The percutaneous and open surgery methods displayed similar effectiveness and proved superior to the conservative CS method regarding the trigger cure and relapse rates. Trial registration. Current Controlled Trials, http://www.controlled-trials.com/, ISRCTN19255926.
CONTEXT AND OBJECTIVE: Various classifi cation systems have been proposed for fractures of the distal radius, but the reliability of these classifications is seldom addressed. For a fracture classification to be useful, it must provide prognostic signifi cance, interobserver reliability and intraobserver reproducibility. The aim here was to evaluate the intraobserver and interobserver agreement of distal radius fracture classifi cations.
DESIGN AND SETTING:This was a validation study on interobserver and intraobserver reliability. It was developed in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo -Escola Paulista de Medicina.METHOD: X-rays from 98 cases of displaced distal radius fracture were evaluated by fi ve observers: one third-year orthopedic resident (R3), one sixth-year undergraduate medical student (UG6), one radiologist physician (XRP), one orthopedic trauma specialist (OT) and one orthopedic hand surgery specialist (OHS). The radiographs were classifi ed on three different occasions (times T1, T2 and T3) using the Universal (Cooney), Arbeitsgemeinschaft für Osteosynthesefragen/ Association for the Study of Internal Fixation (AO/ASIF), Frykman and Fernández classifi cations. The kappa coeffi cient (κ) was applied to assess the degree of agreement.
RESULTS:Among the three occasions, the highest mean intraobserver k was observed in the Universal classifi cation (0.61), followed by Fernández (0.59), Frykman (0.55) and AO/ASIF (0.49). The interobserver agreement was unsatisfactory in all classifi cations. The Fernández classifi cation showed the best agreement (0.44) and the worst was the Frykman classifi cation (0.26).
CONCLUSION:The low agreement levels observed in this study suggest that there is still no classifi cation method with high reproducibility.
Our results show statistically significant improvement in grip strength and range of movement of the wrist and forearm. Pain improved in 80% of the patients and 88% were satisfied with the appearance. One patient had a wound infection and another developed reflex sympathetic dystrophy. Two had some recurrence due to continued growth of the ulna and it is recommended that the procedure be delayed until skeletal maturity, or else combined with epiphysiodesis of the ulna.
This study describes the anatomy of the dorsal digital arteries in the 144 fingers of 18 pairs of fresh human cadaver hands. Previous studies have shown two constant branches in the proximal and middle pulp spaces from each proper digital artery. We have shown that these branches have consistent sites of origin at predictable distances from the proximal interphalangeal joint. Thus cutaneous flaps can be safely planned on these dorsal vessels.
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