Search Results (94)

Background: Humans interacting with virtual objects is becoming common due to the popularity of the devices adopting the mixed reality (MR) techniques. Assessing hand functions using these devices for medical purposes provides alternatives in addition to the traditional hand function assessment techniques. Objectives: The objectives were to compare the movement time (MT) of handing a real and a virtual object between post-surgery wrist fracture patients and healthy adults and to determine the correlation between the MT and commonly adopted hand function indicators. Methods: An experiment was performed. A total of 29 participants, including 17 patients and 12 healthy adults, joined. All the participants moved a real or a virtual tube from an origin to a destination. A set of MR device was adopted to generate the virtual object. The MTs were analyzed to compare differences between the patients and the healthy adults. Regression models were developed to predict the MT under experimental conditions. Results: The MT of the surgical hand was significantly longer than that of the nonsurgical hand of the patients and was significantly longer than that of the left hand of the healthy adults. The MT was negatively correlated with the commonly adopted hand function indicators, including grip strength, range of motion, hand dexterity score, and Modified Mayo Wrist Score. Conclusions: The anticipation that the MT of interacting with virtual objects for patients may reveal hand function characteristics for post-surgery patients was supported. The regression models developed could reveal the progression of hand function recovery for these patients. Having patients interact with virtual objects could be a supplemental approach in assessing their hand functions. Full article

Low-energy bone fractures refer to injuries that occur from minimal trauma or impact. These fractures are often a result of activities, such as falls from standing height or minor accidents, where the force exerted on the bone is insufficient to cause a break under normal conditions. To design an effective orthotic splint, it is critical to select the appropriate material that mimics the mechanical properties of traditional materials like plaster, which has long been used for immobilization purposes. In this case, Ansys CES Edupack 2025 software was utilized to evaluate and identify materials with mechanical characteristics similar to those of plaster. The software provided a list of six materials that met these criteria, but selecting the most suitable material involved more than just mechanical properties. Three different multicriteria decision-making methods were employed to ensure the best choice: TOPSIS, VIKOR, and COPRAS. These methods were applied to consider various factors, such as strength, flexibility, weight, cost, and ease of manufacturing. The results of the analyses revealed a strong consensus across all three methods. Each approach identified PLA (Polylactic Acid) as the most appropriate material for the orthotic design. Following the material selection process, simulations were conducted to assess the structural performance of the orthotic splint. The results determined that the minimum thickness required for the PLA orthosis was 4 mm, ensuring that it met all necessary criteria for acceptable stresses and deformations during the four primary movements exerted by the wrist. This thickness was sufficient to maintain the orthosis’s functionality without compromising comfort or effectiveness. Moreover, a significant improvement in the design was achieved through topological optimization, where the mass of the preliminary design was reduced by 9.58%, demonstrating an efficient use of material while maintaining structural integrity. Full article

Distal radius fractures (DRFs) constitute one of the most prevalent injuries in adults. This study compares the clinical and radiological outcomes of intra- and extra-articular DRFs treated with percutaneous Kirschner wires (PKW) or volar locking plates (VLP). Materials and Methods: A retrospective analysis was conducted on 42 patients (aged 18 to 85) treated between 2017 and 2019 with a minimum follow-up of five years. Outcomes were assessed using radiographic parameters and validated clinical scoring systems such as Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and Mayo Wrist Score (MAYO). Results: Clinical outcomes were better in the VLP group but not statistically significant (p > 0.05). For extra-articular fractures, DASH were 1.5 (VLP) vs. 6.4 (PKW) (p = 0.5007), PRWE were 1.3 (VLP) vs. 2.9 (PKW) (p = 0.4049), and MAYO were 95 (VLP) vs. 86.1 (PKW) (p = 0.2406). For intra-articular fractures, DASH were 6.6 (VLP) vs. 19.7 (PKW) (p = 0.0981), PRWE 12.9 (VLP) vs. 21.1 (PKW) (p = 0.3661), and MAYO 78.9 (VLP) vs. 72.2 (PKW) (p = 0.4503). Conclusions: PKW and VLP showed satisfactory long-term outcomes. VLP fixation allowed better short-term recovery and anatomical restoration, but long-term functional outcomes were comparable. Full article

