Hand
Suresh K. Nayar; Samir Sabharwal; Keith T. Aziz; Umasuthan Srikumaran; Aviram M. Giladi; Dawn M. LaPorte
Volume 8, Issue 2 , March 2020, , Pages 173-183
Abstract
Background: There is a high demand for shoulder/elbow experience among hand-fellowship trainees due to theperception that this exposure will improve their professional “marketability” in a subspecialty they perceive as havinghigher compensation.Methods: Using Medicare data, we investigated ...
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Background: There is a high demand for shoulder/elbow experience among hand-fellowship trainees due to theperception that this exposure will improve their professional “marketability” in a subspecialty they perceive as havinghigher compensation.Methods: Using Medicare data, we investigated the most common surgeries from these fields and determinedwhich have the highest compensation [work relative value unit (wRVU), payment, charge, and reimbursement(payment-to-charge percentage] rates per operative time. We then determined whether the overall non-weightedand weighted (by surgical frequency/volume) compensation rates of shoulder/elbow surgery are greater than thatof hand surgery.Results: Among 30 shoulder/elbow procedures, arthroplasty and arthroscopic rotator cuff repair had the highest paymentand wRVU assignments. Among 83 hand procedures, upper-extremity flaps, carpal stabilization, distal radius openreduction internal fixation (ORIF), both-bone ORIF, and interposition arthroplasty had the greatest wRVU assignmentswith correspondingly high payments. A non-weighted comparison of the two subspecialties showed that hand surgeryhas a higher mean payment/min ($10.46±3.22 vs. $7.52±2.89), charge/min ($51.02±17.11 vs. $41.96±11.32), andreimbursement (21±4.7% vs. 18±5.1%) compared with shoulder/elbow surgery (all, P<0.01). Non-weighted meanwRVUs/min were similar (0.12±0.03 vs. 0.13±0.03, P = 0.12). When weighted by procedure frequency, hand surgeryhad greater wRVUs/min (0.15±0.036 vs. 0.13±0.032), payments/min ($14.17±4.50 vs. $6.97±2.26), charges/min($75.68±30.47 vs. $42.61±7.83), and reimbursement (20±5.0% vs. 17±6.0%) (all, P<0.01).Conclusion: According to Medicare compensation, and when weighted by procedure frequency, hand proceduresare associated with greater overall mean wRVUs/min, payments/min, charges/min, and reimbursement compared withshoulder and elbow procedures. Hand-surgery fellowship applicants should be aware that subspecialty compensationis complex in nature but should seek shoulder/elbow elective experience to acquire an additional surgical skill-set asopposed to primarily monetary reason.Level of evidence: III
Hand
Ludovico Lucenti; Kevin F. Lutsky; Lauren Banner; Zachary Lazev; Pedro K. Beredjiklian
Volume 8, Issue 1 , January 2020, , Pages 70-74
Abstract
Background: The hemi-hamate arthroplasty (HHA) can restore joint congruity and stability in chronic fracturedislocationsof the proximal interphalangeal joint (PIPJ). Purpose of this study was to compare the width of the distalhamate articular surface (DHAS) to the width of the base of the middle phalanges ...
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Background: The hemi-hamate arthroplasty (HHA) can restore joint congruity and stability in chronic fracturedislocationsof the proximal interphalangeal joint (PIPJ). Purpose of this study was to compare the width of the distalhamate articular surface (DHAS) to the width of the base of the middle phalanges (P2) of the fingers. We hypothesizedthe dimensions of the width of the DHAS would be similar to those of P2, leaving a small amount of residual DHASwidth after autograft harvest.Methods: Fifty-nine CT scans of the hand without any bony pathology were evaluated. Three observers measured thefollowing parameters and compared: (a) Width of the DHAS in the axial and coronal planes; (b) Width of the P2 articularbases of all four fingers; (c) Maximum capitate length (MaxCap) in the coronal plane.Results: The residual DHAS on the coronal plane after graft harvest (bone remaining on the radial and ulnar aspectseach, not accounting for saw blade or osteotomy width thickness) among all patients was 1.3, 0.9, 1.4, and 2.4 mm forthe index, long, ring and small fingers respectively. There was a strong correlation between DHAS and MaxCap r=0.76.Conclusion: There is likely to be a very small amount of residual hamate articular surface width left after the graft isharvested if the entire base of P2 is reconstructed.Level of evidence: III
Hand
Keivan Rahbari; Mahmoud Farzan; Hana Saffar; Amir R. Farhoud
Volume 8, Issue 1 , January 2020, , Pages 117-120
Abstract
Malignant transformation of glomus tumor is exceedingly rare and most common reported in lower extremity and abdominal viscera. We could find only 6 previous case report of malignant glomus tumor in the hand. Although large and deeply located glomus tumors are considered to be malignant, evidence ...
