Postoperative Instruction Retention, Written Versus Audiovisual Adjuncts: A Prospective Randomized Study.

Purpose: Adherence to postoperative protocols is an integral perioperative intervention that impacts surgical outcomes. The focus of this study was to identify the baseline postoperative instruction retention of our traditional written format and compare that with the retention when using an audiovisual adjunct. We hypothesize that the addition of audiovisual adjuncts would result in greater patient retention of their postoperative instructions.

Outcomes of Endoscopic Carpal Tunnel Release Surgery With Home Guided Hand Therapy Versus No Hand Therapy: A Prospective Randomized Controlled Trial After Endoscopic Carpal Tunnel Release.

Background: The most recent American Academy of Orthopaedic Surgeons Clinical Practice Guidelines found no high-quality evidence comparing home therapy to no therapy following carpal tunnel release surgery (CTRS). Therefore, this study's purpose is to compare the outcomes of patients receiving home therapy and patients receiving no therapy following endoscopic CTRS.

Methods: A single-blinded prospective randomized controlled trial was performed.

Distal Radius Fractures in Diabetic Patients: An Analysis of Surgical Timing and Other Factors That Affect Complication Rate.

Background: While not studied for distal radius fractures, the effect of surgical timing on complication rate has been extensively analyzed in the treatment of pilon fractures. The primary aim of this study was to identify any effect surgical timing has on postoperative complication rates after surgical fixation of distal radius fractures in diabetic patients.

Methods: All patients who underwent surgical fixation of distal radius fractures at a single suburban academic hospital between 2012 and 2019 were reviewed.

The Influence of Physician-Rating Websites on Patient Physician Preference.

Backgroud: Physician-rating websites (PRWs) are designed to publicly report physician quality information while bringing forth a sense of transparency. This study looks to identify the influence PRWs have on a patient's choice of orthopedic hand surgeon while stratifying patient physician preference by various demographic characteristics.

Methods: This survey-based study was conducted in a suburban outpatient orthopedic hand practice.

Thumb interphalangeal joint arthrodesis angles in patients with carpometacarpal osteoarthritis.

Purpose: Previous studies have shown that thumb interphalangeal (IP) joint arthrodesis is typically performed between 0 and 30° of flexion, with a recent study in healthy subjects having recommended a range of 15-30° to be an ideal functional IP joint fusion angle for various activities of daily living. The current study aimed to evaluate the ideal thumb IP fusion angle in patients with thumb carpometacarpal (CMC) osteoarthritis (OA).

Methods: Twenty-seven patients with thumb CMC OA were evaluated; five patients had bilateral pathology, for a total of thirty-two thumbs included.

Esmarch technique for maintaining reduction during intramedullary nailing of tibial shaft fractures.

Given the frequency of tibial shaft fractures that undergo intramedullary fixation, the aim of this case report is to demonstrate an easily reproducible technique for fracture reduction maintenance intra-operatively using a non-invasive technique. Our technique utilizes an Esmarch bandage applied in specific fashion particularly as a means of maintaining fracture reduction during reaming and insertion of the intramedullary device. When compared to other well-described techniques of tibial shaft fracture reduction and preservation, this method is of minimal insult to soft tissues and without need for additional incisions or implantation of additional devices.

The Clinical Utility of Maceration Dressings in the Treatment of Inpatient Hand Infections: An Evaluation of Treatment Outcomes Compared to Standard Care.

In cases of oral antibiotic-resistant infection of the hand, we propose utilizing a heated, moist maceration dressing to help shorten and simplify the in-hospital clinical course by increasing the efficacy of antibiotic deliverance to infection sites, increasing the success of nonoperative management, and decreasing eradication time of infection of the hand. Fifty-six patients older than 18 years of age who presented with hand infections requiring inpatient intravenous antibiotics at our suburban academic hospital over a 30-month period were included and randomly assigned to either the maceration dressing group or the standard treatment group. Maceration dressings included warm and moist gauze, kerlix, webril, Orthoglass, Aqua K Pad, and sling.

Hand Corticosteroid Injections in Patients on "Blood Thinners".

Our study aims to identify any influence that anticoagulation and antiplatelet ("blood thinner") medications have on hand and wrist corticosteroid injection complication rates. This retrospective chart review looked at patients between the ages of 18 and 89 years who received corticosteroid injections in the hand or wrist between 2013 and 2017, noting anticoagulation and antiplatelet use, demographics, injection placement, and surgical intervention. Only 152 (20.

The Effect of an Orthopedic Hand Surgeon's Attire on Patient Confidence and Trust.

Multiple studies have concluded that patients are more likely to understand and trust physicians who dress in more formal attire (shirt and tie) as opposed to casual attire (t-shirts and jeans). The white coat has repeatedly been reported as a major source of trust and confidence in a patient's eyes. This study explores the effect an orthopedic hand surgeon's attire has on a patient's perception of their surgeon's clinical values.

Wrong-Bone Excision in Hand Surgery.

