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1. A Limited Fixation, Olecranon Sparing Approach, for Management of Geriatric Intra-Articular Distal Humerus Fractures

Author

Philip B. Kaiser MD, Erik T. Newman MD, Christopher Haggerty BS, Paul T. Appleton MD, John J. Wixted MD, Michael J. Weaver MD, and Edward K. Rodriguez MD, PhD

Subjects
Orthopedic surgery, RD701-811, Geriatrics, RC952-954.6
Abstract

Purpose: We propose that geriatric comminuted intra-articular distal humerus fractures can be effectively treated with a limited fixation approach aimed at achieving varus/valgus stability with columnar fixation, but allowing intra-articular comminution to heal by secondary congruency against an intact olecranon, thus avoiding an olecranon osteotomy. Methods: Fifty-six elderly patients with AO 13-C type fractures, who underwent surgical fixation with ≥12-months of follow-up were retrospectively reviewed. Thirty patients were treated with intra-articular open reduction internal fixation (ORIF) with an olecranon osteotomy and 26 patients were treated with our limited fixation (L-ORIF) approach. Outcomes were range of motion (ROM), complications, additional surgery, and patient-reported outcome measures (PROMIS). Results: At final follow-up, the average elbow ROM was 97° (40°-155°) in the ORIF group and 86.5° (20°-145°) in the L-ORIF group. There was a trend toward more complications and additional surgery in the ORIF group. PROMIS scores for pain were 53.1 and 52.14, and PROMIS functional scores were 41.7 and 41.4 in the ORIF and L-ORIF group respectively. No differences in outcomes were statistically significant. Conclusion: A limited fixation technique based on achieving varus/valgus stability with columnar fixation, demonstrated equivalent outcomes in elderly patients with intra-articular distal humerus fractures when compared to intra-articular ORIF with an olecranon osteotomy

Published
2020
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2. Predicting Outcomes After Distal Radius Fracture: A 24-Center International Clinical Trial of Older Adults

Author

Kevin C. Chung, H. Myra Kim, Sunitha Malay, Melissa J. Shauver, Steven C. Haase, Jeffrey N. Lawton, John R. Lien, Adeyiza O. Momoh, Kagan Ozer, Erika D. Sears, Jennifer F. Waljee, Matthew S. Brown, Hoyune E. Cho, Brett F. Michelotti, Tamara D. Rozental, Paul T. Appleton, Edward K. Rodriguez, Laura N. Deschamps, Lindsay Mattfolk, Katiri Wagner, Philip Blazar, Brandon E. Earp, W. Emerson Floyd, Dexter L. Louie, Fraser J. Leversedge, Marc J. Richard, David S. Ruch, Suzanne Finley, Cameron Howe, Maria Manson, Janna Whitfield, Bertrand H. Perey, Kelly Apostle, Dory Boyer, Farhad Moola, Trevor Stone, Darius Viskontas, Mauri Zomar, Karyn Moon, Raely Moon, Loree K. Kalliainen, Christina M. Ward, James W. Fletcher, Cherrie A. Heinrich, Katharine S. Pico, Ashish Y. Mahajan, Brian W. Hill, Sandy Vang, Dawn M. Laporte, Erik A. Hasenboehler, Scott D. Lifchez, Greg M. Osgood, Babar Shafiq, Jaimie T. Shores, Vaishali Laljani, H. Brent Bamberger, Timothy W. Harman, David W. Martineau, Carla Robinson, Brandi Palmer, Ruby Grewal, Ken A. Faber, Joy C. MacDermid, Kate Kelly, Katrina Munro, Joshua I. Vincent, David Ring, Jesse B. Jupiter, Abigail Finger, Jillian S. Gruber, Rajesh K. Reddy, Taylor M. Pong, Emily R. Thornton, David G. Dennison, Sanjeev Kakar, Marco Rizzo, Alexander Y. Shin, Tyson L. Scrabeck, Kyle Chepla, Kevin Malone, Harry A. Hoyen, Blaine Todd Bafus, Roderick B. Jordan, Bram Kaufman, Ali Totonchil, Dana R. Hromyak, Lisa Humbert, Sandeep Sebastin, Sally Tay, Kate W. Nellans, Sara L. Merwin, Ethan W. Blackburn, Sandra J. Hanlin, Barbara Patterson, R. Glenn Gaston, R. Christopher Cadderdon, Erika Gordon Gantt, John S. Gaul, Daniel R. Lewis, Bryan J. Loeffler, Lois K. Osier, Paul C. Perlik, W. Alan Ward, Benjamin Connell, Pricilla Haug, Caleb Michalek, Tod A. Clark, Sheila McRae, Jennifer Moriatis Wolf, Craig M. Rodner, Katy Coyle, Thomas P. Lehman, Yuri C. Lansinger, Gavin D. O’Mahony, Kathy Carl, Janet Wells, David J. Bozentka, L. Scott Levin, David P. Steinberg, Annamarie D. Horan, Denise Knox, Kara Napolitano, John Fowler, Robert Goitz, Cathy A. Naccarelli, Joelle Tighe, Warren C. Hammert, Allison W. McIntyre, Krista L. Noble, Kaili Waldrick, Jeffery B. Friedrich, David Bowman, Angela Wilson, Zhongyu Li, L. Andrew Koman, Benjamin R. Graves, Beth P. Smith, and Debra Bullard

