The native anatomy of the distal biceps tendon is that it inserts onto the posterior aspect of th... more The native anatomy of the distal biceps tendon is that it inserts onto the posterior aspect of the radial tuberosity, allowing the radial protuberance to act as a mechanical cam to optimize supination strength and power. Restoring the distal biceps to its native posterior insertion further allows patients the ability to regain nearly all of their lost supination and flexion strength and power. The Posterior Anatomic Footprint Repair is a reliable technique for preserving the radial protuberance, restoring footprint anatomy, and recovering supination strength and theoretical power.
Background: Failure to recognize a potential wrist arthrotomy may lead to missed septic arthritis... more Background: Failure to recognize a potential wrist arthrotomy may lead to missed septic arthritis and devastating sequelae. The saline load test is routinely used to recognize traumatic arthrotomies of other joints; however, there are limited data optimizing this test for the wrist. The purpose of this study was to investigate and perform saline load testing to identify traumatic arthrotomies of the wrist. Methods: This was a cadaveric study of 15 wrists. Traumatic arthrotomies were created using a blunt trocar through the 3-4 portal. A 3-mL syringe with 0.1 mL markings was used to inject methylene blue dyed saline into the wrist through the 1-2 portal. Once extravasation was visible from the atherectomized site, the volume was recorded. Results: The mean (range) volume injected to identify the arthrotomy of all wrists was 1.22 mL (range, 0.1-3.1 mL). Multivariate regression demonstrated that cadaver age, laterality, and extension range of motion were not significantly associated with the injected saline volume at extravasation ( P > .05, each). Greater joint range of motion was independently associated with higher saline volume load for extravasation (odds ratio: 1.049; 95% confidence interval: 1.024-1.075; P = .003). Conclusions: We found that 2.68 and 3.02 mL of methylene blue dyed saline offered 95% and 99% sensitivity, respectively, for diagnosing traumatic wrist arthrotomy. The maximum volume of saline needed to recognize an arthrotomy was 3.1 mL. We recommend this be the minimum volume used to evaluate a traumatic wrist arthrotomy.
Background: The circumstances surrounding claims against hand surgeons have not been elucidated i... more Background: The circumstances surrounding claims against hand surgeons have not been elucidated in the literature. The purpose of this study was to analyze trends in malpractice litigation regarding hand surgery through a nationwide legal database. Methods: The Westlaw legal research database was queried for verdicts and settlements between 1985 and 2017 for hand surgery–related malpractice cases. Cases were included if the hand surgeon was sued for malpractice. Procedure type and complications and/or adverse events that resulted in litigation were recorded. Patient characteristics, state, date of case, case outcomes, and indemnity payment were also noted. All dollar amounts were adjusted to 2017 values using the Consumer Price Index. Results: In all, 171 cases (35 states) were included. The most frequently litigated surgeries were carpal tunnel releases followed by fracture treatment. Nerve injury was the predominant cause of litigation. The median nerve was predominantly injured, followed by the ulnar and radial nerves. In fracture surgery, malunion was the predominant cause, followed by weakness, nerve injury, and infection. In total, 72.5% of cases yielded verdicts in favor of the defense, 21.6% favored the plaintiff, and 5.9% were settled. Indemnity varied between $7800 and $8.99 million, averaging $570,397 for cases when the jury ruled in favor of the plaintiffs. Settled cases averaged $1,140,527. Conclusions: Malpractice litigation has substantial financial implications on surgeons and the health care system. Litigation arises most commonly from routine procedures (carpal tunnel release and fracture fixation) rather than complex surgical cases, potentially due to the high variability in operating surgeon subspecialization, with discrepant training.
