Journal of Hand Surgery Global Online最新文献

{"title":"Scaphoid Fractures and Nonunion: A Survey-based Review of Hand Surgeon’s Practice and the Evidence","authors":"Jason A. Strelzow MD ,&nbsp;W. Kelsey Snapp MD ,&nbsp;Aviram M. Giladi MD, MS ,&nbsp;Robert Wysocki MD ,&nbsp;Charles C. Jehle MD","doi":"10.1016/j.jhsg.2024.06.013","DOIUrl":"10.1016/j.jhsg.2024.06.013","url":null,"abstract":"<div><h3>Purpose</h3><div>The Evidence-Based Practice Committee of the American Society for Surgery of the Hand set out to assess the membership’s practice patterns (PPs) and familiarity with evidence-based principles for scaphoid fracture and nonunion management.</div></div><div><h3>Methods</h3><div>Using a consensus-generated 25-item online survey, all the American Society for Surgery of the Hand members were invited to participate via email in September 2023. Two question types were used including evidence-based practice (EBP) and PPs. The survey was divided into the following subtopics: minimally displaced scaphoid fracture, operative options for scaphoid fixation, and treatment of scaphoid nonunion.</div></div><div><h3>Results</h3><div>Of 9 EBP questions, only one was answered with the preferred response by &gt;80% of surgeons. The remaining seven EBP questions had greater frequencies of less preferred responses. These questions concerned the current evidence for initial imaging options, optimal nonsurgical immobilization, percutaneous management, and the identification and treatment of nonunion. Of the PP questions, there were substantial differences of opinion on the choice of bone graft for nonunion, revisions, and patients with avascular necrosis. Nearly unanimous agreement was found for the use of headless compression screws for scaphoid fixation; however, the choice of approach for waist fixation was split between dorsal and volar percutaneous techniques and an open dorsal approach.</div></div><div><h3>Conclusions</h3><div>Scaphoid fracture and nonunion management continues to be an area of expanding evidence. There remain opportunities for our community to improve knowledge and familiarization with current evidence-based data. Many PPs areas demonstrated substantial agreement among the membership; however, there are areas of differences particularly graft choice, optimal approach for waist fixation, and postfixation protocols. Knowledge and familiarity with peer practices may help develop future areas of research and help to optimize patient care through a critically review and interpretation of the evidence.</div></div><div><h3>Type of study/level of evidence</h3><div>Economic/decision analyses V.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 836-841"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Study Comparing Wide-Awake Local Anesthesia No Tourniquet Versus General Anesthesia in Hand Fracture Fixation","authors":"Shalimar Abdullah MS (Ortho), Dip Hand Surgery ,&nbsp;Khairul Azmi bin Ghazali MBBS (Ortho & Traumatology) ,&nbsp;Elaine Zi Fan Soh MBBS (Ortho & Traumatology) ,&nbsp;Jamari Sapuan MD, MS (Ortho) ,&nbsp;Parminder Singh Gill MBBS, MS (Ortho) ,&nbsp;Chia Hua Lim MD (Ortho & Traumatology)","doi":"10.1016/j.jhsg.2024.06.008","DOIUrl":"10.1016/j.jhsg.2024.06.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Fixation of metacarpal or phalanx bone fractures is usually performed under general anesthesia (GA) or regional anesthesia and with the use of a tourniquet to minimize bleeding. However, the use of tourniquet causes pain and discomfort after surgery. Wide-awake local anesthesia no tourniquet (WALANT) enables the surgery to be performed with the patient fully awake and without a tourniquet, which allows intraoperative assessment of function during surgery. This study aims to compare the perioperative parameters and clinical outcomes between GA versus WALANT in hand fracture fixations.</div></div><div><h3>Methods</h3><div>Forty-eight patients with hand fractures were recruited over a period of 15 months. Twenty-one patients had undergone fracture fixation under GA, whereas another 27 patients had the surgery under WALANT. Parameters including vital signs (heart rate and systolic blood pressure), surgery duration, estimated blood loss, visual analog scale, and quick disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire were evaluated.</div></div><div><h3>Results</h3><div>Wide-awake local anesthesia no tourniquet group had significantly higher systolic blood pressure values and higher estimated blood less than GA group. Wide-awake local anesthesia no tourniquet group also documented shorter surgical time compared with GA group, but the difference was not significant. In terms of clinical outcomes, WALANT group recorded significantly lower visual analog scale score at 2 hours and 2 weeks postsurgery. However, WALANT has a comparable QuickDASH score with GA group except at 3 months postsurgery.