Publications by authors named "Joel Klena"

Purpose: Although European genome-wide association studies (GWAS) have aided in defining genetic associations in Dupuytren disease (DD), North American populations have been infrequently analyzed. Additionally, there are a paucity of rare variant analyses (RVA) for DD, which can help define both trait variability and risk for low-frequency variants. Our purpose was to perform a GWAS and RVA for DD using a North American database.

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Purpose: To compare rates of revision surgery between primary endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). In addition, we aimed to assess the influence of fellowship training on revision rates. We hypothesized that ECTR would not be associated with higher rates of revision surgery.

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Objective: Artificial intelligence (AI) is capable of answering complex medical examination questions, offering the potential to revolutionize medical education and healthcare delivery. In this study we aimed to assess ChatGPT, a model that has demonstrated exceptional performance on standardized exams. Specifically, our focus was on evaluating ChatGPT's performance on the complete 2019 Orthopaedic In-Training Examination (OITE), including questions with an image component.

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Introduction: Emergency department (ED) visits because of pediatric fractures are not only burdensome for patients and their families but also result in an increased healthcare expenditure. Almost half of all children experience at least one fracture by the age of 15. Many fractures occur in playgrounds, with monkey bars and other climbing apparatuses noted as frequent mechanisms of injury.

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Article Synopsis
  • The study aimed to compare the presence of amyloid deposition in two different biopsy sites (tenosynovium and transverse carpal ligament) during carpal tunnel release surgery, hypothesizing that both sites would show similar results.
  • A total of 148 cases were analyzed, revealing amyloid in 21% of tenosynovial specimens and 22% of transverse carpal ligament specimens, with a 93% agreement rate between the two.
  • The study concluded that using one biopsy site for amyloid testing is a valid approach, and further research is needed to assess cost-effectiveness.
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Purpose: Currently, there is a paucity of prior investigations and studies examining applications for artificial intelligence (AI) in upper-extremity (UE) surgical education. The purpose of this investigation was to assess the performance of a novel AI tool (ChatGPT) on UE questions on the Orthopaedic In-Training Examination (OITE). We aimed to compare the performance of ChatGPT to the examination performance of hand surgery residents.

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Purpose: The purpose of our study was to compare unplanned postoperative patient communication in the form of phone calls and/or electronic patient portal messages (EPPM) after carpal tunnel release (CTR) for patients with and without a postoperative opioid prescription.

Methods: We identified all patients ≥18 years of age who underwent primary CTR between 2017 and 2022 without an opioid ordered within 90 days prior to surgery. The following two groups were created: cases with and without an opioid prescribed on the day of surgery.

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Purpose: The CTS-6 can be used clinically to diagnose carpal tunnel syndrome (CTS) and has demonstrated high levels of interrater reliability when administered by nonexpert clinicians. Our purpose was to assess sensitivity (Sn), specificity (Sp), and interrater reliability of the CTS-6 when administered by medical assistants (MAs).

Methods: A series of patients presenting to an academic, upper-extremity surgery clinic were screened using CTS-6 between May and June of 2023.

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Purpose: Previous investigations assessing the incidence of amyloidosis detected with biopsy during carpal tunnel release (CTR) have focused on open CTR (OCTR). Prior authors have suggested that biopsy may be more technically challenging during endoscopic carpal tunnel release (ECTR). Our purpose was to compare differences in the incidence of amyloid deposition detected during ECTR versus OCTR.

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Purpose: The purpose of this study was to compare the complication rates of endoscopic carpal tunnel release (ECTR) relative to orthopedic resident trainee involvement in the procedure.

Methods: All patients undergoing isolated, elective ECTR by two attending surgeons within a 59-month period were analyzed. Cases were categorized as the following according to the degree of resident involvement: ECTR performed by attending with either no resident or a resident as an assistant (group 1), resident performing a portion of the procedure (group 2), and resident performing the entire procedure (group 3).

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Purpose: Randomized controlled trials (RCTs) are frequently used in creating recommendations contained within clinical practice guidelines (CPGs). However, investigations outside of hand surgery have reported that RCTs within CPGs infrequently report complications and harms-related data. Our purpose was to assess adherence to complication reporting and harms-related outcomes contained in the Consolidated Standards for Reporting (CONSORT) Extension of Harms and Standards for Reporting of Diagnostic Accuracy Studies (STARD) reporting checklists for RCTs within the American Academy of Orthopaedic Surgery (AAOS) CPGs for carpal tunnel syndrome (CTS).

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Purpose: Statistical literacy is the ability of a patient to apply basic statistical concepts to their health care. Understanding statistics is a critical component of shared decision making. The purpose of this investigation was to define levels of statistical literacy in an upper-extremity (UE) patient population.

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Purpose: To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP).

Methods: We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020.

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Purpose: While clinical trials provide high-quality evidence guiding medical decision-making, early trial termination can result in both lost time and resources. Our purpose was to investigate the rate of and reasons for clinical trial termination for hand and wrist-related conditions and identify study characteristics associated with early trial termination.