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Malignant transformation of glomus tumor is exceedingly rare and most common reported in lower extremity and abdominal viscera. We could find only 6 previous case report of malignant glomus tumor in the hand. Although large and deeply located glomus tumors are considered to be malignant, evidence has shown that most of these cases were clinically benign. These lesions are better considered as glomus tumor of uncertain malignant potential. Due to rarity of malignant glomus tumor, decision for operative treatment must be based on few case reports. In this article we review the literature for malignant glomus tumor of hand and their management, also we report a 49 year-old man with glomus tumor of uncertain malignant potential in thumb who was treated by wide amputationLevel of evidence: IV
Hand
Femke M.A.P. Claessen; Ilse Schol; Gregory P. Kolovich; David Ring
Volume 8, Issue 1 , January 2020, , Pages 94-98
Abstract
No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology,classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previoustrauma, and without radiographs were excluded. Based on the radiographs ...
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No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology,classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previoustrauma, and without radiographs were excluded. Based on the radiographs at diagnosis, we classified 13 scaphoids asHerbert Lanzetta stage II, four as stage III, and one as stage IV. In 12 patients nonspecific treatment was offered andonly two patients received surgical treatment. We found that chosen treatment is not associated with the severity ofHerbert Lanzetta stage and the outcome is not influenced by chosen treatment.Level of evidence: I
Hand
Majid Farhadian; Zahra Morovati; Alireza Shamsoddini
Volume 7, Issue 6 , November 2019, , Pages 551-560
Abstract
Background: Osteoarthritis is one of the most prevalent joint diseases in older adults. Since hands play a key role indaily activities, their impairment causes disability and reduction of independency. The present study aimed to investigatethe effect of using Kinesio tape on pain, range of motion (ROM), ...
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Background: Osteoarthritis is one of the most prevalent joint diseases in older adults. Since hands play a key role indaily activities, their impairment causes disability and reduction of independency. The present study aimed to investigatethe effect of using Kinesio tape on pain, range of motion (ROM), hand strength, and functional abilities in patient withhand osteoarthritis (HOA).Methods: In this randomized clinical trial study, 38 patients with the diagnosis of HOA were selected and randomlyassigned to Kinesio tape plus exercise (KT-EXE) and exercise (EXE) groups. Each group included 19 subjects whoparticipated in an 8-week intervention. Visual analog scale, Disabilities of the Arm, Shoulder, and Hand questionnaire,as well as goniometer and dynamometer measurements, were used to assess pain severity, upper extremity functionaldisabilities, ROM, and grip strength, respectively, before and after the intervention and at 2 months of follow-up.Results: There was no significant difference in pre-intervention scores between the two groups. Statistical analysisrevealed significant improvement in pain, ROM, hand strength, and upper-extremity functional abilities after theintervention in KT-EXE and EXE groups. In addition, the follow-up analysis showed significant changes, compared tothe initial assessments except for the pain in the EXE group. Results of the independent t-test revealed that changewas significantly greater in KT-EXE group than that in the EXE group at post-intervention and 2-month follow-upassessments except for the wrist flexion and upper-extremity functional abilities at final evaluation.Conclusion: Obtained results of this study showed that Kinesio taping and hand exercise may have a positive effect onthe improvement of pain, ROM, hand strength, and upper-extremity functional abilities in patients with HOA. In addition,these two methods can be simultaneously used for the rehabilitation of this condition.Level of evidence: III
Hand
Kevin Lutsky; Charles Leinberry; Greg Gallant; Robert Takei; Moody Kwok; Pedro Beredjiklian
Volume 7, Issue 3 , May 2019, , Pages 235-238
Abstract
Background: Distribution of radiographic images in the outpatient setting on compact discs-recordable (CD-R) iscommonplace. Opening, manipulating and interpreting these can be challenging. This study evaluated the availabilityand ease of use of CD-R to evaluate digital images in an outpatient orthopedic ...
