Publications by authors named "Mark A Tait"

9 Publications

  • Page 1 of 1

Retrospective Comparison of Capitolunate Arthrodesis Using Headless Compression Screws Versus Nitinol Memory Staples for SLAC and SNAC Wrist: Radiographic, Functional, and Patient-Reported Outcomes.

Hand (N Y) 2021 Apr 1:1558944721999732. Epub 2021 Apr 1.

OrthoCarolina, Charlotte, USA.

Background: Nitinol memory compression staples have been proposed as an effective alternative to compression screws for capitolunate arthrodesis (CLA) for scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrist. The purpose of this study was to compare the clinical outcomes of CLA for SNAC or SLAC wrist treatment using either compression screws or nitinol staples.

Methods: In all, 47 patients with CLA for SLAC or SNAC wrist with screws or nitinol staples were retrospectively identified. Primary outcome was fusion on radiographs and/or computed tomography. Secondary outcomes were hardware-related complications (HWCs) and other complications, range of motion, grip strength, and patient-reported outcome measures (PROMs), including Visual Analogue Pain scale; Disabilities of the Arm, Shoulder, and Hand score; and patient-rated wrist evaluation.

Results: Of the 47 eligible patients, 40 (85%) were included: 31 patients in the staple group and 9 patients in the screw group. The average age was 49 (17-80) years. There was an 89% union rate for the screw group and a 97% union rate for the staple group. Two patients had screw backout: one who went onto union after screw removal and the other who went onto nonunion after hardware removal. There were 2 (6.5%) HWCs in the staple group. One patient had staple loosening requiring revision and the other dorsal impingement requiring staple removal after radiographic union. In all subsequent cases, the staples were countersunk with no impingement. No significant differences existed between any additional outcomes.

Conclusions: We found no differences between nitinol staples and screws for CLA regarding HWCs or PROMs. Nitinol staples may offer additional benefits as a safe and effective alternative to compression screws for wrist fusions.
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http://dx.doi.org/10.1177/1558944721999732DOI Listing
April 2021

Doctor hopping and doctor shopping for prescription opioids associated with increased odds of high-risk use.

Pharmacoepidemiol Drug Saf 2019 08 5;28(8):1117-1124. Epub 2019 Jun 5.

Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA.

Purpose: Early detection of risky behaviors involving prescription opioids can assist prescribers in implementing safer prescribing. Patient-to-prescriber travel patterns may indicate potential opioid misuse. We introduce doctor hopping, patients bypassing nearby prescribers in favor of more distant ones, as a new spatial estimation of potentially risky behavior, and compare with traditional doctor shopping metrics.

Methods: We examined all filled opioid prescriptions between 2015 and 2016 from the Arkansas Prescription Drug Monitoring Program. We calculated patient-to-prescriber travel times and number of prescribers bypassed for each prescription, adjusted for payment method. Opioid recipients traveling further than the nearest urban area and bypassing more prescribers than 99% of other recipients from the same zip code were identified as doctor hoppers. We calculated odds ratios to evaluate how doctor hopping and doctor shopping correspond to high-risk opioid uses.

Results: Approximately 0.72% of all opioid recipients in Arkansas engaged in doctor hopping two or more times during the study period. Rates of doctor hopping varied spatially but were more common in rural areas. Doctor shopping was more common in urban areas. Both hopping and shopping were significantly associated with higher odds of engaging in high-risk opioid use. The combination of doctor hopping and doctor shopping metrics can predict high-risk use better than either metric alone and may allow for earlier detection than doctor shopping alone.

Conclusions: Doctor hopping is positively associated with high-risk opioid use and is distinct from and complementary to doctor shopping. We recommend Prescription Drug Monitoring Program (PDMP) vendors incorporate similar spatial analyses into their systems.
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http://dx.doi.org/10.1002/pds.4838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679752PMC
August 2019

A Novel Telemedicine System for Care of Statewide Hand Trauma.

Hand (N Y) 2021 Mar 29;16(2):253-257. Epub 2019 May 29.

University of Arkansas for Medical Sciences, Little Rock, USA.

