Abstract Background Context Current metrics to assess a patient's health-related quality-of-life (HRQOL) may not reflect a true change in a patient's specific perception of what is most important to ...them. Purpose To describe the initial experience of a Patient Generated Index (PGI) in which patients create their own outcome domains. Study Design Single center prospective study Patient Sample Adult spinal deformity (ASD) patients Outcome Measures Oswestry Disability Index (ODI), Short-Form 36 (SF36:PCS/MCS), Scoliosis research society 22r (SRS22r), and PGI Methods ODI, SF36, SRS22r, and PGI were administered preoperatively and postoperatively at 6wks, 3mo, 6mo, and 1 and 2yrs. PGI correlations with ODI, SF36, SRS Total score, free text frequency analysis of PGI exact response with text in ODI/SRS22r questionnaires, and the responsiveness (effect size; ES) of the HRQOL metrics were analyzed. No funding was used for this study and there are no conflicts of interest. Results 59 patients with 209 clinical encounters produced 370 PGI written response topics that included affect/emotions, relationships, activities of daily life, personal care, work, and hobbies. Mean preoperative PGI score was 18.6±13.5 (0-71.7 out of 100best) and mean scores significantly improved at every postoperative time point (p<0.05). Preoperative PGI scores significantly correlated with preoperative ODI (r=-0.28,p=0.03), MCS (r=0.48,p<0.01), and SRS Total (r=0.57,p<0.01). Postoperative PGI scores correlated with all HRQOL measures (p<0.0001): ODI (r=-0.65), PCS (r=0.50), MCS (r=0.55), and SRS Total (r=0.63). PGI responses exactly matched ODI and SRS22r text 47.8% and 35.4%, respectively, and 63.2% and 58.9% respectively for categories. PGI ES at minimum 1-year follow-up was -2.39, indicating substantial responsiveness (|ES|>0.8). ES for ODI, SRS22r total and SF-36 PCS and MCS, were 2.16, -2.06, -2.05, and -0.80, respectively. Conclusions PGI is easy to administer and offers additional information about the patient's perspective not captured in standard HRQOL metrics. PGI scores correlated with all of the standard HRQOL scores and were more responsive than ODI, SF-36, and SRS22r suggesting that the PGI may be a step closer to one HRQOL measure that better encompasses concerns and goals of the individual patients.
Volar Approach to Distal Radius Fractures Protopsaltis, Themistocles S., MD; Ruch, David S., MD
The Journal of hand surgery (American ed.),
07/2008, Letnik:
33, Številka:
6
Journal Article
Recenzirano
The volar approach to the distal radius fracture is an important exposure in the treatment of these fractures, particularly with the growing enthusiasm for fixed-angle volar plating. With reports in ...the literature documenting complications associated with external fixation and dorsal plating, the volar approach has become ever more popular. Moreover, advancements in locking plate technology have expanded the indications for palmar plating beyond volar shear and volarly displaced fractures to include unstable intra-articular distal radius fractures. The surgical approach remains the same as when Henry recommended the interval between the flexor carpi radialis and the radial artery. Critical elements of the surgical technique include releasing the brachioradialis, gaining exposure all the way to the sigmoid notch, and building the intra-articular reduction, beginning with the intermediate column and moving radially. The relevant anatomy, indications and contraindications, postoperative care, and a pertinent case presentation are discussed.
Abstract Background For patients with adult spinal deformity (ASD), surgical treatment may improve their health-related quality of life. This study investigates when the greatest improvement in ...outcomes occurs and whether incremental improvements in patient-reported outcomes during the first postoperative year predict outcomes at 3 years. Methods Using a multicenter registry, we identified 84 adults with ASD treated surgically from 2008 through 2012 with complete 3-year follow-up. Pairwise t tests and multivariate regression were used for analysis. Significance was set at P < 0.01. Results Mean Oswestry Disability Index (ODI) and Scoliosis Research Society-22r total (SRS-22r) scores improved by 13 and 0.8 points, respectively, from preoperatively to 3 years (both P < 0.001). From preoperatively to 6 weeks postoperatively, ODI scores worsened by 5 points (P = 0.049) and SRS-22r scores improved by 0.3 points (P < 0.001). Between 6 weeks and 1 year, ODI and SRS-22r scores improved by 19 and 0.5 points, respectively (both P < 0.001). Incremental improvements during the first postoperative year predicted 3-year outcomes in ODI and SRS-22r scores (adjusted R2 = 0.52 and 0.42, respectively). There were no significant differences in the measured or predicted 3-year ODI (P = 0.991) or SRS-22r scores (P = 0.986). Conclusion In surgically treated patients with ASD, the greatest improvements in outcomes occurred between 6 weeks and 1 year postoperatively. A model with incremental improvements from baseline to 6 weeks and from 6 weeks to 1 year can be used to predict ODI and SRS-22r scores at 3 years.
Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated ...with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment.
Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK).
Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p < .05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year.
Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.
Purpose Tear of the triangular fibrocartilage complex (TFCC) and nonunion of the ulnar styloid are common lesions resulting from upper extremity injuries such as distal radius fractures. Whereas ...ulnar styloid fractures are a common feature of the distal radius fracture pattern, symptomatic nonunions of the ulnar styloid are found in a minority of these injuries. The purposes of this study were to confirm the association of symptomatic ulnar styloid nonunions and TFCC tears, and to report intra-articular findings and clinical outcomes for the concurrent arthroscopic management of TFCC tears and open excision of ulnar styloid nonunions in a consecutive series of patients. Methods We retrospectively reviewed the medical records of 8 consecutive patients who underwent open excision of an ipsilateral ulnar styloid nonunion fragment and concurrent diagnostic arthroscopy. The diagnosis of TFCC tear was made by magnetic resonance imaging preoperatively in only 5 of 8 patients. We assessed outcomes with the Disabilities of the Arm, Shoulder, and Hand questionnaire and the visual analog scale. Results Arthroscopic findings demonstrated full-thickness chondral injury on the dorsum of the triquetrum with a tear of the dorsal radiolunotriquetral ligament and avulsion of the ulnar margin of the TFCC from the extensor carpi ulnaris subsheath. The clinical outcome scores showed statistically significant improvement (p<.05) from the preoperative baseline, with a mean Disabilities of the Arm, Shoulder, and Hand score of 3.69 (SD, 9.68) and a mean visual analog scale pain score of 1.0 (SD, 0.83) postoperatively. Conclusions Symptomatic ulnar styloid nonunions can be associated with TFCC tears, and diagnostic arthroscopy should be considered in all patients who are candidates for open excision of an ulnar styloid nonunion. Concurrent arthroscopic TFCC repair and open excision of the ulnar styloid fragment is an effective surgical approach for this combined injury pattern.
Abstract Background context Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment on achieving optimal thoracolumbar ...alignment in ASD surgery is unclear. Purpose This study assesses the relationship between preoperative (preop) cervical spinal parameters and global alignment after thoracolumbar ASD surgery at 2-year follow-up. Study design/setting This study is a retrospective review of a multicenter, prospective database. Patient sample Surgical ASD patients with 2-year follow-up and cervical X-rays were included. Outcome measures The outcome measures were radiographic parameters and self-reported health-related quality-of-life measures (Short-Form 36 SF-36, Oswestry Disability Index ODI, and Scoliosis Research Society 22 SRS-22). Methods Surgical ASD patients of 18 years and older with scoliosis greater than or equal to 20° and one of the following radiographic parameters were included: sagittal vertical axis (SVA) greater than or equal to 5 cm, pelvic tilt (PT) greater than or equal to 25°, or thoracic kyphosis (TK) greater than 60°. The SRS-Schwab sagittal modifiers (PT, global alignment, and pelvic incidence and lumbar lordosis PI-LL) were assessed at 2-year postoperatively as either normal (“0”) or abnormal (“+” or “++”). Patients were classified in the aligned group (AG) or malaligned group (MG) at 2-year follow-up if all three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2–C7 SVA greater than 4 cm, C2–C7 SVA less than 4 cm, cervical kyphosis (CL greater than 0), cervical lordosis (CL less than 0), any deformity (C2–C7 SVA greater than 4 cm or CL greater than 0), and both CD (C2–C7 SVA greater than 4 cm and CL greater than 0). Univariate testing was performed using t or chi-square test, looking at the following preop parameters: CD, C2–C7 SVA, C2–T3 SVA, CL, T1 slope (T1S), T1S-CL, C2–T3 angle, LL, TK, PT, C7–S1 SVA, and PI-LL. Results One hundred four patients met the initial inclusion criteria with 70 in the AG and 34 in MG. Preoperative, patients in the MG had a higher CL (11.7 vs. 4.9, p=.03), higher C2–T3 angle (13.59 vs 4.9 p=.01), higher PT (p<.0001), higher SVA (p<.0001), and higher PI-LL (p<.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both groups. There was no statistically significant difference among groups in the amount of improvement more than 2 years on the ODI or the Physical Component Summary of SF-36. Conclusions Patients with sagittal spinal malalignment associated with significant cervical compensatory lordosis are at increased risk of realignment failure at 2-year follow-up. Assessment of the degree of cervical compensation may be helpful in preop evaluation to assist in realignment outcome prediction.
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