Social Media Posts About Carpal Tunnel Release: A Cross-Sectional Analysis of Patient and Surgeon Perspectives.

BACKGROUND: Social media provides an increasingly popular, unfiltered source of perspectives on healthcare. The objective of this study is to characterize the landscape of social media posts regarding carpal tunnel release (CTR). METHODS: Content was queried from Instagram between February 2, 2019 to August 12, 2021 using the hashtags #carpaltunnelrelease and #carpaltunnelsurgery. The 1500 most-liked posts were analyzed. Poster demographics including age, gender, region, and symptom qualities and post characteristics including type, number, timing relative to surgery, tone, and satisfaction were collected. Categorical variables were compared utilizing chi-squared test. Univariate and multivariate regression were performed. RESULTS: The most popular post types included single photo (55.2%), multiple photos (18.8%), or single video (18.2%). Of all, 70.6% posts had fewer than 50 "likes." Patients accounted for 51.8% of posts, followed by surgeons (13.3%), other health care providers (11.7%), and physical therapists (8.8%). Women (66.7%) outnumbered men (33.3%). Fifty-five percent of posts were domestic. Posts mostly depicted postoperative care (85.6%). The most frequently mentioned symptoms were pain, burning, numbness, and tingling. Of all posts, 45.1% had a positive tone, 49.1% neutral, and 5.7% negative. Univariate analysis revealed that posters who were patients, underwent open CTR, and were female were more likely to post negative sentiments. CONCLUSIONS: Most posts regarding CTR are from patients, are postoperative, and are positive or neutral. Although rare, negative posts were more likely to originate from posters who are patients, female, or underwent open CTR. With this information, surgeons will be better prepared to address patient concerns, set patient expectations, and enter the social media themselves.

Social Media Posts About Distal Radius Fracture: A Cross-Sectional Analysis of Patient and Provider Perspectives.

BACKGROUND: Social media offers a popular, unfiltered source of patient and provider perspectives on health care. This study investigated the characteristics of social media posts referencing distal radius fracture (DRF). METHODS: Content was queried from Instagram from February 06, 2019, to December 08, 2021, using the hashtags "#distalradiusfracture" and "#wristfracture." The 1500 most-liked posts were analyzed. Poster demographics including age, gender, region, laterality, and treatment type and post characteristics including post type, number, content, timing relative to treatment, tone, and satisfaction were examined. Variables were compared using χ2 tests. Univariate, multivariate, and stepwise regression were performed. RESULTS: The most popular post formats were single photo (44.5%), multiple photos (32.3%), and single video (13.9%). Patients (40.3%) were the most common poster followed by surgeons (33.4%). Men (48.7%) and women (51.3) were evenly represented. Of the total posts, 87.7% depicted the post-treatment phase of care; 54.8% of posts depicted operative management, while 26.6% depicted non-operative management; and 73.7% of posts were positive in tone, 18.7% neutral, and 7.6% negative. Univariate analysis demonstrated that posters who were patients, friends/family of patients, female, and posts with >100 "likes" were more likely to share negative tones. Multivariate and stepwise regression were consistent with the above. CONCLUSION: Most posts regarding DRF originate from patients, are post-treatment, and are positive. Negative tone is associated with posts from patients, family/friends of patients, female posters, and posts with >100 likes. With this information, surgeons will be better prepared to address patient concerns, manage expectations, and actively participate in social media themselves.

Characterizing Leadership Trends in Hand Surgery Fellowship Programs.

Purpose: The purpose of this study was to characterize academic and demographic factors most associated with fellowship director (FD) roles in hand surgery programs. A secondary aim was to characterize educational and employment trends. The final aim was to compare these findings with those in other orthopedic subspecialties. Methods: Domestic programs were identified using the American Society for Surgery of the Hand fellowship directory. Data were collected via internet searches of publicly available information and direct contact with programs. Variables included demographic characteristics (age, sex, and race/ethnicity), education and employment history, Hirsch index (H-index) research productivity, and membership of select hand surgery societies. Results: Information about 86 FDs was collected from a total of 88 identified hand surgery fellowships. Seventy-six (88.4%) FDs were men, whereas 10 (11.6%) were women. The mean age was 53.3 years. Most FDs (n = 68, 79.1%) completed their residency in orthopedic surgery. The average Scopus H-index was 16.3. Most FDs were White (n = 64, 74%) followed by Asian (n = 14, 16%). The mean duration from fellowship completion to FD appointment was 12.6 years, whereas the mean duration of employment at an institution before FD appointment was 17.9 years. The mean duration of tenure as an FD was 9.8 years. Twenty-eight (32.94%) individuals served as an FD at their residency institution and 20 (23.5%) led at their fellowship institution. The most frequently attended residency institution by FDs was University of Pennsylvania, whereas Mayo Clinic was the most frequently attended fellowship program. Six FDs have served as the presidents of a hand surgery society. Conclusions: Fellowship directors are largely White and men. They are distinguished by their research productivity. A few select programs contribute an outsized proportion of individuals to FD positions. This may be due to a pipeline effect or because applicants with ambition to become FDs pursue specific programs for training. Clinical relevance: This study characterizes the academic/demographic factors of hand surgery FDs.

