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1. Interobserver Agreement of the Eaton-Glickel Classification for Trapeziometacarpal and Scaphotrapezial Arthrosis

Author

Simon D. Strackee, Gregory L. DeSilva, Charles Cassidy, Maurizio Calcagni, Maximillian Soong, Stéphanie J.E. Becker, Frank L. Walter, Eric P. Hofmeister, Robert R.L. Gray, Thomas Apard, Thomas F. Varecka, Peter J. Evans, Oleg M. Semenkin, Russell Shatford, Warren C. Hammert, Craig M. Rodner, Sidney M. Jacoby, Jason H. Ko, Carlos Henrique Fernandes, Robert R. Slater, Bradley A. Palmer, Wendy E. Bruinsma, R. Glenn Gaston, Fabio Suarez, John T Capo, Michael Nancollas, Ramon De Bedout, Daniel B. Polatsch, Daniel A. Osei, Andrew L. Terrono, Richard L. Hutchison, Carrie R. Swigart, Lewis B. Lane, Prosper Benhaim, Seth D. Dodds, Jennifer Moriatis Wolf, David Ring, Ryan P. Calfee, Stuart M. Hilliard, Chantal M.A.M. van der Horst, Philip E. Blazar, David M. Edelstein, Karel Chivers, Amy L. Ladd, Lawrence Weiss, Brian P.D. Wills, David E. Ruchelsman, Randy M. Hauck, Peter J. L. Jebson, Stephen A. Kennedy, Saul Kaplan, Louis W. Catalano, F. Thomas D. Kaplan, Asif M. Ilyas, Christopher M. Jones, Taizoon Baxamusa, Martin I. Boyer, Steve Kronlage, H. W. Grunwald, Jeffrey Wint, Kendrick E. Lee, David M. Kalainov, Andrew P. Gutow, Erik T. Walbeehm, Cesar Dario Oliveira Miranda, Kevin M. Rumball, H. Brent Bamberger, Paul A. Martineau, Sander Spruijt, Tamara D. Rozental, John A. McAuliffe, L.P. van Minnen, Peter F. Hahn, Todd E. Siff, Marco Rizzo, Richard S. Gilbert, Ngozi M. Akabudike, Michael W. Kessler, Patrick W. Owens, Julie E. Adams, Steven Beldner, Luis Felipe Naquira Escobar, Joshua M. Abzug, Camilo Jose Romero Barreto, Jerry I. Huang, John S. Taras, Thierry G. Guitton, John M. Erickson, Mahmoud I. Abdel-Ghany, M. Jason Palmer, L. C. Bainbridge, Michael W. Grafe, Gerald A. Kraan, Constanza L. Moreno-Serrano, Mark E. Baratz, Ryan Klinefelter, Greg Merrell, Theresa O Wyrick, Plastic, Reconstructive and Hand Surgery, Orthopedic Surgery and Sports Medicine, Other departments, Amsterdam Cardiovascular Sciences, and Other Research

Subjects
Adult, Male, medicine.medical_specialty, Interobserver reliability, Radiography, THUMB CARPOMETACARPAL JOINT, DISTAL RADIUS FRACTURES, INTRARATER, Osteoarthritis, 030230 surgery, Severity of Illness Index, DISEASE, True lateral, interobserver reliability, 03 medical and health sciences, 0302 clinical medicine, Patient age, medicine, Humans, Orthopedics and Sports Medicine, Stage (cooking), Observer Variation, 030222 orthopedics, business.industry, DISABILITY, scaphotrapezial arthrosis, Reproducibility of Results, Carpometacarpal Joints, Limiting, trapeziometacarpal arthrosis, medicine.disease, Multilevel regression, PREVALENCE, Classification agreement, osteoarthritis, Physical therapy, Female, Surgery, Joint Diseases, ARTHRITIS, business, INTRAOBSERVER RELIABILITY
Abstract

Purpose To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis.Methods In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification. We randomly assigned 42 observers to review radiographs alone and also informed 50 of the patient's symptoms and examination. Information about symptoms and examination was randomized. Interobserver reliability was determined with the s* statistic. Because of the hierarchical data structure, cross-classified ordinal multilevel regression analyses were performed to identify factors associated with the severity of arthrosis.Results Shortening the E-G classification to the first 3 stages significantly improved the interobserver reliability, which approached substantial agreement. Providing clinical information to observers marginally improved interobserver reliability. Factors associated with a lower E-G stage for TMC joint arthrosis, among observers who rated the severity of TMC joint arthrosis based on radiographs and clinical information, included female surgeon, practice setting, supervising surgical trainees in the operating room, self-reported number of patients with TMC joint arthrosis typically treated annually, male patient, higher patient age, pain limiting daily activities, and shoulder sign. A self-reported larger number of patients with TMC joint arthrosis treated annually was the only variable associated with a higher modified E-G classification to rate ST joint arthrosis.Conclusions Our findings suggest that simpler classifications that focus on a single anatomical area are reliable and that surgeon and patient factors can bias interpretation of objective pathophysiology such as radiographic findings. Copyright (C) 2016 by the American Society for Surgery of the Hand. All rights reserved.

Published
2016
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2. Motorcycle crashes and upper extremity trauma

Author

Kelsey A Rankin, Lee Yaari, Erin M. Cravez, Carrie R. Swigart, Michael David Leslie, Daniel H. Wiznia, and Nathaniel T. Ondeck

Subjects
medicine.medical_specialty, Upper extremity, medicine.medical_treatment, Intoxication, Trauma, Upper Limb, 03 medical and health sciences, 0302 clinical medicine, lcsh:Orthopedic surgery, Forearm, 0502 economics and business, Epidemiology, medicine, Orthopedics and Sports Medicine, 030212 general & internal medicine, Helmet, 050210 logistics & transportation, Rehabilitation, business.industry, Incidence (epidemiology), 05 social sciences, Trauma center, Glasgow Coma Scale, Retrospective cohort study, lcsh:RD701-811, medicine.anatomical_structure, Motorcycle, Physical therapy, Injury Severity Score, Surgery, business, human activities, Research Article
Abstract

Objectives: Upper extremity injuries following motorcycle crashes (MCC) incur increased healthcare costs and rehabilitation needs. We aim to characterize the epidemiology of MCC upper extremity injuries and identify factors that influence the severity of and cost of care for upper extremity injuries. Methods: We performed a retrospective cohort analysis of 571 patients with upper extremity injuries after MCC at a level 1 trauma center from 2002 to 2013. We collected data pertaining to demographics, helmet use, toxicology, bony injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hospital length of stay (LOS), and cost. Continuous variables were compared using t-test or Wilcoxon rank test, depending on data distribution, and dichotomous variables were compared using Pearson’s chi-squared or Fisher’s exact tests. Regression models were used to evaluate the effect of intoxication or helmets on injury location, severity, cost of care, and LOS. Results: The incidence of MCC upper extremity injury was 47.5%, with hand and forearm fractures the most common injuries (25.5% and 24.7% of total injuries). Intoxicated patients were more likely to have a high cost of care (p = 0.012), extended LOS (p = 0.038), plastic surgery involvement in their care (p = 0.038), but fewer upper extremity bony injuries (p = 0.019). Non-helmeted patients sustained less upper extremity bony injuries (p p = 0.001), yet more severe injuries (ISS ≥ 30, p = 0.006 and GCS p Conclusion: Upper extremity injuries are common in motorcyclists. Despite vital protection for the brain and maxillofacial injury, helmeted MCC patients have an increased incidence of upper extremity injuries compared to non-helmeted patients, but overall have less severe injuries. Intoxicated patients have fewer upper extremity bony injuries, but the higher cost of care, and extended LOS. Therefore, even with the increased risk of injury helmets may expose to the upper extremity, helmets reduced overall morbidity and mortality. In addition to mandatory helmet laws, we advocate for further development of safety equipment focusing specifically on the prevention of upper extremity injuries.

Published
2021
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3. Radiographic Loss of Contact Between Radial Head Fracture Fragments Is Moderately Reliable