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Background: Distribution of radiographic images in the outpatient setting on compact discs-recordable (CD-R) iscommonplace. Opening, manipulating and interpreting these can be challenging. This study evaluated the availabilityand ease of use of CD-R to evaluate digital images in an outpatient orthopedic setting.Methods: 118 CD-R containing diagnostic studies were evaluated by seven board certified orthopaedic surgeons.Surgeon age and self-perceived “tech savvy” scores were tabulated using a visual analog scale (VAS). Surgeonsevaluated: ability and number of computers to open, autorun, and specific reader software. Time to load was recordedin seconds, type of study, presence of “not for diagnostic use”, and if the disc required additional software. Studies weregraded using a VAS for ease of opening, ability to move from image to image and/or between series, to manipulatethe image, and to zoom and pan.Results: There were 79 radiographs, 29 MRI’s, and 10 CT scans. Seven (6%) had to be manually opened andfour (3%) required software installation. Thirteen (11%) contained a warning that the studies should not be used fordiagnostic purposes. Six (5%) of the studies could not be opened. For the opened studies, average time from diskinsertion to image was 43.7 seconds overall (range 3-350), 65.3 seconds (range 21-191) for MRI and CT, and 35.2seconds (range 5-177) for radiographs.Conclusion: The present digital imaging systems include different software types and a variety of interfaces.Improving this would decrease time and effort necessary to open and evaluate these studies, and improveefficiency.Level of evidence: III
Hand
Aslan Baradaran; Ashkan Baradaran; Mohammad H. Ebrahimzadeh; Amir R. Kachooei; Michael Rivlin; Pedro Beredjiklian
Volume 6, Issue 6 , November 2018, , Pages 478-485
Abstract
Background: The goal of this study was to compare the two types of orthoses, prefabricated soft splints versus shortthermoplastic custom-made splints, that are the most commonly used for the management of first carpometacarpal(CMC) osteoarthritis (OA).Methods: We conducted a meta-analysis and systematic ...
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Background: The goal of this study was to compare the two types of orthoses, prefabricated soft splints versus shortthermoplastic custom-made splints, that are the most commonly used for the management of first carpometacarpal(CMC) osteoarthritis (OA).Methods: We conducted a meta-analysis and systematic review in the literature based on the Preferred ReportingItems for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted the outcomes of disabilityscores, pain scores, grip and pinch strength and gathered the unified data accordingly.Results: We included five randomized clinical trials with 230 patients with the mean age of 61 years and the meanfollow-up of 8.1 weeks. The results of the pooled data demonstrated only a statistically significant difference in disabilityscores among splints in favor of the prefabricated splints. The rest of the outcome measures consisting of pain, gripstrength, and pinch strength were not statistically different.Conclusion: According to our systematic review and meta-analysis, both thumb-based splints improved pain andfunction in the first CMC OA in a short-term follow-up, nevertheless the efficacy of prefabricated splints in abatement ofdisability scores was significantly higher than custom-made splints. In contrast, the other outcome measures includingpain, grip and pinch strength were improved identically after wearing either of the splints.Level of evidence: II
Hand
Ahmadreza Zarifian; Hassan Rahimi Shoorin; Mohammad Hallaj Moghaddam; Meysam Fathi Vavsari; Mohammad Gharedaghi; Ali Moradi
Volume 6, Issue 5 , September 2018, , Pages 365-370
Abstract
Background: Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type IIIfractures is still under controversy. Common treatment methods for these fractures include open reduction and internalfixation (ORIF) as well as radial head excision. In this study, we compared ...