Determining the Impact of the COVID-19 Pandemic on Hand Surgery Fellowship Education.

The purpose of this study is to report the impact of COVID-19 on hand surgery fellow learning and preparedness for practice. A multi-dimensional questionnaire was distributed to current hand fellows and fellowship directors across the United States. Survey questions included fellowship location, institutional response, impact on practice, education and job search. Thirty-two hand surgery fellows and 14 fellowship directors completed the survey. Of fellows, 59% reported a greater than 75% decrease in case volume. Mean hours worked per week per fellow decreased by 52%. All fellowship directors and 94% of fellows did not expect COVID-19 to impact their ability to graduate, and nearly all fellows felt prepared to start practice after fellowship training. However, many fellows expressed concern about job opportunities. The work hours and exposure of hand surgery fellows to elective surgical cases have been adversely impacted by COVID-19. Nevertheless, current hand fellows feel prepared to enter practice. (Journal of Surgical Orthopaedic Advances 31(1):048-052, 2022).

Risk Factors for Prolonged Opioid Use After Open Treatment of Distal Radius Fractures.

BACKGROUND: The objective of this study was to evaluate factors associated with postoperative opioid use after open treatment of distal radius fractures. METHODS: The Humana insurance claims database was queried for open treatment of distal radius fractures by Current Procedural Terminology codes. The search was further refined to identify patients who filled an opioid prescription within 6 weeks after their surgery. The study's outcomes were: (1) limited postoperative opioid use, defined as filling a prescription once in the 6-week to 6-month period after surgery; and (2) persistent postoperative opioid use, defined as filling a prescription more than once in the 6-week to 6-month period after surgery. Logistic regression models were performed to identify factors associated with limited and persistent postoperative opioid use. Subgroup analyses were performed among opioid-naïve patients and those with open fractures. RESULTS: This study identified 9141 of 19 220 total patients with limited and persistent opioid use. Significant risk factors included nonhome discharge, inpatient surgical setting, long-term pain, tobacco abuse, and age less than 65 years. Of note, both preoperative opioid use within 1 month before surgery (odds ratio [OR], 2.6; 95% confidence interval [CI], 2.2-2.9) and preoperative opioid use between 1 and 6 months before surgery (OR, 4.0; 95% CI, 3.7-4.4) were significantly associated with persistent postoperative opioid use. CONCLUSIONS: This study has identified numerous risk factors associated with postoperative opioid use after open treatment of distal radius fractures. Understanding these risk factors is the first step toward reducing postoperative opioid use.

Equity and achievement in access to contraceptives in East Africa between 2000 and 2010.

OBJECTIVE: To examine trends in equity in contraceptive use, and in contraceptive-prevalence rates in six East African countries. METHODS: In this repeated cross-sectional study, Demographic and Health Surveys Program data from women aged 15-49 years in Ethiopia, Kenya, Malawi, Rwanda, Tanzania, and Uganda between 2000 and 2010 were analyzed. Individuals were ranked according to wealth quintile, stratified urban/rural populations, and calculated concentration index-a statistic integrating information from all wealth quintiles to analyze disparities. RESULTS: Equity and contraceptive-prevalence rates increased in most country regions over the study period. Notably, in rural Rwanda, contraceptive-prevalence rates increased from 3.9 to 44.0, and urban Kenya became the most equitable country region, with a concentration index of 0.02. The Pearson correlation coefficient between improvements in concentration index and contraceptive-prevalence rates was 0.52 (P=0.011). CONCLUSION: The results indicate that countries seeking to increase contraceptive use should prioritize equity in access to services and contraceptives.

PERFLUOROCARBON LIQUIDS' ABILITY TO PROTECT THE MACULA FROM INTRAOCULAR DROPPING OF METALLIC FOREIGN BODIES: A Model Eye Study.

PURPOSE: To examine the utility of perfluoro-n-octane (PFO) in balanced salt solution (BSS) to shield the macula from the impact of dropped metallic intraocular foreign bodies (IOFBs) by modeling scenarios in which they may fall during surgical removal. METHODS: Model eyes were filled with various fluid mixtures (Group 1: 10% PFO/90% BSS; Group 2: 100% BSS; Group 3: 100% PFO; Group 4: 10% PFO/90% air; Group 5: 10% BSS/90% air). In Groups 1, 4, and 5, the 10% fluid volume covered the theoretical macula. For each fluid mixture, up to 30 IOFB drop scenarios were performed for each of the 5 sample IOFBs from 3 locations. Trajectories were recorded using a camera attached to a Zeiss operating microscope (Carl Zeiss, Jena, Germany). The percentages of IOFBs impacting the macula were calculated and Fisher exact test was used to assess differences. RESULTS: In Group 1, 93% (417/450) of the dropped IOFBs were deflected by the PFO-BSS interface compared with 0% (0/500) in Groups 2, 3, 4, and 5 (P < 0.01). With the exception of the heaviest IOFB (24.4 mg), which impacted the macula in 30% of tests when dropped from the superior posterior segment (P < 0.01), all other IOFBs (2.8-13.4 mg) were deflected by the PFO-BSS interface in 100% of Group 1 drops (P < 0.01). CONCLUSION: As demonstrated by these simulations, the PFO-BSS interface can deflect IOFBs dropped during surgery in a wide range of scenarios, especially when the IOFB is of lower mass.

RETINAL VASCULAR PERFUSION DENSITY MAPPING USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN NORMALS AND DIABETIC RETINOPATHY PATIENTS.

PURPOSE: To describe a new method of retinal vascular perfusion density mapping using optical coherence tomography angiography and to compare current staging of diabetic retinopathy based on clinical features with a new grading scale based on perifoveal perfusion densities. METHODS: A retrospective review was performed on subjects with diabetic retinopathy and age-matched controls imaged with a spectral domain optical coherence tomography system (Optovue XR Avanti, Fremont, CA). Split-spectrum amplitude-decorrelation angiography (SSADA) generated optical coherence tomography angiograms of the superficial retinal capillaries, deep retinal capillaries, and choriocapillaris. Skeletonized optical coherence tomography angiograms were used to create color-coded perfusion maps and capillary perfusion density values for each image. Capillary perfusion density values were compared with clinical staging, and groups were compared using analysis of variance and Kruskal-Wallis analyses. RESULTS: Twenty-one control and 56 diabetic retinopathy eyes were imaged. Diabetic eyes were grouped according to clinical stage. Capillary perfusion density values from each microvascular layer were compared across all groups. Capillary perfusion density values were significantly lower in nearly all layers of all study groups compared with controls. Trend analysis showed a significant decrease in capillary perfusion density values as retinopathy progresses for most layers. CONCLUSION: Quantitative retinal vascular perfusion density mapping agreed closely with grading based on clinical features and may offer an objective method for monitoring disease progression in diabetic retinopathy.

Fracture dislocation of the finger joints.

Fracture dislocations of the hand are difficult and often unforgiving injuries. Keys to treatment include early recognition, stable concentric reduction, and protected early active range of motion maintaining joint stability. The balance between stability and mobility is difficult to manage; therefore, surgeons need a wide array of treatments to tailor management to the specific fracture pattern. With appropriate treatment, residual stiffness and pain can be minimized. This Current Concepts review aims to provide up-to-date management for proximal interphalangeal, distal interphalangeal, and metacarpophalangeal joint fracture dislocations.

Definitive plates overlapping provisional external fixator pin sites: is the infection risk increased?