Author

Daniel Hernandez, David R. Miller, Vispi Jokhi, Matthias Turina, J. C. Goslings, Parag Sancheti, J. L. Marsh, Parag Melvanki, Fred Baumgaertel, Charalampos G. Zalavras, Doug Hanel, Scott Edwards, Marc F. Swiontkowski, Jonathan Rosenfeld, Jason Fanuele, Brent Bamberger, Jeffrey Wint, Lisa L. Lattanza, Michael P. Leslie, Saul Kaplan, Matt Mormino, Loren Potter, Ronald Liem, Eric P. Hofmeister, Francisco Javier Aguilar Sierra, Jeremy A. Hall, Mahmoud I. Abdel-Ghany, Jonathan L. Hobby, Sanjev Jain, Taizoon Baxamusa, Martin I. Boyer, Reto Babst, Nikolaos K. Kanakaris, Gregory L. DeSilva, Ramon De Bedout, Ladislav Mica, Thomas B. Hughes, M. Jason Palmer, John S. Taras, Thomas A. DeCoster, Daphne M. Beingessner, Sanjeev Kakar, Lob Guenter, Arie B. van Vugt, Douglas T. Hutchinson, Hans J. Kreder, R. S. Gulve, J. Andrew, Henry Broekhuyse, Milind Merchant, Elena Grosso, David O. Oloruntoba, Nick Meyer, Iain McGraw, Michael Nancollas, Gustavo Mantovani Ruggiero, Rolf W. Peters, Antonio Barquet, Christopher J. Walsh, Thomas W. Wright, Pradeep Choudhari, Peter J. L. Jebson, Grant E. Garrigues, Richard Barth, Sander Spruijt, Scott F. M. Duncan, Taco Gosens, Thierry G. Guitton, Takashi Sasaki, Philipp Lenzlinger, Edward J. Harvey, Richard Buckley, Qiugen Wang, Platz Andreas, K.J. Ponsen, John Glenden DeVine, Peter Kloen, David Ring, Wendy E. Bruinsma, Jose A. Ortiz, Rodrigo Pesantez, Lawrence Weiss, Michael A. Prayson, Denise Eygendaal, Alberto Pérez Castillo, Edward C. Yang, Ross Leighton, John A. McAuliffe, Frede Frihagen, Amal Basak, Clifford B. Jones, Boyd Lumsden, Edward K. Rodriguez, Brett D. Crist, Martin Richardson, James F. Kellam, Kendrick E. Lee, W. Arnnold Batson, Shep Hurwit, Michael W. Grafe, Todd E. Siff, David Weiss, George L. Thomas, Scott A. Mitchell, Steve Helgemo, Ben Sutker, Joseph M. Conflitti, James Wagg, Toni M. McLaurin, Michael H.J. Verhofstad, Richard L. Uhl, Robert D. Zura, Eric Mark Hammerberg, John Wixted, Jorge G. Boretto, Frank L. Walter, Ian A. Harris, Waldo E. Floyd, Michael A. Baskies, John Howlett, I. Trenholm, Peter L. Althausen, Rozental, Brad Petrisor, John T. Bolger, Raymond Malcolm Smith, Rena Stewart, Leon Elmans, David B. Carmack, Ekkehard Bonatz, David M. Kalainov, George M. Kontakis, Rick F. Papandrea, Andrew H. Schmidt, Julie E. Adams, I. J.V. Kleinlugtenbelt, Gregory J. Della Rocca, Charles Cassidy, Catherine Spath, Lars C. Borris, Fabio Suarez, Chris Wilson, Jim Calandruccio, Sidney M. Jacoby, Thomas J. Fischer, Daniel B. Polatsch, Peter Schandelmaier, Jose Nolla, Richard S. Page, Kenneth A. Egol, Steven J. Rhemrev, Alan Kawaguchi, Timothy G. Havenhill, Jay Pomerance, Patrick T. McCulloch, Richard Jenkinson, Fryda Medina Rodríguez, Bernhard Ciritsis, Abhijeet L. Wahegaonkar, Charles Metzger, Vishwanath M. Iyer, Carrie R. Swigart, Lisa Taitsman, Leon S. Benson, Rudolf W. Poolman, Kyle J. Jeray, Peter R. Brink, Niels W. L. Schep, Marc J. Richard, Kevin Eng, Russell Shatford, George S.M. Dyer, Orthopedic Surgery and Sports Medicine, Surgery, Other Research, Other departments, AMS - Amsterdam Movement Sciences, and Graduate School

Subjects
Joint Instability, Male, medicine.medical_specialty, Sports medicine, Radiography, Elbow, Forearm, Predictive Value of Tests, Elbow Joint, Humans, Medicine, Orthopedics and Sports Medicine, Observer Variation, Orthodontics, business.industry, Reproducibility of Results, General Medicine, Anatomy, Prognosis, musculoskeletal system, body regions, Radius, medicine.anatomical_structure, Symposium: Traumatic Elbow Instability and its Sequelae, Elbow dislocation, Orthopedic surgery, Ligament, Female, Surgery, Radial head fracture, Clinical Competence, Radius Fractures, Elbow Injuries, business, Specialization
Abstract

Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation). (1) What is the interobserver agreement on radiographic loss of contact between radial head fracture fragments? (2) Are there factors associated with the observer such as location of practice or subspecialization that increase interobserver reliability? Fully trained practicing orthopaedic and trauma surgeons from around the world evaluated 27 anteroposterior and lateral radiographs of radial head fractures on a web-based platform for the following characteristics: (1) loss of contact between at least one radial head fracture fragment and the remaining radial head and neck; (2) a gap between fragments of 2 mm or greater; (3) anticipated fracture instability (mobility) on operative exposure; (4) anticipated associated ligament injuries; and (5) recommendation for treatment. Agreement among observers was measured using the multirater kappa measure. Kappas for various observer characteristics were compared using 95% confidence intervals. The overall interobserver agreement was moderate (range, 0.49-0.55) for each question except associated ligament injury, which was fair (0.33). Shoulder and elbow surgeons had substantial agreement (range, 0.51-0.61) in many areas, but kappas were generally in the moderate range (0.41-0.59) based on number of years in practice, radial head fractures treated per year, and trainee supervision. Radiographic signs of radial head fracture instability such as loss of contact have moderate reliability. This characteristic seems clinically useful, because loss of contact between at least one radial head fracture fragment and the remaining radial head and neck is strongly associated with associated ligament injury or other fractures. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence

Published
2014
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4. Hand and Wrist Pain

Author

Carrie R. Swigart and Felicity G. Fishman

Subjects
030222 orthopedics, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Physical medicine and rehabilitation, business.industry, medicine, 030229 sport sciences, Wrist pain, medicine.symptom, business
Published
2017
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5. Contributors

Author

Steven Abramson, KaiNan An, Felipe Andrade, Stacy P. Ardoin, Anne Barton, Robert P. Baughman, Dorcas E. Beaton, Helen M. Beere, Javier Beltran, David Bending, Robert M. Bennett, Bonnie L. Bermas, George Bertsias, Nina Bhardwaj, Johannes W.J. Bijlsma, Linda K. Bockenstedt, Maarten Boers, Eric Boilard, Francesco Boin, Dimitrios T. Boumpas, David L. Boyle, Sean Bradley, Matthew Brown, Maya Buch, Christopher D. Buckley, Ralph C. Budd, Nathalie Burg, Christopher M. Burns, Amy C. Cannella, John D. Carter, Eliza F. Chakravarty, Soumya D. Chakravarty, Christopher Chang, Joseph S. Cheng, Christopher P. Chiodo, Sharon Chung, Leslie G. Cleland, Stanley Cohen, Robert A. Colbert, Paul P. Cook, Joseph E. Craft, Leslie J. Crofford, Bruce N. Cronstein, Mary K. Crow, Cynthia S. Crowson, Kirsty L. Culley, Gaye Cunnane, Maria Dall'Era, Erika Darrah, John M. Davis, Cosimo De Bari, Francesco Dell'Accio, Betty Diamond, Paul E. Di Cesare, Rajiv Dixit, Joost P.H. Drenth, Michael L. Dustin, Hani S. El-Gabalawy, Musaab Elmamoun, Alan R. Erickson, Doruk Erkan, Stephen Eyre, Antonis Fanouriakis, David T. Felson, Max Field, Andrew Filer, Gary S. Firestein, Felicity G. Fishman, Oliver FitzGerald, John P. Flaherty, César E. Fors, Karen A. Fortner, Sherine E. Gabriel, Philippe Gasque, M. Eric Gershwin, Heather S. Gladue, Mary B. Goldring, Steven R. Goldring, Yvonne M. Golightly, Stuart Goodman, Siamon Gordon, Walter Grassi, Douglas R. Green, Adam Greenspan, Peter Gregersen, Christine Grimaldi, Luiza Guilherme, Rula A. Hajj-Ali, Dominik R. Haudenschild, David B. Hellmann, Rikard Holmdahl, Joyce J. Hsu, James I. Huddleston, Alan P. Hudson, Thomas W.J. Huizinga, Gene G. Hunder, Maura D. Iversen, Johannes W.G. Jacobs, Ho Jen, Joanne M. Jordan, Joseph L. Jorizzo, Jorge Kalil, Kenton Kaufman, William S. Kaufman, Arthur Kavanaugh, Robert T. Keenan, Tony Kenna, Darcy A. Kerr, Alisa E. Koch, Dwight H. Kono, Peter Korsten, Deborah Krakow, Svetlana Krasnokutsky, Floris P.J.G. Lafeber, Robert G.W. Lambert, Nancy E. Lane, Carol A. Langford, Daniel M. Laskin, Gerlinde Layh-Schmitt, Lela A. Lee, Tzielan C. Lee, Michael D. Lockshin, Carlos J. Lozada, Ingrid E. Lundberg, Raashid Luqmani, Frank P. Luyten, Reuven Mader, Walter Maksymowych, Joseph A. Markenson, Scott David Martin, Eric L. Matteson, Laura McGregor, Iain B. McInnes, Elizabeth K. McNamara, Ted R. Mikuls, Mark S. Miller, Pedro Azevedo Ming, Kevin G. Moder, Paul A. Monach, Vaishali R. Moulton, Kanneboyina Nagaraju, Amanda E. Nelson, Peter A. Nigrovic, Kiran Nistala, James R. O'Dell, Yasunori Okada, Mikkel Østergaard, Miguel Otero, Bradley M. Palmer, Richard S. Panush, Stanford L. Peng, Shiv Pillai, Michael H. Pillinger, Annette Plüddemann, Gregory R. Polston, Steven A. Porcelli, Mark D. Price, Ann M. Reed, John D. Reveille, Angela B. Robinson, Philip Robinson, William H. Robinson, Goris Roosendaal, Antony Rosen, James T. Rosenbaum, Andrew E. Rosenberg, Eric M. Ruderman, Kenneth G. Saag, Jane E. Salmon, Lisa R. Sammaritano, Jonathan Samuels, Christy I. Sandborg, Amr H. Sawalha, Amit Saxena, Georg Schett, Roger E.G. Schutgens, David C. Seldin, Binita Shah, Keith A. Sikora, Anna Simon, Dawd S. Siraj, Linda S. Sorkin, E. William St. Clair, Lisa K. Stamp, John H. Stone, Abel Suarez-Fueyo, Camilla I. Svensson, Nadera J. Sweiss, Carrie R. Swigart, Zoltán Szekanecz, Stephen Tait, Antoine Tanne, Peter C. Taylor, Robert Terkeltaub, Argyrios N. Theofilopoulos, Thomas S. Thornhill, Kathryn S. Torok, Michael J. Toth, Elaine C. Tozman, Leendert A. Trouw, George C. Tsokos, Peter Tugwell, Zuhre Tutuncu, Shivam Upadhyaya, Annette H.M. Van, Sjef van der Linden, Jos W.M. Van, Jacob M. Van, Heather Van Meter, Ronald F. van Vollenhoven, Lize F.D. van Vulpen, John Varga, Samera Vaseer, Raul Vasquez-Castellanos, Douglas J. Veale, Richard J. Wakefield, Mark S. Wallace, Ruoning Wang, Tingting Wang, David M. Warshaw, Lucy R. Wedderburn, Victoria P. Werth, Fredrick M. Wigley, David Wofsy, Frank A. Wollheim, Elisabeth Wondimu, Cyrus Wong, Robert L. Wortmann, Edward Yelin, Ahmed Zayat, Yong-Rui Zou, and Robert B. Zurier

