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Showing items related by title, author, creator and subject.
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Predicting the Behaviour of Humeral Shaft Fractures: An Independent Validation Study of the Radiographic Union Score for HUmeral Fractures (RUSHU) and Value of Assessing Fracture MobilityObjectives: To externally validate the Radiographic Union Score for Humeral fractures (RUSHU) and to quantify the predictive relationship of fracture motion on physical examination to non-union. Design: Retrospective cohort study. Setting: Single institutional centre (University teaching hospital). Patients: 92 consecutive patients undergoing non-operative treatment of a diaphyseal humeral shaft fracture were identified over a 4-year period. The average age of the population was 62 years and 42% of the cohort was male. Intervention: Clinical examination for fracture stability was routinely performed on patients by the treating physicians. Radiographic assessment of fracture callus (RUSHU score) at 6-weeks was retrospectively determined. Patients were followed up until union. Main outcome measurements: Stability was graded as motion at the fracture site or the humerus moving as a single functional unit. Results: Fractures with RUSHU score ≤7 were 14 times more likely to proceed to non-union at 6-months (78% sensitivity, 80% specificity). The time to union was 49 weeks for a RUSHU score of ≤7 versus 16 weeks for a RUSHU score of ≥8. The number of operations needed to avoid one non-union was 1.7. Fractures mobile at 6-weeks were 6.5 times more likely to proceed to non-union at 6-months (77% specificity, 67% sensitivity). Mobile fractures had a longer time to union (41 weeks) than non-mobile fractures (17 weeks). Conclusion: The RUSHU score and clinical assessment of fracture mobility are effective and valid tools in identifying patients at risk of developing non-union of humeral shaft fractures and can enhance early decision making in fracture management.
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Assessing the risk of re-fracture related to the percentage of partial union in scaphoid waist fracturesAbstract Aims: There is ambiguity surrounding the degree of scaphoid union required to safely allow mobilization following scaphoid waist fracture. Premature mobilization could lead to refracture, but late mobilization may cause stiffness and delay return to normal function. This study aims to explore the risk of refracture at different stages of scaphoid waist fracture union in three common fracture patterns, using a novel finite element method. Methods: The most common anatomical variant of the scaphoid was modelled from a CT scan of a healthy hand and wrist using 3D Slicer freeware. This model was uploaded into COMSOL Multiphysics software to enable the application of physiological enhancements. Three common waist fracture patterns were produced following the Russe classification. Each fracture had differing stages of healing, ranging from 10% to 90% partial union, with increments of 10% union assessed. A physiological force of 100 N acting on the distal pole was applied, with the risk of refracture assessed using the Von Mises stress. Results: Overall, 90% to 30% fracture unions demonstrated a small, gradual increase in the Von Mises stress of all fracture patterns (16.0 MPa to 240.5 MPa). All fracture patterns showed a greater increase in Von Mises stress from 30% to 10% partial union (680.8 MPa to 6,288.6 MPa). Conclusion: Previous studies have suggested 25%, 50%, and 75% partial union as sufficient for resuming hand and wrist mobilization. This study shows that 30% union is sufficient to return to normal hand and wrist function in all three fracture patterns. Both 50% and 75% union are unnecessary and increase the risk of post-fracture stiffness. This study has also demonstrated the feasibility of finite element analysis (FEA) in scaphoid waist fracture research. FEA is a sustainable method which does not require the use of finite scaphoid cadavers, hence increasing accessibility into future scaphoid waist fracture-related research.
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Prediction of 30-day mortality after hip fracture surgery by the Nottingham Hip Fracture Score and the Surgical Outcome Risk ToolThe care of the elderly with hip fractures and their outcomes might be improved with resources targeted by the accurate calculation of risks of mortality and morbidity. We used a multicentre national dataset to evaluate and recalibrate the Nottingham Hip Fracture Score and Surgical Outcome Risk Tool. We split 9,017 hip fracture cases from the Anaesthesia Sprint Audit of Practice into derivation and validation data sets and used logistic regression to derive new model co-efficients for death at 30 postoperative days. The area (95% CI) under the receiver operator characteristic curve of 0.71 (0.67-0.75) indicated acceptable discrimination by the Nottingham Hip Fracture Score and acceptable calibration fit (Hosmer-Lemeshow test), p = 0.23, with a similar discrimination by the Surgical Outcome Risk Tool, 0.70 (0.66-0.74), which was miscalibrated to the observed data, p = 0.001. We recommend that studies test these scores for patients with hip fractures in other countries. We also recommend these models are compared with case-mix adjustment tools used in the UK. Copyright © 2016 The Association of Anaesthetists of Great Britain and Ireland.