Plastic and reconstructive surgery. Global open, Apr 1, 2023
Background: Peripheral nerve injuries not repaired in an effective and timely manner may lead to ... more Background: Peripheral nerve injuries not repaired in an effective and timely manner may lead to permanent functional loss and/or pain. For gaps greater than 5 mm, autograft has been the gold standard. Allograft has recently emerged as an attractive alternative, delivering comparable functional recovery without risk of second surgical site morbidities. Cost is an important factor when considering surgical options, and with a paucity of nerve repair cost data, this study aimed to compare allograft and autograft procedure costs. Methods: A retrospective cross-sectional observational study using the US all-payer PINC AI Healthcare Database examined facility procedure costs and cost drivers in patients undergoing allograft or autograft repair of an isolated single peripheral nerve injury between January 2018 and August 2020. Inpatient repairs were limited to nerve-specific DRGs. Multivariable regression evaluated risk-adjusted procedure cost differences. Results: Peripheral nerve graft repairs (n = 1363) were more frequent in the outpatient setting, and more than half involved the use of allograft nerve. Procedure costs for allograft and autograft repair were not significantly different in the outpatient (P = 0.43) or inpatient (P = 0.71) setting even after controlling for other risk factors. Operating room cost was significantly higher for autograft in outpatient (P < 0.0001) but not inpatient (P = 0.46), whereas allograft implant cost was significantly higher in both settings (P < 0.0001). Conclusions: No significant differences in procedure costs for autograft and allograft repair in inpatient and outpatient settings were found using real-world data. Future research should explore longer-term costs.
Background: Large prospective institutional data provide the opportunity to conduct level II and ... more Background: Large prospective institutional data provide the opportunity to conduct level II and III studies using robust methodologies and adequately powered sample-sizes, while circumventing limitations of retrospective databases. We aimed to validate a prospective data collection tool, the Orthopaedic Minimal Data Set Episode of Care (OME), implemented at a tertiary North American health care system for distal radial fracture (DRF) open reduction and internal fixation (ORIF). Methods: The first 100 DRF ORIFs performed after OME inception (February 2015) were selected for this validation study. A blinded review of the operative notes and charts was performed, and extracted data of 75 perioperative DRF ORIF procedure variables were compared with OME collected data for agreement. Outcomes included completion rates and agreement measures in OME versus electronic medical record (EMR)-based control datasets. Data counts were evaluated using raw percentages and McNemar tests. Cohen (κ)...
BACKGROUND The Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of care (OME) is a prospectively... more BACKGROUND The Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of care (OME) is a prospectively collected database enabling capture of patient and surgeon-reported data in a more efficient, comprehensive, and dependable manner than electronic medical record (EMR) review. We aimed to assess and validate the OME as a data capture tool for carpometacarpal (CMC) arthroplasty compared to traditional EMR-based review. Specifically, we aimed to: (1) compare the completeness of the OME versus EMR data; and (2) evaluate the extent of agreement between the OME and EMR data-based datasets for carpometacarpal (CMC) arthroplasty. METHODS The first 100 thumb CMC arthroplasties after OME inception (Febuary, 2015) were included. Blinded EMR-based review of the same cases was performedfor 48 perioperative variables and compared to their OME-sourced counterparts. Outcomes included completion rates and agreement measures in OME versus EMR-based control datasets. RESULTS The OME demonstrated superior completion rates compared to EMR-based retrospective review. There was high agreement between both datasets where 75.6% (34/45) had an agreement proportion of >0.90% and 82.2% (37/45) had an agreement proportion of >0.80. Over 40% of the variables had almost perfect to substantial agreement (κ > 0.60). Among the 6 variables demonstrating poor agreement, the surgeon-inputted OME values were more accurate than the EMR-based review control. CONCLUSIONS This study validates the use of the OME for CMC arthroplasty by illustrating that it is reliably able to match or supersede traditional chart review for data collection; thereby offering a high-quality tool for future CMC arthroplasty studies.
Background The current literature does not contain a quantitative description of the associations... more Background The current literature does not contain a quantitative description of the associations between operative time and adverse outcomes after open reduction and internal fixation (ORIF) of distal radial fractures (DRF). Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative health care utilization and 2) the incidence of local wound complications. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for DRF ORIF cases (January 2012–December 2018). A total of 17,482 cases were identified. Primary outcomes included health care utilization (length of stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time category. Secondary outcome was incidence of wound complications per operative-time category. Multivariate regression was conducted to determine operative-time categories associated with increased risk while adjusting f...
