Study Characteristics and Impact of the "Best Papers" Presented at ASSH Annual Meetings Over the Past Decade.

Purpose: Each year, the American Society for Surgery of the Hand (ASSH) selects several abstracts for podium presentations during a "Best Papers" session. We examined these papers to better understand their characteristics and impact on the field of hand surgery. Methods: "Best Papers" from the 2010 to 2020 ASSH Annual Meetings were reviewed. Online databases were searched to find matching publications. Descriptive data were collected from the publications. The Hirsch index value for each corresponding author and the number of citations for each publication were recorded. Descriptive statistics were used to analyze the data. Results: Fifty-nine "Best Papers" were awarded during the study period. Forty-nine (83%) were clinical and 10 were basic science studies. A total of 39 observational studies, 11 human trials, 8 experimental studies, and 1 case series were present. Fifty-four (91.5%) were published at the time of our review. Twenty-six of those (48%) were multicenter studies, and the remaining 28 were from a single institution. The average time from presentation to publication was 16 months. The top three journals of publication were the Journal of Hand Surgery (33%), the Journal of Bone and Joint Surgery (9%), and the Journal of Hand Surgery, European (7%). The median level of evidence for all "Best Papers" was 3, with a trend toward a higher level of evidence during the study period. The average h-index value of all corresponding authors was 27.3. The average number of citations per publication was 37. Conclusions: The ASSH "Best Papers" were primarily clinical studies with an increasingly strong level of evidence and were likely led by an author with a history of research productivity. Selection as a "Best Paper" at ASSH Annual Meetings is a strong predictor of future publication and impact. Clinical relevance: This study evaluates the "value" of the best paper designation at the ASSH annual meeting.

Short-term Functional Outcomes and Complications of Custom Patellofemoral Arthroplasty.

Background: Patellofemoral arthroplasty (PFA) is a treatment option for isolated patellofemoral arthritis. Custom PFA is an innovative procedure utilizing patient-specific instrumentation. The purpose of this study is to evaluate short-term functional outcomes and complications of the custom PFA in treatment of isolated patellofemoral arthritis. Methods: A retrospective study was conducted to analyze patients who received a PFA operation from a single surgeon. Inclusion criteria were surgical patients from 2012 to 2018 who underwent PFA using a custom prosthesis implant. Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) and Lower Extremity Functional Scale (LEFS) were collected before and after surgery. Results: A total of 79 patients (94 knees) participated in the study; 55 (69.6%) were women. The median age was 57 at the time of index arthroplasty; 15 patients (30 knees) were bilateral. Follow-up rate was 94%. Median follow-up duration was 3.6 years (2-8.9). Overall prefunctional and postfunctional scores differed significantly for both KOOS, JR and LEFS. Postoperative scores increased for KOOS, JR by 27.5 points, and for LEFS, they increased 26.0 points; P < .001 for both. Complications included 6 reoperations (6.7%) related to PFA: 4 conversions (4.4%) to total knee arthroplasty at a median of 2.5 (1.5-3) years after the index procedure, one vastus medialis oblique advancement (1.1%) secondary to patellar maltracking, and one manipulation under anesthesia (1.1%). Conclusions: Custom PFA in patients with isolated patellofemoral arthritis showed good short-term functional outcomes and low revision rates with very few complications.

Snapping Wrist From Bowstringing of the Digital Flexors After Carpal Tunnel Release: A Case Report.

Symptomatic bowstringing of digital flexor tendons is a rare complication of carpal tunnel release (CTR). Two weeks after open CTR, a 47-year-old man with severe carpal tunnel syndrome had relief of his preoperative median paresthesia but complained of new-onset painful snapping of the wrist and transient ulnar paresthesia occurring with wrist dorsiflexion and concomitant digital flexion. Physical examination localized the audible snapping to the hook of hamate (HOH) where manual pressure eliminated the wrist motion-induced snapping and the associated ulnar paresthesia. Wrist radiographs showed stage III scapholunate advanced collapse (SLAC) with marked palmar subluxation of the lunate. Wrist magnetic resonance imaging revealed palmar and ulnar subluxation of the digital flexors over the HOH due to the mass effect of the palmarly displaced lunate and the chronic carpal malalignment. The snapping wrist and accompanying ulnar paresthesia resolved after HOH excision, and no additional treatment for the asymptomatic SLAC wrist deformity was required. Satisfactory clinical outcome was observed at 5-year follow-up.

Clinical Rotation Handbook Promotes Orthopaedic Resident Wellness: A Quality Improvement Study.