Published
2017
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6. Variation in Recommendation for Surgical Treatment for Compressive Neuropathy

Author

Gregory Dee Byrd, John Jiuliano, Steve Kronlage, Paul M. Guidera, Steven J. McCabe, C. Taleb, Paul A. Martineau, Asif M. Ilyas, Sander Spruijt, Samir Sodha, Paul C. Bettinger, Robert R.L. Gray, German Ricardo Hernandez, Jose A. Ortiz, Thomas Apard, John A. McAuliffe, Desirae M. McKee, Seth D. Dodds, Thomas F. Varecka, Renato M. Fricker, Karel Chivers, Charles A. Goldfarb, John P. Evans, Charles Metzger, Naquira Escobar Luis Felipe, Julie E. Adams, Marco Rizzo, Prasad Sitaram, Hervey L. Kimball, Robert M. Szabo, Charles Cassidy, Fidel Ernesto Cayon Cayon, John S. Taras, Miguel Pirela-Cruz, H. Brent Bamberger, Steven Beldner, Gladys Cecilia Zambrano Caro, Evan S. Fischer, David Ring, William J. Van Wyk, Daniel B. Polatsch, Carlos Henrique Fernandes, David M. Lamey, Michael J. Quinn, Victoria D. Knoll, David R. Miller, Peter H. DeNoble, Richard S. Gilbert, Jim Calandruccio, Jose Nolla, Kevin J. Malone, Harrison Solomon, Frank L. Walter, Randy M. Hauck, David E. Tate, Daniel A. Osei, Christopher M. Jones, Taizoon Baxamusa, Ines C. Lin, Christopher J. Walsh, Sidney M. Jacoby, Thomas J. Fischer, Ryan P. Calfee, Gary M. Pess, Martin I. Boyer, Lawrence Weiss, Oleg M. Semenkin, Russell Shatford, Brian P.D. Wills, Ralph M. Costanzo, Vipul P. Patel, Andrew L. Terrono, Carrie R. Swigart, Ralf Nyszkiewicz, Nicky L. Leung, Karl Josef Prommersberger, Gary R. Kuzma, D. Kay Kirkpatrick, Christopher S. Wilson, Lawrence S. Halperin, W. Arnnold Batson, George W. Balfour, Marc J. Richard, Lior Paz, Doug Hanel, Rick F. Papandrea, R. Glenn Gaston, Joshua M. Abzug, Ryan Klinefelter, Michael Jones, Jennifer B. Green, Todd E. Siff, Louis W. Catalano, Neil G. Harness, Jay Pomerance, Patrick T. McCulloch, Megan M. Wood, Phani Dantuluri, Saul Kaplan, Christopher J. Wilson, Barry Watkins, Philip Coogan, Leon S. Benson, Jessica A. Frankenhoff, Abhijeet L. Wahegaonkar, Rozental, Jochen Fischer, F. Thomas D. Kaplan, Richard L. Hutchison, Craig A. Bottke, Stephen A. Kennedy, Nicholas J. Horangic, Jennifer Moriatis Wolf, Milan M. Patel, Jorge G. Boretto, Michael W. Kessler, Steven Alter, Timothy G. Havenhill, Frank J. Raia, Catherine Spath, Andrew W. Gurman, Cesar Dario Oliveira Miranda, Lewis B. Lane, Kendrick E. Lee, Hal MccUtchan, Michael W. Grafe, David E. Ruchelsman, Theresa O Wyrick, James M. Boler, Patrick W. Owens, Eric P. Hofmeister, Gregory L. DeSilva, Gary K. Frykman, Ross Nathan, Arjan G.J. Bot, Aida E. GarciaG, Charles J. Eaton, Alan Schefer, Scott A. Mitchell, Michael Nancollas, Richard Barth, José Fernando Di Giovanni, Michael A. Baskies, Georg M. Huemer, Warren C. Hammert, David L. Nelson, L. C. Bainbridge, Maurizio Calcagni, Jamie E. Forigua, John Howlett, H. W. Grunwald, Bernard F. Hearon, Michael J. Behrman, John M. Erickson, Eon K. Shin, Stéphanie J.E. Becker, J. E.B. Stuart, Michiel G.J.S. Hageman, M. Jason Palmer, Bruce I. Wintman, Stephen W. Dailey, Sanjeev Kakar, Jonathan Isaacs, Jack Choueka, Stanley Casimir Marczyk, Alberto Pérez Castillo, Lisa L. Lattanza, Jeff W. Johnson, Ekkehard Bonatz, David M. Kalainov, Peter E. Hoepfner, James G. Reid, Ramon De Bedout, Jeffrey Yao, Ngozi M. Akabudike, Stuart M. Hilliard, Colby Young, David M. Ostrowski, Scott F. M. Duncan, Thierry G. Guitton, Peter J. L. Jebson, Jerome W. Oakey, Plastic, Reconstructive and Hand Surgery, and Orthopedic Surgery and Sports Medicine

Subjects
medicine.medical_specialty, business.industry, Mononeuropathies, MEDLINE, Mindset, Hand surgery, Logistic regression, medicine.disease, Decompression, Surgical, Random Allocation, Adaptation, Psychological, Physical therapy, Medicine, Objective test, Humans, Orthopedics and Sports Medicine, Surgery, Clinical significance, Practice Patterns, Physicians', Radial Neuropathy, business, Null hypothesis, Carpal tunnel syndrome
Abstract

Purpose It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions The findings of this study suggest that—at least in a survey setting—surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies. Clinical relevance The role of objective verification of pathophysiology is debated, but it is an influential factor in recommendations for hand surgery.

Published
2013
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7. Assessment of Pronator Quadratus Repair Integrity Following Volar Plate Fixation for Distal Radius Fractures: A Prospective Clinical Cohort Study

Author

Victoria L. Bruegel, Carrie R. Swigart, Mary Ann Badon, and Seth D. Dodds

Subjects
Adult, Male, medicine.medical_specialty, Clinical cohort, Radiography, Statistical difference, Wrist, Cohort Studies, Fracture Fixation, Internal, Grip strength, Fracture fixation, Humans, Medicine, Orthopedics and Sports Medicine, Prospective Studies, Treatment Failure, Muscle, Skeletal, Volar plate, Aged, Wound Healing, business.industry, Middle Aged, Surgery, medicine.anatomical_structure, Female, Distal radius fracture, Radius Fractures, business, Bone Plates, Follow-Up Studies
Abstract

Purpose To assess prospectively the integrity of pronator quadratus (PQ) muscle repair following volar plate fixation of distal radius fractures and to compare the clinical and radiographic outcomes of durable versus failed repairs in 24 subjects. In addition, by grading the degree of PQ injury, an attempt was made to correlate failure of repair with the PQ injury severity. Methods The extent of PQ injury was graded for each fracture. After fracture fixation, the PQ muscle was repaired along its radial and distal borders. Radiopaque hemoclips were attached to each side of the PQ repair, 2 radially and 2 distally. The distance between these markers at time 0 versus x-rays taken at approximately 2 weeks, 6 weeks, and 3 months was recorded. Clip displacement of 1 cm or more compared to time 0 indicated repair failure. Results One of 24 repairs (4%) failed at 3 months. No statistical difference was noted between the type of PQ injury and wrist flexion/extension, pronation/supination, and grip strength. Conclusions Pronator quadratus repairs after volar plate fracture fixation are generally durable. They withstand forces that occur at the distal radius during the healing process with a 4% failure rate. No correlation was shown between type of PQ injury and radiographic failure of the repair. Type of study/level of evidence Therapeutic II.

Published
2012
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8. Trigger finger: etiology, evaluation, and treatment

Author

Matthew E. Oetgen, Seth D. Dodds, Al Hasan Makkouk, and Carrie R. Swigart

Subjects
medicine.medical_specialty, education.field_of_study, Sports medicine, business.industry, Population, Soft tissue, medicine.disease, Article, Trigger finger, Surgery, body regions, Orthopedic surgery, medicine, Etiology, A1 pulley, Surgical management, Orthopedics and Sports Medicine, Percutaneous release, education, business, Pathological, Conservative treatment
Abstract

Trigger finger is a common finger aliment, thought to be caused by inflammation and subsequent narrowing of the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger. Although it can occur in anyone, it is seen more frequently in the diabetic population and in women, typically in the fifth to sixth decade of life. The diagnosis is usually fairly straightforward, as most patients complain of clicking or locking of the finger, but other pathological processes such as fracture, tumor, or other traumatic soft tissue injuries must be excluded. Treatment modalities, including splinting, corticosteroid injection, or surgical release, are very effective and are tailored to the severity and duration of symptoms.

