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David Ring - One of the best experts on this subject based on the ideXlab platform.
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acute proximal row carpectomy after complex carpal Fracture dislocation
Journal of Hand and Microsurgery, 2016Co-Authors: Marjolein Russchen, Amir Reza Kachooei, Teun Teunis, David RingAbstract:Acute proximal row carpectomy is an uncommon definitive treatment for perilunate Fracture dislocations. In this report, we present five patients who had acute proximal row carpectomy (PRC) to treat perilunate Fracture-dislocations. All patients were men between ages 31 and 87. The indication for PRC was lunate Fracture in two patients, concomitant displaced Scaphoid Fracture and scapholunate ligament injury in two patients, and perilunate Fracture-dislocation with preexisting articular damage from long-standing gout in one patient. At the final follow-up ranged from 4.5 month to 7.5 years, four patients had no pain and one patient was lost to follow-up. One patient had a concomitant PRC and a bridging plate that was never removed. The remaining three patients gained satisfactory range of motion. Our observation reveals that acute proximal row carpectomy is an option for some patients with complex carpal Fracture dislocations, particularly those with Fracture of the lunate, concomitant Scaphoid Fracture and scapholunate ligament injury, or preexisting wrist arthritis.
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training improves interobserver reliability for the diagnosis of Scaphoid Fracture displacement
Clinical Orthopaedics and Related Research, 2012Co-Authors: Geert A Buijze, Thierry G Guitton, Niek C Van Dijk, David RingAbstract:BACKGROUND: The diagnosis of displacement in Scaphoid Fractures is notorious for poor interobserver reliability. QUESTIONS/PURPOSES: We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of Scaphoid Fracture displacement on radiographs and CT scans. METHODS: Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced Scaphoid Fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel's multirater kappa and the Z-test was used to test for significance. RESULTS: There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of Scaphoid Fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of Fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups. CONCLUSIONS: Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of Scaphoid Fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.
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clinical prediction rule for suspected Scaphoid Fractures a prospective cohort study
Injury-international Journal of The Care of The Injured, 2010Co-Authors: Steven J. Rhemrev, Frank J. P. Beeres, M. Hogervorst, R H Van Leerdam, David RingAbstract:Abstract Background The low prevalence of true Fractures amongst suspected Fractures magnifies the shortcomings of the diagnostic tests used to triage suspected Scaphoid Fractures. Purpose The objective was to develop a clinical prediction rule that would yield a subset of patients who were more likely to have a Scaphoid Fracture than others who lacked the subset criteria. Methods Seventy-eight consecutive patients diagnosed with a suspected Scaphoid Fracture were included. Standardised patient history, physical examination, range of motion (ROM) and strength measurements were studied. The reference standard for a true Fracture was based on the results of magnetic resonance imaging, bone scintigraphy, follow-up radiographs and examination. Results Analysis revealed three significant independent predictors: extension Conclusion Clinical prediction rules have the potential to increase the prevalence of true Fractures amongst patients with suspected Scaphoid Fractures, which can increase the diagnostic performance characteristics of radiological diagnostic tests used for triage.
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diagnosis of Scaphoid Fracture displacement with radiography and computed tomography
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Santiago A Lozanocalderon, Philip E Blazar, David Zurakowski, David RingAbstract:Background: Displacement is an important risk factor for nonunion of Scaphoid wrist Fractures. We compared computed tomography with radiographs with regard to their ability to detect displacement. Methods: Six blinded observers rated thirty Scaphoid Fractures (ten displaced and twenty nondisplaced) with use of radiographs and computed tomography. The radiographs were evaluated separately from the computed tomography scans and then, in a third evaluation, the two imaging studies were reviewed simultaneously. The evaluations were repeated four weeks later. Observers were asked to evaluate specific measures of Fracture displacement and then to judge the Fracture as being displaced or nondisplaced. Results: Intraobserver reliability was better for computed tomography alone and the combination of radiographs and computed tomography than it was for radiographs alone (kappa values, 0.65, 0.63, and 0.54, respectively; all p < 0.001). The interobserver reliability was also better for computed tomography alone and the combination of radiographs and computed tomography than it was for radiographs alone (kappa values, 0.43, 0.48, and 0.27, respectively; all p < 0.001). The average sensitivity was 75% for radiographs alone, 72% for computed tomography alone, and 80% for both; the average specificity was 64%, 80%, and 73%, respectively; the average accuracy was 68%, 77%, and 75%, respectively. The positive predictive values (assuming a 5% prevalence of Fracture displacement) were low (0.10, 0.13, and 0.16) and the negative predictive values were high (0.97, 0.98, and 0.99) for the radiographs, computed tomography, and combined modality. Conclusions: Computed tomography improves the reliability of detecting Scaphoid Fracture displacement but has a more limited effect on accuracy, which remains <80%. The utility of computed tomography scans for diagnosing Scaphoid Fracture displacement is affected by the low prevalence of Fracture displacement. This study suggests that computed tomography scans are useful for ruling out displacement but not for diagnosing it. We recommend that all Scaphoid Fractures be evaluated with computed tomography in order to rule out displacement. Level of Evidence: Diagnostic Level III. See Instructions to Authors for a complete description of levels of evidence.