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Background: Radial head fractures commonly occur during elbow traumas. Among those, treatment of Mason type IIIfractures is still under controversy. Common treatment methods for these fractures include open reduction and internalfixation (ORIF) as well as radial head excision. In this study, we compared long-term outcomes of both methods intreatment of patients with Mason type III fractures of radial head.Methods: Fifteen men and five women with Mason type III radial head fractures were evaluated retrospectively. Tenpatients had undergone excision whereas the other ten patients had been treated with ORIF. Outcomes were assessedbased on stability and range of motion of the elbow joint, grip strength, and pain. Data were gathered using Mayo elbowperformance index (MEPI), Oxford elbow score, and disability of arm-shoulder-hand (DASH), along with the short form(SF)-36 questionnaire.Results: The mean age of the subjects was 36.25±9.22 years and the mean follow-up time was 25.05±11.43months. The ranges of extension and supination, and frequency of pain reporting was significantly different betweenthe groups. The average grip strength in the operated side was significantly higher in the ORIF group, comparedwith the excision (P= 0.03). Ten (100%) patients of ORIF group and 5 (50%) patients of excision group had elbowjoint stability (P=0.01). Mean MEPI and DASH scores were significantly higher in ORIF group (Prespectively).Conclusion: The results are in favor of ORIF method. Therefore, this method is recommended and preferredover excision in treating radial heads with Mason type III frac ture.Level of evidence: III
Hand
Mark R. McCann; Philippa A. Rust; Robert Wallace
Volume 6, Issue 2 , March 2018, , Pages 105-111
Abstract
Background: The trapeziometacarpal joint (TMCJ) is inherently unstable, relying on ligament restraint to preventsubluxation. Subluxation of the thumb in a dorsoradial direction is often observed in clinical practice, either after acuteligament injury or more commonly with osteoarthritis (OA). This subluxation ...
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Background: The trapeziometacarpal joint (TMCJ) is inherently unstable, relying on ligament restraint to preventsubluxation. Subluxation of the thumb in a dorsoradial direction is often observed in clinical practice, either after acuteligament injury or more commonly with osteoarthritis (OA). This subluxation follows loss of function of trapeziometacarpalligaments that stabilise this joint, resisting the deforming force of abductor pollicis longus (APL). The exact ligamentsthat stabilise and prevent the thumb from the pull of APL causing dorsoradial subluxation remain unknown, although theanterior oblique ligament (AOL) has been implicated. The aim of this study was to measure the direction of subluxationresisted by the AOL.Methods: In this study we used cadaveric limbs and custom made biomechanical testing to measure the influence AOLhas in stabilising the thumb against subluxation in three planes: radial, dorsal and dorsoradial. Three fresh frozen handswere dissected to expose the TMCJ, leaving all ligaments, capsule and APL attachment in place. The force requiredto create a displacement of 5mm between the first metacarpal and the trapezium in these three planes was measuredbefore and after AOL division.Results: The average force to displace in the dorsoradial plane prior to division was 6.68N, and a statistically significantreduction to 1.15N (P<0.001) was found after division of the AOL. A statistically significant increase in force (P<0.001)from 2.89N to 4.04N was seen in the radial plane, while no change was seen dorsally (P=0.98), with average forces of2.74N and 2.62N found pre and post division.Conclusion: There is clinical significance in reporting quantifiable data in this field, as subluxation of the thumb is oftenseen with OA. The results of our study provide support for surgical reconstruction of the AOL as the primary surgicalstabilizer against dorsoradial subluxation of the thumb.
Hand
Jigar S. Gandhi; Michael Rivlin
Volume 6, Issue 1 , January 2018, , Pages 78-81
Abstract
Carpel tunnel syndrome (CTS) is a condition in which median nerve compression results in paresthesias and pain in thewrist and hand. We are going to report a rare case of topiramate-induced neuropathy which clinically resembles CTS.Discontinuation of topiramate resulted in spontaneous resolution of numbness, ...
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Carpel tunnel syndrome (CTS) is a condition in which median nerve compression results in paresthesias and pain in thewrist and hand. We are going to report a rare case of topiramate-induced neuropathy which clinically resembles CTS.Discontinuation of topiramate resulted in spontaneous resolution of numbness, paresthesia and pain in a few days. Highclinical suspicion is advised in patients who are on topiramate and present with signs of compressive neuropathy.
Hand
Golnaz Ghayyem Hassankhani; Ali Moradi; Ali Birjandinejad; Ehsan Vahedi; Amir Reza Kachooei; Mohammad H. Ebrahimzadeh
Volume 6, Issue 1 , January 2018, , Pages 71-77
Abstract
Background: Carpal tunnel syndrome (CTS) is recognized as the most common type of neuropathies. Questionnairesare the method of choice for evaluating patients with CTS. Boston Carpal Tunnel Syndrome (BCTS) is one of the mostfamous questionnaires that evaluate the functional and symptomatic aspects of ...