Subjects
Male, medicine.medical_specialty, predictors of outcomes, Recursive partitioning, Comorbidity, 030230 surgery, Wrist, Affect (psychology), law.invention, Fracture Fixation, Internal, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Outcome Assessment, Health Care, Medicine and Health Sciences, Humans, Medicine, Orthopedics and Sports Medicine, older adults, Aged, Pain Measurement, Aged, 80 and over, 030222 orthopedics, business.industry, Secondary data, Evidence-based medicine, Middle Aged, Prognosis, Identified patient, Clinical trial, medicine.anatomical_structure, Physical therapy, Female, Surgery, Radius Fractures, business, Distal radius fracture
Abstract

© 2019 American Society for Surgery of the Hand Purpose: Current evidence on predictors of outcomes after distal radius fracture is often based on retrospective analyses or may be confounded by fracture type. Using data from the Wrist and Radius Injury Surgical Trial (WRIST), a 24-site randomized study of distal radius fracture treatment, in which all fractures are severe enough to warrant surgery, we set out to perform a secondary data analysis to explore predictors of better or worse hand outcomes. Methods: The primary outcome measure was the Michigan Hand Outcomes Questionnaire (MHQ) summary score 12 months after treatment. We used a regression tree analysis with recursive partitioning to identify subgroups of participants who experienced similar outcomes (ie, MHQ score) and to determine which baseline or treatment factors they had in common. Results: Factors most predictive of 12-month MHQ score were pain at enrollment, education, age, and number of comorbidities. Specifically, participants who had a high school education or less and also reported severe pain had the lowest MHQ scores. Conversely, participants with less pain and more education and who were age 87 years or younger with one or no comorbid condition had the highest MHQ scores. Treatment type or radiographic measurements assessed on post-reduction films did not affect 12-month outcomes. Conclusions: These results identified patient characteristics that can be used by surgeons to identify subgroups of patients who may experience similar hand outcomes. Type of study/level of evidence: Prognostic III.

Published
2019
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3. Selecting the Next Class: The 'Virtual Orthopaedic Rotation'

Author

Joseph L, Yellin, Laura Y, Lu, Andrea S, Bauer, Jennifer, Duane, Paul T, Appleton, Eric M, Berkson, Eric M, Bluman, Christopher M, Bono, Jacob M, Drew, Kaitlin, Duffy, Harold A, Fogel, Collin, May, John E, Ready, Michael J, Weaver, Bertram, Zarins, and George S M, Dyer

Subjects
Orthopedics, genetic structures, SARS-CoV-2, education, COVID-19, Humans, Internship and Residency, Orthopedics and Sports Medicine, Surgery, sense organs, Pandemics, Research Article
Abstract

