Journal of Hand Surgery-American Volume最新文献

{"title":"Looped Penrose Drainages of Acute Hand Infections in Vulnerable Populations.","authors":"Jane N Ewing, Yoshiko Toyoda, Mehdi S Lemdani, John R Vaile, Elizabeth Malphrus, Zachary Gala, Chris Amro, Robyn B Broach, Benjamin Chang","doi":"10.1016/j.jhsa.2024.11.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.11.015","url":null,"abstract":"<p><strong>Purpose: </strong>Acute hand infections (AHIs) remain a challenge for hand surgeons and represent a condition for which clinical outcomes are considerably affected by social barriers. We previously described the looped Penrose drainage technique, where a drain is sutured to itself in a loop and the outflow tract of egress is maintained, thus obviating the need for large incisions, wound closure, or repeat packing, thereby reducing the follow-up burden. In the face of escalating numbers of socioeconomically vulnerable patients, especially in urban settings, we aimed to characterize the clinical features and outcomes of this technique in an urban population of patients with AHI.</p><p><strong>Methods: </strong>A review of all surgical irrigations of AHI by a single, fellowship-trained hand surgeon at an urban hospital from 2013 through 2021 was performed. Patient demographics, procedure details, and postprocedure outcomes were analyzed.</p><p><strong>Results: </strong>Fifty-three patients (average age, 48.6 years) with AHI underwent surgical irrigations with the looped Penrose drainage technique. The majority of patients were Black (50.9%). Approximately 81.1% of the patients received public insurance, 22.6% were unemployed, 35.9% had annual incomes <$40,000, and 17% experienced homelessness. Overall, 34% were lost to follow-up with the Penrose still intact, including 78% of those who were homeless. Most of the cases occurred on the hand, with involvement of the deep spaces (24.5%), tenosynovitis (39.3%), and bone (1.9%). Recurrent infection (1.9%) and abscess formation (5.7%) led to one reoperation (1.9%). There were no amputations or readmissions, and all postoperative emergency department visits (7.1%) were discharged.</p><p><strong>Conclusions: </strong>The looped Penrose technique is a simple and less invasive alternative to traditional incision and drainage with packing and serves as an effective single-episode intervention strategy for AHIs, particularly in patients with complex social challenges because of the ease of wound management and low rates of readmission and reoperation.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Coronal Shear Fractures of the Distal Humerus: Surgical Approach and Outcomes.","authors":"David Wright, Zachary Meyer, Charles A Goldfarb, Lindley B Wall","doi":"10.1016/j.jhsa.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.11.016","url":null,"abstract":"<p><strong>Purpose: </strong>Isolated coronal shear fractures of the distal humerus in adolescents are rare injuries with unique surgical challenges. Respect for the posterior blood supply, open physes, and need for direct visualization to achieve anatomic reduction are critical considerations in surgical fixation. This study presents a case series and a surgical approach used in treating these patients.</p><p><strong>Methods: </strong>A retrospective review of patients aged 10-19 presenting to a single quaternary-care academic center from 2016 to 2023 with isolated capitellar and trochlear shear fractures was performed. Demographic data, injury mechanism, fracture classification, and surgical approach were recorded. Outcomes included elbow range of motion at the final follow-up, visual analogue scale pain scores, pediatric Patient-Reported Outcome Measurement Information System (PROMIS) scales, radiographic and clinical union, return to sport, and postoperative complications.</p><p><strong>Results: </strong>Eight patients were included, four of whom were treated through a single-incision anterolateral approach. Average age was 13 years. Average time of the final clinical follow-up was 21 months, with a radiographic follow-up of 11 months. Five fractures were classified as Dubberly type 2A, two as type 3A, and one as type 3B. At the final follow-up, average elbow range of motion and visual analogue scale pain scores were 3-137 degrees and 0.28 (range: 0-2), respectively. PROMIS scores demonstrated an average mobility score of 55 (SD: 8), pain interference of 35 (SD: 5), and pediatric upper-extremity score of 55 (SD: 4). One patient with sickle cell disease developed avascular necrosis of the capitellum. There were no other postoperative complications.</p><p><strong>Conclusions: </strong>Short-term clinical outcomes reveal low pain scores, near normal elbow motion, radiographic and clinical union, and normal patient-reported outcome measures in operatively treated coronal shear fractures of the distal humerus in adolescent patients. A single-incision anterolateral approach offers visualization of the anterior articular surface while respecting posterior soft tissues and the olecranon apophysis.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic V, case series.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Ultrasound and Electrodiagnostic Studies in Patients Evaluated for Ulnar Neuropathy.","authors":"Soun Sheen, David Speach, Courtney M C Jones, Mattie E Raiford, Warren C Hammert","doi":"10.1016/j.jhsa.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.12.004","url":null,"abstract":"<p><strong>Purpose: </strong>Our goal was to determine the association between the severity of electrodiagnostic (EDX) studies with the cross-sectional area (CSA) of the ulnar nerve at the cubital tunnel using diagnostic ultrasound. Based on our clinical experience, we hypothesized there would not be a positive correlation between the severity of EDX and ulnar nerve CSA.</p><p><strong>Methods: </strong>This was a retrospective analysis of patients 18 years or older evaluated from May 1, 2020, to June 31, 2021, referred for an upper limb EDX and neuromuscular ultrasound to evaluate for an upper limb neuropathy. History, physical examination, ultrasound imaging (ulnar nerve at elbow), and EDX were reviewed. Patients were excluded for age under 18 years or concomitant upper limb radiculopathy. Baseline sample characteristics were analyzed, including age, race, sex, ethnicity, body mass index (normal, overweight, obese, or morbid obesity), and smoking status.</p><p><strong>Results: </strong>Of 1,043 patients, there were more females than males (634 vs 409) with an average age (SD) of 54.0 (15.5). Most of the patients were White (863) compared to Black (113) and other races (67). The average CSA of the ulnar nerve at the elbow increased with increased severity based on EDX results. There was a significant association between increasing severity on EDX and the increased nerve CSA at the elbow.</p><p><strong>Conclusions: </strong>We found a positive association between the EDX severity and the CSA of the ulnar nerve on diagnostic ultrasound at the cubital tunnel. As the severity of ulnar neuropathy at the elbow increases, the CSA of the ulnar nerve correspondingly increases at the elbow.</p><p><strong>Type of study/level of evidence: </strong>Prognostic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-Sparing Protocols in Hand Surgery: Successes and Opportunities.","authors":"Jonathan Lawson, Michael Grzelak, Roland Zama, Jennifer Waljee, Aviram M Giladi","doi":"10.1016/j.jhsa.2024.11.026","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.11.026","url":null,"abstract":"<p><p>The opioid epidemic has been a defining crisis in American health care. Many attempts to address the epidemic have focused on issues around opioid prescribing. Legislation at the state and federal levels has been passed; however, the results from these policies have been mixed. Changes to prescription workflows alongside patient and provider education have also had some success. Within hand surgery in particular, recent progress has been made toward promoting opioid-sparing regimens for postoperative pain, including nonopioid and limited-opioid protocols. These regimens offer promise particularly in the setting of ambulatory surgeries, especially soft tissue procedures, and potentially in more invasive and complicated surgical settings. However, there are downsides and failures from these protocols that must be addressed, such as limited data on bony and complex soft tissue procedures, minimal diversity on published alternatives for limited regimens, and times when multimodal approaches are not adequate. Future work should focus on developing opioid-sparing protocols for more complex procedures as well as identifying patients at risk of requiring more comprehensive pain management approaches even for relatively minor procedures.