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Background: Carpal tunnel syndrome (CTS) is recognized as the most common type of neuropathies. Questionnairesare the method of choice for evaluating patients with CTS. Boston Carpal Tunnel Syndrome (BCTS) is one of the mostfamous questionnaires that evaluate the functional and symptomatic aspects of CTS. This study was performed toevaluate the validity and reliability of the Persian version of BCTS questionnaire.Methods: First, both parts of the original questionnaire (Symptom Severity Scale and Functional Status Scale) weretranslated into Persian by two expert translators. The translated questionnaire was revised after merging and confirmedby an orthopedic hand surgeon. The confirmed questionnaire was interpreted back into the original language (English)to check any possible content difference between the original questionnaire and its final translated version. The finalPersian questionnaire was answered by 10 patients suffering from CTS to elucidate its comprehensibility; afterwards,it was filled by all 142 participants along with the Persian version of Quick-DASH questionnaire. After 2 to 6 days thetranslated questionnaire was refilled by few of the previous patients who had not received any medical treatment duringthat period.Results: Among all 142 patients, 13.4 % were male and 86.6 % were female. The reliability of the questionnaire wastested using Cronbach’s alpha and ICC. Cronbach’s alpha was 0.859 for symptom severity scale (SSS) and 0.878 forfunctional status scale (FSS). Also, ICCs were calculated as 0.538 for SSS and 0.773 for FSS. In addition, constructvalidities of SSS and FSS against QuickDASH were 0.641 and 0.701, respectively.Conclusion: Based on our results, the Persian version of the BCTQ is valid and reliable.
Hand
Suneel B. Bhat; Asif M. Ilyas
Volume 5, Issue 6 , November 2017, , Pages 380-383
Abstract
Background: Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates ...
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Background: Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction. Methods: Age specific distal radius fracture incidence, age specific hip fracture rates after distal radius fracture with and without risendronate treatment, cost of risendronate treatment, risk of atypical femur fracture with bisphosphonate treatment, and cost of hip fracture treatment were obtained from the literature. A unique stochastic Markov chain decision tree model was constructed from derived estimates. The results were evaluated with comparative statistics, and a one-way threshold analysis performed to identify the break-even cost of bisphosphonate treatment. Results: Routine treatment of the current population of all women over the age of 65 suffering a distal radius fracture with bisphosphonates would avoid 94,888 lifetime hip fractures at the cost of 19,464 atypical femur fractures and $19,502,834,240, or on average $2,186,617,527 annually, which translates to costs of $205,534 per hip fracture avoided. The breakeven price point of annual bisphosphonate therapy after distal radius fracture for prevention of hip fractures would be approximately $70 for therapy annually. Conclusion: Routine treatment of all women over 65 suffering distal radius fracture with bisphosphonates would result in a significant reduction in the overall hip fracture burden, however at a substantial cost of over a $2 billion dollars annually. To optimize efficiency of treatment either patients may be selectively treated, or the cost of annual bisphosphonate treatment should be reduced to cost-effective margins.
Hand
Ilaria Morelli; Gianfranco Fraschini; Arianna E. Banfi
Volume 5, Issue 6 , November 2017, , Pages 384-393
Abstract
Background: Conflicting studies link several conditions and risk factors to Dupuytren’s disease (DD). A questionnaire-based case-control study was set to investigate associated conditions and clinical features of DD in a sample of Italian patients. The main purpose was the identification of predicting ...
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Background: Conflicting studies link several conditions and risk factors to Dupuytren’s disease (DD). A questionnaire-based case-control study was set to investigate associated conditions and clinical features of DD in a sample of Italian patients. The main purpose was the identification of predicting factors for: DD development; involvement of multiple rays; involvement of both hands; development of radial DD; development of recurrences and extensions. Methods: A self-administered questionnaire was used to investigate medical and drug histories, working and life habits, DD clinical features, familial history, recurrences and extensions. Binary logistic regression, Mann Whitney U-test and Fisher’s exact test were used for the statistical analysis. Results: A role in DD development was found for male sex, cigarette smoking, diabetes and heavy manual work. The development of aggressive DD has been linked to age, male sex, high alcohol intake, dyslipidemias and positive familial history. Conclusion: Further studies might explain the dual relationship between ischemic heart disease and DD. According to our results, the questionnaire used for this study revealed to be an easy-handling instrument to analyze the conditions associated to DD. Nevertheless, its use in further and larger studies is needed to confirm our results as well as the role of the questionnaire itself as investigation tool for clinical studies.
