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Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: A scoping review. Stambulic, T., Desai, V., Bicknell, R. and Daneshvar, P. (2022) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Terrible triad – Recovery This is a review assessing the recovery of terrible triad injuries. A total of 43 studies were included in the review. Functional outcomes (e.g. QuickDASH), complication rates, and range of movement were recorded at follow-up (average 2-3 years post-surgery). More than 2,000 participants were included across all the studies. The result showed that patients surgically treated for a terrible triad presented with low disability at 2-3 years post-surgery. The re-operation rate for complications was around 8%. In addition, patients recovered a functional range of movement of the elbow. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, surgical treatment of a "Terrible triad" injury leads to reasonable outcomes in terms of function and range of movement at 2-3 years post-surgery. The re-operation rate for complications is around 8%. Hence, we could call rename this condition the "Manageable triad", which may reduce catastrophic thinking in our clients. Considering the extensive recovery time as well as the lack of complete recovery, it is important to set clients' expectations. In addition, it is likely that clients affected by this condition will develop depression, which could further impair their perceived function. URL: https://doi.org/10.1016/j.xrrt.2022.01.002 Abstract Background: The terrible triad injury (TTI) of the elbow is a combination of a posterolateral dislocation of the elbow joint combined with fractures of the radial head and coronoid process most often caused by a fall on an outstretched hand. The injury pattern was named for its poor outcomes and high complication rates following surgical repair, but increased understanding of elbow anatomy and biomechanics has led to the development of standardized surgical protocols in an attempt to improve outcomes. Most existing literature on terrible triad injuries is from small retrospective cohort studies and surgical techniques to improve outcomes. Therefore, the purpose of this scoping review is to provide an overview of the functional outcomes, prognosis, and complications following current surgical treatment of TTIs. Methods: A scoping review was performed to evaluate the literature. In total, 617 studies were identified and screened by 2 reviewers, with 43 studies included for qualitative analysis. These 43 studies underwent data extraction for functional outcomes using the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand score (DASH) and were stratified accordingly. Secondary outcome measures assessed in the study were a range of motion (ROM) and complication rate. Results: The average MEPS was 90 (excellent) from a total of 37 studies with 1609 patients, and the average DASH score was 16 from 16 studies with 441 patients. Another 6 studies with a total of 127 patients reported a mean Q-DASH score of 13. A total of 39 studies consisting of 1637 patients had a mean forearm rotation of 135 degrees, and 36 studies consisting of 1606 patients had a mean flexion-extension arc of 113 degrees. Among the studies, there was a 30% complication rate with a need for revision surgery in 7.8% of cases. The most common complications were radiographic evidence of heterotopic ossification (11%) and ulnar nerve neuropathy (2.6%). Discussion/Conclusions: This study shows that current surgical treatment for terrible triad injuries has resulted in improved outcomes. Based on primary outcome measures using MEPS and DASH scores, almost all of the studies have highlighted good or excellent functional outcomes. This highlighted the marked improvement in outcome scores since the term was coined, suggesting that terrible triad injuries may no longer be so terrible. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Late displacement after lateral condylar fractures of the humerus. Aibara, N., Takagi, T. and Seki, A. (2022) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Lateral condyle fracture of the humerus – Predict displacement This is a retrospective study assessing whether it is possible to predict lateral condyle fracture of the humerus displacement in conservatively treated children/teenagers. Lateral condyle fractures of the humerus account for 10-20% of humeral fractures in children. If they are undisplaced, they can be treated conservatively with immobilisation, however, about 15% of them require delayed surgery due to late displacement. The association between age, sex, elbow immobilisation position, initial displacement, fat pad sign, elbow flexion angle, forearm position (neutral/pronation) and the presence of displacement (>= 1 mm on AP or lateral x-ray) was assessed. A total of 62 participants between 1 and 16 years old (average: 5 yrs old) with undisplaced lateral condyle fractures of the humerus at baseline were included in the study. They were all initially treated conservatively. The results showed that 45% of participants presented with fracture displacement (>= 1 mm on AP or lateral x-ray) at 7 days. The results also showed that there was no association between any of the variables considered and the development of a displaced fracture at 7 days. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, we are currently unable to predict who will develop a displaced lateral condyle fracture of the humerus one week after injury. It is therefore best to repeat a lateral, AP, and internal oblique view seven days post-injury to determine whether surgery is required. After 7 days, the likelihood of fracture displacement appears to plateau. In terms of immobilisation position, there is no evidence that the degree of elbow flexion/extension or forearm supination/pronation will prevent fracture displacement. If you are interested in children/teenagers' elbow conditions, you may also want to read about osteochondritis dissecans. URL: https://doi.org/10.1016/j.jse.2022.06.003 Abstract Background: Nondisplaced or slightly displaced lateral condyle fractures may subsequently displace if treated with cast immobilization alone, and displacement indicates surgery. In this context, placing the forehand in pronation is sometimes recommended, and the prediction of the late displacement based on the presence of the fat pad sign is useful. However, few studies have quantitatively shown the relationships between forearm position during immobilization and late displacement and between the presence of the fat pad sign and late displacement. We investigated the factors that may affect the late displacement and the features of the consequences during the late displacement. Methods: Between October 2003 and July 2020, we observed 62 patients (45 boys and 17 girls). We evaluated the correlation between the factors age, gender, the initial displacement, the presence of a fat pad sign, the flexion angle of the elbow, the forearm position (pronation or neutral), and the late displacement on day 7 after the injury, which means the difference between the displacement on day 0 and that on day 7 in the 62 cases with the minimal displacement. Moreover, of all 62 cases observed, we further investigated those 52 cases that had been treated conservatively for 3 weeks for any resultant effects. We used the Friedman test to evaluate the difference in the late displacement on each day. We acknowledged the P value < .05 as significant. Results: There was no significant correlation between each factor (age, sex, initial displacement, presence of the fat pad sign, flexion angle of the elbow, or forearm position) and displacement on day 7, whereas there was significant progressive displacement until day 7. Conclusion: The present study concluded that late displacement would happen until the 7 postoperative dates, regardless of the splint angle, the fat pad sign, the age, or the gender. Therefore, it is important to follow any case, even with mild-displaced lateral condylar humeral fractures, until day 7 because the late displacement might occur. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Evaluation of a convolutional neural network to identify scaphoid fractures on radiographs. Li, T., et al. (2022). Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Machine learning – Scaphoid fractures detection on x-ray This is a retrospective study assessing whether machine learning algorithms are able to detect scaphoid fractures on baseline x-rays with acceptable diagnostic accuracy. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. The machine learning model was trained on 930 x-ray images and tested on 100 baseline images. Three surgeons with 3, 13, and 14 years of experience assessed the same 100 x-rays and reached an agreement on each x-ray regarding the presence or not of a scaphoid fracture. The results showed that the surgeons had sensitivity and specificity of 76% and 96% respectively. The machine learning algorithm had similar results with a sensitivity and specificity of 82% and 94%. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, machine learning is as good at identifying scaphoid fractures on x-ray as experienced surgeons. In the future, it is likely that these algorithms will be implemented in radiology software to aid scaphoid fracture detection. We are experiencing a surge of research showing the usefulness of machine learning for the prediction of treatment responders and the assessment of patients with upper limb conditions. URL: https://doi.org/10.1177/1753193422112709 Abstract This study aimed to develop and evaluate a convolutional neural network for identifying scaphoid fractures on radiographs. A dataset of 1918 wrist radiographs (600 patients) was taken from an orthopaedic referral centre between 2010 to 2020. A YOLOv3 and a MobileNetV3 convolutional neural network were trained for scaphoid detection and fracture classification, respectively. The diagnostic performance of the convolutional neural network was compared with the majority decision of four hand surgeons. The convolutional neural network achieved a sensitivity of 82% and specificity of 94%, with an area under the receiver operating characteristic of 92%, whereas the surgeons achieved a sensitivity of 76% and specificity of 96%. The comparison indicated that the convolutional neural network’s performance was similar to the majority vote of surgeons. It further revealed that convolutional neural network could be used in identifying scaphoid fractures on radiographs reliably, and has potential to achieve the expert-level performance. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Which patient and surgeon characteristics are associated with surgeon experience of stress during an office visit? Crijns, T., Al Salman, A., Bashour, L., Ring, D. and Teunis, T. (2022) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 thumbs up) Type of study: Therapeutic Topic: Clinicians' stress - Clients' psychosocial health This is a survey assessing the surgeons' levels of stress associated with simulated patients' presentations. A total of 111 surgeons took part in the study. Surgeons' were asked to rate their level of stress when consulting different types of patients. Simulated patients were described as presenting with different characteristics. Simulated patients presented with or without disproportionate levels of pain, a high number of prior consultations with other surgeons, as well as "googling" their condition and being convinced that they knew what to do for their condition prior to the appointment. The results showed that surgeons experience greater levels of futility, inadequacy, and frustration when patients presented with the characteristics described above. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, clinicians experience greater levels of stress when interacting with clients presenting with unhelpful pain beliefs/disproportionate levels of pain or clients with a long list of office visits/second opinions. Being aware of this link may help us provide better care for our clients as well as provide them with a different perspective on pain. URL: https://doi.org/10.1016/j.pecinn.2022.100043 Abstract Objective: To determine clinician and patient factors associated with the surgeon feelings of stress, futility, inadequacy, and frustration during an office visit. Methods: A survey-based experiment presented clinical vignettes with randomized patient factors (such as symptom intensity, the number of prior consultations, and involvement in a legal dispute) and feeling behind schedule in order to determine which are most related to surgeon ratings of stress, futility, inadequacy, and frustration on 11-point Likert scales. Results: Higher surgeon stress levels were independently associated with women patients, multiple prior consultations, a legal dispute, disproportionate symptom intensity, and being an hour behind in the office. The findings were similar for feelings of futility, inadequacy, and frustration. Conclusion: Patient factors potentially indicative of mental and social health opportunities are associated with greater surgeon-rated stress and frustration. Innovation: Training for surgeon self-awareness and effective communication can transform stressful or adversarial interactions into an effective part of helping patients get and stay healthy by diagnosing and addressing psychosocial aspects of the illness. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: Systematic review and meta-analysis. Pozzi, F., et al. (2020) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Prognostic Topic: Elbow injury - Risk factors This is a systematic review and meta-analysis assessing the usefulness of shoulder range of movement screening to predict upper limb injury in overhead athletes. The systematic review included prospective studies only. Shoulder flexion, shoulder internal/external rotation at 90° of shoulder abduction, and shoulder horizontal adduction were assessed. Injury was defined as any shoulder- or elbow-related complaint incurred in the season. A total of 7 studies were included in the meta-analysis. Overhead sports included baseball (n = 2471), handball (n = 535), softball (n = 103), swimming (n = 74), volleyball (n = 66), and tennis (n = 65). The results showed that shoulder external rotation on the throwing arm was a useful screening tool for professional baseball pitchers. Those players who did not present with an external rotation of the throwing arm of at least 5° greater than the contralateral, were twice as likely to injure their pitching shoulder or elbow. Limited evidence was available for the other overhead sports. This may be due to the small number of studies investigating athletes involved in other sports. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, we may test shoulder external rotation in professional baseball pitchers to assess their risk of developing an elbow or shoulder injury. Interventions aimed at modifying these impairments may be useful in reducing their risk of elbow and shoulder injury. For example, eccentric resistance training of internal rotators towards the end of shoulder external rotation may be a useful exercise. Thus, resistance training has been shown to not only improve strength but also the flexibility of the exercising muscles. Structural limitations may be suspected if this exercise regime does not lead to flexibility changes. Open Access URL: http://dx.doi.org/10.1136/bjsports-2019-100698 Abstract Objective: To characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes. Design: Systematic review and meta-analysis. Data sources: Six electronic databases up to 22 September 2018. Eligibility criteria: Inclusion criteria were (1) overhead athletes from Olympic or college sports, (2) preseason measures of shoulder ROM, (3) tracked in-season injuries at the shoulder and elbow, and (4) prospective cohort design. Exclusion criteria were (1) included contact injuries, (2) lower extremity, spine and hand injuries, and (3) full report not published in English. Results: Fifteen studies were identified, and they included 3314 overhead athletes (baseball (74.6%), softball (3.1%), handball (16.1%), tennis (2.0%), volleyball (2.0%) and swimming (2.2%)). Female athletes are unrepresented (12% of the overall sample). Study quality ranged from 11 to 18 points on a modified Downs and Black checklist (maximum score 21, better quality). In one study, swimmers with low (&lt;93°) or high (&gt;100°) shoulder external rotation were at higher risk of injuries. Using data pooled from three studies of professional baseball pitchers, we showed in the meta-analysis that shoulder external rotation insufficiency (throwing arm &lt;5° greater than the non-throwing arm) was associated with injury (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p&lt;0.01). Conclusion: Preseason screening of shoulder external rotation ROM may identify professional baseball pitchers and swimmers at risk of injury. Shoulder ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of injuries. The results of this systematic review and meta-analysis should be interpreted with caution due to the limited number of studies and their high degree of heterogeneity. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Physical examination of the elbow, what is the evidence? A systematic literature review. Zwerus, E. L., et al. (2018) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 👍 (4/4 thumbs up) Type of study: Diagnostic Topic: Elbow conditions – Physical tests This is a systematic review assessing the diagnostic accuracy of physical tests for elbow conditions. A total of ten studies were included. The variables of interest were the sensitivity and specificity of physical tests. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. A large number of studies presented a high risk of bias. The results showed that tests for distal biceps tendon rupture were the most common in the literature. Only a few papers assessed the diagnostic validity of tests for other conditions. One of the largest issues with the published papers was the over-recruitment of people with the studied condition (e.g. PLRI), which makes it hard to generalise the sensitivity/specificity of these tests to clinical practice. Nevertheless, the study provided an extensive table presenting elbow conditions and relative tests (See below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the diagnostic accuracy of clinical tests for elbow conditions has not been investigated thoroughly. Sound anatomical knowledge combined with a thorough subjective examination is therefore necessary when trying to differentiate between common elbow conditions. In the future, we will have more details about the ability of common tests such as the hook test, distal biceps tendinopathy, tennis elbow, and ligament testing in identifying the pathologies that they aim to diagnose. URL: http://dx.doi.org/10.1136/bjsports-2016-096712 Abstract OBJECTIVE: Primary to provide an overview of diagnostic accuracy for clinical tests for common elbow (sport) injuries, secondary accompanied by reproducible instructions to perform these tests. DESIGN: A systematic literature review according to the PRISMA statement. DATA SOURCES: A comprehensive literature search was performed in MEDLINE via PubMed and EMBASE. ELIGIBILITY CRITERIA: We included studies reporting diagnostic accuracy and a description on the performance for elbow tests, targeting the following conditions: distal biceps rupture, triceps rupture, posteromedial impingement, medial collateral ligament (MCL) insufficiency, posterolateral rotatory instability (PLRI), lateral epicondylitis and medial epicondylitis. After identifying the articles, the methodological quality was assessed using the QUADAS-2 checklist. RESULTS: Our primary literature search yielded 1144 hits. After assessment 10 articles were included: six for distal biceps rupture, one for MCL insufficiency, two for PLRI and one for lateral epicondylitis. No articles were selected for triceps rupture, posteromedial impingement and medial epicondylitis. Quality assessment showed high or unclear risk of bias in nine studies. We described 24 test procedures of which 14 tests contained data on diagnostic accuracy. CONCLUSIONS: Numerous clinical tests for the elbow were described in literature, seldom accompanied with data on diagnostic accuracy. None of the described tests can provide adequate certainty to rule in or rule out a disease based on sufficient diagnostic accuracy. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Elbow biomechanics: Soft tissue stabilizers. Kaufmann, R. A. M. D., Wilps, T. B. S., Musahl, V. M. D. and Debski, R. E. P. (2020) Level of Evidence: 5 Follow recommendation: 👍 (1/4 thumbs up) Type of study: Anatomical Topic: Elbow ligaments - Biomechanics This is a narrative review on passive elbow structures contributing to valgus and varus joint stability. The authors report that valgus flexibility at the elbow is greatest at 30° of flexion and that the medial ulnar collateral ligament (MUCL) resists these valgus forces. The MUCL is divided into anterior and posterior bundles, with the anterior bundle being the main source of valgus stability. The MUCL (anterior bundle) tightens incrementally with elbow flexion, reaching the highest tension at 80° of elbow flexion. The lateral collateral ligaments of the elbow control varus forces and they include the lateral ulnar collateral ligament (LUCL) and the radial collateral ligament (RCL). The stabilisation role of these ligaments is debated, however, it is believed that both control varus forces and are important in the postero-lateral rotatory stability of the elbow. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, valgus stress test of the elbow (30° of flexion) is restrained by the anterior bundle of the MUCL. Injury to the lateral collateral ligaments can be assessed through varus stress testing. Simple elbow dislocations may involve injury to a limited number of ligaments whilst complex dislocations are likely to injure multiple ligaments as well as the capsule. Have a look at these synopses for more info on the treatment and classification of elbow dislocations. URL: http://dx.doi.org/10.1016/j.jhsa.2019.10.034 Abstract The elbow positions the hand in a stable manner relative to the trunk while allowing flexion and extension as well as forearm rotation at varying shoulder positions. Its ability to perform this task without joint subluxation is accomplished through a combination of bony congruency, ligamentous restraint, and dynamic stabilization. Elbow stability is challenged repeatedly during everyday activities, particularly when the arm is abducted. Traumatic injuries that lead to an elbow dislocation or the microtrauma associated with pitching are frequent situations that destabilize the elbow. This article reviews the soft tissue stabilizers that contribute to elbow kinematics and stability. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Early functional mobilization for non-operative treatment of simple elbow dislocations: A systematic review. Catapano, M., Pupic, N., Multani, I., Wasserstein, D. and Henry, P. (2022) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Simple elbow dislocation - Rehabilitation This is a systematic review assessing the best rehabilitation interventions for simple elbow dislocations. Simple elbow dislocations were characterised by stability through range after reduction associated or not with small fractures. A total of 15 studies were included in the review. Of these, three studies were randomised controlled studies. The two interventions most commonly utilised were either Plaster of Paris (PoP) for 21 days or early mobilisation with the intermittent use of an elbow splint. The studies adopting an early mobilisation approach performed forearm pronation/supination as well as elbow flexion/extension through a comfortable range. Most commonly, exercises were performed supine with the shoulder at 90° of flexion. In the early mobilisation group, a posterior elbow splint was utilised for three weeks and removed to perform exercises. The results showed that early mobilisation was associated with earlier return to work, reduced elbow stiffness, higher pain, and a lower likelihood of heterotopic ossification in the short term compared to 21 days of PoP cast. At one year, there was no difference between the early motion compared to PoP cast groups. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, simple elbow dislocations treated with early mobilisation appear to have better outcomes compared to PoP immobilisation for three weeks. There may be higher levels of pain in the short term but it appears that the benefit may outweigh this inconvenience. The treatment of complex elbow dislocations should follow surgeons' advice as these often need surgical management. URL: https://doi.org/10.1177/1758573220957631 Abstract Purpose: This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes. Methods: Searches of four databases from inception to 1 January 2020 were performed to identify clinical studies addressing the non-operative management of simple elbow dislocations. Results: Of 2435 studies that were eligible for title screen, 15 studies satisfied inclusion criteria. Three randomized control studies demonstrated that early mobilization expedited the return of range of motion, function and return to work or activities, however, resulted in increased pain within the six-week rehabilitation period compared to Plaster of Paris casting for 21 days. Patients returned to work sooner after early mobilization (10 vs. 18 days; p = 0.02) compared to Plaster of Paris casting. In all studies, early mobilization resulted in similar re-dislocation rates of 1.3% (3/237) versus 2.2% (12/549) in those with Plaster of Paris casting as well as lower incidence of heterotopic ossification (36% vs. 54%). No significant differences between rehabilitation protocols were determined; however, the large majority of recent papers utilized rehabilitation protocols. Conclusion: Early mobilization of simple elbow dislocations results in early return of Range-of-Motion, function and return to work with no increase in complication rates; however, increased pain during the rehabilitation period. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Elbow dislocations: A review ranging from soft tissue injuries to complex elbow fracture dislocations. Englert, C., Zellner, J., Koller, M., Nerlich, M. and Lenich, A. (2013) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic: Elbow dislocation - Classification This is an expert opinion on the diagnosis and treatment of elbow dislocations. What the authors suggest is to classify elbow dislocations as simple and complex. Simple elbow dislocations may be associated with small fractures and can be reduced without anaesthesia. These injuries are usually stable and a splint limiting extension/flexion is usually advisable for a short period of time. Complex dislocations often cannot be reduced without anaesthesia and are often associated with larger displaced fractures, which require surgical interventions. The common complications of elbow dislocations include chronic instability/stiffness, and heterotopic ossification. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, elbow dislocations may be classified as simple or complex according to the size/displacement of the fracture and the stability through range after reduction. Gross neurovascular function assessment and x-ray investigations are often required. If you are uncertain whether an x-ray is required, you can perform the elbow extension test. For the rehabilitation of simple dislocations, have a look at this other synopsis. URL: https://doi.org/10.1155/2013/951397 Abstract This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Catastrophic thinking is associated with finger stiffness after distal radius fracture surgery. Teunis, T., Bot, A. G., Thornton, E. R. and Ring, D. (2015) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Finger stiffness post distal radius fracture - The effect of catastrophising This is a retrospective study assessing the association between several variables and finger stiffness following open reduction internal fixation for distal radius fracture. A total of 96 participants were included in the study. Demographic characteristics, fracture severity and psychological variables (e.g. pain catastrophising) were measured at baseline and utilised to predict finger stiffness (distance to palmar crease across four fingers) at six weeks. The results showed that greater pain catastrophising was associated with worse finger stiffness at six weeks. In particular, for every 10 points increase in catastrophising, there is a 1 cm increase (for each finger) in distance to palmar crease (see figure below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, pain catastrophising at baseline predicts finger stiffness at six weeks after distal radius fracture open reduction internal fixation. This study contributes to the growing amount of evidence showing that pain catastrophising negatively affects recovery in upper limb conditions and upper limb function. URL: https://doi.org/10.1097/bot.0000000000000342 Abstract Objectives: To identify demographic, injury-related, or psychologic factors associated with finger stiffness at suture removal and 6 weeks after distal radius fracture surgery. We hypothesize that there are no factors associated with distance to palmar crease at suture removal. Design: Prospective cohort study. Setting: Level I Academic Urban Trauma Center. Patients: One hundred sixteen adult patients underwent open reduction and internal fixation of their distal radius fractures; 96 of whom were also available 6 weeks after surgery. Intervention: None. Main outcome measurements: At suture removal, we recorded patients' demographics, AO fracture type, carpal tunnel release at the time of surgery, pain catastrophizing scale, Whiteley Index, Patient Health Questionnaire-9, and disabilities of the arm, shoulder, and hand questionnaire, 11-point ordinal measure of pain intensity, distance to palmar crease, and active flexion of the thumb through the small finger. At 6 weeks after surgery, we measured motion, disabilities of the arm, shoulder, and hand, and pain intensity. Prereduction and postsurgery radiographic fracture characteristics were assessed. Results: Female sex, being married, specific surgeons, carpal tunnel release, AO type C fractures, and greater catastrophic thinking were associated with increased distance to palmar crease at suture removal. At 6 weeks, greater catastrophic thinking was the only factor associated with increased distance to palmar crease. Conclusions: Catastrophic thinking was a consistent and major determinant of finger stiffness at suture removal and 6 weeks after injury. Future research should assess if treatments that ameliorate catastrophic thinking can facilitate recovery of finger motion after operative treatment of a distal radius fracture. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis. Swärd, E. M., Brodda-Jansen, G., Schriever, T. U., Andersson-Franko, M. and Wilcke, M. K. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 thumbs up) Type of study: Prognostic Topic: Salvage surgery for wrist osteoarthritis - The role of pain catastrophising This is a retrospective study assessing the association between psychological variables and disability in participants undergoing salvage surgery for wrist osteoarthritis (OA). A total of 79 participants with wrist OA were included in the study. Psychological variables included pain catastrophising, anxiety, and depression. Disability was measured through the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire at 6 and 12 months post surgery. The results showed that greater pain catastrophising and anxiety were associated with worse disability after surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, pain catastrophising and anxiety are associated with recovery following salvage surgery for wrist OA. This study is in line with previous research showing that pain catastrophising explains a large proportion of pain intensity in people with thumb OA, distal radius fracture, and upper limb fractures. Open access URL: https://doi.org/10.1177/17531934221104603 Abstract This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the outcome. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The impact of smoking on delayed osseous union after arthrodesis procedures in the hand and wrist. Foster, B. K., et al. (2022) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Hand arthrodesis – Smoking and non-union This is a retrospective study assessing the effect of smoking on non-union following upper limb arthrodesis. A total of 306 participants were included in the study. Of these, 73 (24%) were smokers. Participants were included if they underwent arthrodesis of wrist/carpometacarpal/metacarpalphalangeal/interphalangeal surgery. Non-union was assessed radiographically at 3 months. Symptomatic non-union was defined as the need for further surgery to correct the non-union. The statistical analyses took into account demographic, comorbidity, and affected joints information to reduce the contribution of confounding factors to the overall results. The results showed that smoking and non-smoking participants presented non-union rates of 27% and 14% of cases respectively. Symptomatic non union was present in 15% and 6% of smokers and non-smokers respectively. Overall, smokers had twice the odds of having non-union or symptomatic non-union compared to non-smokers. One limitation of this study was that there is no information regarding the blinding of the assessors determining union/non-union on x-rays. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, smoking increases the risk of lateral epicondylalgia, post-surgical infections, arthrodesis non-union, and other complications (e.g. re-operation) following distal radius fracture. We should always offer our clients advice to quit smoking. URL: https://doi.org/10.1016/j.jhsa.2022.05.016 Abstract Purpose: The purpose of this study was to evaluate the relationship between smoking and delayed radiographic union after hand and wrist arthrodesis procedures. We hypothesized that smoking would be associated with a higher rate of delayed union. Methods: All cases of hand or wrist arthrodesis procedures in patients aged ≥18 years from 2006 to 2020 were identified. Cases were included if they had >90 days of radiographic follow-up or evidence of union before 90 days. Baseline demographics were recorded for each case including smoking status at the time of surgery. Complications were recorded and all postoperative radiographs were reviewed to assess for evidence of delayed union (defined as lack of osseous union by 90 days after surgery). We compared active smokers and nonsmokers and performed a logistic regression analysis to estimate the odds of experiencing a delayed radiographic union. Results: A total of 309 arthrodesis cases were included and 24% were active smokers. Overall, radiographic evidence of a delayed union was found in 17% of cases. Smokers were significantly more likely to have a delayed union compared with nonsmokers (27% vs 14%). Results of the adjusted logistic regression analysis demonstrated that there was a significantly increased odds of experiencing a delayed union for patients who were active smokers compared with nonsmokers (odds ratio, 2.20; 95% confidence interval, 1.09–4.43). In addition, the rate of symptomatic nonunion requiring reoperation was higher in smokers (15%) compared with nonsmokers (6%). Conclusions: Smoking was associated with increased odds of delayed radiographic union in patients undergoing hand and wrist arthrodesis procedures. Patients should be counseled appropriately on the risks of smoking on bone healing and encouraged to abstain from nicotine use in the perioperative period. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings