Decreased Rate of Complications in Carpal Tunnel Release with Hand Fellowship Training.

PURPOSE: In many procedures, both high case volumes and fellowship training have been shown to improve outcomes. One of the most common procedures performed by hand surgeons, the carpal tunnel release (CTR) is also performed by several other specialties without specialty training in a hand fellowship. This study analyzed the effect that hand fellowship training has on outcomes of CTRs. MATERIALS AND METHODS: Using the American Board of Orthopedic Surgeons (ABOS) Part II candidates' case list submissions, a database was created for all open and endoscopic CTRs. Surgeon training, demographics, technique, and complications were recorded. Complications were then categorized and broken down by technique. Results were then analyzed for statistical significance. RESULTS: A total of 29,916 cases were identified. Hand fellowship-trained surgeons performed six times more CTRs at 31 cases per surgeon compared with five for non-hand fellowship-trained surgeons. They also improved outcomes in rates of infection, wound dehiscence, and overall complications. Rates of nerve injury or recurrence showed no statistical difference. This held true for the open release subset. Endoscopically, fellowship-trained surgeons had only improved rates of overall complications. CONCLUSION: Surgeons undergoing additional hand fellowship training may show improved outcomes in the surgical treatment of carpal tunnel syndrome. However, no effect was seen on nerve injury or recurrence of symptoms.

Relationship between Smoking and Outcomes after Cubital Tunnel Release.

PURPOSE: Several studies have drawn a connection between cigarette smoking and cubital tunnel syndrome. One comparison article demonstrated worse outcomes in smokers treated with transmuscular transposition of the ulnar nerve. However, very little is known about the effect that smoking might have on patients who undergo ulnar nerve decompression at the elbow. The purpose of this study is to evaluate the effect of smoking preoperatively on outcomes in patients treated with ulnar nerve decompression. MATERIALS AND METHODS: This study used a survey developed from the comparison article with additional questions based on outcome measures from supportive literature. Postoperative improvement was probed, including sensation, strength, and pain scores. A thorough smoking history was obtained. The study spanned a 10-year period. RESULTS: A total of 1,366 surveys were mailed to former patients, and 247 surveys with adequate information were returned. No significant difference was seen in demographics or comorbidities. Patients who smoked preoperatively were found to more likely relate symptoms of pain. Postoperatively, nonsmoking patients generally reported more favorable improvement, though these findings were not statistically significant. CONCLUSION: This study finds no statistically significant effect of smoking on outcomes after ulnar nerve decompression. Finally, among smokers, there were no differences in outcomes between simple decompression and transposition.