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Harry Rubash, MD
First Session
Moderator: Harry Rubash, MD

Neil Harness, MD Philip Blazar, MD
The Influence of Three Dimensional Computed Tomography Scans on the Characterization and Treatment of Distal Radius Fractures
Neil Harness, MD
Advisor: David Ring, MD
Discussor: Philip Blazar, MD

Thirty fractures of the distal radius were evaluated with plain film, 2D CT, 3D CT and intraoperatively to determine the contribution of 3D CT to fracture characterization and management. Sensitivity, specificity and accuracy of fracture classification were determined for each imaging method, and compared to fracture description at surgery. 3DCT was found to improve inter observer agreement about fracture description, and to change operative planning in a significant number of cases.

Dr. Blazar noted that the paper confirmed a reasonable hypothesis having more information about a fracture is helpful. He criticized the methodology by noting that in order to assess accuracy of fracture pattern prediction the researchers would have needed to open each and every fracture to confirm the pattern directly. Dr. Harness pointed out that nearly every fracture in his series had in fact been opened.

Brandon Earp, MD Philip Blazar, MD
Arthroscopic Treatment of Post-Traumatic Wrist Instability in Pediatric and Adolescent Patients
Brandon Earp, MD
Advisor: Peter Waters, MD
Discussor: Philip Blazar, MD

The outcomes of arthroscopic management of scapholunate instability in 32 pediatric patients was retrospectively reviewed. Outcome was evaluated with retrospectively calculated Mayo wrist scores, and by contacting many of the patients to administer repeat DASH and Mayo scores with minimum two year follow up. They found sustainable improvement in patients with Geissler II SL tears who were treated arthroscopically.

Dr. Blazar praised the presentation for contributing a landmark series of wrist injuries in a pediatric and adolescent population. He and Dr. Nunley both questioned how the preoperative diagnosis of scapholunate instability had been made, because it seemed more accurate to describe the indica-tion for arthroscopy as "chronic wrist pain" rather than "instability." Dr. Blazar also remarked it was interesting that the authorís findings seemed to contradict the accepted wisdom "kids are not just little adults" because it seemed that a treatment algorithm suitable for adults had worked well in their pediatric patients.

Links of interest: