Medicine and Health Sciences Commons^™

An Undetermined Osteoporotic Disease Managed With Im Rod In A Dog, Hyejong Oh, Byoungho An, Dongwook Kim, Heesoo Ahn, Dongwoo Chang, Gonhyung Kim

The Thai Journal of Veterinary Medicine

Osteoporosis is a systemic bone disorder characterized by decreased bone density, which can weaken bone strength and increase the risk of fractures. Osteogenesis imperfecta (OI), one of the main causes of osteoporosis in children, results in fragile bones and multiple fractures. The present study documented the case of a dog with an undetermined osteoporotic disease managed with intramedullary rod fixation. A 3-month-old intact male Alaskan Malamute dog, weighing 11.6 kg, was presented with lameness in the left pelvic limb. Radiography revealed left pelvic and femoral fractures, and the cortex of the long bones was thin. On CT scanning, a significant …

Evaluation Of Unexplained Bone Fractures In A 3-Month-Old Infant – A Case Report, Hannah Ngo, Rachel Silliman Cohen

Rowan-Virtua Research Day

Child physical abuse is a significant cause of injury in infants and young children and can present in a variety of ways. Failure to recognize abuse in infants and young children can be life-threatening and is often recurrent until safety interventions occur. Consequently, it is of paramount importance that providers strongly consider child physical abuse on the differential, along with metabolic bone disease and accidental traumatic injury, when evaluating fractures in young children and infants. This case report will focus on the evaluation of a 3-month-old male infant who was admitted to the hospital with irritability and decreased right arm …

Five-Year Mortality Rates Following Elective Shoulder Arthroplasty And Shoulder Arthroplasty For Fracture In Patients Over Age 65., Adam Khan, Xiaoran Zhang, Erlyn Macarayan, Matthew Best, Catherine Fedorka, Derek Haas, April Armstrong, Andrew Jawa, Evan O'Donnell, Jason Simon, Eric Wagner, Momin Malik, Michael Gottschalk, Gary Updegrove, Jon Warner, Uma Srikumaran, Joseph Abboud

Rothman Institute Faculty Papers

BACKGROUND: To effectively counsel patients prior to shoulder arthroplasty, surgeons should understand the overall life trajectory and life expectancy of patients in the context of the patient's shoulder pathology and medical comorbidities. Such an understanding can influence both operative and nonoperative decision-making and implant choices. This study evaluated 5-year mortality following shoulder arthroplasty in patients ≥65 years old and identified associated risk factors.

METHODS: We utilized Centers for Medicare & Medicaid Services Fee-for-Service inpatient and outpatient claims data to investigate the 5-year mortality rate following shoulder arthroplasty procedures performed from 2014 to 2016. The impact of patient demographics, including fracture …

Evaluation Of Perioperative Care And Drivers Of Cost In Geriatric Thoracolumbar Trauma, Omar Tarawneh, Rajkishen Narayanan, Michael Mccurdy, Tariq Issa, Yunsoo Lee, Olivia Opara, Nicholas Pohl, Alexa Tomlak, Matthew Sherman, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Gregory Schroeder, Christopher Kepler

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase.

RESEARCH QUESTION: To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care.

MATERIALS AND METHODS: We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60-69(sexagenarians), 70-79(septuagenarians) and 80-89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent …

Tendon Rupture And Tendonitis In Low-Profile Dorsal Versus Volar Plating For Distal Radius Fractures: A Systematic Review And Meta-Analysis, Matthew Myhand, Shreya Balusu, Alex Lindahl Bs, Hardy Evans Md, Charles Day Dr., Eric Jiang Dr.

Medical Student Research Symposium

Tendon Rupture and Tendonitis in Low-Profile Dorsal versus Volar Plating for Distal Radius Fractures: A Systematic Review and Meta-Analysis

Background: Dorsal plating of distal radius fractures has historically been associated with high rates of hardware removal, tendonitis, and tendon rupture. Newer generation low-profile dorsal plates are thinner (<1.6mm thick) with improved characteristics. We examine whether low-profile dorsal plates still have higher rates of tendon complications than volar locking plates.

