Distal radial fractures are extremely common injuries, yet many basic questions remain unanswered about their optimum management. Recently in the United Kingdom several guideline development groups ...have produced national standards and best-practice guidelines based on review of the best available evidence and expert knowledge. All guideline groups agree that when surgery is needed for dorsally displaced distal radial fractures, that can be reduced closed, K-wire fixation and cast immobilization, should be offered. Further research questions have been identified. The important findings and recommendations are summarized in this article.
Solid-state quantum emitters, such as artificially engineered quantum dots or naturally occurring defects in solids, are being investigated for applications ranging from quantum information science ...and optoelectronics to biomedical imaging. Recently, these same systems have also been studied from the perspective of nanoscale metrology. In this letter, we study the near-field optical properties of a diamond nanocrystal hosting a single nitrogen vacancy center. We find that the nitrogen vacancy center is a sensitive probe of the surrounding electromagnetic mode structure. We exploit this sensitivity to demonstrate nanoscale fluorescence lifetime imaging microscopy (FLIM) with a single nitrogen vacancy center by imaging the local density of states of an optical antenna.
The effect of observational constraint on the ranges of
uncertain physical and chemical process parameters was explored in a global
aerosol–climate model. The study uses 1 million variants of the ...Hadley Centre General Environment Model version 3
(HadGEM3) that sample 26 sources of uncertainty, together with over 9000
monthly aggregated grid-box measurements of aerosol optical depth, PM2.5,
particle number concentrations, sulfate and organic mass concentrations.
Despite many compensating effects in the model, the procedure constrains the
probability distributions of parameters related to secondary organic
aerosol, anthropogenic SO2 emissions, residential emissions, sea spray
emissions, dry deposition rates of SO2 and aerosols, new particle
formation, cloud droplet pH and the diameter of primary combustion
particles. Observational constraint rules out nearly 98 % of the model
variants. On constraint, the ±1σ (standard deviation) range
of global annual mean direct radiative forcing (RFari) is reduced by
33 % to −0.14 to −0.26 W m−2, and the 95 % credible interval (CI)
is reduced by 34 % to −0.1 to −0.32 W m−2. For the global annual
mean aerosol–cloud radiative forcing, RFaci, the ±1σ
range is reduced by 7 % to −1.66 to −2.48 W m−2, and the 95 % CI by
6 % to −1.28 to −2.88 W m−2. The tightness of the constraint is
limited by parameter cancellation effects (model equifinality) as well as
the large and poorly defined “representativeness error” associated with
comparing point measurements with a global model. The constraint could also
be narrowed if model structural errors that prevent simultaneous agreement
with different measurement types in multiple locations and seasons could be
improved. For example, constraints using either sulfate or PM2.5
measurements individually result in RFari±1σ ranges
that only just overlap, which shows that emergent constraints based on one
measurement type may be overconfident.
We investigated the effectiveness of cognitive behavioural therapy (CBT) for patients with psychological disorders thought to be influencing recovery from elective and traumatic hand conditions. ...Demographic data and psychological assessment scores (Primary Health Questionnaire 9 (PHQ9), General Anxiety Disorder Assessment (GAD7), Impact of Event Scale (IES)) were prospectively collected before and after CBT treatment. One hundred and fourteen patients underwent CBT with 81 completing treatment. Full data was available for 78 (68%) patients. Mean age was 43 (range 13–84) and 63% were women. Sixty-one per cent had sustained a traumatic hand injury. PHQ9, GAD7 and IES scores decreased significantly following treatment. Many patients with hand conditions have associated psychological problems that may influence outcome. CBT in a hand unit setting appears to be an effective treatment. Further research with a control group should investigate whether CBT improves psychological health or if this may occur as patients recover from their physical hand disorder regardless of CBT.
Level of evidence: IV
Multifocal pattern of regression after neoadjuvant chemotherapy has been identified as a risk factor for ipsilateral breast tumor recurrence (IBTR). We aimed to determine the significance of ...multifocal regression as a predictor of IBTR after neoadjuvant chemotherapy and breast conservation therapy in the modern era.
We retrospectively reviewed 346 patients treated between November 2009 and June 2017. Pattern of regression was categorized as pathologic complete response (pCR), unifocal (tumor present as a cohesive mass), limited multifocal (single cells or clusters of cells concentrated in 1 portion of the fibrotic area), or diffuse multifocal (cells spread over entire fibrotic area). IBTR was defined as new ipsilateral invasive or noninvasive breast tumor after breast conservation therapy. Predictive factors were analyzed using Cox regression.
Incidence of multifocal regression was 25.7% for the overall cohort and 12.2% for estrogen receptor (ER) negative/progesterone receptor (PR) negative/human epidermal growth factor receptor 2 (HER2) positive, 17.5% for triple-negative, 36.9% for ER+ or PR+/HER2-, and 38.5% for triple-positive (P < .001). With a median follow-up of 41.1 months, 4-year IBTR-free survival after pCR or unifocal regression versus multifocal regression was 94.1% versus 90.9% (P = .411). Pattern of regression (P = .010; compared to pCR, hazard ratio HR of 11.2 for diffuse multifocal regression, 1.65 for limited multifocal regression, and 3.81 for unifocal regression), phenotype (P = .001; compared to ER+ or PR+/HER2-, HR of 30.67 for ER-/PR-/HER2+, 25.30 for triple-negative, and 1.60 for triple-positive), and lack of nodal pCR (P = .004; HR of 3.78) predicted for IBTR on multivariate Cox regression. On multivariate subset analysis, pattern of regression and lymphovascular space invasion predicted for IBTR in hormone receptor-negative patients, but pattern of regression was not associated with IBTR for hormone receptor-positive patients.
