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Claessen FMAP, Stoop N, Doornberg JN, Guitton TG, van den Bekerom MPJ, Ring D, Chauhan A, Wahegaonkar A, Shafritz A, Garcia G A, Miller A, Barquet A, Kristan A, Apard T, Armstrong A, Berner A, Jubel A, Kreis B, Babis C, Sutker B, Sears B, Nolan B, Crist B, Cross B, Wills B, Barreto C, Ekholm C, Swigart C, Oliveira Miranda C, Manke C, Zalavras C, Goldfarb C, Cassidy C, Walsh C, Jones C, Garnavos C, Young C, Moreno-Serrano C, Lomita C, Klostermann C, van Deurzen D, Rikli D, Polatsch D, Beingessner D, Drosdowech D, Eygendaal D, Patel M, Brilej D, Walbeehm E, Ballas E, Ibrahim E, Melamed E, Stojkovska Pemovska E, Hofmeister E, Hammerberg E, Kaplan F, Suarez F, Fernandes C, Lopez-Gonzalez F, Walter F, Frihagen F, Kraan G, Kontakis G, Dyer G, Kohut G, Panagopoulos G, Hernandez G, Porcellini G, Bayne G, Merrell G, DeSilva G, Della Rocca G, Bamberger H, Broekhuyse H, Durchholz H, Kodde I, McGraw I, Harris I, Pountos I, Wiater J, Choueka J, Kazanjian J, Gillespie J, Biert J, Fanuele J, Johnson J, Greenberg J, Abrams J, Hall J, Fischer J, Scheer J, Itamura J, Capo J, Braman J, Rubio J, Ortiz J, Filho J, Nolla J, Abboud J, Conflitti J, Abzug J, Patiño J, Rodríguez Roiz J, Adams J, Bishop J, Kabir K, Chivers K, Prommersberger K, Egol K, Rumball K, Dickson K, Jeray K, Poelhekke L, Campinhos L, Mica L, Borris L, Adolfsson L, Schulte L, Elmans L, Lane L, Paz L, Taitsman L, Guenter L, Austin L, Waseem M, Palmer M, Abdel-Ghany M, Richard M, Rizzo M, Pirpiris M, Di Micoli M, Bonczar M, Loebenberg M, Richardson M, Mormino M, Menon M, Soong M, Wood M, Meylaerts S, Darowish M, Nancollas M, Prayson M, Grafe M, Kessler M, Kaminaris M, Pirela-Cruz M, Mckee M, Merchant M, Tyllianakis M, Shafi M, Powell A, Shortt N, Felipe N, Parnes N, Bijlani N, Elias N, Akabudike N, Rossiter N, Lasanianos N, Kanakaris N, Brink O, van Eerten P, Paladini P, Martineau P, Appleton P, Levin P, Althausen P, Evans P, Jebson P, Krause P, Schandelmaier P, Peters A, Dantuluri P, Blazar P, Andreas P, Inna P, Quell M, Ramli R, de Bedout R, Ranade A, Ashish S, Smith R, Babst R, Omid R, Buckley R, Jenkinson R, Gilbert R, Page R, Papandrea R, Zura R, Gray R, Wagenmakers R, Pesantez R, van Riet R, Calfee R, van Helden S, Bouaicha S, Kakar S, Kaplan S, Scott F, Kaar S, Mitchell S, Rowinski S, Dodds S, Kennedy S, Beldner S, Schepers T, Guitton T, Gosens T, Baxamusa T, Taleb C, Tosounidis T, Wyrick T, Begue T, DeCoster T, Dienstknecht T, Varecka T, Mittlmeier T, Fischer T, Chesser T, Omara T, Bafus T, Siff T, Havlicek T, Sabesan V, Nikolaou V, Philippe V, Giordano V, Vochteloo A, Batson W, Hammert W, Satora W, Weil Y, Ruch D, Marsh L, Swiontkowski M, Hurwit S. Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation. J Hand Surg Am 2016; 41:e337-e341. [PMID: 27522299 DOI: 10.1016/j.jhsa.2016.07.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/17/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. METHODS A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. RESULTS The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. CONCLUSIONS When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Femke M A P Claessen
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Nicky Stoop
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Job N Doornberg
- Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands
| | - Thierry G Guitton
- Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands
| | | | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