BACKGROUND There are various approaches to the distal humerus when managing a distal humerus frac... more BACKGROUND There are various approaches to the distal humerus when managing a distal humerus fracture, and controversy exists regarding which approach is optimal. The purpose of this study is to report outcomes of the triceps tongue (TT) approach when used for osteosynthesis of AO 13-A, B, and C distal humerus fractures. Secondarily we aim to compare the outcomes of the TT approach with olecranon osteotomy (OO) when used for osteosynthesis of AO 13-C distal humerus fractures. METHODS A retrospective review was performed on patients with distal humerus fractures treated with open reduction and internal fixation (ORIF) utilizing either a TT or OO approach between 2007-2019 at two separate institutions. TT patients with AO13-C fractures were matched in a 1:1 ratio based on age, sex, and fracture characteristics to OO patients. Surgical time, intraoperative blood loss, elbow motion, fracture union, complications, and DASH (Disabilities of the Arm, Shoulder, and Hand) scores were compared. RESULTS A total of 28 patients treated with TT approach were assessed, and the matched TT and OO cohorts were each comprised of 15 patients. The TT group lost less blood (119.3 mL versus 268.5 mL, p=.03), had greater maximal flexion (126° versus 116°, p=.03), and achieved a larger flexion-extension arc (108° versus 93°, p=.05) when compared to the OO group. In the OO cohort, 27% of patients sustained complications directly related to the olecranon osteotomy, and OO patients had more postoperative ulnar nerve neuritis (33% versus 0%, p=.04). There was no difference in DASH scores (p=.08), procedure time (p=0.2), the total number of patients with 1+ complications (p=0.5), difficulty with union (p=0.7), or the number of patients requiring revision surgery (p=0.7). CONCLUSIONS The TT approach is a safe and effective approach for the treatment of distal humerus fractures. When compared to the OO approach for AO 13-C fractures, we found the TT approach did not differ in functional outcomes, had increased range of motion, decreased intra-operative blood loss, and resulted in less postoperative ulnar nerve neuritis. The triceps tongue approach should be considered as safe and reliable first-line approach for intraarticular distal humerus fractures as it allows adequate visualization of the articular surface, eliminates complications related to osteotomy including delayed or non-union and hardware failure or irritation, and allows for easy conversion to total elbow arthroplasty.
Allogeneic blood transfusions during total hip or knee arthroplasty have been associated with inc... more Allogeneic blood transfusions during total hip or knee arthroplasty have been associated with increased risks for perioperative complications as well as increased medical costs. A multi-modal approach toperioperative management of the patients to minimize the risk for an allogeneic blood transfusion can help both the patient and the health care system. This approach involves optimizing the patients’ hemoglobin preoperatively, utilizing a variety of techniques intraoperatively including tranexamic acid to minimize blood loss, and using patient specific transfusion triggers post-operatively. In particular, the incorporation of tranexamic acid to the perioperative management of total hip and total knee replacement patients dramatically decreased the rate of allogeneic blood transfusions in our hospital.
Background: Patient satisfaction is increasingly being tied to reimbursement rates, and patient s... more Background: Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction is often associated with improving functionality and decreasing disability postoperatively. This study sought to determine if a total shoulder arthroplasty patient's preoperative confidence in his or her ability to attain the level of activity desired would influence postoperative functional scores. Materials and methods: Patients undergoing a primary total shoulder arthroplasty at a single institution were asked to complete a preoperative questionnaire with multiple items including baseline symptom severity measures and their confidence in reaching their level of desired functionality postoperatively (scored 0-10). Patients then completed an identical postoperative questionnaire at their follow-up visits. Associations between the patient's confidence in attaining treatment goals and functional outcomes was established by multiple linear regression models that were adjusted for gender, age, body mass index, baseline 12-Item Short Form Health Survey mental component scores, college education, smoking status, baseline functional scores, and length of follow-up. Results: Patients had a high level of confidence that their outcome would match their expectations, with an average score of 7.8 (range, 0-10; 28.4% reported a full 10/10 confidence). For every 1-point increase in confidence, patients experienced an average increase in their function score of 2.7 points (P ¼ .039) and improvement in their pain score of 2.0 (P ¼ .033) according to the Penn Shoulder Score. There was no significant association with the patient's 12-Item Short Form Health Survey score postoperatively. Conclusions: Patients with greater preoperative confidence actually have significantly better postoperative functional outcomes than their less confident peers even with adjustment for other known risk factors.
A primary concern of many knee surgery patients is their ability to return to work following surg... more A primary concern of many knee surgery patients is their ability to return to work following surgery, but it is often difficult to predict the practicality of returning due to a job's unclear knee demands. A cross-sectional study of employed patients and general population participants was conducted. Study participants were asked if their job required nine separate tasks and if their job had low, moderate, or high physical demands. The relative risk of each task placing high demands on the knee was calculated, and those risk ratios were summated to calculate a scaled score. The scaled score accurately distinguishes the levels of job demands with each reported level of job demands having a significantly higher mean scaled score than the level below it (p < 0.0001). The Occupational Activities Knee Scale offers occupational and health care providers greater precision in comparing the physical requirements of jobs for knee surgery patients.