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Characterization of the Motor Branch to the Fourth Lumbrical: A Cadaver Study.","authors":"Harvey Chim, Ramin Shekouhi, Syeda Hoorulain Ahmed, Chihiro Matsui, Peter Vonu, Brianne Sullivan","doi":"10.1016/j.jhsa.2024.11.023","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.11.023","url":null,"abstract":"<p><strong>Purpose: </strong>The branching pattern of the deep motor branch of the ulnar nerve (DBUN) in the hand is complex. The anatomy of the motor branch innervating the fourth lumbrical (4L), where paralysis results in a claw hand deformity after ulnar nerve injury, is not well defined. This cadaver study focused on mapping and defining anatomical landmarks in relation to the motor branch to the 4L.</p><p><strong>Methods: </strong>Ten fresh-frozen cadaver hands were dissected. The DBUN was exposed and followed distally, identifying all motor branches, until the branch to the 4L was seen. The small finger flexor tendons were reflected distally to enable visualization of the entire 4L motor branch and its distal entry point. The origin of the 4L motor branch was mapped in relation to fixed anatomical landmarks in the hand.</p><p><strong>Results: </strong>A consistent motor branch to the 4L and third palmar interosseous (3PI) muscles was seen originating from the DBUN in all specimens. The mean number of motor branches innervating the hypothenar muscles proximal to the 4L/3PI motor branch was 2.1 (range 1 to 5). The mean distance from the origin of the DBUN to the 4L/3PI motor branch was 2.9 cm (range 2.5 to 4.2 cm). The mean length of the 4L/3PI branch was 3.1 cm (range 2.3 to 4.5 cm). In seven specimens, the 4L/3PI branch demonstrated an intramuscular course through the 3PI before terminating in the 4L. In three specimens the 4L/ 3PI branch ran on the volar surface of the 3PI before terminating in the 4L.</p><p><strong>Conclusions: </strong>A consistent 4L/3PI motor branch was mapped and characterized in all specimens.</p><p><strong>Clinical relevance: </strong>These findings provide a guide for intraoperative localization of the 4L/3PI motor branch and also may provide further evidence to explain findings seen after distal nerve transfers to treat ulnar nerve injury.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the Zone of Acute Peripheral Nerve Injury Using Fluorescence Lifetime Imaging in a Crush Injury Sheep Model.","authors":"Dattesh R Dave, Alba Alfonso Garcia, Lisanne Kraft, Laura Marcu, Clifford T Pereira","doi":"10.1016/j.jhsa.2024.11.020","DOIUrl":"10.1016/j.jhsa.2024.11.020","url":null,"abstract":"<p><strong>Purpose: </strong>Current technologies to define the zone of acute peripheral nerve injury intraoperatively are limited by surgical experience, time, cumbersome electrodiagnostic equipment, and interpreter reliability. In this pilot study, we evaluated a real-time, label-free optical technique for intraoperative nerve injury imaging. We hypothesize that fluorescence lifetime imaging (FLIm) will detect a difference between the time-resolved fluorescence signatures for acute crush injuries versus uninjured segments of peripheral nerves in sheep.</p><p><strong>Methods: </strong>Label-free FLIm uses ultraviolet laser pulses to excite endogenous tissue fluorophores and detect their fluorescent decay over time, generating real-time tissue-specific signatures. A crush injury was produced in eight peripheral nerves of two sheep. A hand-held FLIm instrument captured the time-resolved fluorescence signatures of injured and uninjured nerve segments across three spectral emission channels (390/40 nm, 470/28 nm, and 540/50 nm). The average FLIm parameters (ie, lifetime and intensity ratios) for injured and uninjured nerve segments were compared. We used linear discriminant analysis to differentiate between crushed and uninjured nerve segments.</p><p><strong>Results: </strong>A total of 23,692 point measurements were collected from eight crushed peripheral nerves of two sheep. Histology confirmed the zone of injury. Average lifetime at 470 nm and 540 nm were significantly different between crushed and uninjured sheep nerve segments. The linear discriminant analysis differentiated between crushed and uninjured areas of eight nerve segments with 92% sensitivity, 85% specificity, and 88% accuracy.</p><p><strong>Conclusions: </strong>In this pilot study, FLIm detected differing average lifetime values for crushed versus uninjured sheep peripheral nerves with high sensitivity, specificity, and accuracy.