Steven J. Rhemrev - One of the best experts on this subject based on the ideXlab platform.
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comparison of mri ct and bone scintigraphy for suspected Scaphoid Fractures
European Journal of Trauma and Emergency Surgery, 2016Co-Authors: A.d. De ,zwart, Frank J. P. Beeres, Steven J. Rhemrev, K A Bartlema, Inger B SchipperAbstract:The best diagnostic modality for confirmation of the diagnosis of a Scaphoid Fracture that is not visible on the initial radiograph (occult Scaphoid Fracture) is still subject of debate. The aim of this study was to compare the accuracy of magnetic resonance imaging (MRI), computed tomography (CT) and bone scintigraphy (BS) for the diagnosis of these occult Scaphoid Fractures. In a study period of 12 months, 33 consecutive patients with a clinically suspected Scaphoid Fracture without a Fracture on the Scaphoid radiographs were evaluated with MRI, CT and BS. In case of a discrepancy between the diagnostic modalities, the final diagnosis was based on standardised follow-up with clinical examination and a repeated radiograph. Three of the 33 patients had a Scaphoid Fracture. MRI missed one Scaphoid Fracture and did not over-diagnose. CT missed two Scaphoid Fractures and did not over-diagnose. BS missed no Scaphoid Fractures and over-diagnosed one Scaphoid Fracture in a patient with a Fracture of the trapezium. This study shows that neither MRI, nor CT and BS are 100 % accurate in diagnosing occult Scaphoid Fractures. MRI and CT miss Fractures, and BS tends to over-diagnose. The specific advantages and limitations of each diagnostic modality should be familiar to the treating physicians and taken into consideration during the diagnostic process.
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clinical prediction rule for suspected Scaphoid Fractures a prospective cohort study
Injury-international Journal of The Care of The Injured, 2010Co-Authors: Steven J. Rhemrev, Frank J. P. Beeres, M. Hogervorst, R H Van Leerdam, David RingAbstract:Abstract Background The low prevalence of true Fractures amongst suspected Fractures magnifies the shortcomings of the diagnostic tests used to triage suspected Scaphoid Fractures. Purpose The objective was to develop a clinical prediction rule that would yield a subset of patients who were more likely to have a Scaphoid Fracture than others who lacked the subset criteria. Methods Seventy-eight consecutive patients diagnosed with a suspected Scaphoid Fracture were included. Standardised patient history, physical examination, range of motion (ROM) and strength measurements were studied. The reference standard for a true Fracture was based on the results of magnetic resonance imaging, bone scintigraphy, follow-up radiographs and examination. Results Analysis revealed three significant independent predictors: extension Conclusion Clinical prediction rules have the potential to increase the prevalence of true Fractures amongst patients with suspected Scaphoid Fractures, which can increase the diagnostic performance characteristics of radiological diagnostic tests used for triage.
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a prospective comparison for suspected Scaphoid Fractures bone scintigraphy versus clinical outcome
Injury-international Journal of The Care of The Injured, 2007Co-Authors: Frank J. P. Beeres, Steven J. Rhemrev, M. Hogervorst, Den P Hollander, G N JukemaAbstract:Summary Early diagnosis and treatment of Scaphoid Fractures limits the number of delayed and non-unions. Bone scintigraphy proved to be a sensitive diagnostic tool for the detection of occult Scaphoid Fractures. However, the results have to be interpreted with care. Objective To prospectively correlate the results of bone scintigraphy with clinical outcome. Methods In a prospective study, we analysed 50 consecutive patients with signs of a Scaphoid Fracture at physical examination but no evidence of a Scaphoid Fracture on Scaphoid radiographs. All patients had a protocolised follow up at fixed intervals. The clinical outcome was defined according to a standardised algorithm. Main results Bone scintigraphy revealed 32% (16/50) occult Scaphoid Fractures and 40% (20/50) occult other Fractures. Clinical outcome proved that bone scintigraphy was false positive in five patients and in one case false negative for a Scaphoid Fracture. Conclusion Bone scintigraphy in combination with protocolised physical examination is the gold standard for patients with signs of a Scaphoid Fracture that cannot be proven on Scaphoid radiographs.
