Publications by authors named "Joel C Klena"

35 Publications

Analysis of Gender Diversity Within Hand Surgery Fellowship Programs.

J Hand Surg Am 2021 Jun 7. Epub 2021 Jun 7.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.

Purpose: To define and compare gender diversity among faculty and trainees within hand surgery fellowship programs.

Methods: We determined the gender of each program director for all orthopedic residency and fellowship programs. Specific to hand fellowship programs, we determined the gender of the fellowship director and all faculty members for all plastic surgery and orthopedic hand fellowship programs. Lists of prior hand surgery fellows from 2014 to 2019 were obtained from official program websites or program coordinators. The gender distribution of the hand fellowship program directors and faculty was compared to the prior fellows.

Results: Hand surgery fellowship programs had the second highest percentage of female fellowship directors (13%) behind orthopedic oncology (27%). Within hand surgery, 614 total faculty positions were identified, and 15% were female. Of the 89 hand surgery programs evaluated, 36 (60%) had at least 1 female faculty member. For the 849 prior fellows identified, 213 (25%) were female, and 79% of programs had at least 1 female fellow. Hand programs led by a female director did not have a higher percentage of prior female fellows compared to programs led by a male director (26% vs 25%). Programs with a female fellowship director were as likely to have had at least 1 prior female fellow compared to programs with a male fellowship director.

Conclusions: For orthopedic subspecialties, hand surgery fellowship programs had the second highest percentage of female fellowship directors (13%). While mentorship plays an important role in surgical education, hand fellowship programs with female faculty did not appear to attract more female fellows or faculty.

Clinical Relevance: Hand fellowship programs should recognize that the presence of female faculty may not be a primary factor in fellowship selection for female applicants, and further study into recruiting qualified female candidates should be encouraged.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2021.04.023DOI Listing
June 2021

An Analysis of Formal Patient Complaints and Malpractice Events Involving Hand and Upper Extremity Surgeons.

J Am Acad Orthop Surg 2021 May 17. Epub 2021 May 17.

From the Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.

Introduction: Our purpose was to define and categorize patient complaints within a hand surgery practice over a 10-year period. In addition, we aimed to define surgeon and patient factors associated with formal complaints.

Methods: All patients who filed a complaint with our institution's patient advocacy service against six hand surgeons in an academic practice over a 10-year period were recorded and categorized using the Patient Complaint Analysis System. A control group consisting of all patients seen by the surgeons during the study period was created. Demographic differences between the complaint and control groups were analyzed, as were complaint rates between surgeons. We obtained the number of malpractice events involving each of the surgeons.

Results: During the 10-year study period, 73 of 36,010 unique patients seen (0.20%) filed a complaint. Care and treatment category comprised the highest percentage of complaint designations (30%), followed by access and availability (23%). Forty-three patients (59%) who filed complaints were treated surgically. Patients with a complaint had a significantly higher percentage of mental, behavioral, or neurodevelopmental disorders compared with controls (55% versus 42%, P = 0.03). The complaint rate (total complaints/total new patients seen) ranged between 0.09% and 0.29% for the six surgeons, and these results were not statistically significant.

Discussion: Within an academic hand and upper extremity surgery practice, the rate of patient complaints is 0.20% or approximately one complaint for every 500 new patients seen. Most patient complaints are categorized within the care and treatment domain. Underlying mental health conditions are associated with more frequent complaints. Communication issues appear to represent a modifiable area that hand surgeons can improve to help mitigate potential complaints. Understanding both the frequency and types of patient complaints may allow hand surgeons to recognize areas for improvement and avoid potential exposure to malpractice litigation.

Level Of Evidence: Prognostic level III (case-control).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOS-D-21-00073DOI Listing
May 2021

The Ability of Upper Extremity Surgeons to Assess Patient's Functional Status.

J Hand Surg Am 2021 Apr 9. Epub 2021 Apr 9.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.

Purpose: To compare surgeon and patient assessment of upper extremity functional status at the time of initial consultation. We hypothesized that surgeons and patients demonstrate low levels of agreement with respect to assessing pain scores, functional status, and self-efficacy.

Methods: One hundred forty-three consecutive new patients were evaluated by 1 of 5 fellowship-trained upper extremity surgeons. Patients completed a Numeric Pain Rating Scale as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Pain Interference (PI), and Self-Efficacy (SE) instruments. Surgeons provided their own estimates of patient function on each questionnaire at the conclusion of the visit and were blinded to the results of the patient-reported outcome measures (PROMs) for the duration of the study. Estimation errors, which represent the absolute value of the difference between the patient's actual score and the surgeon's estimated score on each questionnaire, were calculated for each questionnaire.

Results: As a group, surgeons assumed that the PROMIS UE and SE scores were higher than the patients' actual scores and assumed that patients had lower PROMIS PI scores than were actually reported. Mean estimation errors for all PROMIS instruments were greater than 10 points and larger than the SD for these instruments in the general population.

Conclusions: Upper extremity surgeons demonstrate difficulty assessing their patient's self-reported functional status, pain interference, and level of self-efficacy during initial consultations.

Clinical Relevance: Although formalized PROMs are infrequently administered in orthopedic clinics, increased utilization of these questionnaires would allow for a more accurate baseline functional assessment. When evaluating new patients in the outpatient clinic, surgeons should recognize the potential limitations of their assessments of patient-reported function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2021.02.007DOI Listing
April 2021

Analysis of driving simulator performance for post-call orthopaedic surgery residents.

Postgrad Med J 2021 Mar 29. Epub 2021 Mar 29.

Department of Orthopaedic Surgery, Geisinger Health System, Danville, Pennsylvania, USA.

Purpose: Despite the associations between workhours, fatigue and motor vehicle accidents, driving abilities for residents post-call have been infrequently analysed. Our purpose was to compare orthopaedic surgery resident performance on a driving simulator after a night of call compared with their baseline.

