To Örebro University

Finger fractures are among the most common fractures of the upper limb. The number and cost of maltreated and misdiagnosed finger fractures in Sweden is unknown. The aim was to study the number, complications, causes, and cost of maltreated and misdiagnosed finger fractures, 2011-2021, in Sweden.

Claims matching the prespecified ICD-10-SE codes S62.6-7 (finger fractures) and T92.2 (sequelae after finger fracture) during the 2011-2021 timeframe were identified. The data were extracted from the Swedish National Patient Insurance Company Register and analyzed in terms of epidemiology and cost.

Of the 1621 assessed cases, 384 reported maltreated and misdiagnosed finger fractures were found. The mean age was 41 years (range 2-88). Thirty-one percent of the healthcare-related injuries occurred in emergency care, primarily due to maltreatment leading to malunion after non-operative treatment. Thirty-six percent of healthcare-related injuries occurred in specialist departments, mostly due to malunion after surgical intervention. In primary care, the leading cause was misdiagnosis, often due to inadequate examination and lack of X-ray examination. The total aggregated direct and indirect costs amounted to SEK 25 557 200 (USD 2 505 608, Euro 2 165 864, Yen 424 249 520).

CONCLUSION: Finger fractures affect people of all ages and can lead to significant socioeconomic and medical invalidity. Maltreated fractures mainly occur in emergency care (due to malunion after immobilization) and specialist care (due to malunion after surgery). Misdiagnosed fractures were more common in primary care. A suggestion for claims prevention would be improved physician education, updated guidelines regarding the use of X-rays, seeking specialist opinions in uncertain cases, evaluating surgical technique, and optimizing postoperative care could probably help reduce the number of these injuries.

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.

Introduction: Total wrist arthroplasty (TWA) is a motion-preserving treatment option for wrist arthritis. High-precision measurement methods for implant migration such as computed tomography motion-analysis (CTMA) can potentially detect poor implant fixation. The aim of this pilot study was to assess CTMA as a complementary method to diagnose aseptic loosening of TWA.

Materials and Methods: Three patients with a TWA and wrist pain during activity underwent induced displacement CT (CTMA) with alternated provocations as a complement to plain radiographs.

Results: Two of the three patients had displacement of the carpal component on CTMA. The radial component was stable in all cases. The tool was adapted to clinical routine use.

Conclusions: CT motion-analysis could be a valuable adjunct to plain radiographs in assessing component loosening in TWA.

This study aimed to investigate epidemiology, injury characteristics, treatment, mortality and patient-reported outcome measures in patients with a distal radial fracture and Parkinson's disease. The patient population was obtained from the Swedish Fracture Register, and patients with Parkinson's disease were identified by data from the National Board of Health and Welfare. A total of 3179 cases were identified and matched with controls. Most fractures took place in the patient's home after a simple fall and were managed non-operatively. An anterior locking plate was the most common surgical intervention. The 1 year mortality was significantly higher among men with Parkinson's disease than in controls. Patient-reported outcome measures at the 1 year follow-up deteriorated significantly more for patients with Parkinson's disease than in controls, and patients with Parkinson's disease also experienced more problems with reoperations, pain, mobility and carrying out their usual activities. Level of evidence: III.

PURPOSE: Arthroscopy remains the gold standard to diagnose ligamentous lesions in the wrist. The coronavirus disease (COVID)-19 pandemic put a strain on resources, prompting an increase in procedures performed under local anesthesia. Dry needle arthroscopy of the wrist has previously been used in the operating room. The purpose of this study was to assess the results and patient satisfaction of wrist arthroscopy under local anesthesia in an office setting.

METHODS: A prospective series of 15 patients presenting with wrist trauma and a suspected ligamentous injury to the wrist were included. All patients underwent radiography and magnetic resonance imaging (MRI) before the procedure. Dry needle arthroscopy was performed by a surgeon with a nurse assistant, in the office under local anesthesia, using a traction device for distraction of the wrist. Patient satisfaction was assessed with the Picker Patient Experience-15 (PPE-15) questionnaire.

RESULTS: The patient's mean age was 34 years (range: 18-51). There were no intraoperative complications or postoperative infections. The median PPE-15 score was 90 of 100. Visualization of the intraarticular structures was excellent.

CONCLUSIONS: Dry needle arthroscopy of the wrist under local anesthesia in an office setting seems to be a feasible method to diagnose ligament injuries of the wrist. Patient satisfaction with the procedure was high.

CLINICAL RELEVANCE: Dry needle arthroscopy of the wrist under local anesthesia in-office could facilitate and expedite diagnosis of wrist injuries.

Salvage radiocarpal arthrodesis is an option in the treatment of failed wrist arthroplasty. If bony union is achieved the results can be comparable to primary wrist arthrodesis. Substantial bone loss and decreased vascularity of the bone may be an issue in some cases. The present case report describes the case of a 58-yearold man with posttraumatic wrist arthritis after an intraarticular distal radius fracture. He was treated with a wrist hemiarthroplasty which ultimately failed and was converted to a radiocarpal arthrodesis. After two failed arthrodeses with bone grafting and a dorsal locking plate, we performed a free vascularized fibula transfer which resulted in bony union and a pain-free wrist. Free vascularized fibula transfer may be a salvage option in select cases of failed radiocarpal arthrodesis.

BACKGROUND: Distal radius fractures (DRFs) are among the most common orthopedic injuries requiring surgical intervention. Understanding whether single- or dual-surgeon setting correlates to operation time, radiological results, or complication rates is essential for optimizing resource allocation and training strategies in clinical settings.

METHODS: All DRFs treated operatively with volar plate fixation in 2023 were included in the study. Data were collected on the number of surgeons involved in each procedure and their respective levels of experience. These variables were analyzed in relation to operative time, radiological outcomes, postoperative complications, and AO classification.

RESULTS: The study cohort included 163 operatively-treated DRFs with a mean follow-up of 15 months (range: 9-20). The most common fracture types were AO types A (n = 80, 49%) and C (n = 80, 49%). Of all procedures, 45% (n = 73) were performed by a single surgeon, while 55% (n = 90) involved two surgeons. Operative time was significantly shorter when surgeries were performed by a single surgeon. Radiological outcomes and complication rates did not differ significantly based on the number of surgeons involved, irrespective of their experience level. When less experienced surgeons were excluded and only more complex fractures were analyzed, the trend toward shorter operative time with a single surgeon persisted, though the difference did not reach statistical significance.

CONCLUSIONS: The involvement of two surgeons does not necessarily correlate to operative time in the treatment of DRFs. Furthermore, radiological outcomes and complication rates appear unaffected by the number of surgeons. These findings may support more efficient allocation of surgical resources in hospital settings. The impact and importance of teaching and training in this context warrants further investigation.

This study aimed to investigate the association of socioeconomic factors, country of birth and comorbidities with poor patient-reported outcome 1 year after a distal radial fracture. The patient population was obtained from the Swedish Fracture Register. In the study, 17,468 patients 18 years or older were included. Poor outcome was the dependent variable in a multivariate logistic regression analysis. The factors with the strongest association with poor outcome were country of birth outside the European Union (odds ratio (OR) = 2.28; 95% CI = 1.91-2.73), high-energy trauma mechanism (OR = 1.76; 95% CI = 1.46-2.12), a history of anxiety or depression (OR = 1.46; 95% CI = 1.26-1.70), and a Charlson comorbidity index ≥3 (OR = 1.51; 95% CI = 1.17-1.94). Alleviating the effects of these factors could potentially decrease the proportion of patients with a disability after a distal radial fracture.Level of evidence: III.

BACKGROUND: In distal radius fracture (DRF) surgery with volar locking plates, the flexor carpi radialis approach is commonly used. However, the volar central approach (VCA), between the median nerve and the finger flexors, may improve visualization of the volar ulnar corner. A similar approach has been linked with a higher risk of iatrogenic median neuropathy. This study evaluated the risk of median neuropathy after operative treatment using the VCA.

METHODS: Thirty-eight patients with Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C DRF were assessed prospectively with sensory nerve conduction studies preoperatively and at 6 weeks, 3 months, and 12 months postoperatively.

RESULTS: At 6 weeks, 30 of the 38 patients exhibited median neuropathy, decreasing to 12 of the 35 at 12 months. Subjective sensory deficit was reported by 12 of the 38 patients at 6 weeks and 8 of the 37 at 12 months. Patients with median neuropathy (MN) had significantly higher frequency of subjective sensory deficit of the median nerve 12 months postoperatively, but did not have significantly worse patient-reported outcome.

CONCLUSIONS: Our results suggest that the VCA should be reserved for cases needing optimal exposure of the volar ulnar corner.

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.