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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 371 - 371
1 Sep 2012
Dahlin L Bainbridge C Szczypa P Cappelleri J Kyriazis Y Gerber R
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Introduction

Dupuytren's disease (DD) is a fibro-proliferative disorder of the palmar fascia whereby a collagen cord contracts affected joints, resulting in flexion deformity that can impair hand function. Currently, surgery is the only effective treatment option in Europe. This 2-part study, consisting of a surgeon survey and chart audit, was designed to assess current surgical practice patterns by DD severity. We report results from the surgeon survey.

Methods

A total of 687 participants, including 579 orthopedic surgeons (of which 383 were hand specialists) and 108 plastic surgeons, who had been practicing for >3 and <30 years and operated on 5 DD patients between September and December 2008 were surveyed in 12 countries (UK, Germany, France, Italy, Spain, Hungary, Czech Republic, Poland, Netherlands, Sweden, Denmark, Finland). The survey included queries about procedures performed, factors involved in the decision to use a procedure, satisfaction with the procedure, use of physiotherapy, and recurrence.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 168 - 168
1 May 2011
Brogren E Hofer M Petranek M Wagner P Dahlin L Atroshi I
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Purpose: The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability.

Methods: This prospective population-based cohort study included 143 patients above 18 years with acute distal radius fracture treated at one emergency hospital with either closed reduction and cast (55 patients) or with closed reduction and external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (inquiring about disabilities before fracture) and at 6, 12 and 24 months after the fracture. The 12-month follow-up also included the SF-12 health status questionnaire as well as clinical and radiographic examination. The patients were classified according to the degree of malunion (defined as dorsal tilt > 10 degrees or ulnar variance > 0 mm) into three groups; no malunion, malunion involving either dorsal tilt or ulnar variance, and malunion involving both dorsal tilt and ulnar variance. A Cox regression analysis was performed to determine the relationship between the 1-year DASH score (≥ 15 or < 15) and malunion adjusting for age, sex, fracture AO type, and treatment method and the relative risk (RR) of obtaining the higher DASH score was calculated. The number needed to harm (NNH) associated with malunion was calculated.

Results: The mean DASH score at 1 year after fracture was about 10 points worse with each degree of increased malunion. The degree of malunion also correlated with SF-12 score, grip strength and supination. The regression analysis showed significantly higher disability with each degree of malunion compared to no malunion; for malunion involving either dorsal tilt or ulnar variance the RR was 2.4 (95% CI 1.0–5.7; p=0.038), and for malunion involving both dorsal tilt and ulnar variance the RR was 3.2 (95% CI 1.4–7.5; p=0.007). The NNH was 2.5 (95% CI 1.8–5.4).

Conclusion: Malunion after distal radius fracture was associated with higher arm-related disability.