Study Design: All residents from a single orthopaedic programme were asked to complete baseline and post-call driving simulator assessments and surveys. The primary outcome measure was brake reaction time (BRT) and secondary outcome measures included lane variance, speed variance and accidents on the driving simulator.

Results: All 19 orthopaedic residents agreed to participate. Compared with the baseline assessment, residents demonstrated significantly higher levels of sleepiness on the Stanford Sleepiness Scale post-call (1.6 vs 3.4; p<0.0001). Despite higher levels of fatigue post-call, there was no statistically significant differences between baseline and post-call assessments for mean BRT, accidents, lane variation and speed variation.

Conclusions: These data suggest that for orthopaedic residents, driving simulator performance does not appear to be worse after a single night of call compared with baseline. Future collaborative, multicentre investigations on post-call driving safety that incorporate different call types and frequencies are necessary to better define the impact of post-call fatigue on driving performance. Recognising that motor vehicle accidents remain the leading cause of death for people under the age of 30 years, these continued areas of study are necessary to truly establish a culture of resident safety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/postgradmedj-2021-139908DOI Listing
March 2021

Technology, Social Media, and Telemedicine Utilization for Rural Hand and Upper-Extremity Patients.

J Hand Surg Am 2021 Apr 22;46(4):301-308.e1. Epub 2021 Jan 22.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.

Purpose: To define technology and social media use among rural upper-extremity patients. In addition, we aimed to assess how patients use social media in relation to health care and their willingness to participate in telemedicine programs.

Methods: An anonymous multiple-choice written survey was administered to 550 upper-extremity patients at 4 rural outreach clinics. Demographic information was obtained, as was social media use, habits and interests. We compared both users and nonusers of social media to define demographic differences between these groups.

Results: A total of 412 patients completed surveys and were included in our analysis (75%); 225 reported using social media (55%). Of the respondents, 67% had a high school education or less and 60% reported an income of less than $50,000/y with an unemployment rate of 58%. In addition, 28% reported not owning a smartphone and 20% lacked home Internet access. Multivariable regression demonstrated that age, female sex, and home Internet access were all independently associated with increased social media use. Facebook was the most frequently used social media platform. Moreover, 42% were interested in telemedicine and social media users were significantly more likely to be interested in telemedicine programs compared with non-social media users.

Conclusions: Within a population of rural and economically disadvantaged upper-extremity patients, 55% currently use social media; 32% used these platforms to research health conditions. Whereas younger female patients with home Internet access were more likely to use social media, older patients were more likely to use these platforms to research health conditions.

Clinical Relevance: As more health information moves on-line and as telemedicine programs continue to evolve, some rural upper-extremity patients may still have technological barriers in the form of smartphone and computer ownership as well as a lack of home Internet access.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2020.11.019DOI Listing
April 2021

The Handshake Test: A Nonverbal Assessment of Coping Strategies and Functional Status in Patients with Atraumatic Upper-Extremity Conditions.

Iowa Orthop J 2020 ;40(1):49-52

Geisinger Medical Center, Department of Orthopaedic Surgery, Danville, PA.

Background: Maladaptive coping strategies can lead to less functional improvement after upper-extremity surgery. It remains uncertain how well surgeons can recognize signs of less effective coping strategies in patients in the absence of formalized questionnaires. Our purpose is to determine if the "Handshake Test" can be used to identify patients with less effective coping strategies. We hypothesize that a simple physical examination finding (a refusal or inability to shake hands) is associated with higher pain level, maladaptive coping strategies and decreased functional status.

Methods: We prospectively analyzed 246 consecutive new patients presenting to one of three surgeons with atraumatic upper-extremity conditions. Patients completed a pain scale (NPRS) and PROMIS instruments including Self-Efficacy (SE) for Managing Symptoms, Pain Interference (PI) and Upper Extremity (UE). Each surgeon recorded a refusal to shake hands as part of a normal greeting, referred to as a "positive Handshake Test".

Results: 200 patients (81%) patients completed all outcome measures and were included in our analysis. 8% demonstrated a positive Handshake Test. Patients with a positive Handshake Test were more likely to use tobacco; otherwise baseline demographics were similar between the two groups. Patients with a positive Handshake Test demonstrated higher pain scores (NPRS and PROMIS PI), lower levels of self-efficacy and worse self-reported functional status on the PROMIS UE.

Conclusions: For patients with atraumatic upper-extremity conditions, those with a positive Handshake Test report higher pain levels, lower self-efficacy, and decreased self-reported functional status than patients who can perform a handshake. This simple test can aid in identifying patients with less effective coping strategies, allowing surgeons to guide patients towards interventions to improve both illness behavior and functional outcomes..
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368538PMC
February 2021

Telemedicine in Hand and Upper-Extremity Surgery.

J Hand Surg Am 2020 Mar 9;45(3):239-242. Epub 2019 Nov 9.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.

Smartphones, computers, and Internet access continue to become more available to both patients and physicians. As these technologies develop with respect to health care, opportunities for telemedicine visits continue to emerge. The purpose of this review article was to analyze the current use and potential applications of telemedicine in hand and upper-extremity surgery. Although the literature pertaining to the use of telemedicine in hand surgery is limited, videoconferencing visits may provide benefits to patients. Particularly in rural and underserved regions, patients can decrease considerable travel burdens. Potential applications for this technology include remote inpatient and emergency room consultations, outpatient clinic visits, and postoperative care. There are unique considerations with respect to confidentiality and security. As with any new technology, it is important to analyze safety concerns. Future randomized, prospective investigations are necessary to define the economic implications of telemedicine programs more clearly within hand and upper-extremity surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2019.09.007DOI Listing
March 2020

Opioid Versus Nonopioid Analgesia After Carpal Tunnel Release: A Randomized, Prospective Study.

Hand (N Y) 2021 Jan 29;16(1):38-44. Epub 2019 Mar 29.

