Functional Outcomes of Displaced Radial Neck Fractures in Children: Correlation Between Patient-reported Outcomes (PROMIS and QuickDASH)
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Published:
Oct 10, 2021
Keywords:
Elbow, radial neck fracture, children, PROMIS
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Abstract
Introduction: Objectives: 1) to evaluate the subjective outcomes in skeletally immature patients undergoing surgical treatment of displaced radial neck fractures, 2) to compare the performance between PROMIS and QuickDash, 3) to evaluate the floor/ceiling effects of the outcome measurements. We hypothesized that the PROMIS scale would correlate favorably with QuickDash and would demonstrate lower floor or ceiling effects.
Materials and Methods: Demographic data, associated lesions, fracture type, surgical technique, and complications were evaluated. QuickDash and PROMIS scales (PROMIS Upper Extremity (UE), PROMIS Strength and PROMIS Pain interference) were used for functional assessment. The Shapiro-Wilk test was used to analyze the normal distribution of the data. Metrics correlations were made with Spearman's rho coefficient. Ceiling and floor effects were further assessed. The alpha value was set at 0.05.
Results: 26 patients were evaluated. Average age: 7.5 years; average follow-up: 31 months. There were significant correlations between the postoperative QuickDash and PROMIS UE metrics (rs = -0.64, p = 0.003). We found no correlation between PROMIS Pain and PROMIS Strength with QuickDash (rs = 0.001, p = 0.966 and rs = -0.39, p = 0.101 respectively). Ceiling or floor effects were observed at all scales.
Conclusion: We observed a strong correlation between PROMIS UE and QuickDash assessing the results after surgical treatment of radial neck fractures in children. However, all the measures had evident floor/ceiling effects, probably due to the size of the cohort and the fact that a high percentage of these fractures usually present favorable clinical outcomes.
Materials and Methods: Demographic data, associated lesions, fracture type, surgical technique, and complications were evaluated. QuickDash and PROMIS scales (PROMIS Upper Extremity (UE), PROMIS Strength and PROMIS Pain interference) were used for functional assessment. The Shapiro-Wilk test was used to analyze the normal distribution of the data. Metrics correlations were made with Spearman's rho coefficient. Ceiling and floor effects were further assessed. The alpha value was set at 0.05.
Results: 26 patients were evaluated. Average age: 7.5 years; average follow-up: 31 months. There were significant correlations between the postoperative QuickDash and PROMIS UE metrics (rs = -0.64, p = 0.003). We found no correlation between PROMIS Pain and PROMIS Strength with QuickDash (rs = 0.001, p = 0.966 and rs = -0.39, p = 0.101 respectively). Ceiling or floor effects were observed at all scales.
Conclusion: We observed a strong correlation between PROMIS UE and QuickDash assessing the results after surgical treatment of radial neck fractures in children. However, all the measures had evident floor/ceiling effects, probably due to the size of the cohort and the fact that a high percentage of these fractures usually present favorable clinical outcomes.
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Tourn, D., & Masquijo, J. J. (2021). Functional Outcomes of Displaced Radial Neck Fractures in Children: Correlation Between Patient-reported Outcomes (PROMIS and QuickDASH). Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(5), 595-600. https://doi.org/10.15417/issn.1852-7434.2021.86.5.1276
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Clinical Research
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References
1. O’Brien PI. Injuries involving radial head epiphysis. Clin Orthop 1965;41:51-8. PMID: 5832738
2. Gutiérrez-de la Iglesia D, Pérez-López LM, Cabrera-González M, Knörr-Giménez J. Surgical techniques for
displaced radial neck fractures: predictive factors of functional results. J Pediatr Orthop 2017;37(3):159-65.
https://doi.org/10.1097/BPO.0000000000000617
3. Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J
Bone Joint Surg Am 1999;81(10):1429-33. https://doi.org/10.2106/00004623-199910000-00007
4. Ackerson R, Nguyen A, Carry PM, Pritchard B, Hadley-Miller N, Scott F. Intra-articular radial head fractures in the skeletally immature patient: complications and management. J Pediatr Orthop 2015;35(5):443-8.
https://doi.org/10.1097/BPO.0000000000000302
5. De Mattos CB, Ramski DE, Kushare IV, Angsanuntsukh C, Flynn JM. Radial neck fractures in children and
adolescents: an examination of operative and nonoperative treatment and outcomes. J Pediatr Orthop 2016;36(1):6-12. https://doi.org/10.1097/BPO.0000000000000387
6. Nicholson LT, Skaggs DL. Proximal radius fractures in children. J Am Acad Orthop Surg 2019;27(19):e876-e886.
https://doi.org/10.5435/JAAOS-D-18-00204
7. Pring ME. Pediatric radial neck fractures: when and how to fix. J Pediatr Orthop 2012;32(Suppl 1):S14-21.
https://doi.org/10.1097/BPO.0b013e31824b251d
8. Wang J, Chen W, Guo M, Su Y, Zhang Y. Percutaneous reduction and intramedullary fixation technique for
displaced pediatric radial neck fractures. J Pediatr Orthop B 2013;22(2):127-32. https://doi.org/10.1097/BPB.0b013e32835b5700
9. Gerull WD, Okoroafor UC, Guattery J, Goldfarb CA, Wall LB, Calfee RP. Performance of Pediatric PROMIS CATs
in children with upper extremity fractures. Hand (N Y) 2020;15(2):194-200. https://doi.org/10.1177/1558944718793195
10. Beaton DE, Wright JG, Katz JN; Upper Extremity Collaborative Group. Development of the QuickDASH:
comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87(5):1038-46.