Methods: We searched Ovid MEDLINE, Web of Science, and EMBASE for published literature describing tendon complications in association with plating of distal radius fractures. Inclusion criteria encompasses any primary study of low-profile dorsal plates that included data on tendon complications. Studies that included both low-profile dorsal and volar plating arms were included …

Bone Fractures With And Without Sickle Cell Disease In The Pediatric Population, Alexander Wind, Lilian Awad, David Merolla, Alexander Glaros, Ahmed Bazzi, Priya Spencer, Meghan Baske, Emily Ridge, Usha Sethuraman

Medical Student Research Symposium

Background: Individuals with sickle cell disease are restricted from certain physical activities due to the increased risk of complications including fractures secondary to osteopenia. However the exact incidence and outcomes of fractures amongst these patients is unknown.

Objectives: (1) describe the incidence, epidemiology, and outcomes of fractures in patients with SCD. (2) to compare fracture patterns and outcomes in patients with and without SCD.

Methods: This is a retrospective, cohort study of patients aged 0-25 years old with HbSS, HbSC, or HbS-β-thalassemia with a fracture evaluated at a pediatric emergency department from April 2009-April 2022. Eligible patients were identified using …

The Effect Of The Primary Wound Closure Technique In The Surgical Treatment Of Closed Intra-Articular Calcaneal Fractures, Mohamed M. Abd El-Monem Gafar, Ashraf Hassen M. Mohammed, Ahmed A. Elseadawy, Mohamed Salah Labib

Journal of Medicine in Scientific Research

Aim: To assess the impact of the primary wound closure method in the surgical management of closed intra-articular calcaneal fractures, with the aim of improving postoperative wound healing, reducing complications, minimizing expenses, enhancing overall functional outcomes, and restoring foot function and patients' quality of life. Design: Our study, a prospective and retrospective cohort clinical study, was conducted in our hospitals. Patients and Methods: Twenty-eight patients with thirty-one intra-articular calcaneal fractures were enrolled, following stringent inclusion and exclusion criteria for patient selection. These patients underwent open reduction using an extensile lateral approach and internal fixation with plates and screws at our …

Konsep Diagnosis Dan Penatalaksanaan Fraktur Osteoporosis Terkini, I Gusti Ngurah Wien Aryana, Febyan Febyan

Jurnal Penyakit Dalam Indonesia

Osteoporosis is a metabolic bone disease that is caused by a decreased amount of bone mass, and microarchitectural damage to bone tissue that affects the bone to break easily. Osteoporosis can be divided into primary and secondary etiologies. Vertebral, hip, distal radius, and proximal humerus are the most common predilection of fracture complication due to osteoporosis. The diagnosis of osteoporotic fractures is established based on the identification of risk factors, general clinical manifestations, specific manifestation from each fracture predilection, and advanced examinations, including radiology imaging and dual-energy x-ray absorptiometry. The purpose of osteoporotic fractures management in elderly is a stable …

Preoperative Computed Tomography Scan In Distal Radius Fractures And The Effect On Preoperative Planning, Adam L. Haydel, Ryan C. Roubion, Cristina T. Graphia, Corinne E. Cloud, Claudia Leonardi, Christopher E. Marrero

School of Medicine Faculty Publications

Purpose: It is unclear whether computed tomography (CT) scans alter the surgical plan when ordered before surgery for fixation of intra-articular distal radius fractures (DRFs). The purpose of this study was to determine whether a preoperative CT scan alters the planned approach (PA) or planned fixation strategy (PFS) for open reduction internal fixation of intra-articular DRFs. Methods: Radiology records were retrospectively reviewed by one trauma surgeon and two hand surgeons for 33 intra-articular DRFs that met the inclusion criteria and previously underwent open reduction internal fixation. Surgeons were initially provided only preoperative radiographs; they were asked for their PA and …

A Case Of Osteogenesis Imperfecta In A Patient Diagnosed In Adulthood, Khalid Sheikh, M. Lastovica, N. S. Appareddy, R. Wagner, E. Luna

Research Symposium

Background: Osteogenesis imperfecta (OI) is an extremely rare inherited connective tissue disorder, with an incidence of 1 in 20,000 births in the United States. Our aim is to assist other providers in diagnosing and managing patients with OI and concurrent medical morbidities.