Background: Forearm fractures are the most common fractures in children, accounting for 41% of all paediatric fractures. Most research focuses on distal forearm fractures, but studies encompassing the entire forearm are limited. Objective: This retrospective study describes the distribution and patterns of paediatric forearm fractures over a five-year period. Methods: We conducted a retrospective cohort study of children aged 0–15 years who received a radiograph of the forearm, wrist or elbow between March 2019 and December 2023 in the study region. Fractures were manually identified and registered from radiological reports. Fracture location, type (complete/incomplete), and epiphyseal involvement were analyzed across different age groups. Statistical analysis was performed using chi-square tests and descriptive statistics. Results: We identified 4547 forearm fractures from 4291 children. The median age was 10 years, and 57% of the patients were male. Fracture patterns varied significantly across age groups (p < 0.001), with older children experiencing more distal, complete, radial, and epiphyseal fractures. Younger children had a higher proportion of incomplete fractures and fewer distal or epiphyseal fractures. No significant differences in Salter–Harris classifications were found between age groups (p = 0.69). Conclusions: Fracture patterns in paediatric forearm fractures vary with age, with older children showing a higher incidence of complete, distal, and epiphyseal fractures. This study provides a detailed characterization of paediatric forearm fractures, which may inform clinical management and preventive strategies, particularly in tailoring age-specific care. Further research should explore the long-term outcomes of these fracture patterns. Full article

Background/Objectives: Distal radius fractures (DRFs) are among the most common fractures in the elderly, with increasing incidence due to population aging. Recent evidence questions the benefits of operative treatment, particularly in elderly patients. The present study aimed to assess post-traumatic osteoarthritis (OA) and patient-reported outcome measures (PROMs) after a minimum of two years of follow-up of the previously published VOLCON randomized controlled trial (RCT), which compared operative and non-operative treatments of unstable DRFs in patients aged ≥ 65 years. Methods: This study presents a minimum two-year follow-up of a single-center, assessor-blinded RCT. A total of 100 patients with unstable DRFs were randomized to either operative treatment with volar locking plating or non-operative treatment with cast immobilization. The primary outcome was post-traumatic OA, assessed using the Knirk and Jupiter classification. Secondary outcomes included PROMs (Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)) and Patient-Rated Wrist/Hand Evaluation (PRWHE), complications, pain, grip strength, and range of motion (ROM). Statistical analyses were performed using two-way ANOVA. Results: After a median follow-up of 3.0 years, 60 patients (28 non-operative and 32 operative) were available for analysis. There was no significant difference in OA between the groups (p = 0.57). PROMs (Quick-DASH, PRWHE), pain, grip strength, and ROM were time-dependent (p < 0.001) but not treatment-dependent. Complications were more frequent in the operative group, including hardware-related issues requiring reoperation. Conclusions: At a minimum of two years of follow-up, no correlation was found between treatment choice and post-traumatic OA. Functional outcomes were similar between groups, suggesting that non-operative treatment remains a viable option for elderly patients with unstable DRFs. Full article