</div></div><div><h3>Conclusions</h3><div>Wide-awake local anesthesia no tourniquet surgery for hand fracture fixation provides a similar analgesic effect and comparable QuickDASH score except at 3 months postsurgery compared with GA.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 814-817"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Review of Topography and Axon Counts in Upper-Extremity Peripheral Nerves: A Guide for Neurotization","authors":"Ethan Paulin MD ,&nbsp;Evan C. Bowen BS ,&nbsp;Shireen Dogar DO ,&nbsp;Muntazim Mukit MD ,&nbsp;Michael S. Lebhar MD ,&nbsp;Laura I. Galarza MD ,&nbsp;Shelley R. Edwards BS ,&nbsp;Marc E. Walker MD, MBA","doi":"10.1016/j.jhsg.2024.08.002","DOIUrl":"10.1016/j.jhsg.2024.08.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Currently, no comprehensive database detailing topography and axon counts exists. This study aims to review the axon counts and topography of the major peripheral motor nerves of the upper extremity to allow for optimal surgical planning for peripheral nerve reconstruction via neurotization.</div></div><div><h3>Methods</h3><div>Peer-reviewed journal articles were identified through PubMed, ScienceDirect, Google Scholar, and CENTRAL. Studies were included for review based upon the identification of the described topography or axon count of any upper-extremity peripheral motor nerve. Animal research, laboratory studies, and unpublished studies were excluded from our review. A total of 43 studies were identified, and 38 of these met the inclusion criteria. Statistical analysis was performed to determine axon count averages for all upper extremity motor nerves identified in the included studies.</div></div><div><h3>Results</h3><div>Thirty-eight studies were reviewed, giving insights into the topography and axon counts of the major peripheral nerves of the upper extremity, including the brachial plexus and its terminal branches as well as common donor nerves such as the spinal accessory nerve and intercostal nerves. Studies showed considerable variability in reported axon counts.</div></div><div><h3>Conclusions</h3><div>Existing data were relatively weak and included several case reports and series. Taking this into consideration, we posit that there is a need for further studies of upper-extremity nerve axon counts that include large study populations and more consistent methods of nerve specimen analysis.</div></div><div><h3>Clinical relevance</h3><div>Understanding the topographical anatomy of donor and recipient nerves, as well as appropriately matching the motor axon counts for each donor and recipient, is helpful in upper-extremity nerve reconstruction.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 784-795"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter- and Intraobserver Reliability for the Computed Tomography Scan Assessment of Union After Surgery for Scaphoid Fractures and Nonunion","authors":"Morten Kjær MD ,&nbsp;Dimitar Ivanov Radev MD ,&nbsp;Robert Gvozdenovic MD, PhD","doi":"10.1016/j.jhsg.2024.08.005","DOIUrl":"10.1016/j.jhsg.2024.08.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Assessment of scaphoid union after operative treatment might be associated with uncertainty, disagreement, and misinterpretation. Union is defined as consolidation on three of four X-ray views. Computed tomography (CT) scans are increasingly used to evaluate union of scaphoid fractures and nonunion. It allows multiplanar assessment of the scaphoid. Reliability in CT scan assessment of union after operative intervention is limited. We hypothesized that inter- and intraobserver reliability of the CT scan assessment of union after operative treatment for scaphoid fracture and nonunion are substantial and better in fracture cases.</div></div><div><h3>Methods</h3><div>An institutional search identified 230 patients with operative intervention. According to the sample size, we randomly selected 60 patients (30 fractures and 30 nonunion), with age above 18 years and CT scans 6–26 weeks after surgery, when uncertainty about healing status is most pronounced. Three observers evaluated the CT scans on two occasions 6 weeks apart. Observers classified the scaphoid into two categories: No/partial/full union and &gt;/&lt;50% union.</div></div><div><h3>Results</h3><div>Interrater agreement in no/partial/full union was overall substantial, substantial in fractures, and moderate for nonunion cases. Interobserver agreement for &gt;/&lt;50% union was overall moderate and moderate for both fractures and nonunion groups. The interrater agreement of no/partial/full union with CT scans ≥12 weeks after surgery was substantial versus fair for the cases below. Intrarater agreement was overall better in cases with CT scans ≥12 weeks postoperative versus earlier.