Case Presentation: A 21 year old male with a BMI of 34 and a lifetime history of over 10 fractures presented to the Emergency department after a complex seizure at home. The seizure was witnessed by his mother and lasted less than one minute. He had another seizure two weeks prior to presentation. In the ED, the patient …

Bad To The Bone. Not All Bone Tumors Are Cancer: Case Of Long Bone Osteomyelitis, Tat W. Yau, Bennet D. Franz, Hanadi A. Osman, Jessica C. Rivera, Ashaur Azhar

School of Medicine Faculty Publications

Long bone osteomyelitis could mimic bony tumor in clinical presentation and imaging studies. We present a case of a 47-year man who presented with leg pain, weight loss and night sweats that initially was thought to be related to osteosarcoma, later suffered a pathologic fracture from Staphylococcus aureus osteomyelitis. This case highlights the importance of source control of infection and careful clinical evaluation including radiographic and pathologic findings that can help physicians to differentiate between competing diagnoses.

Fracture Prediction And Prevention In Individuals With Chronic Kidney Disease, Andrea C.J. Cowan

Electronic Thesis and Dissertation Repository

Patients with chronic kidney disease (CKD) face increased fracture risk yet our understanding and management of this risk remains poor. We conducted three studies using retrospective cohort analysis in Ontario, Canada. We developed a 3-year fracture prediction model for patients receiving dialysis. Secondly, we contrasted fracture rates among patients on SGLT2i or DPP4i medications, stratified by kidney function. Lastly, we examined hypocalcemia incidence post-denosumab prescription, stratified by kidney function.

Findings: The fracture risk tool, incorporating demographic and lab data, performed well (AUC 0.72). SGLT2i did not elevate fracture risk vs. DPP4i (HR 0.95 [95% CI 0.79,1.13]). In those prescribed denosumab, …

Abdominal Aortic Calcification, Bone Mineral Density And Fractures: A Systematic Review And Meta-Analysis Of Observational Studies, Abadi K. Gebre, Joshua R. Lewis, Kevin Leow, Pawel Szulc, David Scott, Peter R. Ebeling, Marc Sim, Germaine Wong, Wai H. Lim, John T. Schousboe, Douglas P. Kiel, Richard L. Prince, Alexander J. Rodriguez

Research outputs 2022 to 2026

Background: Abdominal aortic calcification (AAC) has been inconsistently associated with skeletal health. We aimed to investigate the association of AAC with bone mineral density (BMD) and fracture risk by pooling the findings of observational studies. Methods: MEDLINE, EMBASE, Web of Science, and Google Scholar were searched (August 2021). All clinical studies that assessed the association between AAC and BMD or fracture were included. AAC was categorized into any/advanced (all higher reported groups) versus no/less advanced (lowest reported group). Pooled standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CI) were determined for BMD and fracture, respectively, using …

Tendonitis And Tendon Rupture In Low-Profile Dorsal Versus Volar Plating For Distal Radius Fractures: A Systematic Review And Meta-Analysis, Matthew Myhand, Dr. Charles S. Day, Hardy Evans Md, Noopur Ranganathan, Shreya Balusu

Medical Student Research Symposium

INTRODUCTION: Dorsal plating of distal radius fractures has been associated with high rates of hardware removal, tendonitis, and tendon rupture. Much of this research was performed using 2.5mm thick distal radius plating, whereas modern dorsal plates are thinner (1.2mm-1.5mm). We examine whether modern plates have higher rates of complications than volar plates.