Introduction: When the COVID-19 pandemic forced the cancellation of visiting subinternships, we pivoted to create a virtual orthopaedic rotation (VOR). The purpose of this study was to assess the effect of the VOR on the residency selection process and determine the role of such a rotation in the future. Methods: A committee was convened to create a VOR to replace visiting orthopaedic rotations for medical students who are interested in pursuing a career in orthopaedic surgery. The VOR was reviewed and sanctioned by our medical school, but no academic credit was granted. We conducted three 3-week VOR sessions. During each session, virtual rotators participated in regularly scheduled educational conferences and attended an invitation-only daily conference in the evenings that was designed for a medical student audience. In addition, students were paired with faculty and resident mentors in a structured mentorship program. Students' orthopaedic knowledge was assessed using prerotation and postrotation tests. Results: From July to September 2020, 61 students from 37 distinct medical schools participated in the VOR. Notable improvements were observed in prerotation and postrotation orthopaedic knowledge test scores. In postrotation surveys, both students and faculty expressed high satisfaction with the curriculum but less certainty about how well they got to know each other. In the subsequent residency application cycle, 27.9% of the students who participated in the VOR were selected to interview, compared with 8.7% of the total application pool. Discussion: The VOR was a valuable substitute for in-person clinical rotations during the COVID-19 pandemic. Although not likely to be a replacement for conventional away rotations, the VOR is a possible adjunct to in-person clinical rotations in the future.

Published
2021

4. Reflections 1 Year Into the 21-Center National Institutes of Health–Funded WRIST Study: A Primer on Conducting a Multicenter Clinical Trial

Author

Mauri Zomar, Suzanne Finley, Tyson L. Scrabeck, Annamarie D. Horan, W. Emerson Floyd, Bertrand Perey, David Boman, Carla Robinson, Sanjeev Kakar, Claudette L. Cooper, Lindsay M Herder, Kristie Millman, Joy C. MacDermid, James W. Fletcher, Jennifer Moriatis Wolf, Jerry I. Huang, David S. Ruch, Jennifer F. Waljee, David Ring, Reuben A. Bueno, Beth P. Smith, Mark McAndrew, Zhongyu Li, Kathy Carl, Edward K. Rodriguez, Jason H. Ko, Jeffrey N. Lawton, Brent Bamberger, Kagan Ozer, Scott Levin, Katherine S. Pico, Sandeep J. Sebastin, Brian W. Hill, Andrew Koman, Jennifer Koechle, Tamara D. Rozental, Tod A. Clark, Thomas P. Lehman, Debra Bullard, Jeffrey B. Friedrich, Paul T. Appleton, Poh Ling Tay, Allison W. McIntyre, Rajesh K. Reddy, Benjamin Connell, David J. Bozentka, Kate W. Nellans, Mark P. Cote, Brandi Palmer, Kevin J. Malone, Michael W. Neumeister, Christian M. Ward, Douglas P. Hanel, Kevin C. Chung, Katiri Wagner, Marc J. Richards, Melissa J. Shauver, Denise Knox, Steven C. Haase, Loree K. Kalliainen, Cherrie A. Heinrich, Ruby Grewal, David R. Steinberg, Glenn Gaston, David G. Dennison, Harry A. Hoyen, Warren C. Hammert, Alexander Y. Shin, Philip E. Blazar, H. Myra Kim, Nicholas B. Vedder, Nada N. Berry, Sunitha Malay, Christopher H. Allan, Kate Kelly, Craig M. Rodner, Brandon E. Earp, and Jesse B. Jupiter

Subjects
medicine.medical_specialty, business.industry, Wrist, law.invention, Clinical trial, medicine.anatomical_structure, Randomized controlled trial, law, Physical therapy, Medicine, Orthopedics and Sports Medicine, Surgery, Center (algebra and category theory), Distal radius fracture, business, Primer (cosmetics)
Published
2013
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5. 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

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