Background: The incidence of wrong-bone excision in hand surgery is not known. The wrist offers a unique challenge in that a single surgical incision yields access to multiple potential surgical sites, thus rendering site marking less effective. Mistaken identification of structures in the wrist is a real and potentially troublesome phenomenon.

Review of Lower Extremity Traction in Current Orthopaedic Trauma.

Although methods of traction for temporizing and definitive treatment of orthopaedic injuries are described in dated textbooks, current literature and recommendations on the use of skin and skeletal traction in orthopaedic trauma are lacking. Elaborate traction schemas have been described, but few of them have been retained in practice and even fewer have been supported by scientific data. Several options exist for traction modalities that involve the pelvis and lower extremities, including portable traction devices and traction pins.

Functional Fusion Angle for Thumb Interphalangeal Joint Arthrodesis.

Background: A thumb interphalangeal (IP) joint arthrodesis is typically performed in 0° to 30° of flexion; most daily activities involve increased flexion at the IP joint to facilitate pinch and grip. This study evaluates the preferred thumb IP joint position with certain tasks of daily living to determine a more satisfactory angle.

Methods: Twenty-eight healthy volunteers were splinted at various degrees (0°, 15°, 30°, 45°, bilaterally) with thumb orthotics, leaving the tip free, to mimic various angles of IP fusion.

Patients' preferences regarding the delivery of health care in a hand surgical practice.

Background: The Patient Protection and Affordable Care Act of 2010 includes patient satisfaction scores in the calculation of reimbursement for services provided. The Medicare and Medicaid Electronic Health Care Record Incentive Program mandate that physicians provide electronic communication with patients. Little data exists regarding patient preferences that might guide the physician adhering to these guidelines.

Outcome following distally locked volar plating for distal radius fractures with metadiaphyseal involvement.

Background: The surgical treatment of metadiaphyseal distal radius fractures may be difficult due to the associated articular or periarticular extension that limits standard fixation techniques. Longer distal radius volar locking plates allow stable fixation of the distal fragments while providing standard plate fixation in the proximal radius. We hypothesize that this plating technique allows adequate fixation to both the distal radius and metadiaphyseal fragments.

The effect of anesthesia type on nonsurgical operating room time.

Purpose: To determine the effect of local-only anesthesia on nonsurgical time compared with monitored anesthesia care (MAC)/local and general anesthesia. Our hypothesis was that local-only anesthesia cases would have lower nonsurgical times compared with MAC/local and general anesthesia.

Methods: We retrospectively reviewed the surgical records of 1,179 patients undergoing elective hand surgery.

Ulnar collateral ligament injuries of the thumb: a comprehensive review.

Injuries to the thumb ulnar collateral ligament (UCL) are common. Failure to address the ensuing laxity of the metacarpophalangeal joint can lead to compromised grip and pinch, pain, and ultimately osteoarthritis. Instability to valgus stress with the lack of a firm end point is a strong indicator of complete rupture of the UCL.

Elbow injuries in the throwing athlete.

High valgus and extension loads imparted to the athlete's elbow during repetitive overhead throwing can lead to acute and chronic pathology. Over time, normal soft tissue and bony stabilizing structures of the elbow undergo progressive structural changes and can succumb to injury. Modern diagnostic modalities, including plain radiographs, computed tomography, and magnetic resonance imaging, in addition to arthroscopy, can aid in diagnosis.

Distal radial traction radiographs: interobserver and intraobserver reliability compared with computed tomography.

Background: Distal radial fracture characterization with standard radiographs has been consistently poor, leading to a widespread use of computed tomography (CT) with this injury. Traction radiographs have recently been shown to improve interobserver reliability for fracture characterization and treatment. Our goal was to compare five traction radiographs and CT images to evaluate the interobserver and intraobserver reliability of individual fracture fragment identification, the correct identification of fracture fragments on CT imaging compared with traction images, and the consistency of treatment recommendations.

Concomitant endoscopic carpal and cubital tunnel release: safety and efficacy.

Background: When performed alone, endoscopic carpal tunnel release and endoscopic cubital tunnel release are safe and effective surgical options for the treatment of carpal and cubital tunnel syndromes, respectively. However, there is currently no literature that describes the performance of both procedures concomitantly. We describe the results of 17 cases in which dual endoscopic carpal and cubital tunnel releases were performed for the treatment of concurrent carpal and cubital tunnel syndromes.

The efficiency of a dedicated staff on operating room turnover time in hand surgery.

Purpose: To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice.

Methods: A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic.

Kienböck disease.

Kienböck disease, or osteonecrosis of the lunate, most often affects patients between the ages of 20 and 40 years. There are 4 major stages of the disease, and treatment is based on the stage of disease. Advancements are still being made with regards to the cause, pathophysiology, and preferred method of treatment of each stage.

Carpal instability of the wrist.

The scaphoid is stabilized by the scapholunate ligament (directly) and lunotriquetral ligament (indirectly). Disruption of either of these ligaments leads to a pattern of instability that, left untreated, leads to altered mechanics of the wrist and ultimately debilitating arthritis and collapse. Although arthroscopy remains the gold standard for diagnosis of these injuries, plain films and advanced imaging are useful adjuncts.