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Tarnasky A, Moghalu T, McNulty C, Shah N, Ibarra A, Orebaugh S. Safety of regional anesthesia for patients with pre-existing ulnar neuropathy undergoing decompressive surgery. Reg Anesth Pain Med 2024:rapm-2024-105781. [PMID: 39160091 DOI: 10.1136/rapm-2024-105781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/27/2024] [Indexed: 08/21/2024]
Affiliation(s)
- Aaron Tarnasky
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tobenna Moghalu
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chris McNulty
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Neal Shah
- Division of OrthoMidwest, Orthoillinois, Rockford, Illinois, USA
| | - Andrea Ibarra
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven Orebaugh
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Majidi M, Rohani E, Chamani V, Rezaei M, Roostayi MM, Ghaznavi A, Khosravi M. Assessing the efficacy of manual reduction and novel traction techniques for distal radius fractures: A randomized controlled trial. Health Sci Rep 2024; 7:e2227. [PMID: 38957863 PMCID: PMC11217017 DOI: 10.1002/hsr2.2227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 06/06/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024] Open
Abstract
Background and Aim One of the leading reasons that patients, particularly older persons, are brought to the orthopedic emergency room is a fracture at the end of the radius. In this study, a new traction method for distal radius fractures was compared with manual reduction. Methods The census method was used in this clinical trial to study 45 patients (46 hands) who were referred to Hamedan Besat Hospital in 2021. Patients were randomly assigned to two groups. The manual reduction (pressure and traction by an assistant and a doctor) method was implemented in Group A, and the new traction procedure (pressure and traction by hardware or a device) was performed in Group B. The radiographic results of reduction in both groups were investigated and compared immediately and in the first and 6 weeks after surgery. Results The following results were observed in the new and manual groups in the sixth week after surgery: average volar tilt: 4.19 ± 3.79 and 4.08 ± 3.88 (p = 0.926), radial angulation: 2.18 ± 1.27 and 2.21 ± 1.35 (p = 0.934), radial shortening: 10.52 ± 0.65 and 10.56 ± 0.68 (p = 0.828), radial inclination: 22.52 ± 2.46 and 22.71 ± 2.01 (p = 0.787), dorsal angulation: -5.89 ± 0.33 and 5.22 ± -1.91 (p = 1.00), ulnar variance: 1.66 ± 0.90 and 1.67 ± 0.81 (p = 0.958), and average pain score: 2.40 ± 0.68 and 2.47 ± 0.73 (p = 0.737). Conclusion The new reduction procedure with hardware in patients with distal radius fractures showed the same effect as the traditional method based on pressure and traction by the assistant and doctor in terms of radiographic changes and pain score of the fracture site.
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Affiliation(s)
- Morteza Majidi
- Medicine SchoolHamedan University of Medical SciencesHamedanIran
| | - Erfan Rohani
- Medicine SchoolHamedan University of Medical SciencesHamedanIran
| | - Vahid Chamani
- Department of Orthotics and ProstheticsUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | - Mehdi Rezaei
- Department of Physiotherapy, School of RehabilitationShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Mohsen Roostayi
- Department of Physiotherapy, School of RehabilitationShahid Beheshti University of Medical SciencesTehranIran
| | - Alireza Ghaznavi
- Department of Orthopedics Surgery, Rasoul Akram HospitalIran University of Medical SciencesTehranIran
| | - Mobina Khosravi
- Department of Orthotics and Prosthetics, School of RehabilitationShahid Beheshti University of Medical SciencesTehranIran
- Physiotherapy Research Center, School of RehabilitationShahid Beheshti University of Medical SciencesTehranIran
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McGrath R, McGrath BM, Jurivich D, Knutson P, Mastrud M, Singh B, Tomkinson GR. Collective Weakness Is Associated With Time to Mortality in Americans. J Strength Cond Res 2024; 38:e398-e404. [PMID: 38595265 PMCID: PMC11189751 DOI: 10.1519/jsc.0000000000004780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
ABSTRACT McGrath, R, McGrath, BM, Jurivich, D, Knutson, P, Mastrud, M, Singh, B, and Tomkinson, GR. Collective weakness is associated with time to mortality in Americans. J Strength Cond Res 38(7): e398-e404, 2024-Using new weakness cutpoints individually may help estimate time to mortality, but their collective use could improve value. We sought to determine the associations of (a) each absolute and body size normalized cut point and (b) collective weakness on time to mortality in Americans. The analytic sample included 14,178 subjects aged ≥50 years from the 2006-2018 waves of the Health and Retirement Study. Date of death was confirmed from the National Death Index. Handgrip dynamometry measured handgrip strength (HGS). Men were categorized as weak if their HGS was <35.5 kg (absolute), <0.45 kg·kg -1 (body mass normalized), or <1.05 kg·kg -1 ·m -2 (body mass index [BMI] normalized). Women were classified as weak if their HGS was <20.0 kg, <0.337 kg·kg -1 , or <0.79 kg·kg -1 ·m -2 . Collective weakness categorized persons as below 1, 2, or all 3 cutpoints. Cox proportional hazard regression models were used for analyses. Subject values below each absolute and normalized cutpoint for the 3 weakness parameters had a higher hazard ratio for early all-cause mortality: 1.45 (95% confidence interval [CI]: 1.36-1.55) for absolute weakness, 1.39 (CI: 1.30-1.49) for BMI normalized weakness, and 1.33 (CI: 1.24-1.43) for body mass normalized weakness. Those below 1, 2, or all 3 weakness cut points had a 1.37 (CI: 1.26-1.50), 1.47 (CI: 1.35-1.61), and 1.69 (CI: 1.55-1.84) higher hazard for mortality, respectively. Weakness determined by a composite measure of absolute and body size adjusted strength capacity provides robust prediction of time to mortality, thus potentially informing sports medicine and health practitioner discussions about the importance of muscle strength during aging.
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Affiliation(s)
- Ryan McGrath
- Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND, USA
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
- Fargo VA Healthcare System, Fargo, ND, USA
- Department of Geriatrics, University of North Dakota, Grand Forks, ND, USA
- Alliance for Research in Exercise, Nutrition, and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | | | - Donald Jurivich
- Department of Geriatrics, University of North Dakota, Grand Forks, ND, USA
| | - Peter Knutson
- Department of Geriatrics, University of North Dakota, Grand Forks, ND, USA
| | - Michaela Mastrud
- Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND, USA
| | - Ben Singh
- Alliance for Research in Exercise, Nutrition, and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Grant R. Tomkinson
- Alliance for Research in Exercise, Nutrition, and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Bridgwater H, Mertz T, Brassett C, Ashwood N. Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications. Clin Anat 2024; 37:425-439. [PMID: 38059329 DOI: 10.1002/ca.24129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
Three commonly used approaches to the forearm in orthopedic surgery are Henry's, Thompson's, and the ulnar approach, each of which has the potential to cause injury to nerves around the wrist. Preserving these nerves is important to prevent complications such as neuroma formation and motor and sensory changes to the hand. We conducted a review of the literature to assess the nerves at risk and whether 'safe zones' exist to avoid these nerves. An independent reviewer conducted searches in Embase and MEDLINE of the literature from 2010 to 2020. A total of 68 papers were identified, with 18 articles being included in the review. Multiple nerves were identified as being at risk for each of the approaches described. In the anterior approach, the palmar cutaneous branch of the median nerve (PCBMN) is most at risk of injury. An incision immediately radial to the flexor carpi radialis (FCR) or directly over the FCR is most likely to avoid injury to both superficial branch of the radial nerve (SBRN) and PCBMN. With Thompson's approach, the safest zone for an incision is directly over or slightly radial to Lister's tubercle to avoid injury to SBRN and lateral cutaneous nerve of the forearm. For the ulnar approach, a safe zone was shown to be on the ulnar side of the wrist around the ulnar styloid (US) when the forearm was in supination or a neutral position to avoid injury to the dorsal branch of the ulna nerve (DBUN). Care must be taken around the US due to the density of nerves and the proximity of the last motor branch of the posterior interosseous nerve to the ulnar head. This review highlighted the proximity of nerves to the three most common surgical incisions used to access the forearm. In addition, anatomical variations may exist, and each of the nerves identified as being at risk has multiple branches. Both factors increase the potential of intraoperative damage if the anatomy is not properly understood. The surgeon must adhere carefully to the established approaches to the wrist and distal forearm to minimize damage to nerves and optimize surgical outcomes for the patient.