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Poublon AR, Kraan G, Lau SP, Kerver ALA, Kleinrensink GJ. Anatomical study of the dorsal cutaneous branch of the ulnar nerve (DCBUN) and its clinical relevance in TFCC repair. J Plast Reconstr Aesthet Surg 2016; 69:983-7. [PMID: 26997325 DOI: 10.1016/j.bjps.2016.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
Abstract
The aim of this study was to define a detailed description of the dorsal cutaneous branch of the ulnar nerve (DCBUN) in particular in relevance to triangular fibrocartilage complex (TFCC) repairs. In 20 formalin-embalmed arms, the DCBUN was dissected, and the course in each arm was mapped and categorized. Furthermore, the point of origin of the DCBUN, that is, from the ulnar nerve in association with the ulnar styloid process, was defined. Finally, the distance between the ulnar styloid process and the branching of the radial-ulnar communicating branch (RUCB) and the first branch of DCBUN was measured. The distance between the origin of the DCBUN in relation to the ulnar styloid process ranges from 55 to 111 mm (mean 87 mm; STD 14 mm). The distance between the ulnar styloid process and the RUCB ranges from 1 to 54 mm (mean 19 mm; STD 12 mm). Finally, the distance between the ulnar styloid process and the lateral distal branch shows a range of -6 to 28 mm (mean 10 mm; STD 9 mm). In general, three dorsal digital nerves (medial, intermediate, and lateral branch), run at the dorsal ulnar aspect of the hand. The RUCB is often less abundant and shows a large amount of variation. No complete safe zone could be identified; the course of the DCBUN suggests a longitudinal incision for the 6R portal. In fact, a more dorsal incision also prevents damage to the main branches of the DCBUN.
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Affiliation(s)
- A R Poublon
- Dept of Neuroscience and Anatomy, Erasmus MC, Dr Molenwaterplein, Rotterdam, Zuid-Holland, The Netherlands.
| | - G Kraan
- Dept of Orthopaedics, Reinier de Graaf Gasthuis, Reinier de Graafweg, Delft, Zuid-Holland, The Netherlands
| | - S P Lau
- Dept of Neuroscience and Anatomy, Erasmus MC, Dr Molenwaterplein, Rotterdam, Zuid-Holland, The Netherlands
| | - A L A Kerver
- Dept of Plastic Surgery, Catharina Ziekenhuis, Michelangelolaan, Eindhoven, Noord-Braband, The Netherlands
| | - G-J Kleinrensink
- Dept of Neuroscience and Anatomy, Erasmus MC, Dr Molenwaterplein, Rotterdam, Zuid-Holland, The Netherlands
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Döring ACD, Hageman MGJS, Mulder FJ, Guitton TG, Ring D, Akabudike NM, Bainbridge L, Balfour GW, Bamberger H, Barreto CJR, Baskies M, Baxamusa T, Behrman M, Benhaim P, Blazar P, Boler JM, Boretto JG, Boyer M, Calfee RP, Cassidy C, Costanzo RM, Darowish M, de Bedout R, Desilva G, Di Giovanni JF, Dodds S, Erickson JM, Luis Felipe NE, Fernandes C, Fricker RM, Frykman GK, Garcia AE, Gaston RG, Gilbert RS, Grafe MW, Greenberg JA, Grunwald H, Guidera P, Hammert WC, Hauck R, Helgemo S, Hernandez GR, Hofmeister E, Hutchison RL, Ilyas A, Jacoby SM, Jebson P, Jones CM, Kakar S, Kaplan FTD, Kaplan S, Katolik L, Kennedy SA, Kessler MW, Kimball HL, Kirkpatrick DK, Klinefelter R, Kraan G, Lane LB, Lattanza L, Lee K, Malone KJ, Manke C, Martineau PA, Matiko J, McAuliffe J, McCabe SJ, McKee DM, Metzger C, Mitchell S, Wolf JM, Nancollas M, Nelson DL, Nolla J, Nyszkiewicz R, Ortiz JA, Overbeck JP, Owens PW, Papandrea R, Paz L, Castillo AP, Polatsch D, Press GM, Richard MJ, Rizzo M, Rozental TD, Ruchelsman D, Semenkin OM, Shatford R, Sierra FJA, Siff T, Spath C, Spruijt S, Sutker B, Swigart C, Taras J, Tavakolian JD, Terrono AL, Tolo ET, Walsh CJ, Walter FL, Watkins B, Weiss L, Wills BP, Wilson C, Wilson CJ, Wint J, Young C. Trigger finger: assessment of surgeon and patient preferences and priorities for decision making. J Hand Surg Am 2014; 39:2208-13.e2. [PMID: 25283491 DOI: 10.1016/j.jhsa.2014.