METHODS: We search Ovid MEDLINE, Web of Science, and EMBASE for literature describing tendon complications associated with plating of distal radius fractures. Inclusion criteria included any comparison between volar and dorsal plating and report of tendon complication. Exclusion criteria included: failure to specify low-profile dorsal plates; lack of …

Metallic Implant-Related Osteosarcoma, Frawa Mohsin, Mustafa Bin Ali Zubairi, Kulsoom Fatima, Muhammad Asad Diwan

Department of Radiology

Orthopedic metallic prostheses are commonly used in the current practice of orthopedic surgery. Although, biomaterials used in these implants are generally considered to be biologically inert, there have been consequences of foreign body reactions and potential carcinogenesis. Majority of implant-related malignancies are high grade, and develop in bone or soft tissue around the implant site. No clear association has been identified between the biomaterial implanted and the type of sarcoma. We report the case of a 36-year-old male who underwent intramedullary nailing of femur for mid-shaft fracture secondary to trauma and presented with osteogenic sarcoma of femur 14 months later.

Machine-Learning Assessed Abdominal Aortic Calcification Is Associated With Long-Term Fall And Fracture Risk In Community-Dwelling Older Australian Women, Jack Dalla Via, Abadi Gebre, Cassandra Smith, Zulqarnain Gilani, David Suter, Naeha Sharif, Pawel Szulc, John T. Schousboe, Douglas P. Kiel, Kun Zhu, William D. Leslie, Richard L. Prince, Joshua R. Lewis, Marc Sim

Research outputs 2022 to 2026

Abdominal aortic calcification (AAC), a recognized measure of advanced vascular disease, is associated with higher cardiovascular risk and poorer long-term prognosis. AAC can be assessed on dual-energy X-ray absorptiometry (DXA)-derived lateral spine images used for vertebral fracture assessment at the time of bone density screening using a validated 24-point scoring method (AAC-24). Previous studies have identified robust associations between AAC-24 score, incident falls, and fractures. However, a major limitation of manual AAC assessment is that it requires a trained expert. Hence, we have developed an automated machine-learning algorithm for assessing AAC-24 scores (ML-AAC24). In this prospective study, we evaluated the …

Presentation Of A Peri-Prosthetic Atypical Femur Fracture After Long Term Anti-Resorptive Medication Use, Jennifer B. Bamford, Jennifer Kelly

Larner College of Medicine Faculty Publications

Peri-prosthetic atypical femur fractures are rare. Most are associated with the use of long-term bisphosphonates and other anti-resorptive medications. This case highlights a 74-year-old female treated with approximately 13 years of bisphosphonate therapy followed by a short course of denosumab, who suffered an atraumatic peri-prosthetic fracture after a several month prodrome. This case report's objectives are to show how the prodrome presents, increase recognition of the condition and work up prior to fracture, and emphasize the need to consider drug holidays.

Pediatric Supracondylar Humeral Fractures: Epidemiology And Mechanisms Of Injury During The Covid-19 Pandemic, Dan Cohen, Jeffrey Kay, Mohammed Shehab, Darren De Sa, Devin C. Peterson, Waleed Kishta

Western Journal of Orthopaedics

Background: The purpose of this study was to evaluate the impact of the COVID-19 pandemic activity restrictions on pediatric supracondylar humerus fracture epidemiology in terms of both mechanism of injury and fracture patterns.

Methods: This was a retrospective chart review of all patients presenting with types II-IV supracondylar humerus fractures between March 15^th and June 30^th 2020 at the McMaster University Medical Centre. Data were collected from our secure electronic medical records for information on patient demographic data, mechanism of injury, operative reports and imaging. 5 treating surgeons independently analyzed each patient’s radiographs and classified them according …

Ex Vivo Biomechanical Comparison Of A Novel Compression Screw Fastener And Traditional Ao Cortical Bone Screw For Fixation Of A Simulated Slab Fracture In The Equine Third Carpal Bone, Allison Salinger

Theses and Dissertations

Frontal plane slab fractures account for the majority of third carpal bone (C3) fractures in performance horses. Treatment is stabilization with an AO cortical screw. Complications are fragment splitting, fragment spinning, and irritation of dorsal soft tissue structures. A novel, headless, cannulated screw with interlocking threads (the Headless Compression Screw Fastener, HCSF) has been developed to resist multidirectional forces. Simulated C3 slab fractures were created in nine paired equine carpi. HCSF or AO cortical screws were loaded in shear to failure. Stiffness, maximum load to failure, and yield load was assessed in linear mixed models. No significant difference was detected …

Evolution Of The Ao Spine Sacral And Pelvic Classification System: A Systematic Review, Barry Ting Sheen Kweh, Jin W. Tee, F. Cumhur Oner, Klaus J. Schnake, Emiliano N. Vialle, Frank Kanziora, Shanmuganathan Rajasekaran, Marcel Dvorak, Jens R. Chapman, Lorin M. Benneker, Gregory Schroeder, Alexander R. Vaccaro

Rothman Institute Faculty Papers

OBJECTIVE: The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.