Geisinger Medical Center, Danville, PA, USA.

The purpose of this investigation was to compare pain control and patient satisfaction for conventional postoperative opioid analgesia and nonopioid multimodal analgesia after elective open or endoscopic carpal tunnel release (CTR). As part of a randomized, prospective study, patients undergoing primary, elective CTR were randomized to receive either postoperative opioids or nonopioid medications as part of a multimodal pain control strategy. Patients currently taking opioids were excluded. Patients completed a postoperative pain journal and completed the shortened version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), Boston Carpal Tunnel Questionnaire, Numeric Pain Rating Scale (NPRS), and satisfaction ratings at their 2-week visit. A total of 68 patients were included. Preoperatively, there were no statistically significant differences between the 2 groups with respect to pain scores, coping skills, or carpal tunnel symptoms. At 2 weeks postoperatively, patients in the nonopioid group had lower average NPRS and QuickDASH scores. Patients who took opioids consumed an average of 5 pills. No patient randomized to the nonopioid group required any opioids. Patients in the nonopioid group demonstrated lower early postoperative NPRS scores. Patient satisfaction with their pain control regimen and outcome was not significantly different between the 2 groups at any time point. Nonopioid medications as part of a perioperative pain control strategy demonstrate improved pain scores compared with opioid medications with similar patient satisfaction and functional outcomes. Considering the risks associated with the use of opioid analgesics, we recommend against prescribing opioids after CTR, particularly in patients not currently taking narcotic medications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944719836211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818044PMC
January 2021

The 70° Supinated Oblique View: A Cadaveric Analysis to Determine Ideal Radial Styloid Screw Position in Locked Volar Plating of Distal Radius Fractures.

Hand (N Y) 2021 Jan 29;16(1):99-103. Epub 2019 Mar 29.

Geisinger Medical Center, Danville, PA, USA.

Defining an intraoperative radiographic view to best determine the radial styloid screw position in locked volar plating of distal radius fractures may improve fixation and aid in decreasing cortical penetration and implant complication. We used a cadaveric model to demonstrate a reproducible, oblique radiographic view to identify the radial styloid screw position. Nine fresh-frozen elbow-to-fingertip cadavers were used for this study. A 2.4-mm variable angle volar distal radius locking plate was applied to the distal radius. A Kirschner wire (K-wire) was inserted into the radial styloid through the plate. Placement of the K-wire through the tip of the styloid at the cortical edge was confirmed through a separate radial incision. A second K-wire was placed through the radius shaft into the ulna to aid in angular measurements. Live fluoroscopic imaging was used as the forearm was brought from full 90° of supination toward neutral. Once the K-wire was abutting the cortical edge, rotation ceased, and a goniometer was used to measure the angle of forearm rotation. This was repeated for a total of 3 repetitions on each specimen. The average angle of supination best depicting the position of the radial styloid screw was 68.5° (range = 64.3°-70.5°). Radial styloid screw fixation in locked volar plating of distal radius fractures increases the ultimate strength to failure, but screw penetration and tendon irritation can occur. The 70° supinated oblique intraoperative view provides the most accurate evaluation of the position of the radial styloid screw.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944719836210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818033PMC
January 2021

The Use of Preoperative Dynamic Ultrasound to Predict Ulnar Nerve Stability Following In Situ Decompression for Cubital Tunnel Syndrome.

J Hand Surg Am 2019 Jan 27;44(1):35-38. Epub 2018 Nov 27.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.

Purpose: To assess the use of preoperative, dynamic ultrasound to predict ulnar nerve instability following in situ decompression for cubital tunnel syndrome.

Methods: Prior to undergoing in situ decompression, 43 consecutive patients underwent dynamic ultrasound to assess the stability of the ulnar nerve during elbow flexion. The dynamic ultrasound findings were compared with the intraoperative assessment of nerve stability following in situ decompression.

Results: The preoperative dynamic ultrasound agreed with intraoperative findings in 38 of 43 patients (88%). Physical examination of ulnar nerve stability agreed with the intraoperative findings in 5 of 43 patients (12%). For the 5 of 43 cases in which the dynamic ultrasound did not correlate with the degree of ulnar nerve stability after in situ decompression, dynamic ultrasound overestimated the degree of ulnar nerve stability in 4 cases.

Conclusions: Preoperative dynamic ultrasound can be used to accurately predict the degree of ulnar nerve instability following in situ decompression.

Type Of Study/level Of Evidence: Diagnostic II.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2018.10.013DOI Listing
January 2019

Incidence and Reason for Readmission and Unscheduled Health Care Contact After Distal Radius Fracture.

Hand (N Y) 2020 03 27;15(2):243-251. Epub 2018 Jul 27.

Geisinger Medical Center, Danville, PA, USA.

Understanding risk factors for readmission may help decrease the rate of these costly events. The purpose of this study is to define the incidence of 30-day readmission and unscheduled health care contact (UHC) after distal radius fracture (DRF). In addition, we aim to define risk factors for readmission and UHC. A retrospective review of patients who sustained a DRF at our trauma center was performed. We recorded baseline demographics, fracture characteristics, and treatment. Any UHC or readmission (including emergency department [ED] visits) was documented. Reasons for readmission and UHC were stratified by cause. We utilized a case-control design comparing patients readmitted within 30 days after DRF versus those who were not, as well as patients with and without UHC. About 353 patients were identified. The 30-day incidence of readmission after DRF was 7% with 2% of patients readmitted for reasons related to their fracture. Twenty percent of patients had UHC within 30 days, most frequently due to pain. Patients with anxiety or depression and those with open fractures were more likely to be readmitted. Patients with UHC were younger, more likely to have depression or anxiety, and more likely to have undergone operative treatment. For patients sustaining DRF, we report a 30-day readmission rate of 7% with 20% of patients having UHC. Patients with depression or anxiety were more likely to be both readmitted and have UHC. Identifying risk factors for readmission during initial presentation may help reduce readmissions. Improving pain relief strategies early may aid in decreasing the burden of UHC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944718788687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076622PMC
March 2020

Comparison of Radiographic and Intraoperative Visual Assessment of Scaphotrapezoid Joint Arthritis in Patients With End-Stage Carpometacarpal Arthritis of the Thumb Base.