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Affiliation(s)
- Hannah Bridgwater
- Department of Trauma and Orthopaedics, East and North Hertfordshire NHS Trust, Lister Hospital, Stevenage, UK
| | - Tamara Mertz
- Burns and Plastic Surgery Department, North Bristol NHS Trust, Bristol, UK
| | - Cecilia Brassett
- Human Anatomy Centre, Anatomy Building, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Neil Ashwood
- Research Institute, Wolverhampton University, Wulfruna St, Wolverhampton, UK
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Yin J, Yin W, Kairis E, Thomas S, Montoya M, Orebaugh S. Neurologic outcomes with peripheral nerve blockade in distal upper extremity nerve trauma: a retrospective study. Reg Anesth Pain Med 2023; 48:141-143. [PMID: 35944935 DOI: 10.1136/rapm-2022-103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/02/2022] [Indexed: 01/31/2023]
Affiliation(s)
- John Yin
- Department of Anesthesiology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Wu Yin
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Kairis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Shavin Thomas
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Mario Montoya
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Steven Orebaugh
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
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Hafez A, Omar I, Ang A, Aly M, Pouwels S, Smeenk F. Common preventable errors in hand surgery: Analysis of NHS never events data and a proposed safety checklist. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2023; 34:169-178. [PMID: 36710688 DOI: 10.3233/jrs-220030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hand surgical procedures are common interventions in elective and emergency settings. The complex nature of the injuries and management by multiple specialities could be a potential source of medical errors and never events (NEs). Awareness of the common NEs could potentially help prevent their occurrence in the future. OBJECTIVE To analyse the NHS England database to identify the common NEs in hand surgery and present a simple, practical safety checklist for hand surgery. METHODS The NHS NEs database from 2012 to 2021 has been analysed to identify the common hand surgery-related never events. We identified the common categories and themes within. Our theme development process is based on anatomical considerations and the nature of the incidents. Additionally, we designed a simple Safety Checklist for hand surgery. RESULTS We identified a total of 3742 never events with 50 incidents related to hand surgery, representing (1.3%). Wrong-site surgery was the commonest category (n = 30), representing 60% of the hand surgery-related NEs. We identified seven different themes under wrong-site surgery. Wrong finger or digit surgery was the commonest theme, with 17 reported incidents representing 57% of wrong-site surgeries. This is followed by five wrong digits injections and three wrong k wire placements representing 16.6% and 10%, respectively. The second most common category was wrong incisions (n = 15), representing 30%; 13 patients had wrong finger incisions. Two patients had carpal tunnel incisions before surgeons realised that the procedures were for trigger finger release. The third category included four wrong procedures, with two incidents of carpal tunnel release instead of trigger finger operation or Dequervain tendon release. Finally, one patient had an injection for carpal tunnel intended for another patient. CONCLUSION Hand surgery-related NEs represent a small fraction (1.3%) of all NEs within the NHS database. We identified 50 hand surgery-related NEs arranged into 14 different themes. Additionally, we proposed a hand surgery-specific safety checklist to reduce the incidence of these incidents in the future.
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Affiliation(s)
| | - Islam Omar
- Northern Health and Social Care Trust, Antrim, UK
| | | | | | | | - Frank Smeenk
- Catharina Hospital, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Peripheral Nerve Injury After Upper-Extremity Surgery Performed Under Regional Anesthesia: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:201-207. [PMID: 35880155 PMCID: PMC9308165 DOI: 10.1016/j.jhsg.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Peripheral nerve injury (PNI) is a known adverse event following upper-limb surgery performed under brachial plexus regional anesthesia (RA). When PNI is noted after surgery, patients and providers often have questions about which factors might have contributed to this complication. This systematic review evaluates the literature on hand and shoulder surgeries performed under ultrasound-guided, plexus RA to identify factors potentially associated with PNI, including the surgery location and block type. We hypothesized that shoulder surgery might be associated with an increased risk of PNI compared to hand surgery. Methods A systematic review of the relevant literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only prospective studies on the use of ultrasound-guided, preoperative, brachial plexus RA for hand or shoulder surgery on adult patients were included. Study groups were categorized according to surgery location and block type and compared across a number of factors via univariate and multivariate analyses. Results A total of 3,037 abstracts were screened; 192 full-text articles were independently reviewed by 2 of the authors; and 53 studies were included in the systematic review analysis. Following hand surgery, PNI was reported at an average rate of 1.35% ± 3.21% across 836 subjects in 40 study groups; after shoulder surgery, the average rate was 0.50% ± 1.57% across 3,383 subjects in 15 study groups. There was no statistically significant correlation between the incidence of PNI and surgery location (P =.70) or any of the most common approaches for brachial plexus anesthesia in the multivariate analysis. Conclusions This systematic review of over 50 articles on upper-limb surgery performed under RA shows no association between the incidence of PNI and the location of surgery or type of brachial plexus block. Type of study/level of evidence Diagnostic II.