Wrist fractures, especially those involving the elbow and distal radius, are the most common injuries in children, teenagers, and young adults, with the highest occurrence rates during adolescence. However, the demand for medical imaging and the shortage of radiologists make it challenging to ensure accurate diagnosis and treatment. This study explores how AI-driven approaches are used to enhance fracture detection and improve diagnostic accuracy. In this paper, we propose the latest version of YOLO (i.e., YOLO11) with an attention module, designed to refine detection correctness. We integrated attention mechanisms, such as Global Attention Mechanism (GAM), channel attention, and spatial attention with Residual Network (ResNet), to enhance feature extraction. Moreover, we developed the ResNet_GAM model, which combines ResNet with GAM to improve feature learning and model performance. In this paper, we apply a data augmentation process to the publicly available GRAZPEDWRI-DX dataset, which is widely used for detecting radial bone fractures in X-ray images of children. Experimental findings indicate that integrating Squeeze-and-Excitation (SE_BLOCK) into YOLO11 significantly increases model efficiency. Our experimental results attain state-of-the-art performance, measured by the mean average precision (mAP50). Through extensive experiments, we found that our model achieved the highest mAP50 of 0.651. Meanwhile, YOLO11 with GAM and ResNet_GAM attained a maximum precision of 0.799 and a recall of 0.639 across all classes on the given dataset. The potential of these models to improve pediatric wrist imaging is significant, as they offer better detection accuracy while still being computationally efficient. Additionally, to help surgeons identify and diagnose fractures in patient wrist X-ray images, we provide a Fracture Detection Web-based Interface based on the result of the proposed method. This interface reduces the risk of misinterpretation and provides valuable information to assist in making surgical decisions. Full article

Background and Objectives: Distal radius fractures (DRFs) are among the most common fractures globally, with a lifetime incidence of around 9%. They typically present in two age peaks: high-impact trauma in patients under 40 and low-energy trauma in those over 40. Intra-articular DRFs are classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, influencing the treatment approach. Surgical management, particularly open reduction and internal fixation (ORIF) using volar plate osteosynthesis, is considered the gold standard. This study aims to compare the treatment costs of fluoroscopy-assisted ORIF and arthroscopy-assisted ORIF for intra-articular DRF. The analysis includes surgical procedure costs, material expenses, and operating time to evaluate the cost-effectiveness of both methods, considering reimbursement within the German healthcare system. Materials and Methods: A retrospective, monocentric study was conducted at Ludwig-Maximilians-University (LMU) Hospital, a supraregional hand trauma center in southern Germany. Patients with DRFs requiring ORIF were treated either with fluoroscopy or arthroscopic assistance. Group 1 included patients treated by the Department of Hand Surgery (Plastic Surgery), subdivided into Group 1a (arthroscopy-assisted) and Group 1b (fluoroscopy-only). Group 2 comprised patients treated by Orthopaedics and Trauma Surgery (fluoroscopy-only). Costs associated with surgical procedures, including materials, operating time, and postoperative care, were analyzed. Results: A total of 43 DRFs were treated. Group 1 consisted of 17 cases, with an average age of 49.6 years (SD = 19.4) and a 64% majority of female patients. Of these, 10 cases were treated with arthroscopy-assisted ORIF (Group 1a) and 7 with fluoroscopy-only ORIF (Group 1b). In Group 1a, the average age was 53.9 years (SD = 16.3) with 60% female and 40% male patients, while in Group 1b, the average age was 43.6 years (SD = 23.1) with 71.4% female patients. Group 2 included 25 cases, with an average age of 54.2 years (SD = 21.0) and a distribution of 64% female and 36% male patients. There was no significant difference in age and gender distribution within the groups and subgroups (p > 0.05). The mean procedure time was longer for arthroscopically assisted ORIF (111.5 min) compared to fluoroscopy-only ORIF (80.1 min), and even longer compared to Group 2 (65.0 min). Material costs were slightly higher in Group 1. Total costs for Group 1 averaged EUR 4906.58, with subgroup costs of EUR 5448.24 for arthroscopy-assisted and EUR 4132.80 for fluoroscopy-only. In comparison, Group 2 costs averaged EUR 3344.08. Conclusions: Intra-articular DRFs with severely displaced fragments or concomitant injuries benefit from arthroscopically assisted fracture treatment. While material costs do not significantly differ between arthroscopically assisted and fluoroscopy-only treatments, the significantly longer procedure time for arthroscopy-assisted ORIF results in the largest cost component. Despite this, reimbursement through the DRG system remains fixed and does not account for the increased operative duration or complexity of arthroscopic procedures. Our findings demonstrate that DRF treatment, regardless of the method used, is either not or only marginally cost-covering under the current German reimbursement structure. In the context of the ongoing shift towards outpatient hand surgery, including the management of DRF, adequate reimbursement rates are necessary to ensure the economic viability of DRF management, particularly for complex intra-articular fractures requiring arthroscopic assistance. Full article

