand University Hospital and Department of Clinical Medicin, University of Copenhagen.
Background: Based on randomized trials and guidelines, non- surgical treatment is recommended for elderly patients with dorsally displaced distal radius fractures (DDDRF). Practice at our institution underwent evaluation in 2020. Using the CEBO model led to a new local guideline favoring non- surgical treatment in patients aged 60 years or older.
Aim: The aim of this retrospective quality assessment study was to investigate whether there has been an increased rate of complications or secondary surgeries following the change in clinical practice.
Materials and Methods: All patients aged 60 years or older treated at our institution for a forearm fracture between February 1, 2019, and January 31, 2020, and between February 1, 2022, and January 31, 2023, were screened for inclusion. Patients with DDDRFs were included. They were stratified based on the practice change in a before (group 1) and an after (group 2) cohort. The diagnosis was confirmed on radiographs. Exclusion criteria were high energy or open fractures, neurovascular compromise, previous fracture on the same side, other fractures, and patients relying on a walking aid in the injured hand or rejected use of data for quality assessment. Data were managed in Redcap according to a predefined protocol. Rates of complications and secondary surgeries within one year were compared between groups using Pearson’s Chi squared test.
Results: 689 patients were screened, 213 were included for analysis. Group 1 included 98 patients with a median age of 72 years (range 60-96), 88% female. Group 2 included 115 patients, with a median age of 76 years (range 60-93), 94% female. Surgical treatment was received by 78% in group 1 and 11% in group 2. In group 1, 12% (12 of 98) had at least one complication compared to 13% (15 of 115) in group 2 (p=0.9). In group 1, 4% (4 of 98) had secondary surgery within one year, compared to 6% (7 of 115) in group 2 (p=0.5). Carpal tunnel syndrome was the predominant indication in both groups.
Interpretation / Conclusion: We found no statistically significant difference in rates of complications and secondary surgery within one year of treatment before and after the practice change favoring non-surgical treatment in elderly patients with a DDDRF.