Telemedicine is an evolving tool to increase patients' access to subspecialty care. Since 2014, Arkansas has been utilizing telemedicine in the evaluation of patients with hand injuries. The purpose of this study is to assess the effect of this novel telemedicine system for the management of hand trauma on patient transfer. We reviewed data from the first year of the telemedicine program (2014) and compared it to data from the year prior (2013). Data collection from both years included number of hand consults and need for transfer. From the 2014 data, we also recorded the use of telemedicine, type of transfer, distance of transfer, and time to disposition. During 2013 (pre-telemedicine), there were 263 hand traumas identified. In all, 191 (73%) injuries required transfer to a higher level of care, while 72 (23%) were managed locally. In the first year of the telemedicine program (2014), a total of 331 hand injuries were identified. A total of 298 (90%) resulted in telemedicine consultation with 65% (195) utilizing video encounters. After telemedicine consultation, local management was recommended for 164 injuries (55%) while transfer was recommended for 134 (45%). Using telemedicine, there was a significant decrease in the percentage of transfer for hand injuries ( < .001). The telemedicine program was well utilized and provided patients throughout the state with continuous access to fellowship trained hand surgeons including regions where hand subspecialty care is not available. The program resulted in a significant decrease in the number of hospital transfers for the management of acute hand trauma.
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http://dx.doi.org/10.1177/1558944719850633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041423PMC
March 2021

A Cadaveric Study of Cutaneous Vascular Anatomy about the Elbow Using Computed Tomography Angiography.

Clin Anat 2019 May 19;32(4):509-514. Epub 2019 Feb 19.

University of Arkansas for Medical Sciences, Little Rock, Arkansas.

The posterior approach is a commonly employed exposure of the elbow that provides excellent visualization and efficacy for various orthopedic procedures, including total elbow arthroplasty (TEA) and fracture care. The posterior approach to the elbow has been associated with an increased rate of wound complications, including infection, skin necrosis, and wound dehiscence. Despite an association between these complications and decreased elbow perfusion, data regarding the intrinsic anatomic etiology for preferential complications in this area has been scarcely reported in the literature. This study characterizes the subdermal and cutaneous vascular perfusion about the elbow by describing the predominant direction of circulation, subdermal anastomoses, and volume of perfusion through cadaveric modeling using computed tomography angiography (CTA). Fifteen upper extremity cadaver specimens were prepared with injection of radiographic contrast directly into the axillary artery immediately preceding CTA imaging of each specimen. Sectra IDS7 software for Windows was used for analysis of all images to produce superimposed axial and 3-D reconstructions of each CTA series. From these images it was discerned that the predominant direction of flow in the posterior elbow integument is anterior medial to posterior lateral. Both the posterior medial and posterior lateral subdermal vascular networks emanate from proximally derived medial arterial sources with few anastomoses and minimal collateral perfusion from the anterolateral location. Consequently, it is important to preserve medial subdermal vascular structures to prevent ischemic wound complications. This is especially true in previously incised elbow integuments. Clin. Anat. 32:509-514, 2019. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23341DOI Listing
May 2019

A Novel Muscle Transfer for Independent Digital Control of a Myoelectric Prosthesis: The Starfish Procedure.

J Hand Surg Am 2019 Feb 19;44(2):163.e1-163.e5. Epub 2018 Jun 19.

OrthoCarolina Reconstructive Center for Lost Limbs, Atrium Healthcare, Charlotte, NC; Department of Orthopedic Surgery, Atrium Healthcare, Charlotte, NC.

Control of independent digital flexion and extension has remained an elusive goal in myoelectric prosthetics for upper extremity amputees. We first performed a cadaver study to determine the feasibility of transferring the interossei muscles for each digit to the dorsum of the hand without damaging the neurovascular pedicles. Once this capability was ensured, a clinical case was performed transferring the interossei of the middle and ring fingers to the dorsum of the hand where they could serve as a myoelectric signal for a partial hand amputee to allow individual digital control with a myoelectric prosthesis. Before surgery, it was impossible to detect an independent signal for each interossei; however, after the surgery, signals were reliably detected, which allowed these muscles to serve as myosites for finger flexion using a myoelectric prosthesis and move each digit independently. This concept of salvaging innervated and perfused muscles from an amputated part and transferring them into the more proximal and superficial portion of a salvaged limb has broad applications for improved myoelectric prosthetic control.
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http://dx.doi.org/10.1016/j.jhsa.2018.04.009DOI Listing
February 2019

Acute Scaphoid Fractures: A Critical Analysis Review.