Published
2007
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9. The Effect of Insurance Type on Patient Access to Carpal Tunnel Release Under the Affordable Care Act

Author

Daniel H. Wiznia, Nidharshan S. Anandasivam, Yuexin Wang, Chang-Yeon Kim, Richard R. Pelker, Ameya V. Save, and Carrie R. Swigart

Subjects
medicine.medical_specialty, Referral, education, Carpal tunnel surgery, 030230 surgery, Medicare, Health Services Accessibility, Insurance Coverage, 03 medical and health sciences, Appointments and Schedules, 0302 clinical medicine, Patient Protection and Affordable Care Act, medicine, Humans, Orthopedics and Sports Medicine, Carpal tunnel syndrome, Referral and Consultation, health care economics and organizations, 030222 orthopedics, business.industry, Medicaid, Incidence (epidemiology), Evidence-based medicine, medicine.disease, Carpal Tunnel Syndrome, United States, Elective Surgical Procedures, Emergency medicine, Insurance, Health, Reimbursement, Surgery, Elective Surgical Procedure, business
Abstract

Purpose To assess the effect of insurance type (Medicaid, Medicare, and private insurance) on access to hand surgeons for carpal tunnel syndrome (CTS). Methods The research team called 240 hand surgeons in 8 states (California, Massachusetts, Ohio, New York, Florida, Georgia, Texas, and North Carolina). The caller requested an appointment for her fictitious mother to be evaluated for CTS and possible surgical management through carpal tunnel release (CTR). Each office was called 3 times to assess the responses for Medicaid, Medicare, or Blue Cross Blue Shield. From each call, we recorded whether an appointment was given and whether there were barriers to an appointment, such as the need for a referral. Results Twenty percent of offices scheduled an appointment for a patient with Medicaid, compared with 89% for Medicare and 97% for Blue Cross Blue Shield. Patients with Medicaid had an easier time scheduling appointments (28% vs 13%) and experienced fewer requests for referrals (25% vs 67%) in states with expanded Medicaid eligibility. Neither Medicaid nor Medicare reimbursement for CTR was significantly correlated with the incidence of successful appointments. Although the difference in Medicaid and Medicare reimbursements for CTR was small, the appointment success incidence for Medicare was approximately 5 times higher. Conclusions Despite the passage of the Affordable Care Act, patients with Medicaid have reduced access to surgical care for CTS and more complex barriers to receiving an appointment. Although Medicaid was accepted at a higher rate in states with expanded Medicaid eligibility, a more robust strategy for increasing access to care may be helpful for patients with Medicaid. Type of study/level of evidence Prognostic II.

Published
2015

10. Microarray Gene Analysis and Expression Profiles of Dupuytren’s Contracture

Author

Deborah Pan, H. Kirk Watson, J. Grant Thomson, Deepak Narayan, Carrie R. Swigart, and Stanton C. Honig

Subjects
Male, Pathology, medicine.medical_specialty, Microarray, Molecular Sequence Data, Disease, Bioinformatics, Sensitivity and Specificity, Sampling Studies, Cohort Studies, Gene product, Gene expression, medicine, Humans, Genetic Predisposition to Disease, Dupuytren's contracture, Gene, Aged, DNA Primers, Oligonucleotide Array Sequence Analysis, Hand function, Base Sequence, Reverse Transcriptase Polymerase Chain Reaction, business.industry, Middle Aged, medicine.disease, Dupuytren Contracture, Gene Expression Regulation, Gene chip analysis, Female, Surgery, business
Abstract

Dupuytren's disease, although not altogether uncommon, has eluded scientists who have sought to explain the cause of this palmar fibroproliferative disorder. It can lead to severe limitations of hand function if left untreated. This study is the first broad genetic survey using microarray technology to find gene products that are overexpressed or underexpressed in diseased tissues. The authors found 23 genes with levels that differ consistently from control levels. Nine were selected for further verification using reverse transcription-polymerase chain reaction. These genes hold potential promise in explaining some of the demographic trends seen with disease, such as correlation with alcoholism and the striking predisposition for the male gender.

Published
2003
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11. Interobserver variability in the treatment of little finger metacarpal neck fractures

Author

Lewis B. Lane, Rick F. Papandrea, Minoo Patel, P. Hahn, Andrew H. Schmidt, Gerald A. Kraan, William Dias Belangero, David E. Ruchelsman, Henry Broekhuyse, J. H. Scheer, Vassilios S. Nikolaou, Travis M. Hughes, C.J.H. Veillette, N. Bijlani, Aida Garcia, Charles Cassidy, S. Moghtaderi, M. A J Van De Sande, Timothy Omara, B. Watkins, E. Forigua Jaime, C. Young, Philipp N. Streubel, A. Berner, R. de Bedout, M. P. J. van den Bekerom, Maurizio Calcagni, Grant Bayne, T. Higgins, Mahmoud I. Abdel-Ghany, Rick Tosti, L. C. Bainbridge, Matthew Rg Menon, Lior Paz, M. Soong, Warren C. Hammert, Yoram A. Weil, Randy M. Hauck, Grant E. Garrigues, S. G. Kaar, D.M. Silva, Thomas G. Stackhouse, Richard L. Hutchison, Augustus D. Mazzocca, Lars C. Borris, M. Quell, Fabio Suarez, Daniel Haverkamp, Chris Wilson, R. Omid, Gladys Cecilia Zambrano Caro, Daniel B. Polatsch, Theodoros I. Tosounidis, Marco Rizzo, Jose Nolla, F. García, Richard S. Page, Charalampos G. Zalavras, Asif M. Ilyas, E.T. Tolo, Megan M. Wood, H. Durchholz, G. Kohut, Michael J. Behrman, Peter Kloen, Christos Garnavos, David L. Nelson, Charles A. Goldfarb, R. Gaston, Michael W. Kessler, Koroush Kabir, Chad Manke, John M. Erickson, Thomas Mittlmeier, Prosper Benhaim, Seth D. Dodds, V. Philippe, K. Dickson, Richard Buckley, Karel Chivers, Bernard F. Hearon, Jonathan Isaacs, M. Ladislav, H. Goost, Peter R. Brink, Edward J. Harvey, Richard S. Gilbert, D.K. Kirkpatrick, Ronald Liem, H. W. Grunwald, R. Wallensten, Sergio Rowinski, Jim Calandruccio, Minos Tyllianakis, G.J. Della Rocca, H. B. Bamberger, Thomas J. Fischer, Kevin J. Malone, Marc J. Richard, Saurabh P. Mehta, Niels W. L. Schep, E.M. Hammerberg, Peter Schandelmaier, Jeffrey Wint, German Ricardo Hernandez, J. Moreta-Suarez, Christopher M. Jones, Taizoon Baxamusa, Martin I. Boyer, W.T. Benjamin, Jennifer Moriatis Wolf, M. Bonczar, Jos J. Mellema, J. Munyak, Julie E. Adams, Matej Kastelec, Milind Merchant, Erik T. Walbeehm, Robert Haverlag, Thomas Apard, C. Klostermann, Sanjeev Kakar, Peter J. L. Jebson, N.L. Leung, A. L. Van Der Zwan, W. A. Batson, Lob Guenter, Denise Eygendaal, S.A. Meylaerts, Renato M. Fricker, Anže Kristan, Michael W. Grafe, T. Begue, Kevin Eng, D. F. P. van Deurzen, Steven Beldner, Martin Richardson, C. J. Barreto, J.F. Di Giovanni, Lars Adolfsson, M. Darowish, Gregory L. DeSilva, Gary K. Frykman, K. Erol, Theresa O Wyrick, Evan D. Schumer, Christopher B. Wall, Antonio Barquet, L.M.S.J. Poelhekke, Scott A. Mitchell, Paul M. Guidera, Constanza L. Moreno-Serrano, E. Stojkovska Pemovska, Frank L. Walter, Michael J. Prayson, John A. McAuliffe, N. Elias, Robert D. Zura, Christopher J. Wilson, Marc F. Swiontkowski, Oleg M. Semenkin, Russell Shatford, Jack Choueka, Ryan P. Calfee, Gary M. Pess, Stanley Casimir Marczyk, C. Taleb, Andrew P. Gutow, Nikolaos K. Kanakaris, Neil Wilson, John T. Capo, Vincenzo Giordano, C. D. Oliveira Miranda, J. Itamura, Joseph M. Conflitti, A. B. Shafritz, George S.M. Dyer, Ralph M. Costanzo, B. E. Kreis, Carl Ekholm, R. Cardoso, Scott F. M. Duncan, David Ring, Nicholas L. Shortt, A.J.H. Vochteloo, Lawrence Weiss, A. Platz, Valentin Neuhaus, T. Havlicek, Charles Metzger, Andrew L. Terrono, Thierry G. Guitton, Kendrick E. Lee, Marinis Pirpiris, Thomas W. Wright, Gertraud Gradl, Georg M. Huemer, B. M. Nolan, David M. Kalainov, D.O. Oloruntoba, Paul A. Martineau, Sander Spruijt, Kyle J. Jeray, Carlos Henrique Fernandes, Frank J. Raia, G. C. Babis, J. Biert, P. Lygdas, Axel Jubel, Brian P.D. Wills, Michael A. Baskies, Peter L. Althausen, Kevin M. Rumball, Rodrigo Pesantez, Mohamed Shafi, Harold Alonso Villamizar, Carrie R. Swigart, Francisco Lopez-Gonzalez, Frede Frihagen, Thomas Dienstknecht, Saul Kaplan, Matt Mormino, M. J. Palmer, Thomas A. DeCoster, A. B. Spoor, Job N Doornberg, W. Satora, Todd E. Siff, Eric P. Hofmeister, Joshua M. Abzug, George W. Balfour, J. C. Goslings, P. Inna, Stephen A. Kennedy, Parag Melvanki, Jochen Fischer, Raymond Malcolm Smith, P. V. van Eerten, George S. Athwal, Diederik O. Verbeek, D. Brilej, L.A.B. Campinhos, Daniel A. Osei, K.J. Ponsen, Iain McGraw, Michael Nancollas, R. van Riet, Philip E. Blazar, C. Cornell, Craig A. Bottke, Taco Gosens, F. T. D. Kaplan, George M. Kontakis, Graduate School, Orthopedic Surgery and Sports Medicine, Other departments, Surgery, Other Research, and AMS - Amsterdam Movement Sciences

Subjects
Adult, Male, medicine.medical_specialty, Radiography, Fractures, Bone, Random Allocation, Finger Injuries, medicine, Humans, Lateral view, Orthopedics and Sports Medicine, Practice Patterns, Physicians', Nonoperative management, Aged, Observer Variation, Orthodontics, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Neck fracture, Little finger, Middle Aged, Surgery, medicine.anatomical_structure, Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10], Orthopedic surgery, Female, Metacarpus, business, Angular deformity
Abstract

Purpose To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. Methods Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. Results Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. Conclusions Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved

Published
2014

12. Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making

Author

Eric P. Hofmeister, Kevin L. Ju, Sidney M. Jacoby, Thomas J. Fischer, Michael Nancollas, Jennifer Moriatis Wolf, R. Glenn Gaston, Christopher M. Jones, Taizoon Baxamusa, Martin I. Boyer, Ralf Nyszkiewicz, Charles Metzger, Gregory Dee Byrd, Peter J. L. Jebson, Chaitanya S. Mudgal, Chris Wilson, Daniel B. Polatsch, Michael W. Kessler, Carlos Henrique Fernandes, Naquira Escobar Luis Felipe, T. Aspard, Louis W. Catalano, Marc J. Richard, Prosper Benhaim, Seth D. Dodds, Paul A. Martineau, Charles Cassidy, Karel Chivers, Sander Spruijt, Asif M. Ilyas, Leonid I. Katolik, Frank J. Raia, Lior Paz, Steven J. McCabe, Colby Young, Jose A. Ortiz, David E. Ruchelsman, Megan M. Wood, Samir Sodha, Gladys Cecilia Zambrano, Ricardo German Hernandez, John S. Taras, Thierry G. Guitton, Rozental, Jason M. Palmer, Carrie R. Swigart, Abhijeet L. Wahegaonkar, Oleg M. Semenkin, Michael Jones, Ralph M. Costanzo, Sanjeev Kakar, Jonathan Isaacs, Leon S. Benson, Desirae M. McKee, Thomas F. Varecka, Gregory L. DeSilva, David Ring, Gary K. Frykman, Hervey L. Kimball, Aguilar Javier Francisco Sierra, Charles A. Goldfarb, Richard L. Hutchison, Stephen A. Kennedy, H. Brent Bamberger, Lawrence Weiss, David L. Nelson, Jason D. Tavakolian, H. W. Grunwald, Brian P.D. Wills, Thomas D. Kaplan, Catherine Spath, Todd E. Siff, Patrick W. Owens, Michiel G.J.S. Hageman, Frank L. Walter, Joshua M. Abzug, Greg Merrell, Ahmet Kinaci, George W. Balfour, Michael W. Grafe, M. Renato Fricker, Phani Dantuluri, Julie E. Adams, Jochen Fischer, Steven Beldner, José Fernando Di Giovanni, Michael A. Baskies, David M. Kalainov, Gerald A. Kraan, G. Jorge Boretto, W. Arnold Batson, John P. Evans, Marco Rizzo, Thomas F. Stackhouse, Warren C. Hammert, Ryan P. Calfee, Gary M. Pess, Christopher S. Wilson, Gallo Fabio Arbelaez, Ramon De Bedout, Andrew L. Terrono, Saul Kaplan, Romero Jose Camilo Barreto, John A. McAuliffe, Aida Garcia, Robert M. Szabo, Randy M. Hauck, and Christopher J. Walsh

Subjects
Adult, Male, medicine.medical_specialty, Decision support system, Attitude of Health Personnel, Decision Making, Decisional conflict, Surveys and Questionnaires, medicine, Humans, Orthopedics and Sports Medicine, Risks and benefits, Carpal tunnel syndrome, Disadvantage, Aged, Aged, 80 and over, Physician-Patient Relations, business.industry, Patient Preference, Middle Aged, medicine.disease, Patient preference, Carpal Tunnel Syndrome, Preference, Family medicine, Physical therapy, Surgery, Female, business, Null hypothesis
Abstract

Purpose This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). Methods One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. Conclusions There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. Clinical relevance Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Published
2013

13. Contributors

Author

Steven B. Abramson, Kai-Nan An, Felipe Andrade, John P. Atkinson, Dominique Baeten, Robert P. Baughman, Dorcas E. Beaton, Robert Bennett, Susanne M. Benseler, George Bertsias, Nina Bhardwaj, Johannes W.J. Bijlsma, Linda K. Bockenstedt, Maarten Boers, Francesco Boin, Dimitrios T. Boumpas, Barry Bresnihan, Doreen B. Brettler, Christopher D. Buckley, Ralph C. Budd, Christopher M. Burns, Amy C. Cannella, Eliza F. Chakravarty, Christopher Chang, Joseph S. Cheng, Christopher P. Chiodo, Leslie G. Cleland, Megan E. Clowse, Paul P. Cook, Joseph E. Craft, Leslie J. Crofford, Bruce N. Cronstein, Mary K. Crow, Gaye Cunnane, John J. Cush, Maurizio Cutolo, Maria Dall'Era, Kathryn H. Dao, Erika Darrah, John M. Davis, Jeroen DeGroot, Clint Devin, Betty Diamond, Federico Díaz-González, Paul E. Di Cesare, Rajiv Dixit, Joost P.H. Drenth, Michael L. Dustin, Hani S. El-Gabalawy, Keith B. Elkon, Doruk Erkan, Antonios Fanouriakis, Max Field, Andrew Filer, Gary S. Firestein, Oliver Fitzgerald, John P. Flaherty, Adrienne M. Flanagan, Karen A. Fortner, Sherine E. Gabriel, J.S. Hill Gaston, Steffen Gay, M. Eric Gershwin, Allan Gibofsky, Mark H. Ginsberg, Mary B. Goldring, Steven R. Goldring, Yvonne M. Golightly, Stuart Goodman, Siamon Gordon, Walter Grassi, Adam Greenspan, Peter K. Gregersen, Christine Grimaldi, Rula A. Hajj-Ali, Lorraine Harper, Edward D. Harris, Dominik R. Haudenschild, David B. Hellmann, Rikard Holmdahl, Joyce J. Hsu, James I. Huddleston, Thomas W.J. Huizinga, Gene G. Hunder, Emily W. Hung, Robert D. Inman, Maura Daly Iversen, Johannes W.G. Jacobs, Joanne M. Jordan, Joseph L. Jorizzo, Kenton R. Kaufman, William S. Kaufman, Arthur Kavanaugh, Robert T. Keenan, Shaukat Khan, Alisa E. Koch, Dwight H. Kono, Deborah Krakow, Robert G.W. Lambert, Robert B.M. Landewé, Nancy E. Lane, Carol A. Langford, Daniel M. Laskin, Ronald M. Laxer, David M. Lee, Lela A. Lee, Tzielan Chang Lee, Michael D. Lockshin, Rik Lories, Carlos J. Lozada, Ingrid E. Lundberg, Raashid Luqmani, Frank P. Luyten, Reuven Mader, Walter P. Maksymowych, Brian Mandell, Scott David Martin, Eric L. Matteson, Matthew J. McGirt, Iain B. McInnes, Elizabeth Kaufman McNamara, Ted R. Mikuls, Mark S. Miller, Kevin G. Moder, Kanneboyina Nagaraju, Stanley J. Naides, Amanda E. Nelson, Peter A. Nigrovic, Kiran Nistala, Johannes Nowatzky, James R. O'Dell, Yasunori Okada, Nataly Manjarrez Orduño, Caroline Ospelt, Mikkel Østergaard, Bradley M. Palmer, Richard S. Panush, Stanford L. Peng, Michael H. Pillinger, Gregory R. Polston, Steven A. Porcelli, Mark D. Price, Johannes J. Rasker, John D. Reveille, W. Neal Roberts, Monika Ronneberger, Antony Rosen, James T. Rosenbaum, Andrew E. Rosenberg, Eric M. Ruderman, Merja Ruutu, Jane E. Salmon, Jonathan Samuels, Christy I. Sandborg, Caroline O.S. Savage, Amit Saxena, Jose U. Scher, Georg Schett, David C. Seldin, Anna Simon, Dawd S. Siraj, Martha Skinner, E. William St. Clair, Lisa K. Stamp, John H. Stone, Rainer H. Straub, Susan E. Sweeney, Nadera J. Sweiss, Carrie R. Swigart, Deborah Symmons, Zoltan Szekanecz, Paul-Peter Tak, Peter C. Taylor, Robert Terkeltaub, Argyrios N. Theofilopoulos, Ranjeny Thomas, Thomas S. Thornhill, Karina D. Torralba, Michael J. Toth, Peter Tugwell, Zuhre Tutuncu, Katherine S. Upchurch, Désirée M.F.M. van der Heijde, Annette H.M. van der Helm-van Mil, Sjef M. van der Linden, Jos W.M. van der Meer, Jacob M. van Laar, John Varga, Mark S. Wallace, David M. Warshaw, Lucy R. Wedderburn, Victoria P. Werth, Fredrick M. Wigley, Christopher M. Wise, David Wofsy, Frederick Wolfe, Frank A. Wollheim, Robert L. Wortmann, Edward Yelin, David Yu, John B. Zabriskie, Robert B. Zurier, and Anne-Marie Zuurmond

Published
2013
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14. How surgeons make decisions when the evidence is inconclusive