Hand
Sezai Ozkan; Jos J. Mellema; David Ring; Neal C. Chen
Volume 5, Issue 5 , September 2017, , Pages 308-314
Abstract
Background: To examine whether interobserver reliability, decision-making, and confidence in decision-making in thetreatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phonecompared to a standard DICOM viewer.Methods: Radiographs of distal radius ...
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Background: To examine whether interobserver reliability, decision-making, and confidence in decision-making in thetreatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phonecompared to a standard DICOM viewer.Methods: Radiographs of distal radius fractures were presented to surgeons on either a smart phone using a mobilemessenger application or a laptop using a DICOM viewer application. Twenty observers participated: 10 (50%) wererandomly assigned to the DICOM viewer group and 10 (50%) to the mobile messenger group. Each observer was askedto evaluate the cases and (1) classify the fracture type according to the AO classification, (2) recommend operative orconservative treatment and (3) rate their confidence about this decision.Results: There was no significant difference in interobserver reliability for AO classification and recommendation forsurgery for distal radius fractures in both groups. The percentage of recommendation for surgery was significantlyhigher in the messenger application group compared to the DICOM viewer group (89% versus 78%, P=0.019) and theconfidence for treatment decision was significantly higher in the mobile messenger group compared to the DICOM viewergroup (8.9 versus 7.9, P=0.026).Conclusion: Messenger applications on mobile phones could facilitate remote decision-making for patients with distalradius fractures, but should be used with caution.
Hand
Efstathios G. Ballas; Konstantinos Raptis; Ioannis P. Stathopoulos; Nikolaos A. Stavropoulos; Sarantis-Petros G. Spyridonos
Volume 5, Issue 5 , September 2017, , Pages 332-336
Abstract
Isolated scaphoid dislocations are extremely rare injuries and are commonly associated with significant ligamentousdisruptions. A dorsiflexion-supination force upon the hand is considered as the most common mechanism of injury.Different treatment options have been proposed for the management of this ...
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Isolated scaphoid dislocations are extremely rare injuries and are commonly associated with significant ligamentousdisruptions. A dorsiflexion-supination force upon the hand is considered as the most common mechanism of injury.Different treatment options have been proposed for the management of this uncommon entity, ranging from conservativetreatment with closed reduction and casting to a wide range of open or percutaneous surgical techniques. In thisarticle, we reported ona case of this rare injury managed with open reduction and pinning along with ligamentousreconstruction.
Hand
Amir R. Kachooei; David Ring
Volume 5, Issue 4 , July 2017, , Pages 264-269
Abstract
Two patients-one with a terrible triad fracture dislocation and one with an anterior olecranon fracture dislocation—weretreated for maltracking of the elbow (medial subluxation). The radial head articulated with the lateral trochlea while theulnar trochlear notch was perched over the medial trochlea. ...
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Two patients-one with a terrible triad fracture dislocation and one with an anterior olecranon fracture dislocation—weretreated for maltracking of the elbow (medial subluxation). The radial head articulated with the lateral trochlea while theulnar trochlear notch was perched over the medial trochlea. The late revision surgery could not correct the subluxationbecause the joints were accustomed to the new alignment, however the overall function was reasonable.
Hand
Casey M. O`Connor; Mariano E. Menendez; Kevin Hughes; David Ring
Volume 5, Issue 4 , July 2017, , Pages 231-234
Abstract
Background: Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms andlimitations it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words andconcepts consistent with medical evidence. The use of words that might ...
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Background: Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms andlimitations it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words andconcepts consistent with medical evidence. The use of words that might reinforce misconceptions about preferencesensitiveconditions (particularly those associated with age) could increase symptoms and limitations and might alsodistract patients from the treatment preferences they would select when informed and at ease.Methods: We reviewed 100 consecutive papers published in 2014 and 2015 in 6 orthopedic surgery scientific journals.We counted the number and proportion of journal articles with questionable use of one or more of the following words:tear, aggressive, required, and fail. For each word, we counted the rate of misuse per journal and the number of specificterms misused per article per journalResults: Eighty percent of all orthopedic scientific articles reviewed had questionable use of at least one term. Tearwas most questionably used with respect to rotator cuff pathology. The words fail and require were the most commonquestionably used terms overall.Conclusion: The use of questionable words and concepts is common in scientific writing in orthopedic surgery. It’sworth considering whether traditional ways or referring to musculoskeletal illness merit rephrasing.