Hand (N Y) 2019 09 20;14(5):609-613. Epub 2018 Mar 20.

Geisinger Medical Center, Danville, PA, USA.

The purpose of this investigation is to compare the radiographic and intraoperative assessment of scaphotrapezoid (ST) joint arthritis in patients with end-stage carpometacarpal (CMC) arthritis of the thumb base. We aim to define the incidence of ST arthritis in this population and determine whether radiographic features such as lunate morphology, dorsal intercalated segment instability (DISI), and scapholunate (SL) diastasis are associated with the incidence of ST arthritis. We retrospectively reviewed consecutive patients with end-stage CMC arthritis of the thumb treated operatively with trapeziectomy. Preoperative wrist radiographs were reviewed, and the presence of ST arthritis was determined using the Sodha classification. Lunate morphology, DISI, and SL diastasis were noted. Intraoperative grading of ST arthritis was assessed using a modified Brown classification. The specificity and sensitivity of radiographic assessment was compared with the gold standard of intraoperative direct visualization. In total, 302 thumbs met inclusion criteria. End-stage ST joint arthritis determined by intraoperative visual inspection was noted in 31% of cases. No radiographic or demographic variables were found to be risk factors for ST arthritis. Plain radiographs were 47% sensitive and 94% specific in their ability to detect end-stage ST joint arthritis. We report a 31% incidence of end-stage ST joint arthritis in surgically treated patients with CMC arthritis based on visual inspection which is lower than previous literature. Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis. It is imperative to directly visualize the ST joint after trapeziectomy, as radiographs demonstrate poor sensitivity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944718765246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759968PMC
September 2019

Anatomic Assessment of K-Wire Trajectory for Transverse Percutaneous Fixation of Small Finger Metacarpal Fractures: A Cadaveric Study.

Hand (N Y) 2018 01 14;13(1):86-89. Epub 2017 Feb 14.

1 Geisinger Medical Center, Danville, PA, USA.

Background: The purpose of this cadaveric study is to evaluate the trajectory of percutaneous transverse Kirschner wire (K-wire) placement for fifth metacarpal fractures relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for the treatment of fifth metacarpal fractures.

Methods: Using 12 unmatched fresh human upper limbs, we evaluated the trajectory of percutaneous transverse K-wire placement relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for treatment of fifth metacarpal fractures. The midpoint of the small and ring finger metacarpals in the sagittal plane was identified at 3 points. At each point, a K-wire was inserted from the small finger metacarpal into the midpoint of the ring finger metacarpal ("center-center" position).

Results: The angle of the transverse K-wire relative to the table needed to achieve a center-center position averaged 20.8°, 18.9°, and 16.7° for the proximal diaphysis, middiaphysis, and the collateral recess, respectively. Approximately 80% of transversely placed K-wires obtained purchase in the long finger metacarpal.

Conclusions: These results can serve as a guide to help surgeons in the accurate placement of percutaneous K-wires for small finger metacarpal fractures and may aid in surgeon training.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944717691128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755863PMC
January 2018

Upper Extremity Trauma Resulting From Agricultural Accidents: Mechanism and Severity for Patients With and Without Upper Extremity Injury.

Hand (N Y) 2018 07 23;13(4):384-390. Epub 2017 Jun 23.

1 Geisinger Medical Center, Danville, PA, USA.

Background: Farming remains the most dangerous occupation in the United States and upper extremity (UE) injuries occur frequently in agricultural accidents. The purpose of this study is to describe the injury mechanisms, severity, and health care costs of UE injuries resulting from agricultural accidents and to compare patients with and without injuries to the UE.

Methods: We performed a 6-year retrospective review of our level I trauma center registry from January 2006 to May 2013, identifying all patients injured in an agricultural accident. Data collection included baseline demographics, injury type and mechanism, costs and treatment. Patients with UE injuries were compared with those without UE injuries.

Results: Ninety-six of 273 patients (35%) sustained an UE injury with fractures of the phalanx and radius/ulna occurring most frequently. Patients with UE injuries were more likely to be injured from table saws ( P = .0003) and farm machinery ( P < .0001). Twenty-one percent with UE injuries sustained a mangled extremity. Patients with UE injuries were more likely to require surgery (68% vs 36%, P < .0001) and were more likely to be readmitted (17% vs 5%, P = .0007) with risk factors for readmission including age >18 years, falls from height, and surgery. Mean hospital charges were $95 147.

Conclusions: Patients sustaining agricultural UE injuries have longer lengths of stay and more frequently require surgery despite similar hospital charges compared with non-UE injured patients. Hospital readmissions occur frequently for patients with UE injuries. Understanding injury mechanisms and the epidemiology of these potentially devastating and costly injuries may help guide agricultural injury prevention programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944717715140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081784PMC
July 2018

Predictors of Recurrence After Corticosteroid Injection for Trigger Digits.

Hand (N Y) 2017 07 16;12(4):352-356. Epub 2016 Sep 16.

1 Geisinger Medical Center, Danville, PA, USA.

Background: We aimed to identify risk factors for recurrence of trigger digit following corticosteroid injection.

Methods: A retrospective review identified patients 18 years and older who presented to a single fellowship-trained hand surgeon with a symptomatic trigger digit during a 1-year period. Baseline demographic data were recorded. Patients with persistent trigger digit after a single injection were offered a second injection. Patients refusing a second injection were excluded from our analysis. Patients with persistent symptoms after 2 injections were offered surgery. For patients with diabetes mellitus, additional information regarding method of disease control and hemoglobin A level was recorded.