Background: With childhood sports opportunities continuing to increase at an enormous rate along ... more Background: With childhood sports opportunities continuing to increase at an enormous rate along with participation starting at younger ages, the number of female participants in sports has increased in paramount fashion over the past few decades. A review of the current literature reveals a very small number of studies (<30) that document specific injuries suffered by competitive female gymnasts. Purpose: To retrospectively evaluate the incidence of various injuries and injury rates for different gymnast levels among young precollegiate female gymnasts over a 21-year period, from 1985 to 2005. Study Design: Descriptive epidemiological study. Methods: This institutional review board–approved study retrospectively evaluated young, precollegiate female gymnasts over a 21-year period. Gymnasts were stratified into 1 of 4 competition levels based on the number of hours spent training. In addition to the frequency of injuries and hours trained, data collected on each gymnast included ...
Background: The saline load test is routinely used to recognize other joints’ traumatic arthrotom... more Background: The saline load test is routinely used to recognize other joints’ traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. Methods: This was a cadaveric study of 16 hands (79 MCPJs). Traumatic arthrotomies were created using 11-blade stab-incisions, followed by blunt probing into the joint on the radial or ulnar side of the flexed MCPJs. A 3-mL syringe was used to inject intra-articular methylene-blue-dyed saline from the contralateral side. The volume at saline extravasation was recorded. Test sensitivity and factors influencing extravasation volume were assessed. Results: The mean (range) volume injected to identify arthrotomy of all MCPJs was 0.18 mL (0.1-0.4 mL). The mean volume to identify MCPJ arthrotomy of the thumb, in...
Journal of Bone and Joint Surgery-british Volume, 2013
Introduction: Patient medical comorbidities are well-established risk modifiers of THA patient ou... more Introduction: Patient medical comorbidities are well-established risk modifiers of THA patient outcomes. Patient9s mental state preoperatively may influence postoperative functional outcomes though just like any medical comorbidity. This study sought to determine if patient confidence in attaining post-operative functional goals was associated with objective and subjective outcomes following THA. Methods: Patients undergoing primary or revision THA at a single institution between 2008 and 2010 were administered a questionnaire consisting of demographics, body mass index, Hip Dysfunction Osteoarthritis and Outcomes Score (HOOS), SF-12 scores, the level of functionality they hoped to gain postoperatively and their confidence in attaining that goal (0–10 scale) preoperatively and postoperatively at last follow-up (minimum 12 months). Measured outcomes included length of stay, 30-day readmission, HOOS, and SF-12 physical component scores. Correlation of patient confidence in attaining t...
Background Historically, scapulothoracic fusion (STF) is performed using steel wire and plate con... more Background Historically, scapulothoracic fusion (STF) is performed using steel wire and plate construct fixation. The purpose of this study is to report a recent fusion achieved through ultra-high-molecular-weight polyethylene-reinforced suture fixation as well as to perform a systematic literature review of techniques, fusion rates, complications, and reoperation. Methods Patient data were gathered from chart review and clinical encounters. For the review, MEDLINE, Embase, and Ovid databases were queried for STF cases. Thirty articles reporting on 386 fusion procedures were included. Results Including this patient, 5 of 387 (1.3%) STFs have been attempted with fiber suture. Fusion rates of metal-only constructs is 90.8% (346 of 381) with 11.3% (43 of 381) requiring wire removal or trimming because of symptomatic hardware and 7% (27 of 381) causing a postoperative pneumothorax. Although a small sample size, all fiber-suture constructs have achieved union without implant removal and without pneumothorax development. In this patient, fusion was determined radiographically at 6 months with substantial improvement in pain level and function. Conclusion Scapulothoracic fusion has benefit to patients to have failed other management options for winged scapula, most commonly those with neurologic trauma or facioscapulohumeral muscular dystrophy. With advancements in surgical options, fiber-suture offers an alternative to steel wire to achieve fusion. Further cases with longer term follow-up are needed to determine if significant differences in outcomes exist between constructs.
The native anatomy of the distal biceps tendon is that it inserts onto the posterior aspect of th... more The native anatomy of the distal biceps tendon is that it inserts onto the posterior aspect of the radial tuberosity, allowing the radial protuberance to act as a mechanical cam to optimize supination strength and power. Restoring the distal biceps to its native posterior insertion further allows patients the ability to regain nearly all of their lost supination and flexion strength and power. The Posterior Anatomic Footprint Repair is a reliable technique for preserving the radial protuberance, restoring footprint anatomy, and recovering supination strength and theoretical power.
Background: Failure to recognize a potential wrist arthrotomy may lead to missed septic arthritis... more Background: Failure to recognize a potential wrist arthrotomy may lead to missed septic arthritis and devastating sequelae. The saline load test is routinely used to recognize traumatic arthrotomies of other joints; however, there are limited data optimizing this test for the wrist. The purpose of this study was to investigate and perform saline load testing to identify traumatic arthrotomies of the wrist. Methods: This was a cadaveric study of 15 wrists. Traumatic arthrotomies were created using a blunt trocar through the 3-4 portal. A 3-mL syringe with 0.1 mL markings was used to inject methylene blue dyed saline into the wrist through the 1-2 portal. Once extravasation was visible from the atherectomized site, the volume was recorded. Results: The mean (range) volume injected to identify the arthrotomy of all wrists was 1.22 mL (range, 0.1-3.1 mL). Multivariate regression demonstrated that cadaver age, laterality, and extension range of motion were not significantly associated with the injected saline volume at extravasation ( P &amp;gt; .05, each). Greater joint range of motion was independently associated with higher saline volume load for extravasation (odds ratio: 1.049; 95% confidence interval: 1.024-1.075; P = .003). Conclusions: We found that 2.68 and 3.02 mL of methylene blue dyed saline offered 95% and 99% sensitivity, respectively, for diagnosing traumatic wrist arthrotomy. The maximum volume of saline needed to recognize an arthrotomy was 3.1 mL. We recommend this be the minimum volume used to evaluate a traumatic wrist arthrotomy.
Background: The circumstances surrounding claims against hand surgeons have not been elucidated i... more Background: The circumstances surrounding claims against hand surgeons have not been elucidated in the literature. The purpose of this study was to analyze trends in malpractice litigation regarding hand surgery through a nationwide legal database. Methods: The Westlaw legal research database was queried for verdicts and settlements between 1985 and 2017 for hand surgery–related malpractice cases. Cases were included if the hand surgeon was sued for malpractice. Procedure type and complications and/or adverse events that resulted in litigation were recorded. Patient characteristics, state, date of case, case outcomes, and indemnity payment were also noted. All dollar amounts were adjusted to 2017 values using the Consumer Price Index. Results: In all, 171 cases (35 states) were included. The most frequently litigated surgeries were carpal tunnel releases followed by fracture treatment. Nerve injury was the predominant cause of litigation. The median nerve was predominantly injured, followed by the ulnar and radial nerves. In fracture surgery, malunion was the predominant cause, followed by weakness, nerve injury, and infection. In total, 72.5% of cases yielded verdicts in favor of the defense, 21.6% favored the plaintiff, and 5.9% were settled. Indemnity varied between $7800 and $8.99 million, averaging $570,397 for cases when the jury ruled in favor of the plaintiffs. Settled cases averaged $1,140,527. Conclusions: Malpractice litigation has substantial financial implications on surgeons and the health care system. Litigation arises most commonly from routine procedures (carpal tunnel release and fracture fixation) rather than complex surgical cases, potentially due to the high variability in operating surgeon subspecialization, with discrepant training.