Methods: The ClinicalTrials.

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Purpose: Bibliometric analysis is a common method for evaluating current trends within a scientific field. The primary aim of this study was to define and analyze the 50 most frequently cited articles in the field of elbow surgery, both of all time and those published during the 21st century.

Methods: We searched the Journal Citation Report to identify articles related to elbow surgery within academic journals.

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Article Synopsis
  • The study aimed to evaluate how previous research has defined nonunion of metacarpals, suspecting that definitions vary greatly across studies.
  • A systematic review of articles from the MEDLINE and Embase databases identified 641 articles, from which 102 provided definitions of nonunion and 97 assessed clinical management and outcomes, revealing that 62% used low-level evidence.
  • Results showed that definitions of nonunion were inconsistent, with the most common criteria being the presence of fracture-site tenderness and lack of healing after 6 months; improving standardization could enhance understanding of incidence rates.
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Purpose: Occupational radiation exposure can have adverse health consequences for surgeons. The purpose of this study was to determine if utilization of an intraoperative, real-time radiograph counter results in decreased radiation exposure events (REEs) during open reduction and internal fixation (ORIF) of distal radius fractures (DRFs).

Methods: We reviewed all cases of isolated ORIF DRFs performed at a single center from January 2021 to February 2023.

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Article Synopsis
  • A meta-analysis was conducted to evaluate the diagnostic validity (sensitivity and specificity) of various physical examination maneuvers for diagnosing carpal tunnel syndrome (CTS), utilizing the PRISMA checklist for methodology.
  • The study included 67 articles assessing multiple tests, including Phalen's test (most sensitive), Tinel's sign, and others, analyzing data from a total of 8,924 hands.
  • Findings highlighted that while Phalen's test had the highest sensitivity, the static 2-point discrimination test exhibited the best specificity, indicating the need for a combination of tests and patient history for accurate CTS diagnosis due to variability in test effectiveness.
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Introduction While Google is frequently used to access internet-based health resources, the quality of online health information remains variable. Our purpose was to assess suggested resources identified through Google search features for common symptoms related to carpal tunnel syndrome (CTS). Methods Two searches were performed.

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Article Synopsis
  • American hospitals are required to provide chargemaster data for price transparency, allowing consumers to estimate medical costs, and a study assessed how well hospitals comply with this requirement for upper-extremity procedures.* -
  • An analysis of 122 hospitals found that 88% had accessible chargemaster files, but price information for specific procedures was reported inconsistently, with imaging studies being more frequently priced than other procedures.* -
  • The study revealed significant price variability for procedures like total shoulder arthroplasty, highlighting the challenges consumers face in understanding medical costs despite the overall compliance with publishing price transparency files.*
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Purpose: Hand surgery remains one of the least racially and ethnically diverse subspecialties in all of medicine, and minority patients demonstrate overall worse health care outcomes compared with White patients. Our purpose was to determine the frequency of race and ethnicity reporting in randomized controlled trials (RCTs) published in journals with an upper-extremity (UE) focus.

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching EMBASE and MEDLINE for RCTs contained in peer-reviewed journals with an UE focus.

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Formal patient complaints and malpractice events involving orthopedic trauma surgeons (OTSs) can have substantial career implications. Our purpose was to analyze formal patient complaints, risk events, and malpractice events against OTSs during a 10-year period. We reviewed all formal patient complaints within our institution's patient advocacy database involving 9 fellowship-trained OTSs throughout a decade.

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Purpose: To describe management trends of fifth metacarpal neck (5MCN) fractures within a large health care system. We aimed to define patient and surgeon factors associated with nonsurgical versus surgical treatment, as well as to identify factors associated with receiving care only in the emergency department (ED).

Methods: We identified all 5MCN fractures within our system for the years 2012-2020 and recorded baseline demographics for cases.

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Purpose: The purpose of this study was to assess the incidence, outcomes, and complications associated with conversion from endoscopic carpal tunnel release (ECTR) to open carpal tunnel release (OCTR).

Methods: A retrospective case review of all patients who underwent ECTR over 4 years by 2 fellowship-trained hand surgeons at a single academic center was performed. We recorded outcomes and the reason for conversion in patients who underwent conversion to an OCTR.

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Article Synopsis
  • The study aimed to evaluate patient satisfaction and functional outcomes of a specific surgical repair technique (suture anchor repair with local soft tissue advancement) for thumb ulnar collateral ligament (UCL) injuries, both acute and chronic.
  • A retrospective review was conducted on 36 patients who underwent surgery between 2006 and 2013, documenting their demographics, pain scores, functional assessments, and return to activities post-surgery.
  • Results indicated that both acute and chronic injury groups experienced comparable levels of pain, function, and satisfaction post-operation, suggesting that the repair technique is a safe and effective treatment for thumb UCL injuries, including those that are chronic.
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