Author

Prashanth Ina, Robert R.L. Gray, Gustavo Mantovani Ruggiero, David J. Rowland, Yoram Weil, M. R. de Vries, Renato M. Fricker, Georges Kohut, Antonio Barquet, Karl Josef Prommersberger, Takashi Sasaki, Eckart Schwab, Taco Gosens, Joseph M. Conflitti, David Ring, M. A. Aita, Ladislav Mica, Joseph A. Abboud, Michael Jones, Daniel Hernandez, Gregory L. DeSilva, Hal MccUtchan, Thomas W. Wright, Kendrick E. Lee, Marinis Pirpiris, Ian A. Harris, Marc F. Swiontkowski, Neil Wilson, Norah M. Harvey, Eric P. Hofmeister, Howard D. Routman, Lawrence Weiss, Nicholas L. Shortt, Jorge Rubio, Axel Jubel, John S. Taras, Gustavo Regazzi, Sergio L. Checchia, Jack Choueka, Jorge L. Orbay, Michael A. Baskies, Rolf Norlin, Vispi Jokhi, Todd E. Siff, Ashish S. Ranade, Lisa L. Lattanza, Jeff W. Johnson, Hans J. Kreder, Rozental, Cayón Cayón, Rajat Varma, Paul T. Appleton, Leonid I. Katolik, Asheesh Bedi, Filip Celestyn Dolatowski, Steve Kronlage, Paul M. Guidera, Elisabeth Prelog-Igler, David M. Kalainov, Charles L. Getz, Chunyan Jiang, Porcellini, A. Iossifidis, J Andrew I Trenholm, Frede Frihagen, K. Sprengel, Minos Tyllianakis, Steven J. McCabe, David Weiss, C. Taleb, Andrew P. Gutow, Sebastian Kluge, Jin Young Park, Michael R. Hausman, Paul A. Martineau, Michel P J Van Den Bekerom, W. A H Van Der Stappen, Thomas G. Stackhouse, Thomas Dienstknecht, Babst H. Reto, Jonathan L. Hobby, Iain McGraw, Tony Wanich, Augustus D. Mazzocca, Samir Sodha, J. Biert, Matthias Turina, Ines C. Lin, Daniel Rikli, Fischmeister Martin, Chad Manke, Roman Pfeifer, Lars C. Borris, M. Quell, Fabio Suarez, Daniel B. Whelan, John P. Evans, Michael Nancollas, Marco Rizzo, Lawrence S. Halperin, Carl Ekholm, David E. Tate, Steven J. Morgan, Betsy M. Nolan, F. J. Seibert, W. Arnnold Batson, Richard Barth, Brent Bamberger, A. B. Spoor, Seth D. Dodds, Jeffrey A. Greenberg, Victoria D. Knoll, Wade R. Smith, Michael D. McKee, Rolf W. Peters, Christopher J. Walsh, Jochen Fischer, Martin I. Boyer, Raymond Malcolm Smith, P. V. van Eerten, Philipp N. Streubel, Thomas B. Hughes, Milind Merchant, Peter J. L. Jebson, Bret C. Peterson, Theodoros H. Tosounidis, Luke S. Austin, David L. Nelson, M. R. Krijnen, K.J. Ponsen, Chris Wilson, Gladys Cecilia Zambrano Caro, Daniel B. Polatsch, Matthew D. Budge, Reza Omid, Louis W. Catalano, Emil H. Schemitsch, Roy G. LiemKulick, Richard S. Page, Michael W. Kessler, Donald Endrizzi, Anna N. Miller, Jorge G. Boretto, Peter Kloen, J. Michael Wiater, Fidel Ernesto, German Ricardo Hernandez, Leon S. Benson, Peter J. Evans, John Howlett, Verhofstad, Michael J. Behrman, A. L. Van Der Zwan, Ryan P. Calfee, Robert D. Zura, Leon Elmans, Anica Eschler, D. Kaplan, Richard S. Gilbert, F. Thomas, Johannes M. Rueger, Eon K. Shin, Sam Moghtaderi, Julie E. Adams, Jaimo Ahn, D. F. P. van Deurzen, Ralf Nyszkiewicz, W. Jaap Willems, Huub Van Der Heide, Aida Garcia, L.M.S.J. Poelhekke, Philip E. Blazar, Daniel C. Wascher, Luis Antonio Buendia, S. Prashanth, Peter Krause, Maarten W.G.A. Bronkhorst, Noah D. Weiss, Kyle J. Jeray, Ronald Liem, Andrew L. Terrono, Niels W. L. Schep, Sander Sprujt, Ryan Klinefelter, Robert Haverlag, Steven Beldner, Nikolaos G. Lasanianos, Ramon De Bedout, Rudolf W. Poolman, I. J.V. Kleinlugtenbelt, Alexander Marcus, Greg Merrell, Naquira Escobar Luis Felipe, Kimberlly S. Chhor, Jeffrey Yao, Lob Guenter, Parag Melvanki, Arie B. van Vugt, Francisco Lopez-Gonzalez, Craig Lomita, Saul Kaplan, Matt Mormino, Theresa O Wyrick, Gregory J. Della Rocca, C. Noel Henley, Edgardo Ramos Maza, Christopher B. Wall, Fred Baumgaertel, Roger P. van Riet, Sebastian Rodriguez-Elizalde, Stuart M. Hilliard, George S. Athwal, Peter V. Giannoudis, Angela A. Wang, Tamir Pritsch, John A. McAuliffe, Robert J. Feibel, Timothy Omara, Paul Levin, Jonathan Rosenfeld, Michael J. Prayson, Mark E. Baratz, R. Bryan Benafield, Christian Perrotto, George L. Thomas, Punita V. Solanki, George M. Kontakis, Robert Wagenmakers, Charles A. Goldfarb, Andrew H. Schmidt, Abhay Shrivastava, Mark D. Lazarus, Frederico C M Vallim, L. Marsh, Keith A. Segalman, H. Goost, Peter R. Brink, Michael W. Grafe, Jonathan P. Braman, April D. Armstrong, Charles Cornell, Thomas A. DeCoster, Daphne M. Beingessner, Neal C. Chen, Charalampos Zalavras, M. A J Van De Sande, Jennifer L. Giuffre, Thuan V. Ly, Georg M. Huemer, Vani J. Sabesan, Rodrigo Pesantez, Kevin Eng, A. Lee Osterman, Darren S. Drosdowech, Michael Moskal, B. Van Den, Nigel Rossiter, Michael Baumgaertner, Christian Heiss, James F. Kellam, P. C. Fuchs, Matej Kastelec, David J. Hak, Karel Chivers, Amy L. Ladd, Reid A. Abrams, Bob Arciero, Russell Shatford, Toni M. McLaurin, George S.M. Dyer, Ralph M. Costanzo, Frank L. Walter, Craig M. Torosian, Koroush Kabir, Timothy G. Havenhill, Brian L. Badman, Joachim P. Overbeck, Charles Metzger, Vishwanath M. Iyer, Annette K B Wikerøy, Carlos Henrique Fernandes, Jay Pomerance, Patrick T. McCulloch, Megan M. Wood, Richard Jenkinson, Brian J. Cross, Christos Garnavos, Marcus Lehnhardt, Ashok K. Shyam, Michael LeCroy, Abhijeet L. Wahegaonkar, Carrie R. Swigart, Lisa Taitsman, Vasileios S. Nikolaou, Gerald R. Williams, J. H. Peters, Sergio Rowinski, William Dias Belangero, Ibrahim Ibrahim, Jeremy A. Hall, Charles Cassidy, Mahmoud I. Abdel-Ghany, Michiel G.J.S. Hageman, M. Jason Palmer, Joseph P A M Vroemen, Frank J. P. Beeres, Alberto Pérez Castillo, Gustavo Borges Laurindo De Azevedo, Martin Richardson, Wolfgang Baer, Shep Hurwit, J. V. Clarke, Robert Tashijan, Scott F. M. Duncan, Thierry G. Guitton, Steven J. Rhemrev, J. Wolkenfelt, Richard Wallensten, Neil Saran, Brett D. Crist, J. Carel Goslings, Qiugen Wang, Francisco Javier Aguilar Sierra, Leonardo Alves De Mendonca, Paula M. Hasenboehler, Sanjeev Kakar, Grant E. Garrigues, Leonardo Rocha, Joel Murachovsky, Vidyadhar Telang, Edward J. Harvey, Richard Buckley, Jose A. Ortiz, Schandelmaier, Edward K. Rodriguez, Konul Erol, H. J. Helling, Nikolaos K. Kanakaris, Jeffry T. Watson, Desirae M. McKee, Graduate School, Orthopedic Surgery and Sports Medicine, AMS - Amsterdam Movement Sciences, Surgery, Other Research, and Other departments

Subjects
Male, medicine.medical_specialty, Decision Making, Alternative medicine, Likert scale, medicine, Humans, Orthopedics and Sports Medicine, Somewhat Important, Reimbursement, Social influence, Evidence-Based Medicine, business.industry, Mentors, Perspective (graphical), Evidence-based medicine, Hand, Surgery, Orthopedics, Family medicine, Practice Guidelines as Topic, Female, Clinical Competence, business, Null hypothesis
Abstract

Purpose To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive. Methods We tested the null hypothesis that the factors surgeons use do not vary by training, demographics, and practice. A total of 337 surgeons rated the importance of 7 factors when deciding between treatment and following the natural history of the disease and 12 factors when deciding between 2 operative treatments using a 5-point Likert scale between "very important" and "very unimportant." Results According to the percentages of statements rated very important or somewhat important, the most popular factors influencing recommendations when evidence is inconclusive between treatment and following the natural course of the illness were "works in my hands," "familiarity with the treatment," and "what my mentor taught me." The most important factors when evidence shows no difference between 2 surgeries were "fewer complications," "quicker recovery," "burns fewer bridges," "works in my hands" and "familiarity with the procedure." Europeans rated "works in my hands" and "cheapest/most resourceful" of significantly greater importance and "what others are doing," "highest reimbursement," and "shorter procedure" of significantly lower importance than surgeons in the United States. Observers with fewer than 10 years in independent practice rated "what my mentor taught me," "what others are doing" and "highest reimbursement" of significantly lower importance compared to observers with 10 or more years in independent practice. Conclusions Surgeons deciding between 2 treatment options, when the evidence is inconclusive, fall back to factors that relate to their perspective and reflect their culture and circumstances, more so than factors related to the patient's perspective, although this may be different for younger surgeons. Clinical relevance Hand surgeons might benefit from consensus fallback preferences when evidence is inconclusive. It is possible that falling back to personal comfort makes us vulnerable to unhelpful commercial and societal influences.

Published
2013

15. Hand and Wrist Pain

Author

Carrie R. Swigart

Subjects
medicine.medical_specialty, Physical medicine and rehabilitation, business.industry, medicine, Wrist pain, medicine.symptom, business
Published
2013
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16. Arthritis of the base of the thumb

Author

Carrie R. Swigart

Subjects
Pathology, medicine.medical_specialty, business.industry, Arthritis, CMC joint, Thumb, medicine.disease, Article, Conservative treatment, medicine.anatomical_structure, Basal joint, Orthopedic surgery, medicine, Orthopedics and Sports Medicine, Presentation (obstetrics), Surgical treatment, Intensive care medicine, business
Abstract

The purpose of this article is to outline the pathophysiology and epidemiology of arthritis of the base of the thumb. The usual presentation and diagnosis will be discussed along with the current conservative treatment options. Surgical treatment options are determined by the stage of the arthritis as well as the demands of the patient. The current standard surgical treatment options will be reviewed along with their results in the literature.