Plastic and reconstructive surgery. Global open, Apr 1, 2023
Background: Peripheral nerve injuries not repaired in an effective and timely manner may lead to ... more Background: Peripheral nerve injuries not repaired in an effective and timely manner may lead to permanent functional loss and/or pain. For gaps greater than 5 mm, autograft has been the gold standard. Allograft has recently emerged as an attractive alternative, delivering comparable functional recovery without risk of second surgical site morbidities. Cost is an important factor when considering surgical options, and with a paucity of nerve repair cost data, this study aimed to compare allograft and autograft procedure costs. Methods: A retrospective cross-sectional observational study using the US all-payer PINC AI Healthcare Database examined facility procedure costs and cost drivers in patients undergoing allograft or autograft repair of an isolated single peripheral nerve injury between January 2018 and August 2020. Inpatient repairs were limited to nerve-specific DRGs. Multivariable regression evaluated risk-adjusted procedure cost differences. Results: Peripheral nerve graft repairs (n = 1363) were more frequent in the outpatient setting, and more than half involved the use of allograft nerve. Procedure costs for allograft and autograft repair were not significantly different in the outpatient (P = 0.43) or inpatient (P = 0.71) setting even after controlling for other risk factors. Operating room cost was significantly higher for autograft in outpatient (P &lt; 0.0001) but not inpatient (P = 0.46), whereas allograft implant cost was significantly higher in both settings (P &lt; 0.0001). Conclusions: No significant differences in procedure costs for autograft and allograft repair in inpatient and outpatient settings were found using real-world data. Future research should explore longer-term costs.
Background: Large prospective institutional data provide the opportunity to conduct level II and ... more Background: Large prospective institutional data provide the opportunity to conduct level II and III studies using robust methodologies and adequately powered sample-sizes, while circumventing limitations of retrospective databases. We aimed to validate a prospective data collection tool, the Orthopaedic Minimal Data Set Episode of Care (OME), implemented at a tertiary North American health care system for distal radial fracture (DRF) open reduction and internal fixation (ORIF). Methods: The first 100 DRF ORIFs performed after OME inception (February 2015) were selected for this validation study. A blinded review of the operative notes and charts was performed, and extracted data of 75 perioperative DRF ORIF procedure variables were compared with OME collected data for agreement. Outcomes included completion rates and agreement measures in OME versus electronic medical record (EMR)-based control datasets. Data counts were evaluated using raw percentages and McNemar tests. Cohen (κ)...
BACKGROUND The Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of care (OME) is a prospectively... more BACKGROUND The Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of care (OME) is a prospectively collected database enabling capture of patient and surgeon-reported data in a more efficient, comprehensive, and dependable manner than electronic medical record (EMR) review. We aimed to assess and validate the OME as a data capture tool for carpometacarpal (CMC) arthroplasty compared to traditional EMR-based review. Specifically, we aimed to: (1) compare the completeness of the OME versus EMR data; and (2) evaluate the extent of agreement between the OME and EMR data-based datasets for carpometacarpal (CMC) arthroplasty. METHODS The first 100 thumb CMC arthroplasties after OME inception (Febuary, 2015) were included. Blinded EMR-based review of the same cases was performedfor 48 perioperative variables and compared to their OME-sourced counterparts. Outcomes included completion rates and agreement measures in OME versus EMR-based control datasets. RESULTS The OME demonstrated superior completion rates compared to EMR-based retrospective review. There was high agreement between both datasets where 75.6% (34/45) had an agreement proportion of >0.90% and 82.2% (37/45) had an agreement proportion of >0.80. Over 40% of the variables had almost perfect to substantial agreement (κ > 0.60). Among the 6 variables demonstrating poor agreement, the surgeon-inputted OME values were more accurate than the EMR-based review control. CONCLUSIONS This study validates the use of the OME for CMC arthroplasty by illustrating that it is reliably able to match or supersede traditional chart review for data collection; thereby offering a high-quality tool for future CMC arthroplasty studies.
Background The current literature does not contain a quantitative description of the associations... more Background The current literature does not contain a quantitative description of the associations between operative time and adverse outcomes after open reduction and internal fixation (ORIF) of distal radial fractures (DRF). Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative health care utilization and 2) the incidence of local wound complications. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for DRF ORIF cases (January 2012–December 2018). A total of 17,482 cases were identified. Primary outcomes included health care utilization (length of stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time category. Secondary outcome was incidence of wound complications per operative-time category. Multivariate regression was conducted to determine operative-time categories associated with increased risk while adjusting f...
