Adherence to Complication Reporting for Randomized Controlled Trials Contained in Clinical Practice Guidelines for the Management of Carpal Tunnel Syndrome.

Purpose: Randomized controlled trials (RCTs) are frequently used in creating recommendations contained within clinical practice guidelines (CPGs). However, investigations outside of hand surgery have reported that RCTs within CPGs infrequently report complications and harms-related data. Our purpose was to assess adherence to complication reporting and harms-related outcomes contained in the Consolidated Standards for Reporting (CONSORT) Extension of Harms and Standards for Reporting of Diagnostic Accuracy Studies (STARD) reporting checklists for RCTs within the American Academy of Orthopaedic Surgery (AAOS) CPGs for carpal tunnel syndrome (CTS). Methods: We identified all RCTs within the AAOS CTS CPGs. All therapeutic RCTs and diagnostic studies were included. We used the CONSORT Harms Checklist criteria to assess adherence to the reporting of adverse events for therapeutic RCTs and the STARD criteria to assess the diagnostic accuracy of the articles. We defined adequate compliance as adherence to ≥50% of the checklist items. Results: We identified 82 therapeutic RCTs and 90 diagnostic accuracy articles within the AAOS CTS CPG. For therapeutic RCTs, we found that the average compliance with the published checklists was 19%. For diagnostic studies, the average compliance with checklists was found to be 55%. Eleven therapeutic RCTs (13%) and 60 diagnostic studies (67%) were determined to have adequate compliance for the CONSORT and STARD checklists, respectively. Conclusions: Randomized controlled trials in the AAOS CPGs for CTS have low compliance with the CONSORT Extension for Harms Checklist. Although the overall adherence to the items published in the STARD statement for diagnostic accuracy evaluation remains higher, future efforts should be made to improve the adherence rates to both checklists. Clinical relevance: Improved standardization of complication reporting may aid in comparing outcomes across multiple clinical investigations of upper-extremity procedures.

An Analysis of Formal Patient Complaints, Risk, and Malpractice Events Involving Orthopedic Trauma Surgeons During a 10-Year Period.

Formal patient complaints and malpractice events involving orthopedic trauma surgeons (OTSs) can have substantial career implications. Our purpose was to analyze formal patient complaints, risk events, and malpractice events against OTSs during a 10-year period. We reviewed all formal patient complaints within our institution's patient advocacy database involving 9 fellowship-trained OTSs throughout a decade. Complaints were categorized using the Patient Complaint Analysis System. Potential risk and malpractice events involving the OTSs were recorded. A control group of all patients seen by the surgeons during the study period was created. Demographics between patients with complaints and the control group were analyzed, as were malpractice, risk, and complaint rates between the surgeons. Of 33,770 patients, 136 filed a formal complaint (0.40%). There were 29 malpractice claims and 2 malpractice lawsuits. The care and treatment domain accounted for the highest percentage of complaints (36%), followed by the access and availability domain (26%). Results of the logistic regression analysis indicated that private insurance (odds ratio, 1.58) and operative treatment (odds ratio, 3.65) were significantly associated with complaints. Despite statistically significant differences in the rates of complaint and risk events between surgeons, malpractice events did not differ. The rate of patient complaints within a large orthopedic trauma practice during a 10-year period was 0.40%. Patients with private insurance and those treated operatively were more likely to file a complaint. Whereas complaint rates among surgeons varied, there was no significant difference in the rate of malpractice events. Understanding patient complaint rates and categorizations may allow surgeons to target areas for improvement. [Orthopedics. 2023;46(2):121-127.].

Intraoperative Conversion From Endoscopic to Open Carpal Tunnel Release: A Systematic Review and Case Series.

PURPOSE: The purpose of this study was to assess the incidence, outcomes, and complications associated with conversion from endoscopic carpal tunnel release (ECTR) to open carpal tunnel release (OCTR). METHODS: A retrospective case review of all patients who underwent ECTR over 4 years by 2 fellowship-trained hand surgeons at a single academic center was performed. We recorded outcomes and the reason for conversion in patients who underwent conversion to an OCTR. Baseline demographics and surgical complications were compared between the 2 groups. A systematic review was performed to define the incidence and reasons for conversion from ECTR to OCTR. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included clinical studies of ECTR from 2000 to 2021. RESULTS: In the retrospective series, 9 of 892 (1.02%) ECTR cases underwent conversion to an OCTR at the time of the index procedure. One of 9 converted cases had transient neurapraxia involving the recurrent motor branch after surgery compared with 0 cases in the group that underwent ECTR without conversion. Improvements in the visual analog scale for pain and QuickDASH were noted at a mean of 46 weeks after surgery in the group that underwent conversion to OCTR. The systematic review identified an incidence of conversion of 0.62%. The most common reasons for conversion to OCTR in the case series and systematic review were poor visualization due to hypertrophic tenosynovium and aberrant nerve anatomy. CONCLUSIONS: The overall incidence of intraoperative conversion from ECTR to OCTR during the index procedure was 1.02%, with the most common reasons for conversion being poor visualization due to hypertrophic tenosynovium and aberrant nerve anatomy. Patients who undergo conversion from ECTR to OCTR demonstrate improvements in pain and disability, similar to patients who undergo ECTR without conversion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Trends in the Management of Fifth Metacarpal Neck Fractures.

