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1. 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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2. 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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3. Effects of a UCBL Orthosis and a Calcaneal Osteotomy on Tibiotalar Contact Characteristics in a Cadaver Flatfoot Model

Author

Brian C. Toolan, Louis F. Draganich, and Timothy G Havenhill

Subjects
Orthotic Devices, medicine.medical_treatment, Osteotomy, Talus, 03 medical and health sciences, 0302 clinical medicine, Calcaneal osteotomy, Cadaver, Pressure, Humans, Medicine, Orthopedics and Sports Medicine, Orthodontics, 030222 orthopedics, Tibia, business.industry, 030229 sport sciences, Anatomy, Flatfoot, Flatfoot deformity, Orthotic device, Calcaneus, medicine.anatomical_structure, Surgery, Ankle, business, Contact area, Posterior Tibial Tendon Dysfunction
Abstract

A flatfoot deformity alters the contact characteristics of the ankle joint, shifting the location of articulation posterolaterally, increasing pressure, and decreasing the contact area within the ankle. These changes may explain the pattern of articular degeneration and subsequent angulation observed in a long-standing adult acquired flatfoot. Corrective orthoses and surgical reconstruction have been used to realign pes planovalgus feet, but the effects of these treatments on tibiotalar contact characteristics are unknown. We hypothesized that realignment of a flatfoot with either corrective orthosis or surgical reconstruction would restore the contact characteristics of the ankle to the intact state.The mean value of the contact area, contact pressure, peak contact pressure, and the relative locations of the global contact area and peak pressure within the ankle joint were determined from imprints created on pressure sensitive film for a series of cadaver lower limbs subjected to a weightbearing load in simulated midstance phase of gait. Each limb was loaded sequentially under four conditions: intact, flatfoot, flatfoot realigned with UCBL orthosis, and flatfoot realigned with a medial translational osteotomy of the calcaneus.The use of the UCBL orthosis and calcaneal osteotomy altered the contact characteristics of the ankle when compared with the flatfoot condition. Both interventions significantly decreased the mean global contact pressure from the flatfoot value, with the orthosis, demonstrating a significantly greater correction than the osteotomy. The orthosis also significantly reduced the peak contact pressure from the flatfoot value. Both interventions significantly corrected the lateral shift of the center of the peak contact pressure from the flatfoot value. The shift in the center of the global contact area approached significance when the orthosis was compared with the flatfoot.The changes observed in the magnitude and location of the mean and peak pressures indicate that the UCBL orthosis and calcaneal osteotomy altered hindfoot alignment to significantly influence tibiotalar contact characteristics. The results further suggest that the UCBL orthosis corrected ankle malalignment better than the calcaneal osteotomy in an adult acquired flatfoot. This study provides biomechanical data to support the clinical impression that realignment of the hindfoot corrects the pathologic tibiotalar contact characteristics associated with an adult acquired flatfoot. The results support the conclusion that the clinical management of a pes planovalgus foot with a UCBL orthosis or a medial translational osteotomy of the calcaneus may avert the onset of pantalar disease seen with late-stage posterior tibial tendon dysfunction.

Published
2005
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4. Pediatric Flexor Tendon Injuries

Author

Roderick Birnie and Timothy G. Havenhill

Subjects
medicine.medical_specialty, Surgical approach, Flexor tendon, business.industry, Hand Injuries, Postoperative rehabilitation, Delayed diagnosis, Tendon, Surgery, Casts, Surgical, Immobilization, Postoperative Complications, medicine.anatomical_structure, Tendon Injuries, Outcome Assessment, Health Care, medicine, Humans, Orthopedics and Sports Medicine, Child, business, Foreign Bodies, Pediatric population
Abstract

Flexor tendon injuries in children differ from adults in their diagnosis and postoperative rehabilitation principles. The child may be uncooperative, so indirect methods of tendon integrity must be used for diagnosis. Radiographs may be useful for associated fracture or retained foreign bodies. A high index of suspicion necessitates surgical exploration. Although surgical approach and repair techniques are identical to those in adults, postoperative immobilization for 3-4 weeks is used instead of an early motion protocol. Delayed diagnosis is more common in the pediatric population, and recognition and management of postoperative complications can be difficult,because the child may be unable to cooperate or comply with the treatment.

Published
2005
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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

6. Type 0 ulnar longitudinal deficiency

Author

Archit Patel, Paul R. Manske, Timothy G. Havenhill, and Charles A. Goldfarb

Subjects
Male, medicine.medical_specialty, Ectrodactyly, Elbow, Ulna, Forearm, medicine, Humans, Orthopedics and Sports Medicine, Syndactyly, Retrospective Studies, business.industry, Anatomy, Aplasia, Metacarpal synostosis, Synostosis, medicine.disease, Hypoplasia, Surgery, body regions, medicine.anatomical_structure, Hand Bones, Female, business, Hand Deformities, Congenital
Abstract

Purpose To describe the characteristics of type 0 ulnar longitudinal deficiency (ULD) in which deficiencies are present in the hand and carpus without involvement of the forearm or elbow. Methods A retrospective chart, radiograph, and clinical photograph review (1960–2005) of patients previously diagnosed with ectrodactyly, hand hypoplasia, or ULD was performed to evaluate for a diagnosis of ULD isolated to the hand. Results Thirteen extremities were identified. Three extremities had complete absence of the small-finger ray (phalanges and metacarpal) and 6 extremities had complete absence of the ring- and small-finger rays. Four hands showed hypoplasia of the small finger, 3 in conjunction with a ring- and small-metacarpal synostosis and 1 in isolation. Three extremities also had radial-sided hypoplasia or aplasia of the rays. Additional common findings included simple syndactyly, delta phalanx, and carpal fusions, most commonly of the capitohamate joint. Conclusions Patients with isolated ulnar-sided hand deficiency such as ectrodactyly of the ring and/or small fingers or synostosis of the small metacarpal of the ring finger in the presence of a normal forearm may be diagnosed as having type 0 ULD. We propose that type 0 be added to the current classification systems for ULD representing those extremities with deficiencies isolated to the hand.

Published
2005

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