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outcome of routine bone scintigraphy in suspected Scaphoid Fractures
Injury-international Journal of The Care of The Injured, 2005Co-Authors: Frank J. P. Beeres, M. Hogervorst, Den P Hollander, Steven J. RhemrevAbstract:Summary Undisplaced Scaphoid Fractures are easily missed on conventional Scaphoid radiographs, but these occult Fractures may seriously impair hand function. Routine bone scintigraphy (BS) is often advocated if there are clinical signs of a Scaphoid Fracture without radiological evidence. However, the results require careful therapeutic management. Objective: To determine the diagnostic value of BS in daily practice for clinically suspected Scaphoid Fractures. Methods: We evaluated our protocol of routine BS in suspected Scaphoid Fractures. Subjects: In a retrospective study, we analysed 111 consecutive cases with signs of a Scaphoid Fracture on physical examination. Radiographs revealed 55 Fractures, the remaining 56 patients all underwent BS. Main results: On average, the BS was performed after 4 days. It showed a Fracture in 38/56 of the patients. The distribution of Fractures was: Scaphoid bone 15, distal radius 11, other carpal bones 9 and metacarpal bones 3. Conclusion: If there is a strong clinical suspicion of a Scaphoid Fracture, which cannot be confirmed by conventional radiology, BS is a valuable diagnostic tool.
Frank J. P. Beeres - One of the best experts on this subject based on the ideXlab platform.
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comparison of mri ct and bone scintigraphy for suspected Scaphoid Fractures
European Journal of Trauma and Emergency Surgery, 2016Co-Authors: A.d. De ,zwart, Frank J. P. Beeres, Steven J. Rhemrev, K A Bartlema, Inger B SchipperAbstract:The best diagnostic modality for confirmation of the diagnosis of a Scaphoid Fracture that is not visible on the initial radiograph (occult Scaphoid Fracture) is still subject of debate. The aim of this study was to compare the accuracy of magnetic resonance imaging (MRI), computed tomography (CT) and bone scintigraphy (BS) for the diagnosis of these occult Scaphoid Fractures. In a study period of 12 months, 33 consecutive patients with a clinically suspected Scaphoid Fracture without a Fracture on the Scaphoid radiographs were evaluated with MRI, CT and BS. In case of a discrepancy between the diagnostic modalities, the final diagnosis was based on standardised follow-up with clinical examination and a repeated radiograph. Three of the 33 patients had a Scaphoid Fracture. MRI missed one Scaphoid Fracture and did not over-diagnose. CT missed two Scaphoid Fractures and did not over-diagnose. BS missed no Scaphoid Fractures and over-diagnosed one Scaphoid Fracture in a patient with a Fracture of the trapezium. This study shows that neither MRI, nor CT and BS are 100 % accurate in diagnosing occult Scaphoid Fractures. MRI and CT miss Fractures, and BS tends to over-diagnose. The specific advantages and limitations of each diagnostic modality should be familiar to the treating physicians and taken into consideration during the diagnostic process.
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clinical prediction rule for suspected Scaphoid Fractures a prospective cohort study
Injury-international Journal of The Care of The Injured, 2010Co-Authors: Steven J. Rhemrev, Frank J. P. Beeres, M. Hogervorst, R H Van Leerdam, David RingAbstract:Abstract Background The low prevalence of true Fractures amongst suspected Fractures magnifies the shortcomings of the diagnostic tests used to triage suspected Scaphoid Fractures. Purpose The objective was to develop a clinical prediction rule that would yield a subset of patients who were more likely to have a Scaphoid Fracture than others who lacked the subset criteria. Methods Seventy-eight consecutive patients diagnosed with a suspected Scaphoid Fracture were included. Standardised patient history, physical examination, range of motion (ROM) and strength measurements were studied. The reference standard for a true Fracture was based on the results of magnetic resonance imaging, bone scintigraphy, follow-up radiographs and examination. Results Analysis revealed three significant independent predictors: extension Conclusion Clinical prediction rules have the potential to increase the prevalence of true Fractures amongst patients with suspected Scaphoid Fractures, which can increase the diagnostic performance characteristics of radiological diagnostic tests used for triage.