Published
2009

17. CONTRIBUTORS

Author

Steven B. Abramson, Leyla Alparslan, Thomas P. Andriacchi, John P. Atkinson, Stefan Bachmann, Leslie R. Ballou, Stanley P. Ballou, Walter G. Barr, Dorcas Eleanor Beaton, Robert M. Bennett, Francis Berenbaum, Johannes W.J. Bijlsma, Linda K. Bockenstedt, Maarten Boers, Robert Alan Bonakdar, Dimitrios T. Boumpas, Barry Bresnihan, Doreen B. Brettler, Paul L. Briant, Ralph C. Budd, Leonard H. Calabrese, Amy C. Cannella, Eugene J. Carragee, Steven Carsons, James T. Cassidy, Eliza F. Chakravarty, Christopher Chang, Joseph S. Cheng, Christopher P. Chiodo, Paul P. Cook, Joseph E. Craft, Gaye Cunnane, Jody A. Dantzig, Jeroen DeGroot, Christopher P. Denton, Clinton Devin, Betty Diamond, Federico Díaz-González, Paul E. Di Cesare, Joost P.H. Drenth, George F. Duna, Michael L. Dustin, Hani S. El-Gabalawy, Keith B. Elkon, Doruk Erkan, Gary S. Firestein, Oliver FitzGerald, John P. Flaherty, Adrienne M. Flanagan, Karen A. Fortner, Howard A. Fuchs, Mark C. Genovese, M. Eric Gershwin, Allan Gibofsky, Mark H. Ginsberg, Joseph Golbus, Yale E. Goldman, Mary B. Goldring, Steven R. Goldring, Stuart B. Goodman, Carl S. Goodyear, Siamon Gordon, Adam Greenspan, Peter K. Gregersen, Christine Grimaldi, Bevra Hannahs Hahn, J. Timothy Harrington, Edward D. Harris, David B. Hellmann, George Ho, James I. Huddleston, Gene G. Hunder, Johannes W.G. Jacobs, Joanne M. Jordan, Joseph L. Jorizzo, Kenneth C. Kalunian, Arthur Kavanaugh, Alisa E. Koch, null Deborah Krakow, Joel M. Kremer, Hollis E. Krug, Irving Kushner, Robert B.M. Landewé, Nancy E. Lane, Daniel J. Laskin, David M. Lee, Lela A. Lee, Marjatta Leirisalo-Repo, David C. Leopold, Peter E. Lipsky, Michael D. Lockshin, Kate R. Lorig, B. Asher Louden, Carlos J. Lozada, Ingrid E. Lundberg, null Reuven Mader, Rashmi M. Maganti, Maren Lawson Mahowald, Walter P. Maksymowych, Scott David Martin, Helena Marzo-Ortega, Dennis McGonagle, Iain B. McInnes, Kevin G. Moder, Eamonn S. Molloy, Kanneboyina Nagaraju, Stanley J. Naides, Lee S. Newman, Peter A. Nigrovic, Kiran Nistala, James R. O'Dell, Peter R. Oesch, Yasunori Okada, Eugenia C. Pacheco-Pinedo, Richard S. Panush, Thomas Pap, Stanford L. Peng, Harris Perlman, Jean-Charles Piette, Michael H. Pillinger, Robert S. Pinals, Steven A. Porcelli, Mark D. Price, Johannes J. Rasker, John D. Reveille, W. Neal Roberts, James T. Rosenbaum, Andrew E. Rosenberg, Clinton T. Rubin, Janet E. Rubin, Jonathan Samuels, Holly M. Sackett, Naveed Sattar, John C. Scatizzi, Jose U. Scher, David C. Seldin, Jérémie Sellam, John S. Sergent, Richard M. Siegel, Karl Sillay, Anna Simon, Dawd S. Siraj, Martha Skinner, Kathleen A. Sluka, C. Michael Stein, John H. Stone, Bob Sun, Carrie R. Swigart, null Zoltán Szekanecz, Paul P. Tak, Ioannis O. Tassiulas, H. Guy Taylor, Peter C. Taylor, Robert Terkeltaub, Thomas S. Thornhill, Helen Tighe, Betty P. Tsao, Peter Tugwell, Zuhre Tutuncu, Katherine S. Upchurch, Wim B. Van den Berg, Filip Van den Bosch, Désirée M.F.M. Van der Heijde, Sjef M. van der Linden, Jos W.M. van der Meer, John Varga, Philippe Vinceneux, Benjamin W.E. Wang, Lucy R. Wedderburn, Karin N. Westlund-High, Barbara N. Weissman, Victoria P. Werth, Michael S. Wildstein, Christopher M. Wise, Frederick Wolfe, Frank A. Wollheim, null Patricia Woo, Anthony D. Woolf, Robert L. Wortmann, David Tak Yan Yu, John B. Zabriskie, Robert B. Zurier, and Anne-Marie Zuurmond

Published
2009
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18. MASTERCASES Hand and Wrist Surgery

Author

Thomas Bienz, Randall W. Culp, John C. P. Floyd, Kostas J. Constantine, Allen T. Bishop, Christopher H. Martin, Carole W. Agin, John D. Wyrick, Paul R Greenlaw, Donald M. Lewis, Carrie R. Swigart, Loryn P. Weinstein, Sokratis Varitimidis, Lisa L. Lattanza, Ziv M. Peled, Robert J. Goitz, James H. Calandruccio, Sam Moghtaderi, Thomas R. Kiefhaber, Kevin D. Plancher, Shrika Sharma, James W. Vahey, Kydee K. Sheetz, Steven Z. Glickel, Thomas J. Graham, Philip E. Blazar, Mark R Belsky, Dennis Rodin, Scott H. Kozin, Ann E. Van Heest, James House, Scott Mair, Steven F. Viegas, John Naranja, Dean G. Sotereanos, Richard W. Barth, Jack Abboudi, David S Zelouf, Waldo E. Floyd, Peter M. Waters, Lawrence H. Schneider, Vincent Ruggiero, Stuart H. Kuschner, William B. Geissler, Michael Jablon, Bradley M. Thomas, William K. Feinstein, Lee Osterman, Alexander D. Mih, Andrew E. Caputo, Manuel F. DaSilva, Andrew H. Borom, Earl W. Brien, Shelly M. Sailer, Mark S. Cohen, David B. Siegel, John D. Mahoney, Timothy Luke, David M. Lichtman, Michelle Gerwin Carlson, John M. Olsewski, Leon S. Benson, Andrew L. Haas, Allan E. Peljovich, Joseph F. Slade, John A. Girotto, Benjamin Chang, Rosa L. Dell’Oca, Mark S. Rekant, Amy Ladd, Kirk Watson, Jonathan S. Schreiber, Michael F. Bothwell, Robert M. Szabo, Matthew D. Putman, Eric Freeman, Angela A. Wang, Jerry G. Kaplan, Roberta T. Ciocco, Mark Katz, and Andrew K. Palmer

Subjects
medicine.medical_specialty, business.industry, medicine, Wrist surgery, business, Surgery
Published
2004
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19. Limited incision open techniques for distal radius fracture management

Author

Carrie R. Swigart and Scott W. Wolfe

Subjects
Adult, Male, medicine.medical_specialty, Osteosynthesis, business.industry, Biomechanics, Soft tissue, Wrist, Middle Aged, Internal Fixators, Surgery, Biomechanical Phenomena, Fixation (surgical), Fracture Fixation, Internal, medicine.anatomical_structure, Orthopedic surgery, medicine, Upper limb, Humans, Orthopedics and Sports Medicine, Female, Range of Motion, Articular, business, Radius Fractures, Surgical incision
Abstract

This article discusses recent innovations in the management of distal radius fractures. Clinical and biomechanical studies have shown that stable fixation can be achieved with small implants aligned in an orthogonal fashion. This technique greatly diminishes the necessary soft tissue dissection needed at surgery and allows for early mobilization of the wrist, which may lead to improved outcomes and fewer soft tissue complications.

Published
2001

20. A biomechanical comparison of different wrist external fixators with and without K-wire augmentation

Author

Mark Lorenze, Gregory L. Austin, Manohar M. Panjabi, Scott W. Wolfe, and Carrie R. Swigart

Subjects
Osteosynthesis, External Fixators, business.industry, medicine.medical_treatment, Biomechanics, Anatomy, Wrist, Biomechanical Phenomena, Fixation (surgical), External fixation, medicine.anatomical_structure, Evaluation Studies as Topic, Muscle tension, medicine, Cadaver, Humans, Orthopedics and Sports Medicine, Surgery, Ulnar deviation, Range of Motion, Articular, Range of motion, business, Radius Fractures, Biomedical engineering
Abstract

To compare stability of wrist external fixation, simulated unstable extra-articular distal radius fractures were created in 7 fresh-frozen cadaveric upper extremities and stabilized using 4 different external fixators. Physiologic muscle tension across the wrist was simulated by application of 40-N load distributed among the wrist tendons. Alternating loads of up to 100 N in flexion and extension of the wrist were applied during stability testing and 3-dimensional kinematics of the proximal and distal fracture fragments were determined using attached infrared light-emitting diodes and a 3-dimensional motion tracking system. Fracture stability was reassessed for each of the constructs after augmentation of the fracture fragments with a single dorsal transfixion K-wire. K-wire augmentation demonstrated a significant reduction in motion of the distal radial fragment of at least 40% in all 3 rotational planes. For flexion/extension, the reduction in motion was from 4.5° to 2.6°. For radial/ulnar deviation, the range of motion decreased from 3.0° to 1.5°. Rotational motion declined from an average of 3.2° to 1.2°. The addition of the single dorsal transfixion K-wire significantly improved stability of each of the 4 fixators in at least 1 of the 3 planes in which motion was measured. While we compared the most rigid with some of the least rigid external fixators, the data do not support an important difference in fracture fragment stability among the 4 fixators. The data much more strongly support the concept of K-wire augmentation for increasing stability of an unstable extra-articular distal radius fracture regardless of the type of external fixator that is used. (J Hand Surg 1999;24A:516–524. Copyright © 1999 by the American Society for Surgery of the Hand.)