OBJECTIVES: The purpose of this study was to compare the infection risk when internal fixation plates either overlap or did not overlap previous external fixator pin sites in patients with bicondylar tibial plateau fractures and pilon fractures treated with a 2-staged protocol of acute spanning external fixation and later definitive internal fixation. DESIGN: Retrospective comparison study. SETTING: Two level I trauma centers. PATIENTS/PARTICIPANTS: A total of 85 OTA 41C bicondylar tibial plateau fractures and 97 OTA 43C pilon fractures treated between 2005 and 2010. Radiographs were evaluated to determine the positions of definitive plates in relation to external fixator pin sites and patients were grouped into an "overlapping" group and a "nonoverlapping" group. INTERVENTION: Fifty patients had overlapping pin sites and 132 did not. MAIN OUTCOME MEASURE: Presence of a deep wound infection. RESULTS: Overall, 25 patients developed a deep wound infection. Of the 50 patients in the "overlapping" group, 12 (24%) developed a deep infection compared with 13 (10%) of the 132 patients in the "nonoverlapping" group (P = 0.033). CONCLUSIONS: Placement of definitive plate fixation overlapping previous external fixator pin sites significantly increases the risk of deep infection in the 2-staged treatment of bicondylar tibial plateau and pilon fractures. Surgeons must make a conscious effort to place external fixator pins outside of future definitive fixation sites to reduce the overall incidence of deep wound infections. Additionally, consideration must be given to the relative benefit of a spanning external fixator in light of the potential for infection associated with their use. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome.

PURPOSE: To prospectively analyze, using validated outcome measures, symptom improvement in patients with mild to moderate cubital tunnel syndrome treated with rigid night splinting and activity modifications. METHODS: Nineteen patients (25 extremities) were enrolled prospectively between August 2009 and January 2011 following a diagnosis of idiopathic cubital tunnel syndrome. Patients were treated with activity modifications as well as a 3-month course of rigid night splinting maintaining 45° of elbow flexion. Treatment failure was defined as progression to operative management. Outcome measures included patient-reported splinting compliance as well as the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the Short Form-12. Follow-up included a standardized physical examination. Subgroup analysis included an examination of the association between splinting success and ulnar nerve hypermobility. RESULTS: Twenty-four of 25 extremities were available at mean follow-up of 2 years (range, 15-32 mo). Twenty-one of 24 (88%) extremities were successfully treated without surgery. We observed a high compliance rate with the splinting protocol during the 3-month treatment period. Quick Disabilities of the Arm, Shoulder, and Hand scores improved significantly from 29 to 11, Short Form-12 physical component summary score improved significantly from 45 to 54, and Short Form-12 mental component summary score improved significantly from 54 to 62. Average grip strength increased significantly from 32 kg to 35 kg, and ulnar nerve provocative testing resolved in 82% of patients available for follow-up examination. CONCLUSIONS: Rigid night splinting when combined with activity modification appears to be a successful, well-tolerated, and durable treatment modality in the management of cubital tunnel syndrome. We recommend that patients presenting with mild to moderate symptoms consider initial treatment with activity modification and rigid night splinting for 3 months based on a high likelihood of avoiding surgical intervention. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis.

Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the two most common patterns of posttraumatic wrist arthritis. This review discusses the etiology and clinical evaluation, as well as up-to-date treatment options, for both of these conditions. Classic as well as newer innovative techniques are discussed with clinical outcomes in order to provide an evidence-based review of the world's literature on SLAC/SNAC wrist.

The influence of insurance status on access to and utilization of a tertiary hand surgery referral center.

BACKGROUND: The purpose of this study was to systematically examine the impact of insurance status on access to and utilization of elective specialty hand surgical care. We hypothesized that patients with Medicaid insurance or those without insurance would have greater difficulty accessing care both in obtaining local surgical care and in reaching a tertiary center for appointments. METHODS: This retrospective cohort study included all new patients with orthopaedic hand problems (n = 3988) at a tertiary center in a twelve-month period. Patient insurance status was categorized and clinical complexity was quantified on an ordinal scale. The relationships of insurance status, clinical complexity, and distance traveled to appointments were quantified by means of statistical analysis. An assessment of barriers to accessing care stratified with regard to insurance status was completed through a survey of primary care physicians and an analysis of both patient arrival rates and operative rates at our tertiary center. RESULTS: Increasing clinical complexity significantly correlated (p < 0.001) with increasing driving distance to the appointment. Patients with Medicaid insurance were significantly less likely (p < 0.001) to present with problems of simple clinical complexity than patients with Medicare and those with private insurance. Primary care physicians reported that 62% of local surgeons accepted patients with Medicaid insurance and 100% of local surgeons accepted patients with private insurance. Forty-four percent of these primary care physicians reported that, if patients who were underinsured (i.e., patients with Medicaid insurance or no insurance) had been refused by community surgeons, they were unable to drive to our tertiary center because of limited personal resources. Patients with Medicaid insurance (26%) were significantly more likely (p < 0.001) to fail to arrive for appointments than patients with private insurance (11%), with no-show rates increasing with the greater distance required to reach the tertiary center. CONCLUSIONS: Economically disadvantaged patients face barriers to accessing specialty surgical care. Among patients with Medicaid coverage or no insurance, local surgical care is less likely to be offered and yet personal resources may limit a patient's ability to reach distant centers for non-emergency care.