Hand
Golnaz Ghayyem Hassankhani; Ali Moradi; Ehsan Vahedi; Sayyed Hadi Sayyed Hoseinian; Zohreh Jahani; Maedeh Rahmani; Mohammad H. Ebrahimzadeh
Volume 5, Issue 4 , July 2017, , Pages 243-250
Abstract
Background: The patient-rated wrist evaluation (PRWE) score is one of the most common clinical instruments usedas an outcome measurement tool for distal radius fractures and other upper extremity conditions. The purpose of thisstudy was to translate the PRWE into its Persian version and to evaluate its ...
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Background: The patient-rated wrist evaluation (PRWE) score is one of the most common clinical instruments usedas an outcome measurement tool for distal radius fractures and other upper extremity conditions. The purpose of thisstudy was to translate the PRWE into its Persian version and to evaluate its validity and reliability in patients with upperextremity conditions.Methods: One hundred and fourthly one adult patients with upper extremity conditions participated in this ethical boardapproved study from August 2015 to May 2016. After translating the original version of the PRWE into Persian, allpatients filled out the PRWE in addition to the VAS (Visual analogue scale) and DASH questionnaires. For evaluatingreliability, after three days the researchers called back some of the patients who did not receive treatment or anychanges in symptoms and asked them to complete the PRWE retest (104 patients).Results: Cronbach’s alpha was calculated as high as 0.934, implying very reliable internal consistency. After each itemdeletion, the Cronbach’s alpha was still constant (range: 0.926 to 0.936). Intraclass correlation coefficient was 0.952and this showed excellent test-retest reliability. The correlation coefficient between the PRWE and DASH scores wasstrong. Multivariable analysis showed an association between the PRWE and years educated.Conclusion: Our study has shown that the Persian version of the PRWE is valid and reliable for patients with upperextremity conditions.
Hand
William Kirpatrick; Jack Abboudi; Nayoung Kim; Juana Medina; Mitchell Maltenfort; Daniel Seigerman; Kevin Lutksy; Pedro K. Beredjiklian
Volume 5, Issue 3 , May 2017, , Pages 139-144
Abstract
Background: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com). Methods: A total of 433 ASSH active members were searched in two ...
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Background: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com). Methods: A total of 433 ASSH active members were searched in two popular rating websites for a total of 866 web searches. Demographic data, overall and subcategory scores, number of reviews, and wait times were scored from each member’s webpage. Results: The average number of reviews per surgeon on Healthgrades.com and Vitals.com were 13.8 (range 1-108) and 9.4 (range 0-148), respectively. The average overall score for physicians was 8.1 out of 10 points. For both websites, the vast majority (80-90%) of active members of the ASSH had 20 or less reviews. Multivariate data analysis revealed no statistical differences in overall score by region (P=0.24) or gender (P=0.38). Increasing physician age negatively correlated with overall score (P=0.01). Wait time was not associated with a negative score (P=0.38). Conclusion: Active members of the ASSH received generally positive reviews. The average number of reviews for active members of the ASSH was exceedingly small, bringing into question the legitimacy and validity of these scores. This is especially important when taking into consideration the increasing popularity of these websites, and the reliance of patients on them to obtain physician information. The clinical implication of this study is that physicians have a vested interest in the legitimacy of the data provided by these websites and other physician rating outlets.
Hand
Silke A. Spit; Stéphanie J.E. Becker; Michiel G.J.S. Hageman; David Ring
Volume 5, Issue 3 , May 2017, , Pages 133-138
Abstract
Background:It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could ...