Results: The overall success of corticosteroid injection was 84% with 16% of patients requiring surgical release. Of the 240 patients successfully treated with injection, 99 (41%) required a second injection. Injections resulted in persistent triggering in 15% of patients with diabetes and 17% of patients without diabetes. A multivariate regression analysis revealed that the 2 strongest risk factors for requiring surgical release were patient age and patients whose fourth digit of the right hand was injected. Diabetes was not a risk factor for persistent triggering after corticosteroid injection.

Conclusions: Our findings can be used to counsel patients prior to their initial injection and suggest that patients with diabetes can be managed with corticosteroid injection with equal efficacy compared with patients without diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944716668862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484445PMC
July 2017

The Use of Residual Collagenase for Single Digits With Multiple-Joint Dupuytren Contractures.

J Hand Surg Am 2017 Jun 4;42(6):472.e1-472.e6. Epub 2017 Apr 4.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.

Purpose: Standard 0.58 mg (0.25 mL) collagenase Clostridium histolyticum (CCH) preparations result in unused CCH that is often discarded. Our purpose was to assess the results on Dupuytren contractures affecting both the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in the same digit utilizing an injection containing the maximum CCH volume that can be withdrawn from a single vial.

Methods: A consecutive series of patients with MCP and PIP cords in the same digit received a single treatment with 2 injections totaling 0.30 mL distributed between the MCP and the PIP cords and underwent manipulation approximately 24 hours later. Reduction in contracture, clinical success, and complications were assessed 30 days after manipulation.

Results: Thirty-one patients (34 digits) had a mean preinjection flexion contracture of 50° at the MCP joint and 53° at the PIP joint. Clinical success (reduction in joint contracture to 0°-5° of full extension 30-days postmanipulation) was noted in 65% of MCP cords and 38% of PIP joint cords. We had a 24% incidence of skin tears, which correlated with the degree of preinjection contracture.

Conclusions: For Dupuytren contractures involving the MCP and PIP joints in the same digit, distributing the maximum amount of CCH that can be withdrawn from a single vial provides efficacy at both joints that is similar to that reported in previously published series, with a comparable complication rate. Utilizing excess CCH typically discarded may provide cost savings.

Type Of Study/level Of Evidence: Therapeutic IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2017.03.001DOI Listing
June 2017

Levels of Evidence for Hand Questions on the Orthopaedic In-Training Examination.

Hand (N Y) 2016 12 22;11(4):484-488. Epub 2016 Jan 22.

Geisinger Medical Center, Danville, PA, USA.

Although analyses of the Orthopaedic In-Training Examination (OITE) subspecialty content domains have been performed, few studies have analyzed the levels of evidence (LoEs) for journal articles used as references to create OITE questions. We present an analysis of reference characteristics and question taxonomy for the hand surgery content domain on the OITE. We aim to determine whether level of evidence (LoE) for hand surgery questions have increased over a 15-year period. All questions and references in the hand surgery content domain on the OITE from 1995-1997 and 2010-2012 were reviewed. The taxonomic classification was determined for each question. Publication characteristics were defined for each reference, and each primary journal article was assigned a LoE. A total of 129 questions containing 222 references met inclusion criteria: 76 questions from 1995-1997 and 53 from 2010-2012. The , , and the were the most frequently cited journals overall. Recent examinations were more likely to have Buckwalter T3 complex clinical management questions. There was a statically significant increase in the LoE used to create hand questions on the 2010-2012 compared with the 1995-1997 OITE. Primary journal articles cited on the hand surgery content domain of the OITE frequently included recent publications from both general and subspecialty journals. More recent examination questions appear to test clinical management scenarios. LoE for hand questions has increased over a 15-year period. Our results can be used as a guide to help prepare orthopedic residents for the OITE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1558944715620793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256643PMC
December 2016

Levels of Evidence for Foot and Ankle Questions on the Orthopaedic In-Training Examination: 15-Year Trends.

J Surg Educ 2016 Nov - Dec;73(6):999-1003. Epub 2016 Aug 25.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania.

Background: The foot and ankle (FA) content domain is a component of the orthopaedic in-training examination (OITE). Levels of evidence (LoE) have been infrequently studied on the OITE. The purpose of this study is to determine if LoE for primary journal articles referenced for FA questions increased over a 15-year period. We also aim to determine if reference characteristics and question taxonomy have changed during this period.

Methods: All 132 questions and 261 references in the FA content domain from 1995 to 1997 and from 2010 to 2012 were included. We defined the characteristics of each reference and taxonomy of each question. Every primary journal article was assigned a LoE based on American Academy of Orthopaedic Surgeons (AAOS) guidelines.

Results: Foot & Ankle International (FAI) was the most frequently cited journal. The change in the distribution of the Buckwalter classifications was statistically significant (p = 0.0286) with an increase in the number of clinical management questions. There were more level I studies on the 2010 to 2012 OITE (p = 0.0478) 6/54 (11%) of questions on the 2010 to 2012 OITE cited level I or II evidence compared with 3/78 (4%) on the 1995 to 1997 examinations (p = 0.1035).

Conclusions: There is a trend toward improved LoE for journal articles within the FA content domain on the OITE over a 15-year period, particularly when analyzing the increase in level I studies. FAI is the most frequently cited journal and questions increasingly test clinical management concepts.

Clinical Relevance: Our results can be used to help improve resident self-study and suggest that reviewing recent FAI articles may aid OITE preparation.

Level Of Evidence: Basic Science.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsurg.2016.05.019DOI Listing
November 2017

Analysis of Orthopedic Resident Ability to Apply Levels of Evidence Criteria to Scientific Articles.

J Surg Educ 2016 May-Jun;73(3):381-5. Epub 2016 Jan 28.

Department of Orthopedic Surgery, Geisinger Medical Center, Danville, Pennsylvaia.

