To Örebro University

INTRODUCTION: Distal radial fractures are the most common fractures in adults. Maltreatment of distal radial fractures can result in pain and disability. The most common complications and maltreatment after distal radial fractures are malunion, tendon injury, infection and nerve injury. The Swedish Patient Insurance Company (LÖF) indemnifies approximately 90% of all healthcare providers in Sweden. The aim of this study was to assess maltreated distal radius fractures using data from the LÖF-register in combination with data from the Swedish Fracture Register.

METHOD: All insurance claims relating to patient-reported maltreatment of distal radial fractures in adults in Sweden, as well as data from the Swedish Fracture Register regarding fracture type and patient-reported outcome measures during the period 2011-2021 were analysed.

RESULTS: Of the total of 1393 claims relating to distal radial fractures during the study period, the frequency of reported maltreatment claims was 1.4%. Eighty-two per cent of the claimants were female and the median age was 60 years. Malunion was the most common overall complication, carpal tunnel syndrome was the most common nerve-related complication and extensor pollicis longus tendon rupture following anterior plating was the most common tendon-related complication. Sixty-four per cent of the claims were accepted and reimbursed. The total direct cost for maltreated distal radial fractures was €4,980,000.

CONCLUSION: Reducing the number of symptomatic malunions, ensuring correct anterior plate placement and identifying other critical steps in treatment would likely improve patient safety and decrease the additional financial burden for the society.

LEVEL OF EVIDENCE: IV.

Arthroscopy has evolved significantly with advancements in instrumentation and surgical techniques. The introduction of needle arthroscopy represents a promising minimally invasive alternative and, has for the wrist proven to offer a reduced soft tissue trauma with still maintained diagnostic and therapeutic efficacy. The purpose of this study was to evaluate the safety and visualization capabilities of needle arthroscopy of the elbow using cadaveric specimens. Six fresh-frozen cadaveric elbows (three right, three left) were examined using a needle arthroscope, followed by dissection to assess portal safety and proximity to neurovascular structures. The arthroscopic portals evaluated included the proximal anteromedial (PAMP), anteromedial (AMP), mid-anterolateral (MALP), postero-lateral (PLP), direct lateral, and direct posterior portals. The visualization quality of the needle arthroscope was found satisfactory and the smaller diameter (1.9 mm), allowed enhanced maneuverability. Needle arthroscopy offers improved access and acceptable visualization, potential risks remain, particularly concerning neurovascular structures. Notably, the anteromedial portal was in close proximity to the median nerve and medial antebrachial cutaneous nerve (MABCN), with one documented case of PBMACN (Posterior Branch of the MA-BCN)injury. Our results support the use of the needle arthroscope for elbow arthroscopy. However, caution is required to minimize neurovascular injury. Further studies are needed to establish standardized protocols and confirm the long-term safety and efficacy of needle arthroscopy in clinical practice.

PURPOSE: The purpose of this study was to compare the clinical and radiographic outcomes 5 years after randomization to volar plating or combined plating for surgical treatment of an AO (Arbeitsgemeinschaft für Osteosynthesefragen) type C distal radius fracture (DRF).

METHODS: A total of 150 patients were previously randomized to a volar locking plate or combined plating for treatment of an AO type C DRF with strict inclusion and exclusion criteria. All participating patients were invited for a 5-year postoperative follow-up. Radiographs, pain (visual analog scale), grip strength, and range of motion were documented, along with the Patient-Rated Wrist Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, and EuroQol 5-Dimension questionnaires. Arthritis in the radiocarpal and distal radioulnar joint was graded on radiographs by a senior radiologist according to the Knirk and Jupiter classification.

RESULTS: There were 135 patients (66 in the volar plate group and 69 in the combined plating group), corresponding to a 90% follow-up rate. Median age at follow-up was 67 years (interquartile range 57-75). There was no difference in radiographic arthritis between the two groups. The volar plate group had significantly better outcomes in flexion, extension, radial deviation, and Patient-Rated Wrist Evaluation (P < .05). There were no significant between-group differences in the Quick Disabilities of the Arm, Shoulder, and Hand, EuroQol 5-Dimension index, or EuroQol Visual Analog Scale (P > 05). Hardware removal was significantly more common in the combined plating group (64%) than in the volar plate group (30%) (P < .001).

CONCLUSIONS: Among surgically treated patients with AO type C DRF, those operated with volar plating had better clinical outcomes 5 years after surgery compared to those treated with combined plating, but the minimal clinically important difference was not reached. These findings support volar plating as the preferred method for AO type C DRFs.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Poland Anomaly (PA) represents pectoral muscle hypoplasia in combination with various forms of hand anomalies. We report a case of PA with pectoral hypoplasia, an upper limb deficiency and an accessory extremity/digit on the ipsilateral thoracic wall (thoracomelia). To our knowledge, this is the first reported case of thoracomelia in PA.