Huub H de Klerk, Lukas P E Verweij, Job N Doornberg, Ruurd L Jaarsma, Tsuyoshi Murase, Neal C Chen, Michel P J van den Bekerom, Kekatpure Al, Bhashyam Ar, Watts Ac, van T A, Alder-Price Ac, Turow A, Boonrod A, Masri B, The B, Jadav B, Mudgal Cs, Lameijer Cm, Langhammer Cg, Tu Cg, Rosso C, Ring D, Ruch Ds, Eygendaal D, Alentorn-Geli E, Kholinne E, Ek Et, Bain Gi, Lawton Jn, White Ja, Phadnis J, Alexander J, Sato K, Shimada K, Boerboom Al, Cohen Ms, Maruyama M, Ramsey Ml, Sandow Mj, Anantavorasakul N, Wallwork N, Schep Nwl, Arrigoni P, Mansat P, Barco R, Tosti Rj, van R R, Garg R, Siebenlist S, Dodds Sd, Thaveepunsan S, Matsuura T, Choi Y
{"title":"与冠状面骨折治疗选择相关的因素。","authors":"Huub H de Klerk, Lukas P E Verweij, Job N Doornberg, Ruurd L Jaarsma, Tsuyoshi Murase, Neal C Chen, Michel P J van den Bekerom, Kekatpure Al, Bhashyam Ar, Watts Ac, van T A, Alder-Price Ac, Turow A, Boonrod A, Masri B, The B, Jadav B, Mudgal Cs, Lameijer Cm, Langhammer Cg, Tu Cg, Rosso C, Ring D, Ruch Ds, Eygendaal D, Alentorn-Geli E, Kholinne E, Ek Et, Bain Gi, Lawton Jn, White Ja, Phadnis J, Alexander J, Sato K, Shimada K, Boerboom Al, Cohen Ms, Maruyama M, Ramsey Ml, Sandow Mj, Anantavorasakul N, Wallwork N, Schep Nwl, Arrigoni P, Mansat P, Barco R, Tosti Rj, van R R, Garg R, Siebenlist S, Dodds Sd, Thaveepunsan S, Matsuura T, Choi Y","doi":"10.1302/0301-620X.106B10.BJJ-2024-0359.R1","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures.</p><p><strong>Methods: </strong>A three-round electronic (e-)modified Delphi survey study was performed between March and December 2023. A total of 55 elbow surgeons from Asia, Australia, Europe, and North America participated, with 48 completing all questionnaires (87%). The panellists evaluated the factors identified as important in literature for treatment decision-making, using a Likert scale ranging from \"strongly influences me to recommend nonoperative treatment\" (1) to \"strongly influences me to recommend operative treatment\" (5). Factors achieving Likert scores ≤ 2.0 or ≥ 4.0 were deemed influential for treatment recommendation. Stable consensus is defined as an agreement of ≥ 80% in the second and third rounds.</p><p><strong>Results: </strong>Of 68 factors considered important in the literature for treatment choice for coronoid fractures, 18 achieved a stable consensus to be influential. Influential factors with stable consensus that advocate for operative treatment were being a professional athlete, playing overhead sports, a history of subjective dislocation or subluxation during trauma, open fracture, crepitation with range of movement, > 2 mm opening during varus stress on radiological imaging, and having an anteromedial facet or basal coronoid fracture (O'Driscoll type 2 or 3). An anterolateral coronoid tip fracture ≤ 2 mm was the only influential factor with a stable consensus that advocates for nonoperative treatment. Most disagreement existed regarding the treatment for the terrible triad injury with an anterolateral coronoid tip fracture fragment ≤ 2 mm (O'Driscoll type 1 subtype 1).</p><p><strong>Conclusion: </strong>This study gives insights into areas of consensus among surveyed elbow surgeons in choosing between operative and nonoperative management of coronoid fractures. These findings should be used in conjunction with previous patient cohort studies when discussing treatment options with patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors associated with the choice of treatment for coronoid fractures.\",\"authors\":\"Huub H de Klerk, Lukas P E Verweij, Job N Doornberg, Ruurd L Jaarsma, Tsuyoshi Murase, Neal C Chen, Michel P J van den Bekerom, Kekatpure Al, Bhashyam Ar, Watts Ac, van T A, Alder-Price Ac, Turow A, Boonrod A, Masri B, The B, Jadav B, Mudgal Cs, Lameijer Cm, Langhammer Cg, Tu Cg, Rosso C, Ring D, Ruch Ds, Eygendaal D, Alentorn-Geli E, Kholinne E, Ek Et, Bain Gi, Lawton Jn, White Ja, Phadnis J, Alexander J, Sato K, Shimada K, Boerboom Al, Cohen Ms, Maruyama M, Ramsey Ml, Sandow Mj, Anantavorasakul N, Wallwork N, Schep Nwl, Arrigoni P, Mansat P, Barco R, Tosti Rj, van R R, Garg R, Siebenlist S, Dodds Sd, Thaveepunsan S, Matsuura T, Choi Y\",\"doi\":\"10.1302/0301-620X.106B10.BJJ-2024-0359.R1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>This study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures.</p><p><strong>Methods: </strong>A three-round electronic (e-)modified Delphi survey study was performed between March and December 2023. A total of 55 elbow surgeons from Asia, Australia, Europe, and North America participated, with 48 completing all questionnaires (87%). The panellists evaluated the factors identified as important in literature for treatment decision-making, using a Likert scale ranging from \\\"strongly influences me to recommend nonoperative treatment\\\" (1) to \\\"strongly influences me to recommend operative treatment\\\" (5). Factors achieving Likert scores ≤ 2.0 or ≥ 4.0 were deemed influential for treatment recommendation. Stable consensus is defined as an agreement of ≥ 80% in the second and third rounds.</p><p><strong>Results: </strong>Of 68 factors considered important in the literature for treatment choice for coronoid fractures, 18 achieved a stable consensus to be influential. Influential factors with stable consensus that advocate for operative treatment were being a professional athlete, playing overhead sports, a history of subjective dislocation or subluxation during trauma, open fracture, crepitation with range of movement, > 2 mm opening during varus stress on radiological imaging, and having an anteromedial facet or basal coronoid fracture (O'Driscoll type 2 or 3). An anterolateral coronoid tip fracture ≤ 2 mm was the only influential factor with a stable consensus that advocates for nonoperative treatment. Most disagreement existed regarding the treatment for the terrible triad injury with an anterolateral coronoid tip fracture fragment ≤ 2 mm (O'Driscoll type 1 subtype 1).</p><p><strong>Conclusion: </strong>This study gives insights into areas of consensus among surveyed elbow surgeons in choosing between operative and nonoperative management of coronoid fractures. These findings should be used in conjunction with previous patient cohort studies when discussing treatment options with patients.</p>\",\"PeriodicalId\":48944,\"journal\":{\"name\":\"Bone & Joint Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bone & Joint Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1302/0301-620X.106B10.BJJ-2024-0359.R1\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.106B10.BJJ-2024-0359.R1","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Factors associated with the choice of treatment for coronoid fractures.
Aims: This study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures.
Methods: A three-round electronic (e-)modified Delphi survey study was performed between March and December 2023. A total of 55 elbow surgeons from Asia, Australia, Europe, and North America participated, with 48 completing all questionnaires (87%). The panellists evaluated the factors identified as important in literature for treatment decision-making, using a Likert scale ranging from "strongly influences me to recommend nonoperative treatment" (1) to "strongly influences me to recommend operative treatment" (5). Factors achieving Likert scores ≤ 2.0 or ≥ 4.0 were deemed influential for treatment recommendation. Stable consensus is defined as an agreement of ≥ 80% in the second and third rounds.
Results: Of 68 factors considered important in the literature for treatment choice for coronoid fractures, 18 achieved a stable consensus to be influential. Influential factors with stable consensus that advocate for operative treatment were being a professional athlete, playing overhead sports, a history of subjective dislocation or subluxation during trauma, open fracture, crepitation with range of movement, > 2 mm opening during varus stress on radiological imaging, and having an anteromedial facet or basal coronoid fracture (O'Driscoll type 2 or 3). An anterolateral coronoid tip fracture ≤ 2 mm was the only influential factor with a stable consensus that advocates for nonoperative treatment. Most disagreement existed regarding the treatment for the terrible triad injury with an anterolateral coronoid tip fracture fragment ≤ 2 mm (O'Driscoll type 1 subtype 1).
Conclusion: This study gives insights into areas of consensus among surveyed elbow surgeons in choosing between operative and nonoperative management of coronoid fractures. These findings should be used in conjunction with previous patient cohort studies when discussing treatment options with patients.
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