Objective: In the era of evidence-based medicine, understanding study design and levels of evidence (LoE) criteria is an important component of resident education and aids practicing surgeons in making informed clinical decisions. The purpose of this study is to analyze the ability of orthopedic residents to accurately determine LoE criteria for published articles compared with medical students.

Design: Basic science article.

Setting: Geisinger Medical Center (Danville, PA), tertiary referral center.

Participants: Overall, 25 U.S. orthopedic residents and 15 4th year medical students interviewing for a residency position in orthopedic surgery voluntarily participated and provided baseline demographic information. A total of 15 articles from the American Volume of Journal of Bone and Joint Surgery were identified. Study participants were provided with the article title, the abstract, and the complete methods section. The assigned LoE designation was withheld and access to the LoE criteria used by Journal of Bone and Joint Surgery was provided. Each participant was assigned a study type and LoE designation for each article.

Results: There were more correct responses regarding the article type (67%) than for LoE designation (39%). For LoE, the intraclass correlation coefficient was 0.30. The percentage of correct responses for article type and LoE increased with more years of training (p = 0.005 and p = 0.002). Although residents had a higher proportion of correct LoE responses overall than medical students, this difference did not reach statistical significance (42% vs. 35%, p = 0.07).

Conclusions: Although improvements in accurately determining both article type and LoE were seen among residents with increasing years of training, residents were unable to demonstrate a statistically significant improvement for determining LoE or article type when compared with medical students. Strategies to improve resident understanding of LoE guidelines need to be incorporated into orthopedic residencies, especially when considering the increased emphasis on evidence-based medicine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsurg.2015.11.012DOI Listing
January 2017

Incidence and Risk Factors for Extensor Pollicis Longus Rupture in Elastic Stable Intramedullary Nailing of Pediatric Forearm Shaft Fractures.

J Pediatr Orthop 2016 Dec;36(8):810-815

*Geisinger Medical Center, Danville, PA †Washington Hand Surgery, Kirkland, WA.

Background: Elastic stable intramedullary nailing (ESIN) is an effective means of fixation for unstable, pediatric forearm shaft fractures with the benefit of smaller incisions, less soft tissue manipulation, and ease of removal. This study was designed to evaluate the incidence of and risk factors for extensor pollicis longus (EPL) rupture after fixation of pediatric radial shaft fractures with ESIN.

Methods: A retrospective review of all patients younger than 19 years who had a repair of a forearm fracture with flexible intramedullary nailing between 2006 and 2011 was performed. Nineteen consecutive patients were identified from the electronic medical record. All patients were treated with a titanium elastic nailing system using a dorsal approach to the radius. The patients were followed postoperatively for at least 2 years, and all fractures healed. An extensive chart review assessing for persistent pain, EPL function, and risk factors for EPL rupture was performed. Implants were removed in all but 1 patient.

Results: Seventeen records were available for review. Fourteen (82%) were male, and the mean age at time of fracture was 10 years old (range, 5 to 14 y). Follow-up averaged 5.5 years (range, 2.9 to 7.8 y). The mean weight was 32.7 kg for males and 50.6 kg for females corresponding to the 61st and 60th percentile respectively of weight-for-age (range, 8th to 99.9th percentile). Hardware was removed in all but 1 case, and the median time from surgery to hardware removal was 21 weeks (range, 8 to 63). Three of the 17 patients (18%) experienced rupture of the EPL. Two were treated with additional surgery following hardware removal, and one was untreated due to patient preference. None of the 17 patients (including those with rupture) had independent risk factors for tendon rupture: inflammatory arthritis, diabetes, or prior steroid use. Time to removal, patient age, and percentile of weight-for-age did not correlate with EPL rupture.

Conclusions: Although ESIN of pediatric forearm shaft fractures has gained acceptance as a treatment option, our series of 17 patients revealed an 18% rate of EPL rupture. With this small patient cohort, no patient characteristics proved to be significant risk factors for predicting tendon rupture. However, awareness should be raised for an increased risk of EPL rupture with this fixation method.

Level Of Evidence: Level IV-Therapeutic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BPO.0000000000000568DOI Listing
December 2016

Orthopaedic trauma in the Anabaptist community: epidemiology and hospital charges.

J Agromedicine 2015 ;20(2):140-8

a Department of Orthopaedic Surgery , Geisinger Medical Center , Danville , Pennsylvania , USA.

This study aims to define the epidemiology of orthopaedic trauma in the rural Anabaptist community and analyze the hospital charges associated with their treatment. The authors performed a retrospective review of 79 Amish and 40 Mennonite patients who had been seen in their rural level I trauma center emergency department for an orthopaedic injury from January 2006 to May 2013. Data collection included baseline demographics, injury mechanism and severity, injury complex, operative interventions, outcomes, and hospital charges. Amish and Mennonite groups were similar except for a higher percentage of males in the Mennonite group. For Amish patients, occupational injuries (52%) and buggy accidents (16%) accounted for the highest percentage of admissions. Eighty-seven percent sustained at least one fracture, most commonly of the hand (11%). Amish patients were statistically more likely to sustain fractures of the spine, and Mennonite patients were more likely to sustain fractures of the foot and femur. Over half of patients required surgery (58%). Total hospital charges did not differ based between the groups. Amish patients completed outpatient follow-up less frequently than Mennonite patients. Anabaptist patients are at risk for a variety of orthopaedic injuries related to their unique lifestyle and vocations. Socioreligious beliefs must be taken into consideration when educating these patients regarding postinjury care, as attendance at outpatient follow-up is low. Understanding the types of injuries that these patients sustain can help create strategies to prevent costly transportation and agricultural accidents within the Anabaptist community.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/1059924X.2015.1010066DOI Listing
December 2016

Airborne Exposure of Methyl Methacrylate During Simulated Total Hip Arthroplasty and Fabrication of Antibiotic Beads.