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Background:It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could document a subset of undiagnosed and untreated hamate hook fractures which might change our understanding about the natural history.Methods: Reports of 2489 hand, wrist, and forearm CT scans for hamate hook abnormalities were searched. We excluded 19 patients with anticipated hamate fractures and 1 patient that had a hamate hook excision. Twenty-eight patients had an unanticipated hamate hook abnormality.Results: There was a significant difference in the prevalence of incidental hamate hook abnormalities by sex but not by age. Among the 28 unexpected hamate hook abnormalities, there were 16 fractures of the base (12 acute, 1 nonunion, and 3 of uncertain age), 5 acute oblique fractures, and 7 tip abnormalities/ossicles. The patient with an incidental nonunion had a CT scan for wrist pain and was diagnosed with gout.All fractures involved a direct blow to the hand (distal radius or scaphoid fracture, or crush injury). The 7 patients with a hamate tip abnormality had a CT scan for a distal radius or metacarpal fracture, crush injury or wrist pain. Five acute fractures were treated operatively with excision and the other 23 fractures were treated nonoperatively.Conclusion: Hamate fractures can be diagnosed incidental to other hand and wrist problems on CT.
Hand
Ahmadreza Afshar; Ali tabrizi
Volume 5, Issue 3 , May 2017, , Pages 193-195
Abstract
Koebner phenomenon is observed in a number of inflammatory skin diseases. Psoriasis is one of the most common skin diseases associated with Koebner phenomenon. Nail psoriasis may be developed independently from inflammatory arthritis and skin psoriasis. This study reports on the reconstruction ...
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Koebner phenomenon is observed in a number of inflammatory skin diseases. Psoriasis is one of the most common skin diseases associated with Koebner phenomenon. Nail psoriasis may be developed independently from inflammatory arthritis and skin psoriasis. This study reports on the reconstruction of third web of a 30-year-old woman, which performed on her right, due to congenital syndactyly. Four months postoperatively, she developed nail dystrophy, onycholysis and onychorrhexis of the middle, ring and little fingernails. The clinical and histopathology findings were compatible with diagnosis of isolated nail psoriasis.
Hand
AndrewJ. Miller; Christopher Jones; Frederick Liss; Jack Abboudi; William Kirkpatrick; Pedro Beredjiklian
Volume 5, Issue 1 , January 2017, , Pages 10-13
Abstract
Object: The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital ...
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Object: The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital hand X-rays in osteoporosis screening. We hypothesized that similar to analog counterparts, digital hand X-rays have poor correlation and reliability in determining bone mineral density (BMD) relative to DEXA.Methods: We prospectively evaluated female patients older than 65 years who presented to our hand clinic with digital hand and wrist X-rays as part of their evaluation over six months. Patients who had a fracture and were without DEXA scans within the past two years were excluded. Five fellowship-trained hand surgeons, blinded to DEXA T-scores, evaluated the x-rays over two assessments separated by four weeks and classified them as osteoporotic, osteopenic, or normal BMD. Accuracy relative to DEXA T-score, interobserver and intraobserver rates were calculated.Results: Thirty four patients met the inclusion criteria and a total of 340 x-rays reviews were performed. The assessments were correct in 169 cases (49%) as compared to the DEXA T-scores. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) reflecting a fair agreement. The first and second assessment for all five physicians was 0.46 (range 0.19-0.78) reflecting a moderate agreement. Grouping osteoporosis and osteopenia together compared to normal, the accuracy, interobserver and intraobserver rates increased to 63%, 0.42 and 0.54 respectively.Conclusion: Abnormally low BMD is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy relative to DEXA scan and only fair agreement in diagnosing osteoporosis using visual assessments of digital x-rays.
Hand
Tessa Drijkoningen; Robert Knotter; Frank J. Beeres; Emile G. Coerkamp; Anton H.J. Koning; Steven J. Rhemrev
Volume 4, Issue 4 , October 2016, , Pages 343-347
Abstract
Background: The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures. Methods: A convenient ...
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Background: The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures. Methods: A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by 7 observers of which 3 observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. Results: The Kappa value varied from 0.11 to 0.33 for the first assessment. For the three observers who assessed the CT-scans twice; observer 1 improved from a kappa of 0.33 to 0.50 (95% CI 0.26-0.74, P=0.01), observer 2 from 0.17 to 0.78 (95% CI 0.36-1.0, P<0.001), and observer 3 from 0.11 to 0.24 (95% CI 0.0-0.77, P=0.24). Conclusion: Following our findings the I-Space has a fast learning curve and has a potential place in the diagnostic modalities for suspected scaphoid fractures.