</div></div><div><h3>Conclusions</h3><div>CT scans show substantial agreement in the assessment of no/partial/full union after operative intervention, although the presence of metal artifacts and bone grafts potentially impair visibility among observers. The agreement was better in scaphoid fractures. CT scan assessment of &gt;/&lt;50% union is with overall moderate agreement. Inter- and intrarater agreement is improved when CT scans are taken 12 weeks or later after operative treatment, blinded to the clinical information.</div></div><div><h3>Level of Evidence</h3><div>Diagnostic, III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 865-869"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrodiagnostic Testing Predicts Postdecompression Outcomes in Patients With Cubital Tunnel Syndrome","authors":"Kevin R. Cuneo BS ,&nbsp;Thomas J. McQuillan MD ,&nbsp;Constance M. Sullivan BS, BA ,&nbsp;Hayden L. Cooke BS ,&nbsp;Sabryn A. Kapp BS ,&nbsp;Eric R. Wagner MD, MSc ,&nbsp;Michael B. Gottschalk MD","doi":"10.1016/j.jhsg.2024.08.013","DOIUrl":"10.1016/j.jhsg.2024.08.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Electrodiagnostic (EDX) testing is commonly used in conjunction with symptoms and physical examination findings to diagnose cubital tunnel syndrome (CuTS). The purpose of this study was to investigate the relationship between preoperative EDX diagnosis and the degree of Disabilities of the Arm, Shoulder, and Hand (<em>Quick</em>DASH) improvement after surgery within the CuTS patient population.</div></div><div><h3>Methods</h3><div>A retrospective review was designed to analyze patients from a single institution who underwent a cubital tunnel release. Patients who had preoperative EDX testing, as well as preoperative and 3-month postoperative <em>Quick</em>DASH scores were eligible for inclusion. These patients were divided into two groups, EDX-positive or EDX-negative, based on the findings of their EDX testing for CuTS. Demographics, preoperative <em>Quick</em>DASH, postoperative <em>Quick</em>DASH, and changes in <em>Quick</em>DASH were compared between the two groups.</div></div><div><h3>Results</h3><div>Fifty-seven patients were included—34 EDX-positive and 23 EDX-negative. The EDX-negative cohort had higher preoperative <em>Quick</em>DASH scores, which approached but did not reach significance (<em>P</em> = .06). Both groups had significant improvement in <em>Quick</em>DASH following cubital tunnel release (<em>P</em> = .021, <em>P</em> &lt; .01). Patients with EDX-negative testing had a significantly greater improvement in <em>Quick</em>DASH from before surgery to 3 months after surgery (25 points vs 11, <em>P</em> &lt; .01).</div></div><div><h3>Conclusions</h3><div>Patients who underwent cubital tunnel release had a significant short-term improvement in their <em>Quick</em>DASH scores, regardless of EDX diagnosis. However, negative preoperative EDX studies in the setting of strong clinical suspicion of CuTS do not exclude diagnosis and may in fact be a positive, rather than a negative, predictive factor for short-term postoperative functional improvement.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 779-783"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presenteeism and Absenteeism Before and After Carpal Tunnel Release or Open Reduction and Internal Fixation for Distal Radius Fracture","authors":"David N. Bernstein MD, PhD ,&nbsp;Alexy Ilchuk BA ,&nbsp;Monica M. Shoji MD ,&nbsp;Carl M. Harper MD ,&nbsp;Tamara D. Rozental MD","doi":"10.1016/j.jhsg.2024.08.009","DOIUrl":"10.1016/j.jhsg.2024.08.009","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of a person’s hands is crucial to their ability to succeed at work. Hand pathologies can impact work success by increasing absenteeism (ie, not being able to go to work) and presenteeism (ie, being able to work but in a reduced capacity). In this study, we quantified employed patients’ presenteeism and absenteeism following carpal tunnel release or surgical fixation of a distal radius fracture (DRF).</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 91 patients (carpal tunnel syndrome [CTS]: n = 62; DRF: n = 29) from June 2022 to December 2023 were included. Baseline patient characteristics and patient-reported outcome measures (PROMs) were collected. Presenteeism and absenteeism were calculated using the World Health Organization’s Health and Work Performance Questionnaire. Questionnaires were sought before surgery and at 3 and 6 months after surgery. Clinical improvement was determined using minimal clinically important difference (MCID) cutoff range estimates. The employee value of lost work was calculated as a percentage of the average patient in each group before surgery and at 6 months after surgery.</div></div><div><h3>Results</h3><div>The average change in PROMs scores from before to after surgery at 6 months surpassed the low-end MCID estimates for all functional and pain-related PROMs. For patients undergoing surgery for CTS and DRF, retained employee value rose from 85.6% to 130.2% (ie, worked more than expected) and 52.7% to 56.9%, respectively.</div></div><div><h3>Conclusions</h3><div>Patients undergoing surgery for CTS or DRF have clinically appreciable improvement in functional and pain symptoms by 6 months after surgery. However, by 6 months after surgery, carpal tunnel release results in greater than complete employee value recovery, compared with surgical fixation of DRFs in which greater than 40% of the employee value remains lost after surgery. These findings can assist with preoperative expectation setting.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic II.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 882-887"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Hemi-Hamate Autograft for Two Proximal Interphalangeal Joint Fracture Dislocations: A Case Report","authors":"Levonti Ohanisian MD ,&nbsp;Michael P. Kucharik MD ,&nbsp;Kathryn S. King MD ,&nbsp;Tantien Nguyen BS ,&nbsp;Michael Doarn MD","doi":"10.1016/j.jhsg.2024.07.001","DOIUrl":"10.1016/j.jhsg.2024.07.001","url":null,"abstract":"<div><div>A 27-year-old man sustained right ring and little finger proximal interphalangeal joint fracture dislocations. He subsequently underwent bilateral hemi-hamate autograft to treat these intra-articular injuries. The patient was followed periodically and demonstrated return of normal grip strength and radiographic union of the hemi-hamate reconstruction arthroplasties. This is the first reported case of a patient who underwent bilateral hamates as donor grafts for two proximal interphalangeal joint fracture dislocations. When patients present with multiple unrepairable proximal interphalangeal joint fracture dislocations, surgeons can consider bilateral hemi-hamate reconstruction arthroplasty as a consideration to restore normal function.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 915-919"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Digit Replantation and Revision Amputation in the United States From 2009 to 2019","authors":"Joseph G. Monir MD ,&nbsp;Hayden Cooke BS ,&nbsp;Olivia Jagiella-Lodise BS ,&nbsp;Thomas McQuillan MD ,&nbsp;Eric Wagner MD ,&nbsp;Nicole A. Zelenski MD","doi":"10.1016/j.jhsg.2024.07.012","DOIUrl":"10.1016/j.jhsg.2024.07.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Digit amputations can be managed either with replantation or revision amputation. The advent and refinement of microsurgical techniques allowed for the reliable success of replantation. Despite this, rates of digit replantation have been decreasing over the past several decades. A paucity of data exists on recent trends. The authors hypothesize that rates of both replantation and revision amputation will continue to downtrend.</div></div><div><h3>Methods</h3><div>IBM Watson Health Marketscan Commercial Claims and Encounters and Medicare Supplemental databases were queried for digit replantation and revision amputations from 2009 to 2019. National volumes and incidences were estimated by combining these data with population data from the United States Census Bureau Public Use Microdata Sample. Linear regression was performed to evaluate trends. Subgroup analysis was performed for both volume and incidence to elucidate the role of age, sex, and geographical location.</div></div><div><h3>Results</h3><div>Between 2009 and 2019, there were an estimated 2,207 digit replantations and 53,810 digit revision amputations. The volume of replantations decreased by 42.2%, and the incidence of replantations decreased by 46.3%. The volume of revision amputations decreased by 16.2%, and the incidence of revision amputations decreased by 22.2%. Men were the majority of both groups, accounting for 75.6% of replantations and 83.6% of amputations. The replantation-to-amputation ratio decreased from 0.057 to 0.039 (−31.0%).</div></div><div><h3>Conclusions</h3><div>Both digit replantations and revision amputations continued to decline over the decade from 2009 to 2019. The downtrend in replantations outpaced the downtrend in revision amputations, resulting in a decreased replantation-to-amputation ratio.