J Arthroplasty 2015 Aug 2;30(8):1464-9. Epub 2015 Mar 2.

Department of Orthopaedic Surgery, Geisinger Health System, Danville, Pennsylvania.

As the use of cement remains prevalent in orthopedic surgery, so do concerns over the safety of its active ingredient, methyl methacrylate (MMA). The Occupational Health and Safety Agency (OSHA) limits the airborne exposure to 100 parts per million (ppm) averaged over an 8 hour period. We measured MMA exposure to operating room personnel during simulated total hip arthroplasty (THA), antibiotic bead fabrication and simulated spill of MMA. Cumulative and peak exposures during simulated THA and antibiotic bead fabrication did not exceed OSHA limits of 100ppm. Vacuum mixing and greater distance from the vapor source reduced measured MMA exposure. Spilled MMA led to prolonged and elevated MMA levels. MMA levels returned to a negligible level in all scenarios by 20 minutes after mixing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2015.02.036DOI Listing
August 2015

Levels of evidence have increased for musculoskeletal trauma questions on the orthopaedic in-training examination.

J Surg Educ 2015 Mar-Apr;72(2):258-63. Epub 2014 Dec 3.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania.

Objective: The purpose of this study was to determine if the levels of evidence for primary journal articles used as references for musculoskeletal trauma questions on the Orthopaedic In-Training Examination (OITE) have increased over a 15-year period.

Design: Basic science article.

Setting: Geisinger Medical Center (Danville, PA), tertiary referral center.

Participants: All 329 questions in the musculoskeletal trauma content domain on the OITE from 1995 to 1997 and 2010 to 2012 were reviewed. Baseline characteristics for each question and each reference were recorded. References were categorized as a textbook, a journal review article, an instructional course lecture, or a primary journal article. For each primary journal article, the level of evidence for the article was determined in accordance with the American Academy of Orthopaedic Surgeons Levels of Evidence Guidelines.

Results: The level of evidence used for primary journal articles demonstrated a statistically significant increase from 1995 to 1997 to 2010 to 2012. Overall, 27% of primary journal articles cited on the 1995 to 1997 OITEs were level I, II, or III studies, increasing to 43% during the 2010 to 2012 period (p = 0.04). The Buckwalter classification for the OITE questions changed significantly between the 2 periods, with questions from 2010 to 2012 including more T1 questions (25% vs 39%) and fewer T3 questions (46% vs 39%, p = 0.016). The Journal of Bone and Joint Surgery and the Journal of Orthopaedic Trauma were the most frequently cited journals overall.

Conclusions: The levels of evidence for primary journal articles cited on the OITE for questions within the musculoskeletal trauma content domain have increased between 1995 and 2012. Our analysis can be used as a guide to help examinees prepare for musculoskeletal trauma questions on the OITE and as an aid in core curriculum development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsurg.2014.10.005DOI Listing
December 2015

The incidence of trigger digit after carpal tunnel release in diabetic and nondiabetic patients.

J Hand Surg Am 2014 Feb 20;39(2):280-5. Epub 2013 Dec 20.

Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.

Purpose: To determine whether patients with diabetes mellitus (DM) are at greater risk for developing postoperative trigger digits (TD) after carpal tunnel release (CTR) compared with patients without diabetes.

Methods: A retrospective review of our electronic medical records identified all patients who had undergone CTR by a single hand fellowship-trained surgeon from September 2007 through May 2012. For patients with DM, additional information regarding method of disease control and hemoglobin A1c (HbA1c) level was recorded. We recorded HbA1c levels 3 months before and 3 months after CTR. The location and time to development of postoperative, new-onset TD were recorded for each case. Statistical testing included chi-square or Student t test and multivariate logistic regression analysis.

Results: Of the 1,217 CTRs, 214 had DM. Of the 1,003 CTRs in cases without DM, 3% developed TD within 6 months of CTR and 4% within 1 year of CTR, compared with 8% and 10%, respectively, for diabetic cases. A multivariate regression analysis revealed DM as a significant risk factor for developing TD after CTR at 6 and 12 months. We found no significant association between HbA1c level at the time of CTR and the likelihood of developing TD.

Conclusions: The incidence of TD after CTR was higher in the diabetic population compared with a nondiabetic cohort. The presence of DM rather than its severity was the most important factor for developing TD. Preoperative counseling for patients with DM undergoing CTR may alert them to the possibility of developing TD.

Type Of Study/level Of Evidence: Prognostic IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2013.10.023DOI Listing
February 2014

Clinical outcomes of endoscopic carpal tunnel release in patients 65 and over.

J Hand Surg Am 2013 Aug;38(8):1524-9

Geisinger Orthopaedics, Danville, PA, USA.

Purpose: To examine outcomes of endoscopic carpal tunnel release (ECTR) in patients 65 and older. We hypothesized that this population could expect relief of pain, night pain/numbness, and numbness.

Methods: A retrospective review was conducted of all patients 65 years of age and over who had ECTR for nerve conduction study-confirmed carpal tunnel syndrome (CTS) from October 2007 to July 2010. The charts were reviewed for demographic data, symptoms and physical findings, patient satisfaction, and 3 patient-reported outcome scores. Preoperative and postoperative results for pain, night pain/numbness, and numbness were compared. Logistic regression analysis was used to assess whether age influenced symptom resolution. Boston carpal tunnel, Short Form-36 and Disabilities of the Arm, Shoulder, and Hand scores were compared between patients with mild, moderate, or severe CTS.

Results: A total of 78 patients had ECTR. Their ages ranged from 65 to 93 years (mean, 73 y). Before surgery 69% of patients had constant numbness. Night pain/numbness was present in 65 patients before surgery, and 61 had complete resolution. All 70 patients who presented with pain reported complete relief by the 6-month follow-up. Following ECTR, the average Boston carpal tunnel symptom severity, functional status, and Disabilities of the Arm, Shoulder, and Hand scores were 1.5,1.5, and 13, respectively. At final evaluation, 79% of patients were very satisfied or satisfied with their outcome. A significant number of patients were found to have improvement in pain, night pain/numbness, and numbness following ECTR.