https://doi.org/10.2106/JBJS.D.02060
11. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH
(disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am
J Ind Med 1996;29(6):602-8. Erratum en: Am J Ind Med 1996;30(3):372. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
12. DeWalt DA, Rothrock N, Yount S, Stone AA; PROMIS Cooperative Group. Evaluation of item candidates: the
PROMIS qualitative item review. Med Care 2007;45(5 Suppl 1):S12-21. https://doi.org/10.1097/01.mlr.0000254567.79743.e2
13. Brodke DJ, Saltzman CL, Brodke DS. PROMIS for orthopaedic outcomes measurement. J Am Acad Orthop Surg
2016;24(11):744-9. https://doi.org/10.5435/JAAOS-D-15-00404
14. Judet J, Judet R, Lefranc J. Fracture du col radial chez l’enfant. Ann Chir 1962;16:1377-85. PMID: 13957959
15. Hung M, Baumhauer JF, Latt LD, Saltzman CL, SooHoo NF, Hunt KJ; National Orthopaedic Foot & Ankle
Outcomes Research Network. Validation of PROMIS® Physical Function computerized adaptive tests for
orthopaedic foot and ankle outcome research. Clin Orthop Relat Res 2013;471(11):3466-74.
https://doi.org/10.1007/s11999-013-3097-1
16. Hung M, Clegg DO, Greene T, Saltzman CL. Evaluation of the PROMIS physical function item bank in orthopaedic patients. J Orthop Res 2011;29(6):947-53. https://doi.org/10.1002/jor.21308
17. Hung M, Hon SD, Franklin JD, Kendall RW, Lawrence BD, Neese A, et al. Psychometric properties of the PROMIS physical function item bank in patients with spinal disorders. Spine (Phila Pa 1976) 2014;39(2):158-63.
https://doi.org/10.1097/BRS.0000000000000097
18. Overbeek CL, Nota SP, Jayakumar P, Hageman MG, Ring D. The PROMIS physical function correlates with the
QuickDASH in patients with upper extremity illness. Clin Orthop Relat Res 2015;473(1):311-7.
https://doi.org/10.1007/s11999-014-3840-2
19. Basmajian HG, Choi PD, Huh K, Sankar WN, Wells L, Arkader A. Radial neck fractures in children: experience from two level-1 trauma centers. J Pediatr Orthop B 2014;23(4):369-74. https://doi.org/10.1097/BPB.0000000000000057
20. Zimmerman RM, Kalish LA, Hresko MT, Waters PM, Bae DS. Surgical management of pediatric radial neck
fractures. J Bone Joint Surg Am 2013;95(20):1825-32. https://doi.org/10.2106/JBJS.L.01130
21. Canavese F, Athlani L, Marengo L, Rousset M, Rouel-Rabiau N, Samba A, et al. Evaluation of upper-extremity
function following surgical treatment of displaced proximal humerus fractures in children. J Pediatr Orthop B
2014;23(2):144-9. https://doi.org/10.1097/BPB.0000000000000009
22. Bae DS, Gholson JJ, Zurakowski D, Waters PM. Functional outcomes after treatment of scaphoid fractures in
children and adolescents. J Pediatr Orthop 2016;36(1):13-8. https://doi.org/10.1097/BPO.0000000000000406
23. Sprangers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: a review. J Clin Epidemiol 1992;45(7):743-60. https://doi.org/10.1016/0895-4356(92)90052-o
24. Achenbach TM, McConaughy SH, Howell CT. Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull 1987;101(2):213-32. PMID: 3562706
25. Upton P, Lawford J, Eiser C. Parent-child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res 2008;17(6):895-913. https://doi.org/10.1007/s11136-008-9350-5
2. Gutiérrez-de la Iglesia D, Pérez-López LM, Cabrera-González M, Knörr-Giménez J. Surgical techniques for
displaced radial neck fractures: predictive factors of functional results. J Pediatr Orthop 2017;37(3):159-65.
https://doi.org/10.1097/BPO.0000000000000617
3. Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J
Bone Joint Surg Am 1999;81(10):1429-33. https://doi.org/10.2106/00004623-199910000-00007
4. Ackerson R, Nguyen A, Carry PM, Pritchard B, Hadley-Miller N, Scott F. Intra-articular radial head fractures in the skeletally immature patient: complications and management. J Pediatr Orthop 2015;35(5):443-8.