METHODS: A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.

RESULTS: A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary …

The Use Of A Clinical Pathway To Increase Child Abuse Screenings Of Young Children With Fractures, Stephanie Li Schaller

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Nationally, infants and young children who present to emergency departments with fractures are not being screened adequately for possible physical abuse with a skeletal survey (Paine & Wood, 2018; Shelmerdine et al., 2014; Wood et al., 2019). Without universal screenings, implicit bias along racial and socioeconomic lines becomes a factor in deciding which children with fractures get screened, resulting in either under-or over-utilization of skeletal survey screenings (Kim et al., 2017; Paine & Wood, 2018). When child abuse is not diagnosed correctly, further abusive injuries or death can occur (Ravischandiran et al., 2010). Purpose: This evidence-based practice project …

The Development Of Thermoresponsive Hydrogel-Based Drug Delivery Systems For The Treatment Of Musculoskeletal Diseases, Ningrong Chen

Theses & Dissertations

Water-soluble polymers are one of the most commonly used drug delivery vehicles for musculoskeletal diseases. During the past few decades, various biocompatible polymers have been employed in the development of thermoresponsive hydrogels as drug delivery systems for the treatment of local musculoskeletal pathologies. As part of our laboratory’s contribution to this field of study, I have successfully developed three thermoresponsive hydrogel-based formulations for the treatment of three different pathologies associated with the musculoskeletal system.

As my initial effort, I have developed a bone-targeting injectable hydrogel drug delivery system based on Pluronic 127 (Poloxamer 407), which is a Generally Recognized As …

Fracture Of The Lateral Tibial Condyle With Depression Of The Articular Surface - A Case Report, Krzysztof Ficek, Paulina Cyganik, Magdalena Strozik, Anna Serniak, Joanna Rajca

Baltic Journal of Health and Physical Activity

Background: Fractures of the proximal epiphysis of the tibia constitute one of the more frequently occurring types of sports injuries, and at the moment constitute about 1% of all reported bone fractures. They appear mainly as a result of traffic accidents, falls from heights, as well as being observed in groups of physically active people whose disciplines involve high-impact landings. From time to time, improperly executed movements or steps without falling result in injury. Case Report: We present a case study of a 21-year-old male football player with fracture of the lateral tibia condyle with indentation of articular surface. The …

Survivorship, Complications, And Outcomes Following Distal Femoral Arthroplasty For Non-Neoplastic Indications., Keenan Rhys Sobol, Brianna R Fram, John T Strony, Scot A Brown

Department of Orthopaedic Surgery Faculty Papers

AIMS: Endoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship, complications, and risk factors for patients who underwent DFA for non-neoplastic indications.

METHODS: We performed a retrospective review of 75 patients from a single institution who underwent DFA for non-neoplastic indications, including aseptic loosening or mechanical failure of a previous prosthesis (n = 25), periprosthetic joint infection (PJI) (n = 23), and native or periprosthetic distal femur fracture or nonunion (n = 27). Patients with less than 24 months' follow-up …

Innovations In Cervical Spine Trauma: Developing The Next Generation Upper Cervical Spine Injury Classification System, Brian A Karamian, Hannah Levy, Paul D. Minetos, Michael L. Smith, Alex R. Vaccaro