Background: Scaphoid reconstruction after an established non- or malunion is challenging and recent developments have shown the feasibility to reconstruct it with 3D-planned and -printed patient-specific instrumentation. Methods: Our study compared the clinical outcome of computer assisted 3D-reconstructions of the scaphoid using patient-specific guides for primary and revision reconstructions of scaphoid nonunion regarding clinical outcome. Therefore, 39 patients with primary scaphoid nonunion or malunion and 15 patients with nonunion or malunion after a previous operative treatment were treated with patient-specific guides and followed up for a mean of 10.5 months. The consolidation was assessed with a CT-scan, and the time to consolidation was recorded. Pain level, satisfaction, wrist range of motion, and grip strength were measured and compared. Results: The wrist range of motion and grip strength of the two groups were similar, except for the wrist extension, which was significantly reduced in the revision group. Consolidation was observed in 36/39 patients (92%) in the primary group and in 13/15 patients (87%) in the revision group. Our results showed similar clinical results postoperatively between primary reconstructions and revision surgery. Conclusions: The use of 3D-planned and -printed patient-specific instrumentation proves to be similarly effective in revision surgeries for the reconstruction of the scaphoid as it is in primary surgeries. Full article

The purpose of this study was to investigate changes in bone trabecular structure during adolescence using the fractal analysis (FA) method on hand–wrist radiographs (HWRs) and to evaluate the relationship of these changes with pubertal growth stages. HWRs of healthy individuals aged 8–18 years were included (N = 600). Pubertal stages were determined by the Fishman method and divided into 10 groups (early puberty [EP], pre-peak [PRPK], peak [PK], post-peak [PTPK], late puberty [LP]). FA was performed using FIJI (ImageJ) software and the BoneJ plugin on circular regions of interest (ROIs) selected from the first metacarpal bone head and distal radius. Image processing steps were applied according to the White and Rudolph method. Differences between groups were statistically evaluated. Fractal dimension (FD) values of the distal radius (RAFAM) and metacarpal bone head (MAFAM) showed significant differences according to pubertal growth stages (p < 0.05). The highest FD value was observed in the LP group, and the lowest FD value was observed in the EP group (except MAFAM in females). FD generally increased from EP to LP in the whole population, but a significant decrease was observed in all groups during the PK period. This decrease was more pronounced in RAFAM of males. These findings suggest a potential decrease of bone mechanical properties in the PK, which is found the be more suitable for orthodontic treatment in the literature. FA on HWRs is a useful and sensitive tool for quantitatively assessing pubertal changes in trabecular bone microarchitecture. The findings demonstrate a significant decrease in FD in both bone regions during the pubertal growth spurt, particularly at the peak period. This may indicate a temporary reduction in bone mechanical strength during this critical stage and could contribute to increased distal radius fracture incidence. Clinically, the relationship between FD and pubertal stages suggests this method could serve as a valuable biomarker in orthodontic treatment planning, allowing for optimized timing of interventions. Furthermore, it may aid in pediatric fracture risk assessment, potentially leading to preventative strategies for high-risk individuals. Full article