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8
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Becciolini M, Pivec C, Raspanti A, Riegler G. Ultrasound of the Radial Nerve: A Pictorial Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2751-2771. [PMID: 33629784 DOI: 10.1002/jum.15664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 06/12/2023]
Abstract
This pictorial review focuses on the ultrasound (US) appearance of the normal and pathological radial nerve (RN) and its branches and provides tips with which to locate them and avoid misinterpretation of normal findings. A wide range of our pathological cases are reviewed and presented to help in familiarizing the reader with common and uncommon clinical scenarios that affect the RN and its main branches.
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Affiliation(s)
- Marco Becciolini
- Misericordia di Pistoia, Pistoia, Italy
- Scuola Siumb di Ecografia Muscolo-Scheletrica, Pisa, Italy
| | | | - Andrea Raspanti
- SOC Ortopedia e Traumatologia, Ospedale Santa Maria Annunziata, Azienda USL Toscana Centro, Florence, Italy
| | - Georg Riegler
- PUC - Private Ultrasound Center Graz, Lassnitzhoehe, Austria
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
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9
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Gonzalez M, Rahman A, Leucht P, Tejwani N. The demographics and outcomes in patients with bilateral distal radius fractures. Acta Orthop Belg 2021. [DOI: 10.52628/87.2.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although distal radius fractures are quite common, bilateral distal radius fractures seldomly occur. Due to this, treatment is primarily based on surgeon experience with unilateral fractures, however bi- lateral fractures add a level of complexity : loss of functional independence. The purpose of this study was to examine a cohort of patients with bilateral distal radius fractures to identify differences in demographics, mechanism of injury, and outcomes to further our understanding of these rare injuries. 23 patients were identified retrospectively over a 5-year period that met inclusion criteria. The medical records were reviewed with multiple demographic and clinical parameters recorded and analyzed. Males were more likely to sustain high-energy mechanisms (80% vs. 53%). Patients <50 years old were more likely to sustain high-energy mechanisms (90% vs. 46%) and were more likely to be treated operatively (80% vs. 62%). The most commonly associated injury was a head injury (30%). All patients treated non-operatively reported minimal/no pain upon final follow-up where 57% of patients treated operatively noted regular pain. 75% of patients with medical comorbidities had minimal/no pain upon final follow- up. Conclusions : Patients with bilateral fractures were more likely to be younger males who suffered from higher energy mechanisms. Age was a critical factor in determining treatment strategy. Rates of associated head injuries were elevated, which is an important factor for the clinician to keep in mind when treating this population. As we further our understanding of this unique population, we can improve our treatment approaches and subsequently attain better outcomes.
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10
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Sneag DB, Zochowski KC, Tan ET. MR Neurography of Peripheral Nerve Injury in the Presence of Orthopedic Hardware: Technical Considerations. Radiology 2021; 300:246-259. [PMID: 34184933 DOI: 10.1148/radiol.2021204039] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
As the frequency of orthopedic procedures performed each year in the United States continues to increase, evaluation of peripheral nerve injury (PNI) in the presence of pre-existing metallic hardware is in higher demand. Advances in metal artifact reduction techniques have substantially improved the capability to reduce the susceptibility effect at MRI, but few reports have documented the use of MR neurography in the evaluation of peripheral nerves in the presence of orthopedic hardware. This report delineates the challenges of MR neurography around metal given the high spatial resolution often required to adequately depict small peripheral nerves. It offers practical tips, including strategies for prescan assessment and protocol optimization, including use of more conventional two-dimensional proton density and T2-weighted fat-suppressed sequences and specialized three-dimensional techniques, such as reversed free-induction steady-state precession and multispectral imaging, which enable vascular suppression and metal artifact reduction, respectively. Finally, this article emphasizes the importance of real-time monitoring by radiologists to optimize the diagnostic yield of MR neurography in the presence of orthopedic hardware. © RSNA, 2021.
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Affiliation(s)
- Darryl B Sneag
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
| | - Kelly C Zochowski
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
| | - Ek T Tan
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, Room 2P-040, New York, NY 10021
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Sneag DB, Curlin J, Saltzman EB, Carlson MG, Lee SK. Role of high-resolution peripheral nerve magnetic resonance imaging in diagnosing median nerve tethering in a case of both-bone forearm fracture in a child. Pediatr Radiol 2021; 51:148-151. [PMID: 32621015 DOI: 10.1007/s00247-020-04732-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/07/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
Forearm fractures are common injuries in pediatric patients. We present a case of median nerve tethering as a complication of both-bone forearm fracture in a child, with an emphasis on MRI as an appropriate and important complement to clinical and electrodiagnostic examination. Early intervention is essential because delayed surgical management of median nerve tethering can result in poor clinical outcomes as a result of irreversible muscle denervation. In this case, we highlight the importance of MRI to facilitate management, including early surgical intervention when appropriate, in median neuropathy following forearm fractures.
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Affiliation(s)
- Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA.
| | - Jahnavi Curlin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA
| | | | - Michelle G Carlson
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Steve K Lee
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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12
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Malik AT, Khan SN, Goyal KS. Declining Trend in Medicare Physician Reimbursements for Hand Surgery From 2002 to 2018. J Hand Surg Am 2020; 45:1003-1011. [PMID: 33012614 DOI: 10.1016/j.jhsa.2020.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 06/23/2020] [Accepted: 08/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate trends in Medicare physician reimbursements for 20 common hand procedures/surgeries from 2002 to 2018. METHODS The Physician Fee Schedule Look-up Tool was used to retrieve average reimbursement rates for 20 common hand surgeries/procedures from 2002 to 2018. All reimbursement data were adjusted for inflation to 2018 dollars. RESULTS After adjusting all data for inflation, the average reimbursement for all included procedures decreased by 20.9% from 2002 to 2018, with a compound annual growth rate of -3.25%. Reimbursement percentage decreases were the greatest prior to 2010 (18.4% decrease), followed by a relative stabilization (0.94% increase) from 2010 to 2014, after which physicians experienced a decrease of 3.9% in reimbursements between 2014 and 2018, following implementation of the Medicare Access and Children's Health Insurance Program Reauthorization Act in 2015. The most significant decreases in reimbursements over time were noted for primary tendon/muscle repair (-49.6%), wrist arthroscopy for triangular fibrocartilage repair/debridement (-44.0%), trigger finger release in facility (-40.1%), excision of extensor tendon sheath (-38.2%), ganglion cyst excision (-36.7%), wrist arthroscopy for diagnostic/synovial biopsy (-35.7%), wrist arthroscopy for drainage/infection/lavage (-35.1%), wrist arthrodesis (-30.6%), endoscopic carpal tunnel release (-27.2%), total wrist arthroplasty (-26.6%), carpometacarpal/basal joint arthroplasty (-25.1%), and open carpal tunnel release (-22.3%). The only procedures with a significant increase in reimbursement over time were trigger finger release in office (+4.2%), open reduction internal fixation distal radius fracture (+2.5%), and cubital tunnel release (+1.5%). CONCLUSIONS After adjusting for inflation, Medicare physician reimbursements for a major proportion of hand surgical procedures have decreased over time. CLINICAL RELEVANCE Health-policy makers need to understand the impact of decreasing reimbursements to develop policies of reimbursements that will not only ensure provider satisfaction but also maintain access to care for patients.