Rothman Institute Faculty Papers

The upper cervical spine not only consists of intricate bony and ligamentous anatomy affording unique flexibility but also has increased susceptibility to injuries. The upper cervical spine trauma can result in a wide spectrum of injuries that can be managed both operatively and nonoperatively. Several existing classification systems have been proposed to describe injuries of the upper cervical spine, many of which rely on anatomic descriptions of injury location. Prior fracture classifications are limited in scope, characterizing fractures restricted to a single region of the upper cervical spine, and fail to provide insight into injury management. The AO Spine Upper …

Osteoporosis Implications For The Aging Adult, Grace Alford

Nursing Student Class Projects (Formerly MSN)

This poster describes the pathophysiology, symptoms, implications for care, and treatment of osteoporosis for advanced practice RNs. The research was conducted within health-related databases. The literature review narrowed the search to only include the pathophysiology, interventions, and care for osteoporosis. Literature was restricted to within the past five years. The research showed that osteoporosis reduces mineral density in bones and can be adequately treated within a short amount of time. It is important for nurses and advanced practice providers to be aware of current guidelines, screenings, and treatments for osteoporosis.

Frequency Of Angular Malalignment After Intramedullary Nailing For Femur Shaft Fractures - A Cross-Sectional Study, Hammad Naqi Khan, Moiz Ali, Rizwan Haroon Rashid, Yasir Mohib, Pervaiz Hashmi

Section of Orthopaedic Surgery

Objective: To determine the frequency of angular malalignment of femur in patients undergoing Intra Medullary nailing for femur shaft fracture by measuring axis on immediate postoperative plain radiographs.
Methods: A cross-sectional study was conducted at the Section of Orthopaedics, Department of Surgery, Aga Khan University Hospital, Karachi from 1st January 2019 till 30th June 2019. All patients between the ages of 15 to 80 years who underwent IM nailing for femur shaft fractures were included. Angulation was measured on immediate post-operative X-ray films and an angle of ≥5° on AP and/or lateral views was defined as malalignment.
Results: A total …

Neighborhood Socioeconomic Status, Green Space, And Walkability And Risk For Falls And Fracture Among Postmenopausal Women: The Women’S Health Initiative, Marilyn Elizabeth Wende

Theses and Dissertations

The purpose of this study was to assess whether neighborhood socioeconomic status (SES), walkability, and green space impacts fall and fracture incidence among postmenopausal women, and to assess important modifiers for these relationships, such as fall history, physical activity, physical impairment, race/ethnicity, and rurality. Data from the Women’s Health Initiative study from 1993 to 2012 (N=161,808) was used.

SES had a significant relationship with falling after adjustment (intermediate vs low SES OR=0.99, p=0.0309; high vs low SES OR=0.99, p=0.1192). Study arm participation and fall frequency at baseline significantly modified this relationship. Walkability had a significant relationship with falling incidence after …

Descriptive Analysis Of Fall-Related Injuries Among Older Adults In Ontario, Nicolette Lappan

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. The purpose of this study was to describe the characteristics of older adults who experienced fall-related injuries (FRIs) and the types of falls that caused them. We analyzed Ontario-wide secondary data from three databases (NACRS, DAD, RPDB) covering 2010-2014. Older adults (≥ 65 years) who visited emergency departments (ED) with FRIs were selected using ICD-10-CA codes for a fall and injury. Counts, measures of central tendency, and prevalence rates (crude, age- and sex-specific, age-standardized) were calculated. There were 304,610 (63.0% females) ED admissions (3,089 per 100,000 population) …

Therapist Perception Of The Clarity And Implementability Of Relevant Recommendations From American Academy Of Orthopedic Surgeon’S Distal Radius Fracture Clinical Practice Guidelines, Saravanan Esakki

Electronic Thesis and Dissertation Repository

Fractures of the distal radius are common and can cause substantial either transient or permanent impairment and disability.

Clinical practice guidelines (CPGs) are systematically developed statements or recommendations based on the best available evidence and aimed at assisting health care practitioners in clinical decision-making. Many professional organizations have developed practice guidelines for common clinical conditions. The overall objective of this thesis is to evaluate the therapist's perception of the clarity and implementability of rehabilitation relevant recommendations from The American Academy of Orthopaedic Surgeons (AAOS) CPG for distal radius fractures (DRF) and to identify the quality of CPG related to DRF. …