Driving with an Arm Immobilized in a Splint: A Randomized Higher-Order Crossover Trial

Chong, Paul Y.; Koehler, Elizabeth; Shyr, Yu; Watson, Jeffry T.; Weikert, Douglas R.; Rowland, Justin H.; Lee, Donald H.

doi:10.2106/jbjs.i.01170

Cited by 35 publications

(54 citation statements)

References 10 publications

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“…Tests of braking function are not applicable with upper extremity surgeries. Healthy patients driving on courses indicated that it is unsafe for patients with most forms of upper extremity immobilization to drive [6,7,20,21]. A driving simulator that includes avoiding obstacles could be a better method of evaluating driving ability than an isolated evaluation of braking function, as there is more to driving and avoiding accidents than accounting for the time it takes to press the brake pedal.…”

Section: Discussionmentioning

confidence: 99%

“…Two of these articles discussed procedures that were not on our original list, one was not indexed in either database, one did not have driving as a primary focus, and the remaining six articles discussed driving with limb immobilization. Thirty-four articles had data relevant to our study Question 1 [1, 4, 5, 9, 10, 12, 13, 15, 19, 22, 23, 26-30, 34, 36, 37, 39, 41, 42, 45-50, 53, 55, 57, 60, 63, 64], eight had data relevant to Question 2 [2,6,7,17,20,21,43,46], and seven had data relevant to Question 3 [3,31,32,35,54,58,59] (Table 1). The range of MINORS scores for comparative studies was 17 to 24, and the range for noncomparative studies was 11 to 15.…”

Section: Study Selectionmentioning

confidence: 99%

“…Brake force was reported in four articles [30,39,60,64]. Upper extremity immobilization studies used driving abilities score, simulators, and standardized tracks [6,7,20,21]. The driving score reflected specific activities of driving such as steering and signaling [6].…”

Section: Study Design and Populationsmentioning

confidence: 99%

“…Driving simulators and standardized tracks showed that driving ability is impaired when patients wear a right or left scaphoid and Bennett's cast, above-or below-elbow immobilization, or a shoulder sling on the dominant arm [6,7,20,21] (Table 4). No articles that evaluated observerreported outcome measures after upper extremity surgery matched our search criteria.…”

Section: Observer-reported Outcome Measuresmentioning

confidence: 99%

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When Can I Drive After Orthopaedic Surgery? A Systematic Review

DiSilvestro

Santoro

Tjoumakaris

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patients often ask their doctors when they can safely return to driving after orthopaedic injuries and procedures, but the data regarding this topic are diverse and sometimes conflicting. Some studies provide observer-reported outcome measures, such as brake response time or simulators, to estimate when patients can safely resume driving after surgery, and patient survey data describing when patients report a return to driving, but they do not all agree. We performed a systematic review and quality appraisal for available data regarding when patients are safe to resume driving after common orthopaedic surgeries and injuries affecting the ability to drive.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Design and Populationsmentioning

confidence: 99%

Section: Observer-reported Outcome Measuresmentioning

confidence: 99%

See 2 more Smart Citations

When Can I Drive After Orthopaedic Surgery? A Systematic Review

DiSilvestro

Santoro

Tjoumakaris

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…11,103 The risks of immobilization are difficult to quantify, but can include difficulty performing fine hand tasks, diminished driving performance, decreased ability to perform work-related tasks, and pain or pruritis discomfort requiring splint removal. 104,105 The risk of splint-related complications requiring further management was estimated at 6.7% in one recent meta-analysis. 105 In nondisplaced fractures, multiple systematic reviews demonstrate no advantage to operative management or splints in reducing nonunion rates or patient discomfort.…”

Section: Test-treatment Thresholdmentioning

confidence: 99%

Adult Scaphoid Fracture

Carpenter

Pines

Schuur

et al. 2014

Academic Emergency Medicine

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ObjectivesScaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x‐rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial‐sided tenderness on physical examination. This study was a meta‐analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x‐ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge.MethodsA medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED and EMBASE. The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings. All abstracts were independently reviewed by the two physicians, and Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS‐2) was used to assess individual study quality. When two or more qualitatively similar studies were identified, meta‐analysis was conducted using Meta‐DiSc software. Primary outcomes were sensitivity, specificity, and likelihood ratios (LRs) for predictors of scaphoid fracture detected on follow‐up in patients with normal ED x‐rays.ResultsA total of 957 unique citations were identified, yielding 75 studies eligible for inclusion in this systematic review. Studies were significantly heterogeneous in design, study population, and criterion standard. The majority of studies were conducted in non‐ED settings (e.g., orthopedic clinics). No studies used accepted diagnostic research publishing guidelines, and the overall QUADAS‐2 methodologic quality was low, indicating an increased risk of bias in the estimates of diagnostic accuracy. The prevalence of scaphoid fractures ranged from 12% to 57% with the point estimate of 25% pretest probability for adult ED patients with concern for scaphoid injuries, nondiagnostic index x‐rays, and scaphoid fractures on later imaging studies. Except for the absence of snuffbox tenderness (LR– = 0.15), physical examination findings lack accuracy to rule in or rule out scaphoid fractures, and no validated clinical decision rules exist. In patients with persistent concern for injury, magnetic resonance imaging (MRI) is superior to bone scan, computed tomography (CT), or ultrasound (US) to both rule in and rule out scaphoid fractures. Both MRI and CT share the added benefit of identifying alternative etiologies for posttraumatic wrist pain.ConclusionsExcept for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x‐rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.

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Occult Scaphoid Fractures

Raja

2023

Evidence‐Based Emergency Care

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Driving with an Arm Immobilized in a Splint: A Randomized Higher-Order Crossover Trial

Abstract: Driving performance as measured with a standardized track and scoring system was significantly degraded with splint immobilization of the left arm. Further studies are required to determine the effect of arm immobilization on normal driving conditions.

Cited by 35 publications

References 10 publications

When Can I Drive After Orthopaedic Surgery? A Systematic Review

When Can I Drive After Orthopaedic Surgery? A Systematic Review

Adult Scaphoid Fracture

Occult Scaphoid Fractures

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