Background/Objectives: Scaphoid fractures are notorious for a high rate of nonunion, resulting in chronic pain and impaired wrist function. The decision for surgical intervention often involves extensive imaging and prolonged conservative management, leading to delays in definitive treatment. The effectiveness of such treatment remains a subject of ongoing clinical debate, with no universally accepted predictive tool for surgical success. The objective of this study was to train a deep learning algorithm to reliably identify cases of nonunion with a high probability of subsequent union following operative revision. Methods: This study utilized a comprehensive database of 346 patients diagnosed with scaphoid nonunions, with preoperative and postoperative X-rays available for analysis. A classical logistic regression for clinical parameters was used, as well as a TensorFlow deep learning algorithm on X-rays. The latter was developed and applied to these imaging datasets to predict the likelihood of surgical success based solely on the preoperative anteroposterior (AP) X-ray view. The model was trained and validated over six epochs to optimize its predictive accuracy. Results: The logistic regression yielded an accuracy of 66.3% in predicting the surgical outcome based on patient parameters. The deep learning model demonstrated remarkable predictive accuracy, achieving a success rate of 93.6%, suggesting its potential as a reliable tool for guiding clinical decision-making in scaphoid nonunion management. Conclusions: The findings of this study indicate that the preoperative AP X-ray of a scaphoid nonunion provides sufficient information to predict the likelihood of surgical success when analyzed using our deep learning model. This approach has the potential to streamline decision-making and reduce reliance on extensive imaging and prolonged conservative treatment. Full article

Objectives: The impact of the COVID-19 pandemic on hand surgery in Japan has not been fully elucidated. This study investigated changes in the volume of hand surgery practiced during the pandemic. Methods: We used the National Database Open Data Japan (NDB-ODJ), a comprehensive repository of healthcare data administered by the government, to investigate changes in the volume of hand surgery services delivered during the COVID-19 pandemic. The type and number of upper extremity surgical procedures was examined during each month of the pandemic to identify associations. Results: During the first wave in the spring of 2020, scheduled surgeries decreased by 44% compared to pre-pandemic levels, with arthroplasties, osteotomies, and polydactyly surgeries experiencing the largest reductions. Trauma surgeries remained relatively stable, and some procedures like tendon repair and replantation even increased. While overall surgical volumes recovered in the second half of the pandemic, certain procedures, including finger pinning and tendon repair, remained below pre-pandemic levels. Interestingly, surgeries for Dupuytren contracture and amputation increased compared with the pre-pandemic period. Many scheduled and emergency procedures shifted to outpatient surgeries during the pandemic, and the proportion of inpatient surgeries decreased. In particular, the proportion of outpatient surgeries increased significantly in open reduction and internal fixation for wrist and forearm fractures, as well as in amputation surgeries. Conclusions: The COVID-19 pandemic had a minimal impact on the volume of hand surgery conducted in Japan, with a decrease in elective surgeries only during the first wave in the spring of 2020. Notably, the pandemic triggered a shift from inpatient to outpatient surgery for many procedures. Full article

Background: Fractures of the distal radius are common, particularly among young men and elderly women, often leading to painful wrist arthritis, especially if the joint surface has been affected. Traditional treatments of the wrist, such as full or partial wrist fusion, limit movement, and common wrist prostheses have high complication rates. Regenerative medicine and 3D bioprinting offer the potential for personalized joint replacements. Methods: This study evaluates using the contralateral radius as a template for creating customized distal radius prostheses. Bilateral CT scans of healthy wrists were analyzed to assess the shape and symmetry of the distal radius using a landmark-free morphometric method. Instead of comparing defined landmarks, the entire surface of the radius is analyzed employing dense point- and deformation-based morphometry to detect subtle morphological differences, providing an unbiased and more accurate comparison of the overall deformations in the distal radii. Results: results show strong intraindividual symmetry in joint surfaces. Interindividual comparisons revealed significant morphological variations, particularly gender-specific differences. Conclusions: These findings support the use of the contralateral radius as a template for the replaced side. At the same time, the interindividual results endorse the approach of pursuing personalized prostheses as the optimal replacement for distal joint surfaces. The increasing improvement of 3D-printed prostheses promises new methods for better outcomes in distal radius arthrosis after intraarticular fractures. Further research into clinical applications and biocompatible 3D printing materials is recommended. Full article