JBJS Rev 2016 09;4(9)

OrthoCarolina Hand Center, Charlotte, North Carolina.

Nondisplaced scaphoid fractures can be effectively treated nonoperatively, with union rates approaching or, in some series, exceeding the rates attained with operative intervention. The evidence supports equal outcomes when using a short arm or long arm cast for the closed treatment of nondisplaced scaphoid fractures. Also, equivalent outcomes have been demonstrated with or without a thumb spica component to the cast. Operative intervention is the recommended treatment for displaced scaphoid fractures. Advanced imaging should be obtained if clinical suspicion is present for a scaphoid fracture with negative radiographs more than 2 weeks after the injury. In some settings, it may even be more cost-effective to obtain advanced imaging sooner.
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http://dx.doi.org/10.2106/JBJS.RVW.15.00073DOI Listing
September 2016

Preoperative Patient Education for Hip and Knee Arthroplasty: Financial Benefit?

J Surg Orthop Adv 2015 ;24(4):246-51

Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Of 904 patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) at the same hospital, 802 participated in a preoperative education day called "Joint Academy" (JA). The length of stay of JA participants was 2.12 days (49.5%) less than patients who did not attend a JA (p < .01). JA attendees were 62% more likely to be discharged to home (p < .01) and had an average internal hospital cost $1,493 (18.9%) lower than the non-JA group (p < .01). Total costs incurred by JA attendees averaged $4,016 (27.2%) less than total costs for those patients who did not participate in a JA (p < .01). Patient participation in a preoperative education program may significantly reduce overall costs for primary TKA and THA procedures.
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February 2016

Applying a Dermal Regenerative Template in Management of Congenital Melanocytic Nevi of the Hand.

Plast Reconstr Surg Glob Open 2015 Sep 22;3(9):e515. Epub 2015 Sep 22.

Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark.; Division of Plastic and Reconstructive Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark.; and Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark.

Congenital melanocytic nevus of the hand in the pediatric population is an uncommon diagnosis. These lesions have malignant potential and can cause psychosocial effects from cosmetic deformity. Early surgical intervention is recommended in these cases. The literature suggests that full-thickness skin grafting is to be performed in the hand to maintain functionality and avoid contracture and scarring. This creates a large donor-site defect and increased risk of graft loss due to slow revascularization from graft thickness. In addition, for large defects, the full-thickness skin graft donor site would require a split-thickness graft. However, split-thickness skin grafting is avoided in the hand due to increased scarring and contracture and decreased range of motion despite decreased donor-site morbidity and better revascularization. We describe a novel reconstructive technique that uses a dermal regenerative template (Integra) with split-thickness grafting. Having performed in 2 pediatric patients, we demonstrate that aesthetic and functional outcomes are equivalent to full-thickness grafting while creating a superficial donor site and allowing for improved revascularization from decreased graft thickness.
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http://dx.doi.org/10.1097/GOX.0000000000000483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596440PMC
September 2015

Rosenberg versus 20/10 views in osteoarthritic knees.

J Knee Surg 2013 Oct 7;26(5):343-5. Epub 2013 Feb 7.

Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

It has become a common practice to obtain weight-bearing radiographs for the assessment of early-stage osteoarthritis of the knee, and weight bearing with the knee in full extension has been the most common method. Other methods for evaluating knee joint space using weight-bearing radiography include the Rosenberg and 20/10 views. Eighty consecutive patients with knee pain were evaluated with standing Rosenberg and standing 20/10 views as part of their radiographic evaluation. The joint space for the right and left knee of each patient was measured. There was no statistically significant difference between the measurements for the 20/10 or Rosenberg views in left or right knees. We found no indication to additionally include 20/10 views in routine examinations of osteoarthritic knees when Rosenberg views had been obtained.
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http://dx.doi.org/10.1055/s-0033-1333906DOI Listing
October 2013
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