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a prospective comparison for suspected Scaphoid Fractures bone scintigraphy versus clinical outcome
Injury-international Journal of The Care of The Injured, 2007Co-Authors: Frank J. P. Beeres, Steven J. Rhemrev, M. Hogervorst, Den P Hollander, G N JukemaAbstract:Summary Early diagnosis and treatment of Scaphoid Fractures limits the number of delayed and non-unions. Bone scintigraphy proved to be a sensitive diagnostic tool for the detection of occult Scaphoid Fractures. However, the results have to be interpreted with care. Objective To prospectively correlate the results of bone scintigraphy with clinical outcome. Methods In a prospective study, we analysed 50 consecutive patients with signs of a Scaphoid Fracture at physical examination but no evidence of a Scaphoid Fracture on Scaphoid radiographs. All patients had a protocolised follow up at fixed intervals. The clinical outcome was defined according to a standardised algorithm. Main results Bone scintigraphy revealed 32% (16/50) occult Scaphoid Fractures and 40% (20/50) occult other Fractures. Clinical outcome proved that bone scintigraphy was false positive in five patients and in one case false negative for a Scaphoid Fracture. Conclusion Bone scintigraphy in combination with protocolised physical examination is the gold standard for patients with signs of a Scaphoid Fracture that cannot be proven on Scaphoid radiographs.
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outcome of routine bone scintigraphy in suspected Scaphoid Fractures
Injury-international Journal of The Care of The Injured, 2005Co-Authors: Frank J. P. Beeres, M. Hogervorst, Den P Hollander, Steven J. RhemrevAbstract:Summary Undisplaced Scaphoid Fractures are easily missed on conventional Scaphoid radiographs, but these occult Fractures may seriously impair hand function. Routine bone scintigraphy (BS) is often advocated if there are clinical signs of a Scaphoid Fracture without radiological evidence. However, the results require careful therapeutic management. Objective: To determine the diagnostic value of BS in daily practice for clinically suspected Scaphoid Fractures. Methods: We evaluated our protocol of routine BS in suspected Scaphoid Fractures. Subjects: In a retrospective study, we analysed 111 consecutive cases with signs of a Scaphoid Fracture on physical examination. Radiographs revealed 55 Fractures, the remaining 56 patients all underwent BS. Main results: On average, the BS was performed after 4 days. It showed a Fracture in 38/56 of the patients. The distribution of Fractures was: Scaphoid bone 15, distal radius 11, other carpal bones 9 and metacarpal bones 3. Conclusion: If there is a strong clinical suspicion of a Scaphoid Fracture, which cannot be confirmed by conventional radiology, BS is a valuable diagnostic tool.
Nikolas H Kazmers - One of the best experts on this subject based on the ideXlab platform.
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an epidemiologic perspective on Scaphoid Fracture treatment and frequency of nonunion surgery in the usa
HSS Journal, 2018Co-Authors: Nikolas H Kazmers, Jack Baty, Kerry M Bommarito, Daniel A OseiAbstract:Background Scaphoid Fractures treated non-operatively and operatively may be complicated by nonunion. Questions/purposes We sought to test the primary hypothesis that the incidence density of Scaphoid Fracture treatment is higher than previously estimated, to determine the frequency and risk factors for nonunion treatment, and to determine whether the frequency of surgical treatment increased over time. Methods The MarketScan® database was queried for all records of treatment (casting and surgery) for closed Scaphoid Fractures over a 6-year period. We examined subsequent claims to determine frequency of additional procedures for nonunion treatment (revision fixation or vascularized grafting occurring 28 days or more after initial treatment). Trend analyses were used to determine whether changes in frequency of surgical treatment or revision procedure occurred. Results The estimated incidence density of Scaphoid Fracture is 10.6 per 100,000 person-years in a commercially insured population of less than 65 years of age. Of 8923 closed Scaphoid Fractures, 29 and 71% were treated with surgery and casting, respectively. The frequency of surgical treatment rose significantly, from 22.1% in 2006 to 34.1% in 2012. The frequency of nonunion treatment was 10.8% after surgery and 3% after casting; neither changed over time. Younger age, male sex, and surgical treatment are associated with a higher risk of nonunion treatment. Conclusions Our estimated incidence of Scaphoid Fracture is higher than previously reported. The increased enthusiasm in the USA to surgically treat Scaphoid Fractures is reflected by our trend analysis. The frequency of surgical treatment for presumed nonunion after initial surgical management for closed Scaphoid Fractures exceeded 10%. Given the increased utilization of surgery, surgeons and patients should be aware of the frequency of nonunion treatment to inform treatment decisions.
