The Impact of Obesity and Smoking on Outcomes After Volar Plate Fixation of Distal Radius Fractures

Hall, Matthew J.; Ostergaard, Peter J.; Dowlatshahi, Arriyan S.; Harper, Carl M.; Earp, Brandon E.; Rozental, Tamara D.

doi:10.1016/j.jhsa.2019.08.017

Cited by 29 publications

(21 citation statements)

References 85 publications

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“…Another patient factor previously evaluated in the literature is obesity. Interestingly, Hall and colleagues 17 noted that although obese patients may have slightly higher Quick DASH scores, the difference between patient groups was not enough to meet MCID. Similarly, we found that BMI did not appear to be a recovery factor.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 13 , 14 In the case of Quick DASH, a commonly used value is 14. 13 Although several prior investigations identified patient and surgical factors that affect Quick DASH scores after DRF fixation, 10 , 15 , 16 , 17 , 18 , 19 there are limited data on the timing of when patients achieve a change reflective of the MCID. Furthermore, there is a paucity of literature using the MCID to evaluate the level of functional recovery for patients after surgical fixation of DRFs.…”

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confidence: 99%

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Using the QuickDASH to Model Clinical Recovery Trajectory After Operative Management of Distal Radius Fracture

Ingall

Bernstein

Shoji

et al. 2021

Journal of Hand Surgery Global Online

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Purpose: There is a paucity of literature examining the trajectory of meaningful clinical improvement after distal radius fracture (DRF) fixation. We sought to answer the following questions: (1) When do patients meet the minimum clinically important difference (MCID) in the QuickeDisabilities in Arm, Shoulder, and Hand questionnaire (QuickDASH) score change after DRF fixation? (2) What gains in terms of number of MCIDs achieved (as measured by QuickDASH) do patients make as they recover from DRF fixation? (3) What patient and injury factors are characteristic of patients who meet or do not meet the average recovery trajectory? Methods: We performed a retrospective review of an institutional database of DRF patients treated with operative fixation. The change in QuickDASH scores from before surgery to approximate follow-up intervals of 0 to 2 months, 3 to 6 months, and a minimum of 9 of 12 months was assessed, in which a delta of 14 reflected the MCID. The change in QuickDASH score from before surgery to each follow-up interval was divided by 14 to determine the number of MCIDs, representing appreciable clinical improvement. Patient characteristics were compared between those who did and did not reach average levels of clinical improvement. Results: The study included 173 patients. Mean QuickDASH score before surgery was 74 (SD, 19; range, 0 e100). After surgery, this improved to 50 (SD, 24; range, 0e100) by 0 to 2 months, 22 (SD, 22; range, 0 e98) by 3 to 6 months, and 9.8 (SD, 15; range, 0e75) by a minimum of 9 to 12 months. Overall, 96% of patients reached the MCID by 1 year. Mean cumulative number of MCIDs achieved (ie, number of 14point decreases in QuickDASH score) at each interval was 1.57, 3.64, and 4.43, respectively. Assuming 4.43 represents maximum average improvement at 1 year, patients achieved 35% (1.57 of 4.43) of recovery from 0 to 2 months after surgery and 82% (3.64 of 4.43) of recovery by 3 to 6 months after surgery. There appeared to be no difference in terms of age, sex, or body mass index with respect to these findings. Conclusions: Overall, 96% of patients undergoing DRF fixation will achieve one QuickDASH MCID by 1 year after surgery. Patients achieved over 80% of total expected functional improvement by 3 to 6 months after surgery, which appeared to be irrespective of age, sex, or body mass index. Type of study/level of evidence: Therapeutic IV.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Using the QuickDASH to Model Clinical Recovery Trajectory After Operative Management of Distal Radius Fracture

Ingall

Bernstein

Shoji

et al. 2021

Journal of Hand Surgery Global Online

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“…Obesity has been associated with nonunion for the humerus, femur and tibia in a number of studies [10] . In studies of distal radial fractures [30] and ankle fractures [31] it was not associated with an increased risk of nonunion. In a large database study of over 309,0 0 0 fracture patients, obesity was a risk factor for nonunion with an odds ratio of 1.19, so the effect would seem to be modest [2] .…”

Section: General Factorsmentioning

confidence: 79%

Fracture nonunion in long bones: A literature review of risk factors and surgical management

Nicholson

Makaram

Simpson³

et al. 2021

Injury

154

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Nonunion following a long bone fracture causes considerable morbidity when it occurs. Risk factors depend on specific fractures but there is a complex interplay of injury severity, comorbidities, patient medication and infection. The majority of nonunions occur after long bone fractures with the tibia, femur, forearm, humerus and clavicle predominating. Despite interest in the biological augmentation of fracture healing, the majority of nonunions can be effectively managed with conventional surgical techniques. In this review we present a review of risk factors for nonunion and the outcome following surgical management.

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“…There are many risk factors for bone nonunion, such as age, smoking, type II diabetes, energy of injury,severity of soft tissue injury,infection of internal xators, the degree of mechanical stability, the inherent degree of vascularization around fracture and numerous medications (14,15).Some studies have shown that the incidence of nonunion is higher in young people, but high-energy injuries usually occur in young patients (16,17).In this study, 9 patients with humeral shaft nonunion and 10 patients with femoral shaft nonunion. These two fracture sites are usually caused by high-energy injury.…”

Section: Discussionmentioning

confidence: 99%

A novel bone graft technique combined with plating for aseptic recalcitrant long bone nonunion

Jiang

Wang

Huang

et al. 2022

Preprint

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BackgroundFracture nonunion sometimes occurs after treatment, and some patients are still difficult to heal after many times of treatment. In order to more effectively treat nonunion and heal patients with recalcitrant nonunion, a new technique for autogenous iliac crest bone grafting combined with locking compression plate(LCP) vertical fixation is presented.This study retrospectively analyzed the data of patients with recalcitrant long bone nonunion treated in our hospital to investigate the effect of this technique .MethodsFrom July 2010 to September 2020,34 patients with recalcitrant long bone nonunion underwent surgical treatment and completed follow-up at Xi’an Hong Hui Hospital.Follow-up was for at least 12 months after intervention.The injury mechanism,nonunion type,the duration of nonunion,prior treatments and the outcomes following surgery were recorded for all patients.ResultsThis study enrolled 34 patients(24 males and 10 females), with a mean age of 49.8 ± 12.3years. There were 3 patients with ulnar nonunion,1 patients with ulna and radius nonunion,9 patients with humeral shaft nonunion,1 patient with proximal humerus,2 patient with supracondylar humeru nonunion,10 patient with femoral shaft nonunion, 1 patient with supracondylar femoral nonunion,1 patient with tibiofibular nonunion,5 patient with tibia nonunion and 1 patient with clavicular nonunion.All patients received more than one regular treatment.32 patients union after 6.8 ± 2.4 months, and 2 patients had still nonunion with implants intact.ConclusionBone-forming channel technique combined with LCP vertical fixation is an excellent option for the treatment of recalcitrant long bone nonunion.Level of evidenceTherapeutic Level IV.

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The Impact of Obesity and Smoking on Outcomes After Volar Plate Fixation of Distal Radius Fractures

Cited by 29 publications

References 85 publications

Using the QuickDASH to Model Clinical Recovery Trajectory After Operative Management of Distal Radius Fracture

Using the QuickDASH to Model Clinical Recovery Trajectory After Operative Management of Distal Radius Fracture

Fracture nonunion in long bones: A literature review of risk factors and surgical management

A novel bone graft technique combined with plating for aseptic recalcitrant long bone nonunion

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