Bicolumnar intercarpal arthrodesis: minimum 2-year follow-up.

PURPOSE: To determine greater than 2-year outcomes for combined lunate-capitate and triquetrum-hamate arthrodeses. METHODS: We identified 16 patients who underwent scaphoid excision and combined arthrodeses of the lunate-capitate and triquetrum-hamate joints (bicolumnar arthrodesis) from 2007 to 2010. Eleven patients returned for follow-up evaluation, which included measurement of operative and contralateral control wrist flexion, extension, and grip strength, and completion of a patient-reported outcomes questionnaire, visual analog scale pain assessment, and Disabilities of the Arm, Shoulder, and Hand questionnaire. Radiographs of each patient were reviewed for evidence of union. Complications including nonunion and hardware migration were recorded. RESULTS: Wrist flexion-extension in the operative wrist was 68% of the contralateral control wrist. Grip strength of the operative wrist was 97% of the contralateral wrist. All 11 patients had radiographic bicolumnar union; 8 patients had spontaneous radiographic fusion of the capitohamate joint. One patient required capitolunate screw removal for migration despite having evidence of union. CONCLUSIONS: Results from scaphoid excision and bicolumnar intercarpal arthrodesis are comparable to those reported for traditional scaphoid excision and 4-corner arthrodesis, with a similar loss of wrist range of motion and with possible preservation of better grip strength in the operative wrist. Advantages of this modification include preservation of the normal lunate-triquetrum and capitate-hamate anatomic relationships and simplification of operative technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The influence of patient insurance status on access to outpatient orthopedic care for flexor tendon lacerations.

PURPOSE: To determine the effect of patient insurance status on access to outpatient orthopedic care for acute flexor tendon lacerations. METHODS: The research team contacted 100 randomly chosen orthopedic surgery practices in North Carolina by phone on 2 different occasions separated by 3 weeks. The research team attempted to obtain an appointment for a fictitious 28-year-old man with an acute flexor tendon laceration. Insurance status was presented as Medicaid in 1 call and private insurance in the other call. Ability of an office to schedule an appointment was recorded. RESULTS: Of the 100 practices, 13 were excluded because they did not perform hand surgery, which left 87 practices. The patient in the scenario with Medicaid was offered an appointment significantly less often (67%) than the patient in the scenario with private insurance (82%). The odds of the patient with private insurance obtaining an appointment were 2.2 times greater than the odds of the Medicaid patient obtaining an appointment. The Medicaid patient was more likely not to be offered an appointment owing to the lack of a hand surgeon at a practice (28% of appointment denials) than privately insured patients (13% of appointment denials). CONCLUSIONS: For patients with acute flexor tendon lacerations, insurance status has an important role in the ability to obtain an orthopedic clinic appointment. We found that patients with Medicaid have more barriers to accessing care for a flexor tendon laceration than patients with private insurance. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

To Flip or Not to Flip: Learning Style Preferences among Millennial Physician Assistant Students.

INTRODUCTION: Presenting material in a manner that is most palatable to students is important to improve the learning process. We evaluated the efficacy of different teaching styles including the flipped classroom and assessed the learning style preferences of a cohort of medical learners in a preclinical obstetrics and gynecology course. METHODS: We conducted three teaching sessions with 35 physician assistant students. A different teaching style was implemented for each session including a traditional lecture with interactive learning technology augmentation, a flipped classroom, and a hybrid approach incorporating lecture and group work. Students were surveyed using a Likert scale regarding the efficacy of the format, clinical relevance of the material, and their learning preference for future sessions. RESULTS: Students rated the traditional approach as the most effective, most relevant, and most preferred method. Students preferred the flipped classroom least, but they rated it as slightly more effective and relevant than the hybrid approach. CONCLUSION: The teaching style of various coursework including the preclinical obstetrics and gynecology curriculum may not need to be altered for millennial learners. This study showed the flipped classroom was the least favored teaching style and that there was a marked preference by students for a more traditional didactic lecture.