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a scapholunate ligament sparing technique utilizing the medial femoral condyle corticocancellous free flap to reconstruct Scaphoid nonunions with proximal pole avascular necrosis
Journal of Hand Surgery (European Volume), 2016Co-Authors: Nikolas H Kazmers, Stephanie Thibaudeau, Scott L LevinAbstract:This article demonstrates a technique for the treatment of Scaphoid Fracture waist and proximal pole nonunions with avascular necrosis using a free vascularized medial femoral condyle flap. We present our surgical technique and representative case examples in which the scapholunate ligament, a key structure required to preserve carpal kinematics, is spared.
M. Hogervorst - One of the best experts on this subject based on the ideXlab platform.
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clinical prediction rule for suspected Scaphoid Fractures a prospective cohort study
Injury-international Journal of The Care of The Injured, 2010Co-Authors: Steven J. Rhemrev, Frank J. P. Beeres, M. Hogervorst, R H Van Leerdam, David RingAbstract:Abstract Background The low prevalence of true Fractures amongst suspected Fractures magnifies the shortcomings of the diagnostic tests used to triage suspected Scaphoid Fractures. Purpose The objective was to develop a clinical prediction rule that would yield a subset of patients who were more likely to have a Scaphoid Fracture than others who lacked the subset criteria. Methods Seventy-eight consecutive patients diagnosed with a suspected Scaphoid Fracture were included. Standardised patient history, physical examination, range of motion (ROM) and strength measurements were studied. The reference standard for a true Fracture was based on the results of magnetic resonance imaging, bone scintigraphy, follow-up radiographs and examination. Results Analysis revealed three significant independent predictors: extension Conclusion Clinical prediction rules have the potential to increase the prevalence of true Fractures amongst patients with suspected Scaphoid Fractures, which can increase the diagnostic performance characteristics of radiological diagnostic tests used for triage.
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a prospective comparison for suspected Scaphoid Fractures bone scintigraphy versus clinical outcome
Injury-international Journal of The Care of The Injured, 2007Co-Authors: Frank J. P. Beeres, Steven J. Rhemrev, M. Hogervorst, Den P Hollander, G N JukemaAbstract:Summary Early diagnosis and treatment of Scaphoid Fractures limits the number of delayed and non-unions. Bone scintigraphy proved to be a sensitive diagnostic tool for the detection of occult Scaphoid Fractures. However, the results have to be interpreted with care. Objective To prospectively correlate the results of bone scintigraphy with clinical outcome. Methods In a prospective study, we analysed 50 consecutive patients with signs of a Scaphoid Fracture at physical examination but no evidence of a Scaphoid Fracture on Scaphoid radiographs. All patients had a protocolised follow up at fixed intervals. The clinical outcome was defined according to a standardised algorithm. Main results Bone scintigraphy revealed 32% (16/50) occult Scaphoid Fractures and 40% (20/50) occult other Fractures. Clinical outcome proved that bone scintigraphy was false positive in five patients and in one case false negative for a Scaphoid Fracture. Conclusion Bone scintigraphy in combination with protocolised physical examination is the gold standard for patients with signs of a Scaphoid Fracture that cannot be proven on Scaphoid radiographs.
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outcome of routine bone scintigraphy in suspected Scaphoid Fractures
Injury-international Journal of The Care of The Injured, 2005Co-Authors: Frank J. P. Beeres, M. Hogervorst, Den P Hollander, Steven J. RhemrevAbstract:Summary Undisplaced Scaphoid Fractures are easily missed on conventional Scaphoid radiographs, but these occult Fractures may seriously impair hand function. Routine bone scintigraphy (BS) is often advocated if there are clinical signs of a Scaphoid Fracture without radiological evidence. However, the results require careful therapeutic management. Objective: To determine the diagnostic value of BS in daily practice for clinically suspected Scaphoid Fractures. Methods: We evaluated our protocol of routine BS in suspected Scaphoid Fractures. Subjects: In a retrospective study, we analysed 111 consecutive cases with signs of a Scaphoid Fracture on physical examination. Radiographs revealed 55 Fractures, the remaining 56 patients all underwent BS. Main results: On average, the BS was performed after 4 days. It showed a Fracture in 38/56 of the patients. The distribution of Fractures was: Scaphoid bone 15, distal radius 11, other carpal bones 9 and metacarpal bones 3. Conclusion: If there is a strong clinical suspicion of a Scaphoid Fracture, which cannot be confirmed by conventional radiology, BS is a valuable diagnostic tool.