</p><p><strong>Clinical relevance: </strong>With further investigation, FLIm may guide the peripheral nerve surgeon to the precise zone of injury for reconstruction.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient- and Provider-Perceived Barriers to Reconstructive Surgery for Patients With Upper Limb Spasticity.","authors":"Sean R Cantwell, Peter C Rhee","doi":"10.1016/j.jhsa.2024.11.019","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.11.019","url":null,"abstract":"<p><strong>Purpose: </strong>The benefits of upper-extremity reconstructive surgery for patients with spastic deformities are well documented, but a small portion of eligible patients undergo surgery. We sought to determine perceptions of upper-extremity reconstructive surgery among brain injury patients and nonsurgical providers to identify potential barriers to surgical evaluation.</p><p><strong>Methods: </strong>Electronic medical records at a referral center were reviewed for patients diagnosed with upper limb spasticity following brain injury. A patient-specific survey was distributed by email to all eligible patients. An anonymous provider-specific electronic survey was distributed to the members of United States-based professional societies that routinely provide nonsurgical medical care to patients with spasticity.</p><p><strong>Results: </strong>Forty-three of 143 patients (30%) responded to the survey. All subjects underwent initial nonsurgical management for their spastic upper limbs, but only 19% (n = 8) underwent subsequent reconstructive upper-extremity surgery. Hesitancy to undergo surgery was primarily related to \"uncertainty regarding its benefits\" and \"fear of worsened postoperative function.\" Thirty-seven medical providers responded to the survey. Seventy-six percent (n = 28) saw more than 10 patients afflicted with spasticity annually, but 83% referred fewer than 10 patients for surgical evaluation. Barriers to referral included \"uncertainty regarding procedure effectiveness\" (58%), \"concerns regarding insurance approval\" (56%), \"uncertainty whether a patient is a surgical candidate\" (53%), and \"no relationship with an upper extremity surgeon\" (39%) for referral.</p><p><strong>Conclusions: </strong>Surgery is infrequently performed among brain injury patients with spastic upper limb deformities. Patients report unfamiliarity with surgical options and concerns regarding surgical risks and benefits. Nonsurgical providers describe uncertainty regarding surgical efficacy and candidacy and underdeveloped referral networks.</p><p><strong>Clinical relevance: </strong>Surgical treatment of upper-extremity spasticity following brain injury is infrequently provided to eligible patients. Patient and provider perceptions of upper-extremity reconstructive surgery may help identify the factors that underlie the relative infrequency of surgical treatment and suggest opportunities to optimize the delivery of surgical care.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Bracing and Therapy Services on Perioperative Costs for Patients Undergoing Distal Biceps Tendon Repair","authors":"Jessica L. Baylor BS ,&nbsp;Austin Kloc MD ,&nbsp;Stephanie Delma BA ,&nbsp;Brian K. Foster MD ,&nbsp;Louis C. Grandizio DO","doi":"10.1016/j.jhsa.2023.04.019","DOIUrl":"10.1016/j.jhsa.2023.04.019","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to quantify and assess perioperative costs in an integrated healthcare system for patients undergoing distal biceps tendon (DBT) repair with and without the use of postoperative bracing and formal physical (PT) or occupational (OT) therapy services. In addition, we aimed to define clinical outcomes after DBT repair using a brace-free, therapy-free protocol.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all cases of DBT repairs within our integrated system from 2015 to 2021. We performed a retrospective review of a series of DBT repairs utilizing the brace-free, therapy-free protocol. For patients with our integrated insurance plan, a cost analysis was conducted. Claims were subdivided to assess total charges, costs to the insurer, and patient costs. Three groups were created for comparisons of total costs: (1) patients who had both postoperative bracing and PT/OT, (2) patients who had either postoperative bracing or PT/OT, and (3) patients who had neither postoperative bracing nor PT/OT.