BACKGROUND There are various approaches to the distal humerus when managing a distal humerus frac... more BACKGROUND There are various approaches to the distal humerus when managing a distal humerus fracture, and controversy exists regarding which approach is optimal. The purpose of this study is to report outcomes of the triceps tongue (TT) approach when used for osteosynthesis of AO 13-A, B, and C distal humerus fractures. Secondarily we aim to compare the outcomes of the TT approach with olecranon osteotomy (OO) when used for osteosynthesis of AO 13-C distal humerus fractures. METHODS A retrospective review was performed on patients with distal humerus fractures treated with open reduction and internal fixation (ORIF) utilizing either a TT or OO approach between 2007-2019 at two separate institutions. TT patients with AO13-C fractures were matched in a 1:1 ratio based on age, sex, and fracture characteristics to OO patients. Surgical time, intraoperative blood loss, elbow motion, fracture union, complications, and DASH (Disabilities of the Arm, Shoulder, and Hand) scores were compared. RESULTS A total of 28 patients treated with TT approach were assessed, and the matched TT and OO cohorts were each comprised of 15 patients. The TT group lost less blood (119.3 mL versus 268.5 mL, p=.03), had greater maximal flexion (126° versus 116°, p=.03), and achieved a larger flexion-extension arc (108° versus 93°, p=.05) when compared to the OO group. In the OO cohort, 27% of patients sustained complications directly related to the olecranon osteotomy, and OO patients had more postoperative ulnar nerve neuritis (33% versus 0%, p=.04). There was no difference in DASH scores (p=.08), procedure time (p=0.2), the total number of patients with 1+ complications (p=0.5), difficulty with union (p=0.7), or the number of patients requiring revision surgery (p=0.7). CONCLUSIONS The TT approach is a safe and effective approach for the treatment of distal humerus fractures. When compared to the OO approach for AO 13-C fractures, we found the TT approach did not differ in functional outcomes, had increased range of motion, decreased intra-operative blood loss, and resulted in less postoperative ulnar nerve neuritis. The triceps tongue approach should be considered as safe and reliable first-line approach for intraarticular distal humerus fractures as it allows adequate visualization of the articular surface, eliminates complications related to osteotomy including delayed or non-union and hardware failure or irritation, and allows for easy conversion to total elbow arthroplasty.
Allogeneic blood transfusions during total hip or knee arthroplasty have been associated with inc... more Allogeneic blood transfusions during total hip or knee arthroplasty have been associated with increased risks for perioperative complications as well as increased medical costs. A multi-modal approach toperioperative management of the patients to minimize the risk for an allogeneic blood transfusion can help both the patient and the health care system. This approach involves optimizing the patients’ hemoglobin preoperatively, utilizing a variety of techniques intraoperatively including tranexamic acid to minimize blood loss, and using patient specific transfusion triggers post-operatively. In particular, the incorporation of tranexamic acid to the perioperative management of total hip and total knee replacement patients dramatically decreased the rate of allogeneic blood transfusions in our hospital.
Background: Patient satisfaction is increasingly being tied to reimbursement rates, and patient s... more Background: Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction is often associated with improving functionality and decreasing disability postoperatively. This study sought to determine if a total shoulder arthroplasty patient's preoperative confidence in his or her ability to attain the level of activity desired would influence postoperative functional scores. Materials and methods: Patients undergoing a primary total shoulder arthroplasty at a single institution were asked to complete a preoperative questionnaire with multiple items including baseline symptom severity measures and their confidence in reaching their level of desired functionality postoperatively (scored 0-10). Patients then completed an identical postoperative questionnaire at their follow-up visits. Associations between the patient's confidence in attaining treatment goals and functional outcomes was established by multiple linear regression models that were adjusted for gender, age, body mass index, baseline 12-Item Short Form Health Survey mental component scores, college education, smoking status, baseline functional scores, and length of follow-up. Results: Patients had a high level of confidence that their outcome would match their expectations, with an average score of 7.8 (range, 0-10; 28.4% reported a full 10/10 confidence). For every 1-point increase in confidence, patients experienced an average increase in their function score of 2.7 points (P ¼ .039) and improvement in their pain score of 2.0 (P ¼ .033) according to the Penn Shoulder Score. There was no significant association with the patient's 12-Item Short Form Health Survey score postoperatively. Conclusions: Patients with greater preoperative confidence actually have significantly better postoperative functional outcomes than their less confident peers even with adjustment for other known risk factors.
A primary concern of many knee surgery patients is their ability to return to work following surg... more A primary concern of many knee surgery patients is their ability to return to work following surgery, but it is often difficult to predict the practicality of returning due to a job's unclear knee demands. A cross-sectional study of employed patients and general population participants was conducted. Study participants were asked if their job required nine separate tasks and if their job had low, moderate, or high physical demands. The relative risk of each task placing high demands on the knee was calculated, and those risk ratios were summated to calculate a scaled score. The scaled score accurately distinguishes the levels of job demands with each reported level of job demands having a significantly higher mean scaled score than the level below it (p < 0.0001). The Occupational Activities Knee Scale offers occupational and health care providers greater precision in comparing the physical requirements of jobs for knee surgery patients.