PURPOSE: To describe management trends of fifth metacarpal neck (5MCN) fractures within a large health care system. We aimed to define patient and surgeon factors associated with nonsurgical versus surgical treatment, as well as to identify factors associated with receiving care only in the emergency department (ED). METHODS: We identified all 5MCN fractures within our system for the years 2012-2020 and recorded baseline demographics for cases. Injury, treatment, and fracture characteristics were all recorded. For fractures treated nonsurgically, we determined the type of immobilization used (if any) and recorded whether patients were seen only in the ED or received subsequent outpatient follow-up. Demographic comparisons were made between groups, and adjusted logistic regression models were generated to predict the odds of having a surgical 5MCN fracture or being seen in the ED only. RESULTS: There were 611 5MCN fractures over an 8-year period, of which 10% were treated surgically. During the first half of the study period, 8% of isolated cases were treated surgically compared with 7% of cases in the second half. Soft dressings were increasingly used. There were no nonsurgically managed cases that underwent subsequent surgical procedures for symptomatic nonunion or malunion. Twenty-one percent of patients were seen only in the ED. Fracture angulation, associated injuries, insurance status, and treatment by a hand surgeon were all significantly associated with an increased likelihood of surgery. CONCLUSIONS: Of the 611 5MCN fractures identified, 90% were treated nonsurgically. Patient and surgeon factors were associated with increased odds of surgery. Of patients who sought care for 5MCN injuries, >20% received no follow-up care outside of the ED. These data can be used to assess future changes in management trends and suggest that nonunion and symptomatic malunions are uncommon occurrences. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

The Effect of Salary Compensation for Time Spent Teaching in an Orthopaedic Residency Program: An Analysis of Teaching Performance Reviews.

INTRODUCTION: Although there has been a recent emphasis on standardized resident assessments within Accrediation Council for Graduate Medical Education programs, assessments of faculty teaching performance and effectiveness are less frequent. Our purpose was to compare the teaching performance of orthopaedic surgery faculty receiving compensation for time spent teaching with faculty without compensation. METHODS: For this prospective investigation, we collected anonymous resident reviews of 23 orthopaedic faculty within a rural, academic orthopaedic residency program over 2 academic years. Performance reviews of the faculty used a validated assessment of clinical teaching effectiveness with nine domains (faculty knowledge, organization, enthusiasm, rapport, involvement in learning experiences, feedback, clinical skill, accessibility, and overall effectiveness). A composite teaching effectiveness score was determined by adding each of the scores from the individual domains. We compared reviews for faculty members with and without compensation for time spent teaching. RESULTS: A total of 202 performance reviews for 23 orthopaedic faculty were analyzed. Most of the faculty were male (91%), and 61% received compensation for teaching. No demographic differences were observed between the two faculty groups. Notable differences between the groups were noted in three domains: enthusiasm, ability to establish rapport as well as direction, and feedback. Faculty compensated for teaching demonstrated a markedly higher composite teaching effectiveness score than those without compensation. DISCUSSION: These data suggest that orthopaedic faculty compensated for teaching responsibilities provide a better educational experience for resident trainees compared with faculty without compensation for teaching. Future studies should aim to assess varying compensation models for teaching responsibilities across different departments.

Analysis of the Most Frequently Cited Articles in Hand and Wrist Surgery: A Modern Reading List.

The aim of this investigation was to analyze the 50 most frequently cited articles on hand and wrist surgery of all time and those published during the 21st century. We aimed to evaluate the article, author, and journal characteristics for these publications in order to create a modern reading list of impactful upper-extremity articles. A search of the Journal Citation Reports 2022 edition to identify journals containing possible hand or wrist-related articles was performed. Related journals were identified and then searched on the Web of Science database to identify hand and wrist articles. The top 50 most cited articles overall and the top 50 most cited articles from 2000-2021 were identified and indexed. Several bibliometric parameters, such as study type, study topic, study design, level of evidence, citation count, citation density, the institution of the lead author, the gender of lead and senior authors, and country were analyzed. For the most cited articles of all time, the number of citations ranged from 224 to 1109 with a mean of 368 citations and 15.0 citation density. Citations for the top 50 articles from 2000-2021 ranged from 153 to 950 with a mean of 233 citations and 14.5 citation density. For both groups, the most common level of evidence was level IV (33% and 27%). No correlation between journal impact factor and citation count or citation density was found. In both groups, "fracture" was the most common topic and papers were predominantly written by male authors. Frequently cited publications on hand and wrist surgery are often clinical papers that contain low levels of evidence and tend to focus on topics related to fracture care. Female authors remain underrepresented.