Biomedical subjects

Lauren Adey

Publications and source records attributed to Lauren Adey.

3 recordsLinked to original sources

PubMed2007

Computed tomography of suspected scaphoid fractures.

PURPOSE: Computed tomography (CT) can be used to triage suspected scaphoid fractures. This study assessed intraobserver and interobserver reliability and positive and negative predictive values of CT for the diagnosis of a nondisplaced scaphoid fracture. METHODS: Eight observers evaluated CT scans from 30 patients (13 with nondisplaced scaphoid fractures, 17 with no scaphoid fractures) for the presence or absence of a fracture. Five observers evaluated the scans a second time. Statistical analyses included intraobserver and interobserver reliability and diagnostic characteristics. RESULTS: Computed tomography had substantial intraobserver and interobserver reliability for the diagnosis of a nondisplaced scaphoid fracture. The average sensitivity, specificity, and accuracy of CT for a nondisplaced scaphoid fracture were 89%, 91%, and 90% for the first round and 97%, 85%, and 88% for the second round of observations, respectively. Based on an estimated prevalence of 5% true fractures among patients with suspected scaphoid fractures, the average positive predictive value for the detection of radiographically occult scaphoid fractures with tomography of the wrist was 0.28. The average negative predictive value was 0.99. CONCLUSIONS: Computed tomography should be used with caution for triage of nondisplaced scaphoid fractures because false-positive results occur, perhaps from misinterpretation of vascular foraminae or other normal lines in the scaphoid. Given the relative infrequency of true fractures among patients with suspected scaphoid fractures, CT is better for ruling out a fracture than for ruling one in.

Adult↗

PubMed2006

Elbow capsulectomy for posttraumatic elbow stiffness.

PURPOSE: To determine factors associated with diminished elbow function and upper-extremity-specific health status after elbow capsulectomy for posttraumatic stiffness. METHODS: Forty-six adult patients with posttraumatic elbow stiffness were evaluated an average of 48 months after open capsular excision. A second capsular excision was performed in 9 patients (29%). Stepwise multiple linear regression analysis was used to identify predictors of the American Shoulder and Elbow Surgeons Elbow Score, the Mayo Elbow Performance Index, and the Disabilities of the Arm, Shoulder, and Hand scores after all procedures. RESULTS: The average improvement in ulnohumeral motion after the index surgery for capsular release was 53 degrees . (The average flexion was 98 degrees .) The 9 patients who had subsequent repeat elbow contracture release gained an additional 24 degrees , leading to a final average flexion arc for the entire cohort of 103 degrees . Multiple linear regression identified the American Shoulder and Elbow Surgeons pain score, persistent ulnar nerve dysfunction, and duration of follow-up evaluation after the initial capsular release as independent predictors of a higher Disabilities of the Arm, Shoulder, and Hand questionnaire score; flexion arc and pain score as independent predictors of the Mayo Elbow Performance Index; and flexion arc, forearm arc, pain score, and persistent ulnar neuropathy as independent predictors of the American Shoulder and Elbow Surgeons score. CONCLUSIONS: Open elbow capsulectomy for posttraumatic elbow stiffness restores a near-100 degrees flexion arc on average. Second elbow releases provide limited additional motion in most patients. Final motion influences physician-based rating scales but not patient-specific health status (Disabilities of the Arm, Shoulder, and Hand questionnaire), which is dominated by pain and persistent ulnar neuropathy. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Adolescent↗

PubMed2005

Health status after total wrist arthrodesis for posttraumatic arthritis.

PURPOSE: Total wrist arthrodesis is regarded as the most predictable way to relieve the pain of posttraumatic wrist arthritis. Wrist arthrodesis also is believed to be compatible with a high level of upper-extremity function. This study evaluated the effect of total wrist arthrodesis on both general and upper-extremity-specific health status in patients treated for posttraumatic wrist arthritis. METHODS: By using an institutional review board-approved protocol 22 patients were evaluated an average of 6 years after total wrist arthrodesis for posttraumatic arthritis. Upper-extremity-specific and general health status were measured using the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Short-Form 36 (SF-36) instruments, respectively. Patient satisfaction and interest in pursuing a wrist-mobilizing procedure should one become available also were assessed. Objective assessment included grip strength, digit range of motion, and radiographic fusion. RESULTS: Grip strength averaged 79% of the uninvolved wrist. The average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 25. The average physical component score of the Short-Form 36 was 39 and the average mental component score was 52. Fourteen patients complained of wrist pain, including severe pain in 4 patients. Fifteen patients were satisfied or very satisfied with the result of the fusion, 5 patients were neutral, and 2 patients were mildly dissatisfied. Twenty patients would elect to have a procedure that could make their wrist move again if one were available. CONCLUSIONS: Substantial dysfunction was noted on both upper-extremity-specific and general health status measures after total wrist arthrodesis for posttraumatic conditions. Pain was improved but not eliminated.

Adult↗