https://doi.org/10.1097/BPO.0000000000000302
5. De Mattos CB, Ramski DE, Kushare IV, Angsanuntsukh C, Flynn JM. Radial neck fractures in children and
adolescents: an examination of operative and nonoperative treatment and outcomes. J Pediatr Orthop 2016;36(1):6-12. https://doi.org/10.1097/BPO.0000000000000387
6. Nicholson LT, Skaggs DL. Proximal radius fractures in children. J Am Acad Orthop Surg 2019;27(19):e876-e886.
https://doi.org/10.5435/JAAOS-D-18-00204
7. Pring ME. Pediatric radial neck fractures: when and how to fix. J Pediatr Orthop 2012;32(Suppl 1):S14-21.
https://doi.org/10.1097/BPO.0b013e31824b251d
8. Wang J, Chen W, Guo M, Su Y, Zhang Y. Percutaneous reduction and intramedullary fixation technique for
displaced pediatric radial neck fractures. J Pediatr Orthop B 2013;22(2):127-32. https://doi.org/10.1097/BPB.0b013e32835b5700
9. Gerull WD, Okoroafor UC, Guattery J, Goldfarb CA, Wall LB, Calfee RP. Performance of Pediatric PROMIS CATs
in children with upper extremity fractures. Hand (N Y) 2020;15(2):194-200. https://doi.org/10.1177/1558944718793195
10. Beaton DE, Wright JG, Katz JN; Upper Extremity Collaborative Group. Development of the QuickDASH:
comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87(5):1038-46.
https://doi.org/10.2106/JBJS.D.02060
11. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH
(disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am
J Ind Med 1996;29(6):602-8. Erratum en: Am J Ind Med 1996;30(3):372. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
12. DeWalt DA, Rothrock N, Yount S, Stone AA; PROMIS Cooperative Group. Evaluation of item candidates: the
PROMIS qualitative item review. Med Care 2007;45(5 Suppl 1):S12-21. https://doi.org/10.1097/01.mlr.0000254567.79743.e2
13. Brodke DJ, Saltzman CL, Brodke DS. PROMIS for orthopaedic outcomes measurement. J Am Acad Orthop Surg
2016;24(11):744-9. https://doi.org/10.5435/JAAOS-D-15-00404
14. Judet J, Judet R, Lefranc J. Fracture du col radial chez l’enfant. Ann Chir 1962;16:1377-85. PMID: 13957959
15. Hung M, Baumhauer JF, Latt LD, Saltzman CL, SooHoo NF, Hunt KJ; National Orthopaedic Foot & Ankle
Outcomes Research Network. Validation of PROMIS® Physical Function computerized adaptive tests for
orthopaedic foot and ankle outcome research. Clin Orthop Relat Res 2013;471(11):3466-74.
https://doi.org/10.1007/s11999-013-3097-1
16. Hung M, Clegg DO, Greene T, Saltzman CL. Evaluation of the PROMIS physical function item bank in orthopaedic patients. J Orthop Res 2011;29(6):947-53. https://doi.org/10.1002/jor.21308
17. Hung M, Hon SD, Franklin JD, Kendall RW, Lawrence BD, Neese A, et al. Psychometric properties of the PROMIS physical function item bank in patients with spinal disorders. Spine (Phila Pa 1976) 2014;39(2):158-63.
https://doi.org/10.1097/BRS.0000000000000097
18. Overbeek CL, Nota SP, Jayakumar P, Hageman MG, Ring D. The PROMIS physical function correlates with the
QuickDASH in patients with upper extremity illness. Clin Orthop Relat Res 2015;473(1):311-7.
https://doi.org/10.1007/s11999-014-3840-2
19. Basmajian HG, Choi PD, Huh K, Sankar WN, Wells L, Arkader A. Radial neck fractures in children: experience from two level-1 trauma centers. J Pediatr Orthop B 2014;23(4):369-74. https://doi.org/10.1097/BPB.0000000000000057
20. Zimmerman RM, Kalish LA, Hresko MT, Waters PM, Bae DS. Surgical management of pediatric radial neck
fractures. J Bone Joint Surg Am 2013;95(20):1825-32. https://doi.org/10.2106/JBJS.L.01130
21. Canavese F, Athlani L, Marengo L, Rousset M, Rouel-Rabiau N, Samba A, et al. Evaluation of upper-extremity
function following surgical treatment of displaced proximal humerus fractures in children. J Pediatr Orthop B
2014;23(2):144-9. https://doi.org/10.1097/BPB.0000000000000009
22. Bae DS, Gholson JJ, Zurakowski D, Waters PM. Functional outcomes after treatment of scaphoid fractures in
children and adolescents. J Pediatr Orthop 2016;36(1):13-8. https://doi.org/10.1097/BPO.0000000000000406
23. Sprangers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: a review. J Clin Epidemiol 1992;45(7):743-60. https://doi.org/10.1016/0895-4356(92)90052-o
24. Achenbach TM, McConaughy SH, Howell CT. Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull 1987;101(2):213-32. PMID: 3562706
25. Upton P, Lawford J, Eiser C. Parent-child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res 2008;17(6):895-913. https://doi.org/10.1007/s11136-008-9350-5