BackgroundUpper extremity injuries account for a large proportion of attendances to the Emergency Department. The aim of this study was to assess population-based trends in the incidence of upper extremity injuries in the Dutch population between 1986 and 2008, and to give a detailed overview of the associated health care costs.MethodsAge-standardized incidence rates of upper extremity injuries were calculated for each year between 1986 and 2008. The average number of people in each of the 5-year age classes for each year of the study was calculated and used as the standard (reference) population. Injury cases were extracted from the National Injury Surveillance System (non-hospitalized patients) and the National Medical Registration (hospitalized patients). An incidence-based cost model was applied in order to estimate associated direct health care costs in 2007.ResultsThe overall age-adjusted incidence of upper extremity injuries increased from 970 to 1,098 per 100,000 persons (13%). The highest incidence was seen in young persons and elderly women. Total annual costs for all injuries were 290 million euro, of which 190 million euro were paid for injuries sustained by women. Wrist fractures were the most expensive injuries (83 million euro) due to high incidence, whereas upper arm fractures were the most expensive injuries per case (4,440 euro). Major cost peaks were observed for fractures in elderly women due to high incidence and costs per patient.ConclusionsThe overall incidence of upper extremity injury in the Netherlands increased by 13% in the period 1986–2008. Females with upper extremity fractures and especially elderly women with wrist fractures accounted for a substantial share of total costs.

NTR 2025.

Background After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM. Questions/purposes We asked: (1) In complex elbow fracture-dislocations, does treatment with a hinged external fixator result in reduction of disability and pain, and in improvement in ROM, function, and quality of life? (2) Does delayed treatment (7 days or later) have a negative effect on ROM after 1 year? (3) What are the complications seen after external fixator treatment?Methods During a 2-year period, 11 centers recruited 27 patients 18 years or older who were included and evaluated at 2 and 6 weeks and at 3, 6, and 12 months after surgery as part of this prospective case series. During the study period, the participating centers agreed on general indications for use of the hinged external fixator, which included persistent instability after closed reduction alone or closed reduction combined with surgical treatment of associated fracture(s), when indicated. Functional outcome was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH; primary outcome) score, the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score, and the level of pain (VAS). ROM, adverse events, secondary interventions, and radiographs also were evaluated. A total of 26 of the 27 patients (96%) were available for followup at 1 year.The institution of one or more of the authors (GITI, DDH, EMMVL, PP, MHJV) has received, during the study period, funding from the Osteosynthesis and Trauma Care ( Results All functional and pain scores improved. The median QuickDASH score decreased from 30 (25 th -75 th percentiles [P 25 -P 75 ], 23-40) at 6 weeks to 7 (P 25 -P 75 , 2-12) at 1 year with a median difference of À25 (p \ 0.001). The median MEPI score increased from 80 (P 25 -P 75 , 64-85) at 6 weeks to 100 (P 25 -P 75 , 85-100) at 1 year with a median difference of 15 (p \ 0.001). The median Oxford Elbow Score increased from 60 (P 25 -P 75 , 44-68) at 6 weeks to 90 (P 25 -P 75 , 73-96) at 1 year with a median difference of 29 (p \ 0.001). The median VAS decreased from 2.8 (P 25 -P 75 , 1.0-5.0) at 2 weeks to 0.5 (P 25 -P 75 , 0.0-1.9) at 1 year with a median difference of À2.1 (p = 0.001). ROM also improved. The median flexionextension arc improved from 50°(P 25 -P 75 , 33°-80°) at 2 weeks to 118°(P 25 -P 75 , 105°-138°) at 1 year with a median difference of 63°(p \ 0.001). Similarly, the median pronation-supination arc improved from 90°(P 25 -P 75 , 63°-124°) to 160°(P 25 -P 75 , 138°-170°) with a median difference of 75°(p \ 0.001). At 1 year, the median residual deficit compared with the uninjured side was 30°( P 25 -P 75 , 5°-35°) for the flexion-extension arc, and 3°( P 25 -P 75 , 0°-25°) for the pronation-supination arc. Ten patients (37%) experienced a fixa...

Study designValidation study using data from a multicenter, randomized, clinical trial (RCT).ObjectivesTo evaluate the reliability, validity, responsiveness, and minimal important change (MIC) of the Dutch version of the Oxford Elbow Score (OES) and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) in patients with a simple elbow dislocation.BackgroundPatient-reported outcome measures are increasingly important for assessing outcome following elbow injuries, both in daily practice and in clinical research. However measurement properties of the OES and Quick-DASH in these patients are not fully known.MethodsOES and Quick-DASH were completed four times until one year after trauma. Mayo Elbow Performance Index, pain (VAS), Short Form-36, and EuroQol-5D were completed for comparison. Data of a multicenter RCT (n = 100) were used. Internal consistency was determined using Cronbach’s alpha. Construct and longitudinal validity were assessed by determining hypothesized strength of correlation between scores or changes in scores, respectively, of (sub)scales. Finally, floor and ceiling effects, MIC, and smallest detectable change (SDC) were determined.ResultsOES and Quick-DASH demonstrated adequate internal consistency (Cronbach α, 0.882 and 0.886, respectively). Construct validity and longitudinal validity of both scales were supported by >75% correctly hypothesized correlations. MIC and SDC were 8.2 and 12.0 point for OES, respectively. For Quick-DASH, these values were 11.7 and 25.0, respectively.ConclusionsOES and Quick-DASH are reliable, valid, and responsive instruments for evaluating elbow-related quality of life. The anchor-based MIC was 8.2 points for OES and 11.7 for Quick-DASH.

The Hertel and Neer classifications showed a fair to substantial inter- and intra-observer agreement on the three diagnostic modalities used. Although inter-observer agreement was highest for Hertel classification on CT-scans, Neer classification had the highest intra-observer agreement on 3D-reconstructions. Data of this study do not confirm superiority of either classification system for the classification of comminuted proximal humeral fractures.