Conclusions: This study has demonstrated relief of symptoms in a statistically significant number of patients following ECTR. We found that preoperative CTS severity, based on nerve conduction study result, did not significantly correlate with patient outcome following ECTR. Advanced symptoms at presentation do not preclude symptom resolution and should not be a contraindication to ECTR.

Type Of Study/level Of Evidence: Therapeutic III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2013.05.016DOI Listing
August 2013

Use of an integrated, anatomic-based, orthopaedic resident education curriculum: a 5-year retrospective review of its impact on orthopaedic in-training examination scores.

J Grad Med Educ 2012 Jun;4(2):250-3

Introduction: Experts have called for a comprehensive didactic curriculum in orthopaedic residency training. This study examined the effects of an anatomic-based, integrated conference program on annual Orthopaedic In-Training Examination (OITE) scores at a single orthopaedic residency program.

Methods: We implemented a new, integrated, anatomic-based curriculum in January 2005. Differences between scores were analyzed by postgraduate year (PGY) of training. OITE scores (percentile ranking and raw scores) of year 1 (PGY-2) through year 4 (PGY-5) residents exposed to the curriculum (2005-2009) were compared to prior PGY-2 through PGY-5 residents (2000-2004) who had experienced the previous unstructured curriculum. To evaluate for cohort effects, United States Medical Licensing Examination (USMLE) Step I scores for these 2 groups were also compared.

Results: Eight residents were exposed to the new conference program and 8 to the prior conference program. All residents' percentile rankings improved after exposure to the curriculum, although improvement was not statistically significant for all participants. The most dramatic improvements in OITE scores were seen for PGY-4 and PGY-5 residents, which improved from 65th to 91st percentile (P  =  .03) and from 66th to 91st percentile (P  =  .06), respectively. There were no differences between the cohorts in USMLE Step I scores.

Discussion: Initiation of an integrated, anatomic-based, resident conference program had a positive impact on resident performance on the OITE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4300/JGME-D-11-00116.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399622PMC
June 2012

In reply.

J Hand Surg Am 2013 Jun;38(6):1265-6

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2013.03.058DOI Listing
June 2013

Magnetic resonance imaging after endoscopic carpal tunnel release.

J Hand Surg Am 2013 Feb 3;38(2):331-5. Epub 2013 Jan 3.

Geisinger Orthopaedics, Danville, Pennsylvania, USA.

Purpose: To determine with magnetic resonance imaging (MRI) the morphologic changes in the carpal tunnel and median nerve 3 months after endoscopic carpal tunnel release (ECTR).

Methods: We enrolled patients who had complete resolution of numbness and pain by 6 weeks after ECTR. Patients who met these inclusion criteria received an MRI at 3 months after surgery. Images were analyzed to determine whether median nerve morphology changes and discrete gap or separation of the flexor retinaculum could be appreciated on MRI.

Results: There were 17 patients screened and 15 met the inclusion criteria. Three-month MRI in all patients demonstrated changes in the flexor retinaculum over the median nerve. In all 15 patients, a distinct gap or separation in the fibers of the flexor retinaculum overlying the median nerve could not be appreciated. Median nerve width-to-height ratios at the level of the pisiform and at the hook of the hamate were 2.4 and 2.1, respectively. Median nerve cross-sectional area was 14.1 at the pisiform and 13.3 at the hook of the hamate.

Conclusions: MRI of patients 3 months after successful ECTR does not demonstrate a discrete gap or separation in the flexor retinaculum overlying the median nerve but may be useful for evaluating median nerve morphology.

Type Of Study/level Of Evidence: Diagnostic II.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2012.11.013DOI Listing
February 2013

Anomalous tendon to the middle finger for sagittal band reconstruction: report of 2 cases.

J Hand Surg Am 2012 Aug 30;37(8):1646-9. Epub 2012 Jun 30.

Geisinger Orthopaedics, Danville, PA, USA.

Multiple techniques with good outcomes have been described for sagittal band reconstruction. We describe 2 cases of sagittal band reconstruction using an anomalous slip of the extensor tendon to the middle finger. This anomalous slip can be a resource for surgical reconstruction that can add stability to primary sagittal band repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2012.05.029DOI Listing
August 2012

Anomalous extensor tendons to the long finger: a cadaveric study of incidence.

J Hand Surg Am 2012 May 4;37(5):938-41. Epub 2012 Apr 4.

Geisinger Orthopaedics, Danville, PA, USA.

Purpose: To evaluate the incidence and anatomic insertion sites of extensor medii proprius and extensor indicis medii communis tendons to the long finger in cadaveric dissection and to describe the insertion of the extensor medii proprius.

Methods: Thirty randomly selected adult cadavers, 44 upper extremities, were examined for the presence or absence of an anomalous extensor tendon to the long finger. If present, tendon origin and insertion sites were documented, and the width of the tendon was evaluated.

Results: The extensor medii proprius was observed in 4 of 44 extremities, an incidence of 9%. The extensor indicis medii communis was observed in 7 of 44 extremities, an incidence of 16%. Tendon widths for both the extensor medii proprius and extensor indicis medii communis specimens ranged from 1.5 to 3.0 mm.

Conclusions: The incidence of an anomalous slip of tendon to the long finger might be higher than previously reported, with a combined incidence of 25% in this cadaveric study. This anomalous slip can be a resource for surgical reconstruction.

Clinical Relevance: The presence of anomalous tendinous slips to the long finger can be easily overlooked. Understanding the anatomical relationships, incidence, and donor tendon availability of these anomalous tendons might aid with surgical planning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhsa.2012.02.014DOI Listing
May 2012
-->