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/03/2014] [Accepted: 08/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons. METHODS One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. RESULTS Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids. CONCLUSIONS Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TF-differences that might be addressed by a decision aid. CLINICAL RELEVANCE Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.
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Affiliation(s)
- Anne-Carolin D Döring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Michiel G J S Hageman
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Frans J Mulder
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Thierry G Guitton
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA.
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Hageman MGJS, Kinaci A, Ju K, Guitton TG, Mudgal CS, Ring D, Adams J, Arbelaez GF, Aspard T, Balfour GW, Bamberger HB, Barreto RJC, Baskies M, Batson WA, Baxamusa T, de Bedout R, Beldner S, Benhaim P, Benson L, Boretto GJ, Boyer M, Dee Byrd G, Calfee RP, Zambrano GC, Cassidy C, Catalano L, Chivers K, Costanzo RM, Dantuluri P, DeSilva G, Dodds S, Evans JP, Felipe NEL, Fernandes C, Fischer TJ, Fischer J, Fricker MR, Frykman GK, Garcia AE, Gaston RG, Di Giovanni JF, Goldfarb CA, Grafe MW, Grunwald H, Hammert WC, Hauck R, Hernandez RG, Hofmeister E, Hutchison RL, Ilyas A, Isaacs J, Jacoby SM, Jebson P, Jones CM, Jones M, Kakar S, Kalainov DM, Kaplan TD, Kaplan S, Katolik L, Kennedy SA, Kessler MW, Kimball HL, Kraan G, Martineau PA, McAuliffe J, McCabe SJ, McKee DM, Merrell G, Metzger C, Nancollas M, Nelson DL, Nyszkiewicz R, Ortiz JA, Owens PW, Palmer JM, Paz L, Pess G, Polatsch D, Raia FJ, Richard MJ, Rizzo M, Rozental, Ruchelsman D, Semenkin OM, Sierra AJF, Siff T, Sodha S, Spath C, Spruijt S, Stackhouse TF, Swigart C, Szabo R, Taras J, Tavakolian J, Terrono A, Varecka TF, Wahegaonkar AL, Walsh CJ, Walter FL, Weiss L, Wills BP, Wilson C, Wilson C, Wolf JM, Wood M, Young C. Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making. J Hand Surg Am 2014; 39:1799-1804.e1. [PMID: 25087865 DOI: 10.1016/j.jhsa.2014.05.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). METHODS One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. RESULTS Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. CONCLUSIONS There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. CLINICAL RELEVANCE Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.
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Affiliation(s)
| | - Ahmet Kinaci
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Ju
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Thierry G Guitton
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Chaitanya S Mudgal
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, Massachusetts
| | - David Ring
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, Massachusetts.
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