Introduction: Transitioning from one clinical rotation to the next may be particularly stressful for orthopaedic residents attempting to navigate new work environments with new faculty mentors and new patients. The purpose of this quality improvement (QI) project was to determine if resident stress could be improved by using a handbook to disseminate key rotation-specific data during quarterly rotation transition periods. Methods: A comprehensive electronic handbook was created by residents to describe each rotation in our orthopaedic training program in terms of: (1) faculty and staff contact data, (2) daily clinic and surgery schedules, (3) resident responsibilities and faculty expectations, and (4) key resources and documents. At rotation transition, a session in the academic schedule was dedicated for outgoing residents to update the handbook and to sign-out to incoming residents. Pre- and post-handbook questionnaires were administered to assess resident perceptions of stress or anxiety, preparedness, and confidence before commencing the new rotation. Nonparametric data derived from the surveys were analyzed using the sign test choosing p < 0.05 for a two-tailed test as the level of statistical significance. Results: Most residents perceived improvements in stress/anxiety, preparedness, and confidence understanding rotation expectations after the handbook was implemented. Changes in these three outcome parameters were statistically significant. Conclusions: This rotation transition QI initiative consisting of a resident-authored, rotation-specific electronic handbook and dedicated verbal sign-out session enhanced resident wellness by decreasing stress, increasing preparedness, and improving confidence among residents starting a new rotation. Similar online resources may be useful for trainees in other specialties.

Local inhibition of uptake2 transporters augments stress-induced increases in serotonin in the rat central amygdala.

Organic cation transporter 3 (OCT3) is a corticosterone-sensitive, low-affinity, high-capacity transporter. This transporter functions, in part, to clear monoamines, including serotonin (5-HT), from the extracellular space. The central nucleus of the amygdala (CeA) is an important structure controlling fear- and anxiety-related behaviors. The CeA has reciprocal connections with brainstem nuclei containing monoaminergic systems, including serotonergic systems arising from the dorsal raphe nucleus, which are thought to play an important role in modulation of CeA-mediated behavioral responses. Organic cation transporter 3 (OCT3) is expressed in the CeA, but little is known about the role of OCT3 within the CeA in modulating serotonergic signaling. We hypothesized that inhibition of OCT3-mediated transport in the CeA during restraint stress would increase extracellular 5-HT. In Experiment 1, rats received unilateral reverse dialysis of either corticosterone or normetanephrine, which interfere with OCT3-mediated transport, into the CeA under home cage control conditions. In Experiment 2, rats received unilateral reverse dialysis of corticosterone, normetanephrine, or vehicle into the CeA, while undergoing a 40-min period of restraint stress. Infusion of these drugs had no effect on extracellular concentrations of 5-HT during home cage control conditions, but, in contrast, markedly increased extracellular concentrations of 5-HT during restraint stress, relative to vehicle-treated controls. These findings suggest a role for OCT3 in the CeA in control of serotonergic signaling during stressful conditions.

A Novel Closed-Head Model of Mild Traumatic Brain Injury Using Focal Primary Overpressure Blast to the Cranium in Mice.

Mild traumatic brain injury (TBI) from focal head impact is the most common form of TBI in humans. Animal models, however, typically use direct impact to the exposed dura or skull, or blast to the entire head. We present a detailed characterization of a novel overpressure blast system to create focal closed-head mild TBI in mice. A high-pressure air pulse limited to a 7.5 mm diameter area on the left side of the head overlying the forebrain is delivered to anesthetized mice. The mouse eyes and ears are shielded, and its head and body are cushioned to minimize movement. This approach creates mild TBI by a pressure wave that acts on the brain, with minimal accompanying head acceleration-deceleration. A single 20-psi blast yields no functional deficits or brain injury, while a single 25-40 psi blast yields only slight motor deficits and brain damage. By contrast, a single 50-60 psi blast produces significant visual, motor, and neuropsychiatric impairments and axonal damage and microglial activation in major fiber tracts, but no contusive brain injury. This model thus reproduces the widespread axonal injury and functional impairments characteristic of closed-head mild TBI, without the complications of systemic or ocular blast effects or head acceleration that typically occur in other blast or impact models of closed-skull mild TBI. Accordingly, our model provides a simple way to examine the biomechanics, pathophysiology, and functional deficits that result from TBI and can serve as a reliable platform for testing therapies that reduce brain pathology and deficits.

Motor, visual and emotional deficits in mice after closed-head mild traumatic brain injury are alleviated by the novel CB2 inverse agonist SMM-189.

We have developed a focal blast model of closed-head mild traumatic brain injury (TBI) in mice. As true for individuals that have experienced mild TBI, mice subjected to 50-60 psi blast show motor, visual and emotional deficits, diffuse axonal injury and microglial activation, but no overt neuron loss. Because microglial activation can worsen brain damage after a concussive event and because microglia can be modulated by their cannabinoid type 2 receptors (CB2), we evaluated the effectiveness of the novel CB2 receptor inverse agonist SMM-189 in altering microglial activation and mitigating deficits after mild TBI. In vitro analysis indicated that SMM-189 converted human microglia from the pro-inflammatory M1 phenotype to the pro-healing M2 phenotype. Studies in mice showed that daily administration of SMM-189 for two weeks beginning shortly after blast greatly reduced the motor, visual, and emotional deficits otherwise evident after 50-60 psi blasts, and prevented brain injury that may contribute to these deficits. Our results suggest that treatment with the CB2 inverse agonist SMM-189 after a mild TBI event can reduce its adverse consequences by beneficially modulating microglial activation. These findings recommend further evaluation of CB2 inverse agonists as a novel therapeutic approach for treating mild TBI.