</div></div><div><h3>Results</h3><div>A total of 36 patients had our institutional insurance plan and were included in the cost analysis. For patients using both bracing and PT/OT, these services contributed 12% and 8% of the total perioperative costs, respectively. Implant costs accounted for 28% of the overall cost. Forty-four patients were included in the retrospective review with a mean follow-up of 17 months. The overall QuickDASH was 12; two cases resulted in unresolved neuropraxia, and there were no cases of re-rupture, infection, or reoperation.</div></div><div><h3>Conclusions</h3><div>Within an integrated healthcare system, postoperative bracing and PT/OT services increase the cost of care for DBT repair and account for 20% of the total perioperative charges in cases where bracing and therapy are used. Considering the results of prior investigations indicating that formal PT/OT and bracing offer no clinical advantages over immediate range of motion (ROM) and self-directed rehabilitation, upper-extremity surgeons should forego routine brace and PT/OT utilization after DBT repair.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 94.e1-94.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9596382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Distance Between the Flexor Pollicis Longus Tendon and Volar Locking Plate: An Ultrasonographic Study","authors":"Keiichiro Oura MD, PhD ,&nbsp;Nobumasa Matsumura MD ,&nbsp;Ryosuke Noguchi MD ,&nbsp;Tatsuji Fujiwara MD, PhD","doi":"10.1016/j.jhsa.2023.04.021","DOIUrl":"10.1016/j.jhsa.2023.04.021","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Flexor pollicis longus rupture is a major complication after volar locking plate fixation of </span>distal radius fractures<span>. Although the distance between the flexor pollicis longus tendon and the plate (plate–tendon distance) measured by ultrasonography<span> is used to predict tendon rupture risk, the timing of the ultrasonography can affect the measurements. Therefore, this study aimed to analyze the chronological change of the plate–tendon distance between the tendon and plate.</span></span></div></div><div><h3>Methods</h3><div>A total of 166 wrists underwent the plate–tendon distance measurement twice or more times within 15 months after surgery. Longitudinal ultrasonography scans with the wrist in a neutral position and the thumb flexed were used to measure the plate–tendon distance. The plate–tendon distances at 0–5 months, 5–10 months, and 10–15 months after surgery were compared. A multiple linear regression analysis was performed to evaluate the influence of the interval between surgery and examination, Soong grade, and plate type on the plate–tendon distance.</div></div><div><h3>Results</h3><div>The plate–tendon distance decreased as the interval between surgery and examination increased. The plate–tendon distance was an average of 2.0 ± 1.1 mm, 1.4 ± 0.9 mm, and 1.2 ± 0.9 mm at 0–5 months, 5–10 months, and 10–15 months after surgery, respectively. Significant differences were observed between 0–5 months and 5–10 months and between 5–10 months and 10–15 months after surgery. A multiple linear regression showed that significant predictors of the plate–tendon distance were the intervals between surgery and examination and Soong grade.</div></div><div><h3>Conclusions</h3><div>The plate–tendon distance decreased as the time since surgery increased. When ultrasonography is used for the assessment of tendon rupture risk, it should be considered that the plate–tendon distance decreases as the interval between the surgery and examination increases.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 99.e1-99.e5"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013–2021","authors":"Rishub K. Das MD ,&nbsp;Olivia Bittles PA ,&nbsp;Wesley P. Thayer MD, PhD ,&nbsp;Brian C. Drolet MD","doi":"10.1016/j.jhsa.2024.08.015","DOIUrl":"10.1016/j.jhsa.2024.08.015","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to 2021.</div></div><div><h3>Methods</h3><div>Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed.</div></div><div><h3>Results</h3><div>From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue.</div></div><div><h3>Conclusions</h3><div>There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue.</div></div><div><h3>Clinical relevance</h3><div>With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 27-33"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}