Distal radius fractures are common, with an incidence of 254 to 278 per 100 000 person-years. 1,2 The indications for operative and nonoperative management of these fractures are still subject to debate. Recent systematic reviews and meta-analysis show little difference between the 2 options. 3,4 In the past few decades, there have been minimal advances and few reports on materials used for nonoperative treatment of distal radius fractures. 5-8 The primary emphasis has been on optimizing operative treatment of these fractures by means of optimizing surgical techniques, fracturespecific plates, and rehabilitation protocols. Nonoperative management of distal radius fractures typically includes an early period of wrist and elbow immobilization by means of either a sugar-tong splint or a long-arm cast followed by transition to a short-arm cast. In our experience, the transition time to a short-arm cast varies among practices. The rationale for a short-arm cast is that with early callus formation and fracture consolidation, limited forearm pronation and supination is tolerated and elbow motion is allowed. Nonoperatively treated distal radius fractures are most often immobilized in a fiberglass cast. The drawback of a cast is that patients often complain that it is cumbersome, irritating, and malodorous, and that it interferes with personal hygiene. This is especially problematic with injuries that require prolonged immobilization, such as scaphoid fractures. An emphasis on patient satisfaction has gained more importance recently in the wake of patient-centered reform in health care. New developments in 3-dimensional (3D) printing make it possible to fabricate a patient-specific cast to immobilize the fractured distal radius. These casts use an open-lattice, ventilated design 831341H ANXXX10.
BACKGROUND AND RATIONALE Although general trauma care systems and their effects on mortality reduction have been studied, little is known of the current state of musculoskeletal trauma delivery globally, particularly in low-income (LI) and low middle-income (LMI) countries. The goal of this study is to assess and describe the development and availability of musculoskeletal trauma care delivery worldwide. MATERIALS METHODS A questionnaire was developed to evaluate different characteristics of general and musculoskeletal trauma care systems, including general aspects of systems, education, access to care and pre-and posthospital care. Surgical leaders involved with musculoskeletal trauma care were contacted to participate in the survey. RESULTS Of the 170 surveys sent, 95 were returned for use for the study. Nearly 30 percent of surgeons reported a formalized and coordinated trauma system in their countries. Estimates for the number of surgeons providing musculoskeletal trauma per one million inhabitants varied from 2.6 in LI countries to 58.8 in high-income countries. Worldwide, 15% of those caring for musculoskeletal trauma are fellowship trained. The survey results indicate a lack of implemented musculoskeletal trauma care guidelines across countries, with even high-income countries reporting less than 50% availability in most categories. Seventy-nine percent of the populations from LI countries were estimated to have no form of health care insurance. Formalized emergency medical services were reportedly available in only 33% and 50% of LI and LMI countries, respectively. Surgeons from LI and LMI countries responded that improvements in the availability of equipment (100%), number and locations of trauma-designated hospitals (90%), and physician training programs (88%) were necessary in their countries. The survey also revealed a general lack of resources for postoperative and rehabilitation care, irrespective of the country's income level. CONCLUSION This study addresses the current state of musculoskeletal trauma care delivery worldwide. These results indicate a greater need for trauma system development and support, from prehospital through posthospital care. Optimization of these systems can lead to better outcomes for patients after trauma. This study represents a critical first step toward better understanding the state of musculoskeletal trauma care in countries with different levels of resources, developing strategies to address deficiencies, and forming regional and international collaborations to develop musculoskeletal trauma care guidelines.
Segmental transport is an effective method of treatment for segmental defects, but the need for external fixation during the transport phase is a disadvantage. To avoid external fixation, we have developed a Cylinder-Kombi-Tube Segmental Transport (CKTST) module for combination with a commercially available motorized lengthening nail. This CKTST module allows for an all-internal segmental bone transport and also allows for optional lengthening if needed. The concept and surgical technique of CKTST are described and illustrated with a clinical case.
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