Work

Surgical Implant Generation Network Implant Follow-up: Assessment of Squat and Smile and Fracture Healing

Year: 2019

Type: article

Abstract: OBJECTIVES: To evaluate the reliability, sensitivity, and specificity of the Squat and Smile (S&S) test, a clinical photographic follow-up, in determination of fracture healing and to assess the extent of continued fracture healing beyond 1-year postoperation. DESIGN: Retrospective review of the Surgical Implant Generation Network (SIGN) database. SETTING: The S&S test is utilized in low-resource settings where the SIGN intramedullary nail is used due to unavailability of intraoperative fluoroscopy. PATIENTS/PARTICIPANTS: One hundred fifty patients undergoing fracture fixation utilizing SIGN intramedullary nails with data available at least 1 year (9-16 months) after surgery. INTERVENTION: None. MAIN OUTCOME MEASURES: We extracted clinical data and calculated scores for the S&S photographs and radiographs at the 1-year (9-16 month postoperative) follow-up and last follow-up available beyond that. We analyzed the sensitivity of S&S scoring, using Radiographic Union Scale for Tibia fracture scores as the gold standard for fracture union. RESULTS: Of the 126 patients analyzed, 21% were found to have incomplete healing at 1 year, whereas 17% of the 64 patients with further follow-up past 1 year had incomplete healing. We found that both S&S and radiographic fracture healing scores had good interrater reliability (k = 0.73-0.78 for S&S and 0.94 for radiographs). The S&S test had poor sensitivity (0.11) and specificity (0.85) in determining fracture healing at the 1-year follow-up. CONCLUSIONS: The S&S scoring method was reliable but neither sensitive nor specific for determining fracture healing at 1 year. Fractures deemed incompletely healed by radiographic evaluation at 1 year after SIGN implant may still have the potential to heal over time. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Source: Journal of Orthopaedic Trauma

DOI: 10.1097/bot.0000000000001671

Authors: Kristin M. Alves, Ariel Lerner, Genevieve S. Silva, Jeffrey N. Katz

Institutions: Brigham and Women's Hospital, Boston Children's Hospital, Harvard University

Language: English

Topic: Bone fractures and treatments

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funder: National Institute of Arthritis and Musculoskeletal and Skin Diseases