Arthrex Mini Tightrope Fixation for Chronic Distal Radioulnar Joint Instability.

Chronic distal radioulnar joint (DRUJ) instability is a complex clinical condition that is difficult to treat. Currently, there is no gold standard treatment. We present a novel technique using Arthrex Mini Tightrope for DRUJ stabilization. In this case series, a 1.6 mm K-wire was passed transversely through the distal ulna and radius. The Mini Tightrope was inserted into the end of the K-wire and pulled through the bone tunnels. Appropriate tension was achieved to stabilize the joint according to individual laxity comparable to the contralateral side. Five patients (3 males and 2 females) comprised this pilot series, with a mean age of 27.1 years. All sustained a traumatic injury at an average of 12.4 months before surgery (range: 5 to 32 mo). In addition, 3 patients had central triangular fibrocartilage complex tears treated with arthroscopy at the time of Mini Tightrope placement. While one patient was lost to follow-up after 7 weeks postoperative due to incarceration, 4 patients demonstrated coronal and sagittal stability in the context of DRUJ motion and a satisfactory range of motion. The mean time for the return to work for the two patients who were laborers or normal activity postoperatively was 5.2 weeks (range: 1 to 16.4 wk). Unrestricted activity was generally allowed 8 weeks postoperatively but varied by patient. The same 4 patients underwent hardware removal at an average of 31 weeks (range: 15 to 44 wk). Although this is only a pilot series, this suggests that temporary Mini Tightrope stabilization of the DRUJ may be a viable solution while upholding the benefits of minimally invasive surgery.

Relation of satisfaction score with payer class in dermatology patients.

As value-based reimbursement continues to grow as a means of compensation in the US healthcare system, ensuring effective evaluation of patient care is becoming increasingly important. The aim of this study was to systematically collect and review data to identify potential patient bias based on a nonmodifiable patient characteristic, payer type, in patient satisfaction scores from an academic dermatology clinic setting. This retrospective study used Press Ganey self-reported, deidentified patient satisfaction surveys completed at Texas Tech University Health Sciences Center's outpatient dermatology clinic between January 1, 2010, and December 21, 2021, with a total of 21,408 surveys included in the study. The results found the self-pay/uncompensated group reported the highest mean satisfaction score (96.25%), followed by other government (94.76%), Medicare (94.34%), commercial (92.82%), workers' comp (88.10%), and Medicaid (82.78%). Analysis of variance resulted in an F value of 3.02 (P < 0.01). This study confirmed the results of existing research suggesting that payer class significantly impacts patient experience scores.

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets.

As the epidemic of gunshot injuries and firearm fatalities continues to proliferate in the United States, knowledge regarding gunshot wound (GSW) injury and management is increasingly relevant to health-care providers. Unfortunately, existing guidelines are largely outdated, written in a time that high-velocity weapons and deforming bullets were chiefly restricted to military use. Advances in firearm technology and increased accessibility of military grade firearms to civilians has exacerbated the nature of domestic GSW injury and complicated clinical decision-making, as these weapons are associated with increased tissue damage and often result in retained bullets. Currently, there is a lack of literature addressing recent advances in the field of projectile-related trauma, specifically injuries with retained bullets. This review aims to aggregate the available yet dispersed findings regarding ballistics, GSW etiology, and treatment, particularly for cases involving retained projectiles.

Orthopaedic surgery residency match trends during COVID-19 pandemic: a cross-sectional study.

Orthopaedic surgery is one of the more competitive specialties for medical students to pursue. Students often complete subinternship rotations to demonstrate skill, work ethic, and fit within a program. Away rotations were suspended during the COVID-19 pandemic. Methods: This investigation compared home and regional match rates before the pandemic to the match cycle of 2020-2021. Results: There was a statistically significant increase in students matching to their home program, and insignificant increase in regional matches. Conclusions: This increase is likely due in part to the familiarity of students to programs where they could still rotate during the pandemic. Level of Evidence: Level IV.

Association between Payer-Class and Patient Satisfaction Scores in an Academic Urology Outpatient Clinic.

INTRODUCTION: As physician reimbursement models transition from fee-for-service to value-based purchasing, patient satisfaction is becoming an important payment modifier. Studies have shown correlation between nonmodifiable patient attributes and satisfaction scores. This study aims to investigate potential patient bias in survey scores associated with payer type in an academic urology outpatient clinic setting. METHODS: The survey results of 20,944 patients seen in an academic urology clinic were analyzed, and the weighted mean±SD scores of patient experience in 6 major payer categories were compared: 1) commercial insurance, 2) Medicare, 3) Medicaid, 4) other government plans, 5) workers' comp and 6) self-pay/uncompensated. ANOVA and Tukey-Kramer Honestly Significant Difference were utilized to assess statistical significance. RESULTS: Medicare patients reported the highest satisfaction scores (93.03), followed by other government coverage (91.49), commercial insurance (91.32), workers' comp (90.72), Medicaid (89.21) and self-pay/uncompensated (89.00). ANOVA analysis resulted in an F value of 40.198 (p <0.001). Tukey-Kramer demonstrated statistical significance in the difference between the means of the following groups: commercial vs Medicaid (p <0.001), commercial vs Medicare (p <0.001), commercial vs self-pay/uncompensated (p <0.01), other government vs Medicaid (p <0.001), other government vs Medicare (p <0.01), Medicaid vs Medicare (p <0.001), Medicare vs self-pay/uncompensated (p <0.001). CONCLUSIONS: Our data suggest that patient experience scores are impacted by the type of coverage the patient carries and not only by the quality of care provided. Urology clinicians should be aware of these nuances when selecting MIPS quality reporting metrics. Currently, these biased scores may have an impact on physicians' reimbursement, and policymakers should consider adjusting reimbursement according to payer-mix.

Potential Bias of Patient Payer Category on CG-CAHPS Scores and Its Impact on Physician Reimbursement.

INTRODUCTION: Patient satisfaction scores play an ever increasing role in physician reimbursement. Positive scores contribute to a physician earning up to 9% reimbursement bonuses, while negative scores may contribute up to 9% reduction in reimbursement. This method of reimbursement modification is already standard within the Centers for Medicare and Medicaid Services and is quickly catching on with commercial payers. We suspect patient satisfaction scores will eventually influence reimbursement for all payers. Incentivizing patient satisfaction calls into question whether patient-specific variables exist that inherently impact survey scores without any physician input. METHODS: This review specifically assesses the effect insurance status has on CG-CAHPS® scores since the survey was first implemented in 2007. Peer-reviewed articles that met inclusion criteria were graded on a scale of 0-3 according to significance of patient bias observed. RESULTS: Commercial insurance and Medicare are associated with higher patient satisfaction survey scores, while Medicaid and Workers' Compensation are associated with lower scores. CONCLUSIONS: Because most physicians have no control over the type of insurance that covers their patients, we recommend augmenting reimbursement models to account for payer mix.