Amrubicin: a synthetic anthracyclin analogue in the treatment of extensive stage small cell lung cancer.

Amrubicin is a synthetic anthracyclin analogue that has significant activity in Japanese patients with extensive stage small cell lung cancer (ES-SCLC). There has not been significant advances made in the treatment of this disease in last several years and new therapies are desperately needed to change the natural history of this disease. Preliminary data has shown that amrubicin possesses anti-tumor activity in patients with extensive stage small cell lung cancer in the western population. Clinical trials are on going to evaluate this agent further in Europe and U.S. If effective, it may be an invaluable addition into the current armamentarium to treat this deadly disease. The review includes patent coverage on the treatment of small cell lung cancer.

Protein disulfide-isomerase mediates delivery of nitric oxide redox derivatives into platelets.

S-nitrosothiol compounds are important mediators of NO signalling and can give rise to various redox derivatives of NO: nitrosonium cation (NO+), nitroxyl anion (NO-) and NO* radical. Several enzymes and transporters have been implicated in the intracellular delivery of NO from S-nitrosothiols. In the present study we have investigated the role of GPx (glutathione peroxidase), the L-AT (L-amino acid transporter) system and PDI (protein disulfide-isomerase) in the delivery of NO redox derivatives into human platelets. Washed human platelets were treated with inhibitors of GPx, L-AT and PDI prior to exposure to donors of NO redox derivatives (S-nitrosoglutathione, Angeli's salt and diethylamine NONOate). Rapid delivery of NO-related signalling into platelets was monitored by cGMP accumulation and DAF-FM (4-amino-5-methylamino-2'7'-difluorofluorescein) fluorescence. All NO redox donors produced both a cGMP response and DAF-FM fluorescence in target platelets. NO delivery was blocked by inhibition of PDI in a dose-dependent manner. In contrast, inhibition of GPx and L-AT had only a minimal effect on NO-related signalling.PDI activity is therefore required for the rapid delivery into platelets of NO-related signals from donors of all NO redox derivatives. GPx and the L-AT system appeared to be unimportant in rapid NO signalling by the compounds used in the present study. This does not, however, exclude a possible role during exposure of cells to other S-nitrosothiol compounds, such as S-nitrosocysteine. These results further highlight the importance of PDI in mediating the action of a wide range of NO-related signals.

Brain: the common site of relapse in patients with pancoast or superior sulcus tumors.

PURPOSE: We conducted a retrospective analysis to determine the occurrence of brain metastasis with superior sulcus tumors. METHODS AND MATERIALS: We reviewed 685 charts of patients treated for upper lobe lung cancer between 1997 and 2003. Twenty-nine out of 685 patients (4%) had a diagnosis of Pancoast or superior sulcus tumor. The histology includes 11 patients with adenocarcinoma, seven with non-small cell lung cancer (NSCLC), six with squamous cell carcinoma, four with large cell carcinoma, and one with anaplastic carcinoma. Regarding stage at presentation: seven patients had stage IIB, two had stage IIIA, 16 had stage IIIB, and four had stage IV. RESULTS: The median follow-up is 14 months (range 6-70 months). The total occurrence of brain metastasis is seven out of 29 patients (24%). Two patients (stage IV) had brain metastasis at the time of presentation and five patients (stage IIB-III) developed brain metastasis at a median time of 10 months after the diagnosis. Stage associated with brain metastasis after diagnosis is two patients for stage IIB, two for stage IIIA, and one for stage IIIB. For the 25 patients with stage IIB to stage III disease, nine (36%) developed distant metastasis after definitive therapy. Out of these nine patients, five (55%) developed brain metastasis. It was the most common site of distant failure. Histology for seven patients with brain metastasis was four of seven with adenocarcinoma, two of seven with squamous cell carcinoma, and one of seven with NSCLC. CONCLUSION: Brain metatasis may be relatively common at diagnosis. The brain is the frequent site of failure for superior sulcus tumors. We recommend careful surveillance for brain metastasis during and after the therapy. We also recommend obtaining brain imaging prior to surgery in patients receiving induction therapy for the primary tumor.