Published
1999

21. Splinting in the treatment of arthritis of the first carpometacarpal joint

Author

Steven Z. Glickel, Richard G. Eaton, Caryl Johnson, and Carrie R. Swigart

Subjects
musculoskeletal diseases, Adult, Male, Wrist Joint, medicine.medical_specialty, Arthritis, Pain, Osteoarthritis, Thumb, stomatognathic system, Carpometacarpal joint, Surveys and Questionnaires, Arthropathy, Activities of Daily Living, medicine, Humans, Pain Management, Orthopedics and Sports Medicine, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Middle Aged, equipment and supplies, medicine.disease, Surgery, body regions, stomatognathic diseases, Splints, medicine.anatomical_structure, Treatment Outcome, Arthritis therapy, Female, business, Bandage
Abstract

Although much has been written about surgical treatment of arthritis of the first carpometacarpal joint, no literature exists on splinting as a conservative treatment. One hundred fourteen patients (130 thumbs) were retrospectively reviewed to determine the efficacy of splinting. Patients were grouped according to their stage of disease and whether they had carpometacarpal joint surgery. Seventy-six percent of patients with stage I and II disease and 54% of patients with stage III and IV disease had improvement in their symptoms with splinting. There was no significant difference in the degree of improvement between the 2 groups. All patients who had initial improvement in their symptoms with splinting had between 54% and 61% average improvement in symptom severity 6 months after splinting. All groups were found to be equally tolerant of the splinting protocol and no group had a significantly higher rate of activity modification. Overall, splinting was found to be a well-tolerated and effective conservative treatment to diminish, but not completely eliminate, the symptoms of carpometacarpal joint arthritis and inflammation.

Published
1999

22. Load-displacement behavior in a distal radial fracture model. The effect of simulated healing on motion

Author

Gregory L. Austin, Scott W. Wolfe, Carrie R. Swigart, Manohar M. Panjabi, and Mark Lorenze

Subjects
Wrist Joint, External Fixators, medicine.medical_treatment, Colles' Fracture, Bone healing, Osteotomy, Models, Biological, Weight-Bearing, Fixation (surgical), External fixation, Fracture Fixation, Fracture fixation, medicine, Cadaver, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, Orthodontics, Fracture Healing, Colles' fracture, business.industry, Biomechanics, General Medicine, Anatomy, medicine.disease, Surgery, Range of motion, business, Bone Wires
Abstract

External fixation of fractures of the distal end of the radius neutralizes external forces and maintains axial alignment during healing. As far as we know, there have been no biomechanical studies of the effects of early removal of the fixator in a partially healed fracture model. The purpose of the present study was to observe the load-displacement behavior of a distal radial fracture model in which we had simulated partial healing by injection of butyl-rubber caulk and augmented this simulated healing with Kirschner-wire fixation. Sixteen fresh-frozen hand-wrist-forearm specimens from cadavera were mounted in mid-rotation in resin pots, and a load was applied. An osteotomy was used to simulate the fracture. Relative motion at the site of the osteotomy was compared, with use of a three-dimensional Optotrak kinematic device, during physiological loading of six constructs with Kirschner-wire transfixion or outrigger fixation. In the experimental group, partial healing was simulated by injection of butyl-rubber caulk into the site of the osteotomy and testing with simulated muscle-loading was performed through a full range of motion of the wrist. No difference could be detected between the relative motion at the osteotomy sites that had been treated with standard fully augmented external fixation and that in the experimental group (p > 0.05). T test analysis revealed that motion was equivalent regardless of whether Kirschner-wire transfixion or outrigger fixation had been used (p = 0.62) and that all of the augmented constructs had significantly less relative motion than all of the nonaugmented constructs (p < 0.001).

Published
1999

23. Augmented external fixation of distal radius fractures: a biomechanical analysis

Author

Carrie R. Swigart, Manohar M. Panjabi, Jonathan N. Grauer, Scott W. Wolfe, and Joseph F. Slade

Subjects
Wrist Joint, External Fixators, medicine.medical_treatment, Colles' Fracture, Fixation (surgical), External fixation, Fracture Fixation, medicine, Cadaver, Humans, Orthopedics and Sports Medicine, Kirschner wire, Range of Motion, Articular, Orthodontics, Osteosynthesis, business.industry, Neutral zone, Anatomy, Wrist Injuries, Sagittal plane, medicine.anatomical_structure, Coronal plane, Surgery, Stress, Mechanical, Cadaveric spasm, business, Bone Wires
Abstract

An in vitro model of an unstable extra-articular distal radius fracture was created in 8 fresh-frozen cadaveric specimens and stabilized with an external fixator. Rotation and translation kinematics of the distal radial fracture fragment were measured in relation to the proximal radius during physiologic loading, using infrared light-emitting diodes and a 3-dimensional motion-sensing device. The effect of supplemental single and combination Kirschner wire (K-wire) fixation on fracture fragment stability was assessed. Fixation of supplemental K-wires to the fixator frame via a custom-developed outrigger assembly was also analyzed. Significant reductions in sagittal plane (flexion/extension) rotation and neutral zone were recorded when the fracture fragment was stabilized with a single styloid or dorsal transfixion K-wire. Equivalent stability was afforded by attachment of a nontransfixion K-wire to the fixator frame via the outrigger assembly. The dorsal constructs compared favorably to the styloid constructs in reduction of the sagittal plane neutral zone and coronal (radioulnar) rotation. These data lend biomechanical support to the concept of augmentation of distal radius external fixation and provide a physiologic model to test fixation methods for other fracture patterns.

Published
1998

24. Enhanced susceptibility to histamine-induced cardiac arrhythmias in spontaneously hypertensive rats

Author

Arthur L. Bassett, Grace S. Shin, John S. Cameron, Carrie R. Swigart, and Deborah Katz

Subjects
Male, medicine.medical_specialty, Ischemia, Action Potentials, Propranolol, In Vitro Techniques, Muscle hypertrophy, chemistry.chemical_compound, Species Specificity, Internal medicine, Rats, Inbred SHR, medicine, Repolarization, Animals, Drug Interactions, cardiovascular diseases, Cimetidine, Pharmacology, business.industry, Antagonist, Arrhythmias, Cardiac, Rats, Inbred Strains, medicine.disease, Rats, Endocrinology, chemistry, Verapamil, cardiovascular system, Disease Susceptibility, Cardiology and Cardiovascular Medicine, business, Histamine, circulatory and respiratory physiology, medicine.drug
Abstract

To clarify mechanisms underlying an enhanced susceptibility to cardiac rhythm disturbances in hypertension and myocardial hypertrophy, we evaluated the vulnerability to histamine-induced arrhythmias of isolated left ventricles from spontaneously hypertensive rats (SHR) and age-matched controls (Wistar-Kyoto rats, WKY). Before drug administration, left ventricle-to-body weight ratios, spontaneous firing rates, and the incidence of arrhythmias (including delayed afterdepolarizations) were significantly increased in SHR ventricles versus WKY. In addition, action potential duration (APD) was prolonged in SHR at all levels of repolarization. In WKY but not SHR hearts, histamine (10(-7)-10(-4) M) increased spontaneous firing rates; the incidence of arrhythmias was increased in all hearts, but the response to histamine was most pronounced and occurred at lower threshold drug levels in SHR. After potentials and triggered activity were observed only in SHR. The H2-receptor blocker cimetidine (10(-5) M) and the Ca2(+)-channel antagonist verapamil (10(-6) M) each attenuated the arrhythmogenic influence of histamine in SHR and WKY preparations. Neither chlorpheniramine nor propranolol had any effect. The enhanced vulnerability to arrhythmogenesis observed in SHR myocardium may reflect elevated intracellular calcium levels, which may in turn be potentiated by local ischemia and/or intracardiac histamine release.

Published
1990

25. Histamine attenuates the arrhythmogenic effects of norepinephrine in hearts of spontaneously hypertensive rats

Author

Arthur L. Bassett, Carrie R. Swigart, Deborah Katz, and John S. Cameron

Subjects
Male, medicine.medical_specialty, Adrenergic receptor, Action Potentials, Cardiomegaly, Propranolol, In Vitro Techniques, Rats, Inbred WKY, Membrane Potentials, Norepinephrine (medication), chemistry.chemical_compound, Electrocardiography, Norepinephrine, Internal medicine, Rats, Inbred SHR, medicine, Repolarization, Animals, cardiovascular diseases, Cimetidine, Pharmacology, business.industry, Antagonist, Arrhythmias, Cardiac, Heart, Rats, Electrophysiology, Endocrinology, chemistry, cardiovascular system, business, Histamine, medicine.drug
Abstract

A potential physiological role for cardiac histamine and its interaction with norepinephrine were investigated in isolated left ventricles from spontaneously hypertensive rats (SHR). Prior to drug administration, left ventricle-to-body weight ratios and spontaneous firing rates (beats per min) were significantly increased in SHR ventricles vs. age- and sex-matched controls (WKY). Also, action potential duration was significantly prolonged in SHR at all levels of repolarization. In all hearts, norepinephrine (10(-7)-10(-4) M) increased spontaneous rate and the percent incidence of arrhythmias. The H2-receptor antagonist cimetidine (10(-5) M) potentiated the rate and arrhythmogenic effects of norepinephrine in SHR and, to a lesser extent, in WKY preparations; propranolol (10(-6) M) reduced them. Histamine (10(-7) M) also inhibited the norepinephrine-induced increase in arrhythmias in SHR, but not in WKY. The attenuation of adrenergically induced rhythm disturbances by histamine and their potentiation by cimetidine in hypertensive hearts support the hypothesis that histamine plays a role as a postjunctional modulator of adrenoceptor function in a setting of hypertension and myocardial hypertrophy.

Published
1989

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