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 855-860"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Social Deprivation on Cubital Tunnel Syndrome Treatment Timeline","authors":"Akhil Dondapati MD ,&nbsp;Janet Ngoc Tran BA ,&nbsp;Callista Zaronias BA ,&nbsp;Cody C. Fowler MD ,&nbsp;Thomas J. Carroll MD ,&nbsp;Bilal Mahmood MD","doi":"10.1016/j.jhsg.2024.08.019","DOIUrl":"10.1016/j.jhsg.2024.08.019","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to establish the impact of area deprivation index (ADI) on treatment timelines of patients with cubital tunnel syndrome (CuTS). We hypothesize that increased social deprivation will correlate with increased time between care milestones from presentation to surgery.</div></div><div><h3>Methods</h3><div>This is a retrospective study of patients diagnosed with CuTS who underwent surgical intervention at a single academic institution. Variables including age, sex, body mass index, ADI, electrodiagnostic (EDX) severity classification, and time elapsed between treatment milestones were obtained. Treatment milestones included time elapsed between initial presentation to hand surgery and EDX studies, and surgery. Analysis included univariate χ² tests and analysis of variance, as well as multivariate linear and logistic regressions.</div></div><div><h3>Results</h3><div>Six hundred and fifty-three patients were divided by ADI national percentiles from the least to most deprived tertiles. Univariate analysis found no differences in care timelines across ADI tertiles. Multivariate analysis revealed a nonsignificant trend toward higher ADI predicting longer time from presentation to surgery. Moderate EDX rating correlated with increased time from presentation to surgery. Mild EDX ratings correlate with increased time from EDX studies to surgery. Age was a significant predictor of decreased time between initial presentation and surgery and between EDX and surgery. Completion of EDX studies prior to presentation significantly decreased time to surgery.</div></div><div><h3>Conclusions</h3><div>Social deprivation does not significantly correlate with delays in the treatment timeline for CuTS. Increased age was significantly correlated with shorter treatment timelines, which may reflect differences in physicians’ approaches to patients of different ages. Electrodiagnostic testing obtained prior to initial presentation expedited care following presentation to hand clinic. However, this could reflect either an overall delay in care (if EDX were obtained because of a delay from referral to presentation) or truly expedited care.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic II.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 894-897"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper-Extremity Injuries in a Level 1 Trauma Center Following Border Wall Height Increase","authors":"Emma Williams BA ,&nbsp;Vivian Hu MD ,&nbsp;Cooper Haaland BS ,&nbsp;Meera Reghunathan MD ,&nbsp;Laura N. Haines MD ,&nbsp;Jay J. Doucet MD ,&nbsp;Todd W. Costantini MD ,&nbsp;Katharine M. Hinchcliff MD","doi":"10.1016/j.jhsg.2024.07.002","DOIUrl":"10.1016/j.jhsg.2024.07.002","url":null,"abstract":"<div><h3>Purpose</h3><div>From 2018–2019, the height of over 400 miles of southern border wall was raised to 30 feet. Our aim was to evaluate the impact of the increase in border wall height on upper-extremity injuries sustained via barrier fall.</div></div><div><h3>Methods</h3><div>A retrospective review of patients admitted with upper-extremity injuries sustained via border wall fall between January 2015 and December 2022 at a Level 1 trauma center serving the United States-Mexico border. Patients admitted between 2015–2018 were included in the preincrease group, and those admitted between 2019–2022 were included in the postincrease group. Demographic data, injury severity metrics, fracture characteristics, operative treatments, hospital charges, and lengths of stay were compared.</div></div><div><h3>Results</h3><div>In total, 110 patients were identified, with 16 preincrease and 94 postincrease. Following the barrier height increase, patients had higher injury severity scores. Radial fractures were most common pre- and postincrease and accounted for nearly one-third of all fractures. Postincrease upper-extremity trauma patients required more operative events (2.15 ± 2.10 vs 1.44 ± 0.73 preincrease). The average cost for each patient’s hospital stay also quadrupled after the increase in wall height ($397,632 ± $1,057,574 vs $98,978 ± $84,169 preincrease).</div></div><div><h3>Conclusions</h3><div>The increase in overall injury severity and costly inpatient treatment of upper-extremity injuries among patients who fell from the border following construction has placed additional stress on an already strained health care system.</div></div><div><h3>Level of Evidence</h3><div>Differential Diagnosis/Symptom Prevalence Study, IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 830-835"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}