The occurrence of wrong-site surgery self-reported by candidates for certification by the American Board of Orthopaedic Surgery.

BACKGROUND: The concept of "Sign Your Site" was established in 1997 to prevent wrong-site surgery in the U.S., and this was expanded to the mandated Universal Protocol in 2008. However, the true incidence of wrong-site surgery in the U.S. is not known, nor do we know whether the incidence has changed. The American Board of Orthopaedic Surgery (ABOS) requires that candidates for Board certification provide a list of their cases, including surgical complications, whether wrong-site surgery was performed, and whether they complied with the "Sign Your Site" practice. Each candidate attests to the accuracy of his or her notarized case list. The purpose of this study was to report the incidence and nature of wrong-site surgery self-reported by orthopaedic surgeon candidates for certification between 1999 and 2010 and to assess whether any change was associated with the timeline of implementation of the Universal Protocol. METHODS: The ABOS database was queried for the number of examinees, cases, and wrong-site surgery cases reported; a description of each wrong-site surgery case; whether the site was signed; and the surgeon's subspecialty. RESULTS: From 1999 through 2010, 9255 orthopaedic surgeons submitted 1,291,396 cases, and sixty-one of these surgeons reported performing seventy-six wrong-site surgical procedures. Spine surgeons were the most likely to report wrong-site surgery, most commonly single-level lumbar laminotomy. The rate of wrong-site surgical procedures before and after implementation of the Universal Protocol mandate was not significantly different. Eighteen of the twenty wrong-site surgical procedures performed since ABOS data collection for "Sign Your Site" began had been signed preoperatively. CONCLUSIONS: Keeping patients safe remains an essential goal worthy of enormous effort. This study suggests that additional layers of precautions may yield diminishing returns and that attention should be focused on methods to prevent wrong-level spine surgery. Improving communication among the health-care team and shared responsibility may bring us closer to eliminating wrong-site surgery.

Bilateral exertional compartment syndrome of the forearm: evaluation and endoscopic treatment in an elite swimmer.

Exertional compartment syndromes are uncommon but can significantly impair athletic performance. This report describes an unusual case of bilateral forearm compartment syndromes in an elite-level swimmer that was able to be treated successfully using a novel endoscopic fasciotomy method.

Flexor tendon reconstruction.

Successful flexor tendon repair has narrowed the indications for flexor tendon grafting. Flexor tendon grafting is the preferred method of treatment for patients with neglected digital flexor tendon lacerations and after the failure of flexor tendon repair. Improvements in tendon repair methods and in aftercare methods have improved the outcomes after flexor tendon grafting. Future improvements in tissue engineering may also improve the results of flexor tendon repair.

Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36.

The construct validity of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was evaluated by examining its correlation to the Medical Outcomes Study Short Form-36 (SF-36). The study sample was 90 patients seen at the upper-extremity clinic of a university-based orthopedic practice. Patients were asked to complete a packet that included the DASH and SF-36 questionnaires. Pearson correlation coefficients of the DASH questionnaire to the SF-36 subscales ranged from -0.36 to -0.62. The DASH questionnaire had fewer ceiling and floor scores than most of the SF-36 subscales. These results support the DASH questionnaire as a valid measure of health status useful in patients with a wide variety of upper-extremity complaints.