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Affiliation(s)
- Azeem Tariq Malik
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Safdar N Khan
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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Vaghela KR, Velazquez-Pimentel D, Ahluwalia AK, Choraria A, Hunter A. Distal radius fractures: an evidence-based approach to assessment and management. Br J Hosp Med (Lond) 2020; 81:1-8. [PMID: 32589543 DOI: 10.12968/hmed.2020.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Distal radius fractures account for one in five bony injuries in both primary and secondary care. These are commonly the result of a fall on outstretched hands or high-energy trauma. On assessment, clinicians should determine the mechanism of injury, associated bony or soft tissue injuries, and neurovascular symptoms. Investigations should always include radiographs to evaluate for intra-articular involvement and fracture displacement. Owing to the heterogeneous injury patterns and patient profiles, the preferred management should consider the severity of the fracture, desired functional outcome and patient comorbidities. Non-operative management in select patients can give good results, especially in older adults. Immobilisation with or without reduction forms the mainstay of non-operative treatment. Surgical management options include closed reduction and application of a cast, percutaneous K-wires, open reduction and internal fixation with plates, or external fixation. Patients should be encouraged to mobilise as soon as it is safe to do so, to prevent stiffness. Median nerve compression is the most common complication followed by tendon rupture, arthrosis and malunion. This article outlines the British Orthopaedic Association Standards for Trauma and Orthopaedics for the management of distal radius fractures.
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Affiliation(s)
- Kalpesh R Vaghela
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Anika Choraria
- Department of Radiology, University College Hospital, London, UK
| | - Alistair Hunter
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
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14
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Evans A, Ibrahim M, Pope R, Mwangi J, Botros M, Johnson SP, Al Kassis S. Treating hand and foot osteoarthritis using a patient's own blood: A systematic review and meta-analysis of platelet-rich plasma. J Orthop 2020; 18:226-236. [PMID: 32071509 DOI: 10.1016/j.jor.2020.01.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 02/07/2023] Open
Abstract
Background This study summarizes all literature investigating platelet-rich plasma (PRP) in the treatment of osteoarthritis of the hands and feet. Materials & methods This is a PRISMA compliant systematic review of 7 databases and includes a meta-analysis of randomized controlled trial (RCT) data on pain and function. Results Nine articles were included in the review. Meta-analysis of 4 RCTs shows PRP significantly improves pain and function versus control. More results are significant at longer duration follow-up. Conclusions PRP improves pain and function of osteoarthritis. Heterogeneity and risk-of-bias limit current data, requiring more RCTs to determine any regenerative potential of PRP. Prospero Systematic Review Registration Number 136582.
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Affiliation(s)
- Adam Evans
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Maryo Ibrahim
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Rand Pope
- Vanderbilt University School of Medicine, 1161 21st Ave South, Nashville, TN, 37232, USA
| | - James Mwangi
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Mina Botros
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Shepard P Johnson
- Vanderbilt University Medical Center Department of Plastic Surgery, D-4207 Medical Center North, 1211 Medical Center Drive, Nashville, TN, 37212, USA
| | - Salam Al Kassis
- Vanderbilt University Medical Center Department of Plastic Surgery, D-4207 Medical Center North, 1211 Medical Center Drive, Nashville, TN, 37212, USA
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Sathish M, Hemanthakumar G, Muthalagan N. Wrist Arthrodesis in Rheumatoid Arthritis by Parallel K Wires and Ulna Autograft: A Case Report. JOURNAL OF ORTHOPEDICS AND JOINT SURGERY 2020. [DOI: 10.5005/jp-journals-10079-1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Case description
Nowadays, management of end-stage rheumatoid wrist remains controversial between fusion and arthroplasty. We present a simple method of rheumatoid wrist fusion in a 56-year-old woman, using parallel Kirschner (K) wires and local ulna graft. Wrist fusion was achieved at 8 weeks, while implants are removed a month later without any complications in the immediate or late postoperative period.
Conclusion
Management of end-stage rheumatoid wrist with parallel wires remains a simple, versatile, and reliable method to achieve wrist fusion without any complication due to hardware or the disease by itself.
How to cite this article
Hemanthakumar G, Sathish M, Muthalagan N. Wrist Arthrodesis in Rheumatoid Arthritis by Parallel K Wires and Ulna Autograft: A Case Report. J Orth Joint Surg 2020;2(1):38–40.
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