A Cadaver Investigation of Screw Purchase With 2 Retrograde Techniques for Capitolunate Arthrodesis.

PURPOSE: To examine the hypothesis that the amount of bone purchase within the lunate is greater when using a technique for intermetacarpal retrograde screw placement across the capitolunate joint than when using a dorsal capitate technique. METHODS: Seven fresh cadaver limbs were dissected. We exposed the carpus and scaphoidectomy and performed selective capitolunate decortication. We compared the technique of dorsal capitate placement of headless compression screws with intermetacarpal placement by measuring the depth of purchase in the lunate. RESULTS: Drill hole depths in the lunate were greater using the intermetacarpal technique versus the dorsal capitate technique; the average depth was 9.0 and 6.4 mm, respectively. The calculated number of threads was also greater with the intermetacarpal technique than with the dorsal capitate technique (15 vs 9 threads, respectively). CONCLUSIONS: The intermetacarpal technique for retrograde headless compression screw placement in a capitolunate arthrodesis provided a greater depth of purchase in the lunate portion of the construct. It also afforded more ease of placement than previously described antegrade techniques without the risk of hardware migration into the radiocarpal joint. CLINICAL RELEVANCE: The knowledge gained from this study may help guide surgeons to choose a technique for retrograde placement of headless compression screws in capitolunate arthrodesis to gain better purchase within the lunate.

Constructing post-surgical discharge instructions through a Delphi consensus methodology.

OBJECTIVE: Patient education materials are a crucial part of physician-patient communication. We hypothesize that available discharge instructions are difficult to read and fail to address necessary topics. Our objective is to evaluate readability and content of surgical discharge instructions using thyroidectomy to develop standardized discharge materials. METHODS: Thyroidectomy discharge materials were analyzed for readability and assessed for content. Fifteen endocrine surgeons participated in a modified Delphi consensus panel to select necessary topics. Using readability best practices, we created standardized discharge instructions which included all selected topics. RESULTS: The panel evaluated 40 topics, selected 23, deemed 4 inappropriate, consolidated 5, and did not reach consensus on 8 topics after 4 rounds. The evaluated instructions' reading levels ranged from grade 6.5 to 13.2; none contained all consensus topics. CONCLUSION: Current post surgical thyroidectomy discharge instructions are more difficult to read than recommended by literacy standards and omit consensus warning signs of major complications. Our easy-to-read discharge instructions cover pertinent topics and may enhance patient education. Delphi methodology is useful for developing post-surgical instructions. PRACTICE IMPLICATIONS: Patient education materials need appropriate readability levels and content. We recommend the Delphi method to select content using consensus expert opinion whenever higher level data is lacking.