Background: With childhood sports opportunities continuing to increase at an enormous rate along ... more Background: With childhood sports opportunities continuing to increase at an enormous rate along with participation starting at younger ages, the number of female participants in sports has increased in paramount fashion over the past few decades. A review of the current literature reveals a very small number of studies (<30) that document specific injuries suffered by competitive female gymnasts. Purpose: To retrospectively evaluate the incidence of various injuries and injury rates for different gymnast levels among young precollegiate female gymnasts over a 21-year period, from 1985 to 2005. Study Design: Descriptive epidemiological study. Methods: This institutional review board–approved study retrospectively evaluated young, precollegiate female gymnasts over a 21-year period. Gymnasts were stratified into 1 of 4 competition levels based on the number of hours spent training. In addition to the frequency of injuries and hours trained, data collected on each gymnast included ...
Background: The saline load test is routinely used to recognize other joints’ traumatic arthrotom... more Background: The saline load test is routinely used to recognize other joints’ traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. Methods: This was a cadaveric study of 16 hands (79 MCPJs). Traumatic arthrotomies were created using 11-blade stab-incisions, followed by blunt probing into the joint on the radial or ulnar side of the flexed MCPJs. A 3-mL syringe was used to inject intra-articular methylene-blue-dyed saline from the contralateral side. The volume at saline extravasation was recorded. Test sensitivity and factors influencing extravasation volume were assessed. Results: The mean (range) volume injected to identify arthrotomy of all MCPJs was 0.18 mL (0.1-0.4 mL). The mean volume to identify MCPJ arthrotomy of the thumb, in...
Journal of Bone and Joint Surgery-british Volume, 2013
Introduction: Patient medical comorbidities are well-established risk modifiers of THA patient ou... more Introduction: Patient medical comorbidities are well-established risk modifiers of THA patient outcomes. Patient9s mental state preoperatively may influence postoperative functional outcomes though just like any medical comorbidity. This study sought to determine if patient confidence in attaining post-operative functional goals was associated with objective and subjective outcomes following THA. Methods: Patients undergoing primary or revision THA at a single institution between 2008 and 2010 were administered a questionnaire consisting of demographics, body mass index, Hip Dysfunction Osteoarthritis and Outcomes Score (HOOS), SF-12 scores, the level of functionality they hoped to gain postoperatively and their confidence in attaining that goal (0–10 scale) preoperatively and postoperatively at last follow-up (minimum 12 months). Measured outcomes included length of stay, 30-day readmission, HOOS, and SF-12 physical component scores. Correlation of patient confidence in attaining t...
Background Historically, scapulothoracic fusion (STF) is performed using steel wire and plate con... more Background Historically, scapulothoracic fusion (STF) is performed using steel wire and plate construct fixation. The purpose of this study is to report a recent fusion achieved through ultra-high-molecular-weight polyethylene-reinforced suture fixation as well as to perform a systematic literature review of techniques, fusion rates, complications, and reoperation. Methods Patient data were gathered from chart review and clinical encounters. For the review, MEDLINE, Embase, and Ovid databases were queried for STF cases. Thirty articles reporting on 386 fusion procedures were included. Results Including this patient, 5 of 387 (1.3%) STFs have been attempted with fiber suture. Fusion rates of metal-only constructs is 90.8% (346 of 381) with 11.3% (43 of 381) requiring wire removal or trimming because of symptomatic hardware and 7% (27 of 381) causing a postoperative pneumothorax. Although a small sample size, all fiber-suture constructs have achieved union without implant removal and without pneumothorax development. In this patient, fusion was determined radiographically at 6 months with substantial improvement in pain level and function. Conclusion Scapulothoracic fusion has benefit to patients to have failed other management options for winged scapula, most commonly those with neurologic trauma or facioscapulohumeral muscular dystrophy. With advancements in surgical options, fiber-suture offers an alternative to steel wire to achieve fusion. Further cases with longer term follow-up are needed to determine if significant differences in outcomes exist between constructs.
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Papers by Joseph Styron