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1. 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

2. 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

3. Extraosseous chondrosarcoma of the wrist: A case report

Author

Thomas G. Stackhouse and Andrew J. Weiland

Subjects
musculoskeletal diseases, medicine.medical_specialty, business.industry, Chondrosarcoma, Extraosseous Chondrosarcoma, En bloc resection, Soft Tissue Neoplasms, Middle Aged, Wrist, body regions, Rare tumor, surgical procedures, operative, medicine.anatomical_structure, Axial tomography, X ray computed, medicine, Humans, Female, Orthopedics and Sports Medicine, Surgery, Radiology, Tomography, Tomography, X-Ray Computed, business
Abstract

An extraosseous chondrosarcoma of the wrist treated with en bloc resection and reconstruction with autogenous, corticocancellous bone graft is reported. Computerized axial tomography (CAT) was critical for evaluating the extent of the tumor. Review of the literature reveals this to be the first case report of this rare tumor involving the wrist.

Published
1984
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