Objectives: This study aims to define three-dimensional (3D) parameters for the inclination of the distal radius joint surface. The goal is to develop standardized parameters for fracture reduction through comprehensive 3D evaluations of the joint surfaces. Methods: We analyzed 112 CT scans of unaffected wrists (56 males and 56 females) to construct 3D models of the distal radius. Using 3D coordinates, the normal vectors and angles were calculated based on three reference points on the distal radius joint surface. These normal vector components were then converted into unit vector components A, B, and C for the x, y, and z axes, respectively. Additionally, the angles of these unit vectors were assessed in the xy, yz, and xz planes. The 3D measurements were compared between males and females and against traditional two-dimensional (2D) parameters such as palmar tilt and radial inclination. Results: For males, the unit vector components were as follows: A: −0.14 ± 0.09, B: −0.92 ± 0.02, and C: −0.36 ± 0.07; for females, A: −0.21 ± 0.08, B: −0.90 ± 0.03, and C: −0.36 ± 0.05. Significant differences were found between males and females for the A and B vector components (representing the palmar–dorsal and proximal–distal axes, p < 0.01). The angles of the unit vectors in the xy, yz, and xz planes were 8.9 ± 5.4°/12.9 ± 5.0°, 21.3 ± 4.1°/22.1 ± 3.2°, and 22.2 ± 14.8°/28.8 ± 10.1° for males and females, respectively. There were significant differences between males and females in the angles of the xy and xz planes (sagittal and axial planes, p < 0.01). Strong correlations were observed between the xy-plane vectors and palmar tilt (r = 0.96), as well as between the yz-plane vectors and radial inclination (r = 0.88). Conclusions: This study evaluated the 3D inclination of the distal radius joint surface, revealing significant gender differences. This method, which also allows for the assessment of rotational alignment—difficult with conventional techniques—is expected to be a key 3D parameter in treating distal radius fractures. Full article

Background/Objectives: Acute isolated distal radioulnar joint (DRUJ) dislocations are rare and often misdiagnosed during initial evaluation due to subtle clinical presentation, low index of suspicion, and imaging barriers. Prompt diagnosis and treatment are critical to avoid chronic instability, limited wrist mobility, and osteoarthritis. This systematic review evaluates the functional outcomes of conservative and surgical treatment protocols for acute isolated DRUJ dislocations. Methods: A systematic search of PubMed, Scopus, and Mendeley databases (2000–2024) was conducted following PRISMA guidelines. Inclusion criteria involved adult patients with isolated DRUJ dislocations diagnosed and managed within one week of injury. Studies reporting on underage patients, associated fractures, delayed management, and open injuries were excluded. Data on demographics, injury mechanism, diagnostic methods, treatment protocols, and functional outcomes were extracted and analyzed. Results: In total, 22 cases across 20 studies were included. The majority (90.9%) were males, with a mean age of 37.9 years (range: 20–70 years). Falls and sports injuries were the major causes, with volar dislocations predominating (18/22). The misdiagnosis rate was equal to 18%. Most cases were treated conservatively with closed reduction and immobilization for an average of 4.9 weeks. Operative treatment was performed in 6 cases, mainly following failed closed reductions. Functional outcomes were generally favorable, although the same parameters were not consistently studied in all patients. Overall, 82% (14 of 17 patients) achieved a full range of motion; 88% (14 of 16 patients) reported no pain, and all assessed cases had stable DRUJs at follow-up. Conclusions: This review highlights the rarity and diagnostic challenges of this injury. The functional outcomes of both conservative and operative treatment are generally satisfactory. Conservative treatment should be the first-line approach, with surgery reserved for irreducible or unstable cases. Future research using standardized outcome measures is needed to provide guidance for clinicians. Full article