Multifocal regression, hormone receptor-negative phenotype, and lack of nodal pCR predict for increased risk of IBTR after neoadjuvant chemotherapy. Although more common in hormone receptor-positive disease, multifocal regression was associated with worse outcome only in hormone receptor-negative patients.
•Distal radius fracture rate was higher in deprived areas.•Less falls occurred in the home in deprived patients with more falls outdoors.•No relationship was found between deprivation and FRAX ...scores.•A significant relationship was identified between deprivation and increased number of falls risk factors.
Social deprivation is associated with many adult fractures including distal radius fractures but the mechanisms for this are unclear. The aim of this study was to identify if social deprivation was associated with falls risk, mechanism of injury or osteoporosis in patients with a fragility fracture of the distal radius.
Details of all patients aged 50 years and over presenting with a radiographically confirmed fracture of the distal radius over a one year period, were prospectively recorded. Patients were sent a questionnaire pack including questions regarding place and mechanism of injury, comorbidity assessment, falls risk assessment tool and FRAX assessment of bone health and fracture risk.
333 out of 521 eligible patients completed the questionnaire (279 female; 54 male, response rate = 64%). There was no difference between characteristics of responders and non-responders (p = 0.58). DRF rate was higher in socially deprived quintiles (p = 0.040). Less falls occurred in the home in socially deprived patients (Q1/2: 35%: Q3–5: 48%, p = 0.037) with more falls outdoors (Q1/2: 39%: Q3–5: 24%, p = 0.001). There was no difference in height from which falls took place with most occurring from standing height (Q1/2: 81%: Q3–5: 86%, p = 0.336). Linear regression analysis found no relationship between social deprivation rank and FRAX scores (major fracture risk: p = 0.274, hip fracture risk: p = 0.283) but demonstrated a significant relationship between social deprivation and increased number of falls risk factors (p = 0.002). Mean number of falls risk factors was higher in the two most socially deprived quintiles (Q1/2: 3.62: Q3–5: 2.79, p = 0.028).
We have identified increased falls risk as an important reason for DRF in socially deprived patients. Knowing which patients are at highest risk allows interventions to be efficiently targeted. We would recommend resources should be targeted towards patients from socially deprived areas and focused on specific falls prevention strategies.
We explored patterns of shortening of the distal radius and investigated the effect of displacement on ‘ulnar variance’ in 250 patients with distal radial fractures. A small number of patients (5%) ...had a fracture that resulted in true shortening. Thirty-two per cent had fractures that appeared short, but lateral radiographs revealed that the articular surface was tilted, with either the anterior or dorsal rim of the articular surface being proximal to the distal ulna but the other rim was distal to it. We recommend initial assessment of variance on lateral radiographs. If the anterior and dorsal rims of the distal radial articular surface are proximal to the distal ulna, then true shortening is present and lengthening and stabilization, to hold the radius distracted, should be considered. If only one rim is proximal to the distal ulna, then correction of the tilt will lessen the apparent positive variance.
Level of evidence: IV
Loss of anterior tilt after a distal radial fracture can lead to carpal malalignment, which may cause functional impairment. The aim of this study was to establish whether distal radial osteotomy for ...malunion, which primarily restores the dorsal tilt, will also improve carpal malalignment as measured by capitate shift. Radiographs of 67 patients who underwent osteotomy after malunion of a distal radial fracture were reviewed. Measurements of capitate shift and dorsal tilt were recorded. Linear regression modelling was used to assess the relationship between dorsal tilt and capitate shift. Change in capitate shift was strongly associated with change in dorsal tilt following osteotomy. This relationship was maintained on long-term radiographs. Capitate shift is strongly related to dorsal tilt following a distal radial fracture. Correcting the dorsal tilt during an osteotomy, therefore, will improve capitate shift and carpal malalignment. Capitate shift is unrelated to age, sex and is easy to visually assess.
Level of evidence: IV
Distal radial fractures are the most common adult orthopaedic fracture. We sought to determine whether the incidence of this injury is changing and identify trends in its occurrence. We analysed data ...for all adult patients presenting to University Hospitals of Leicester with a distal radial fracture from 2007–2016. Incidence rates were calculated using United Kingdom population data. Poisson regression techniques were used to analyse weekly, seasonal and annual variation in fracture incidence. There was no significant change in average age or incidence of fracture. Increased incidence was associated with inclement weather conditions. Younger patients more commonly sustain fractures on weekends. We predict a 23% rise in the number of fractures in the United Kingdom in the next 20 years. The incidence of fracture does not appear to be changing, although the number of fractures is growing. Weekly and seasonal trends are apparent.
Level of evidence: III
We sought to establish whether carpal and cubital tunnel syndrome requiring surgery is associated with deprivation in England. Data from 10,496 adult patients who were treated in our hand unit over a ...20-year period were reviewed. The Index of Multiple Deprivation was used to measure deprivation from the patients’ postcode. The mean age at surgery in the most deprived three quintiles was significantly lower than in the least deprived two quintiles for carpal tunnel release (55 vs 59 years, respectively) and cubital tunnel release (52 vs 57 years, respectively). The incidence rate was significantly lower for the three least deprived quintiles when compared with the most deprived quintile for both conditions. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for carpal tunnel release was 0.70 for men and 0.76 for women. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for cubital tunnel release was 0.79 for men and 0.49 for women. Carpal tunnel and cubital tunnel syndrome requiring surgery is more common in deprived patients and occurs at an earlier age.
Level of evidence: IV
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