Journal of Hand Surgery-American Volume最新文献

{"title":"Radial Head Arthroplasty for Fracture: Implant Survivorship and Outcomes at Mean Follow-Up of 8 Years","authors":"Benjamin R. Campbell MD ,&nbsp;Santiago Rengifo MS ,&nbsp;Catherine B. Wickes BA ,&nbsp;Kamil M. Amer MD ,&nbsp;Asif M. Ilyas MD, MBA","doi":"10.1016/j.jhsa.2023.04.020","DOIUrl":"10.1016/j.jhsa.2023.04.020","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>The purpose of this study was to evaluate implant survivorship and clinical outcomes following </span>radial head </span>arthroplasty for fracture at long-term follow-ups.</div></div><div><h3>Methods</h3><div><span><span>A retrospective analysis was conducted on adult patients who underwent primary uncemented radial head arthroplasty for radial head or neck fractures between 2012 and 2015. </span>Medical records were reviewed to collect information regarding demographics, injury characteristics, </span>reoperations<span>, and revisions requiring implant removal. A bivariate analysis was conducted to identify potential risk factors for reoperation. A Kaplan-Meier curve was created to determine implant survival rates. Eligible patients were contacted to confirm any reoperations and obtain Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups.</span></div></div><div><h3>Results</h3><div>A total of 89 patients were eligible for analysis and assessed at a mean of 97 months after surgery (range, 81–128). Reoperation rate was 16% (14 of 89 patients), including 5% of patients requiring implant removal or revision. However, 93% of reoperations occurred within the first 12 months of the index surgery. Fracture dislocations of the elbow had a higher rate of reoperation. A Kaplan-Meier curve demonstrated an implant survival rate of 96% at 10-year follow-up. Of the patients who responded, the mean Quick Disability of the Arm, Shoulder, and Hand score was 8.7 ± 10.3, with none requiring additional reoperations or revisions. There were otherwise similar outcome scores among patients requiring reoperation versus those who did not.</div></div><div><h3>Conclusions</h3><div>Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. Fractures with associated elbow dislocation may be at a higher risk for reoperation, and it is important to provide this prognostic information to patients who are likely to require arthroplasty for more extensive injuries.</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 97.e1-97.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683926","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":"Occult Amyloid Deposition in Older Patients Presenting With Bilateral Carpal Tunnel Syndrome or Multiple Trigger Digits","authors":"Aaron M. Gray MD, PhD ,&nbsp;Amit C. Patel MD ,&nbsp;F. Thomas D. Kaplan MD ,&nbsp;Gregory A. Merrell MD ,&nbsp;Jeffrey A. Greenberg MD, MS","doi":"10.1016/j.jhsa.2023.05.008","DOIUrl":"10.1016/j.jhsa.2023.05.008","url":null,"abstract":"<div><h3>Purpose</h3><div><span>The diagnosis of amyloidosis is important for early intervention, disease monitoring, and prevention of complications and progression. </span>Carpal tunnel syndrome (CTS) and trigger digit (TD) are two common conditions associated with early disease. The purpose of this study was to define disease prevalence among patients with bilateral CTS and multiple TDs and assess for an increased rate of diagnosis in the presence of both.</div></div><div><h3>Methods</h3><div>Men older than 50 years and women older than 60 years of age diagnosed with bilateral CTS, multiple TDs, or a combination of the 2 were prospectively enrolled in our study. Tenosynovial biopsy samples taken at the time of surgery were tested for the presence of amyloid using Congo red staining. Demographic and medical covariates were also collected and analyzed for differences between amyloid-positive and -negative patients.</div></div><div><h3>Results</h3><div>Fifty-six patients were enrolled in the study, and nine patients tested positive for amyloid deposition. The demographics and medical comorbidities were similar between amyloid-positive and -negative patients. Thirty patients with bilateral CTS were enrolled, and four tested positive for amyloid. For patients with multiple TDs, a total of 17 patients were enrolled, and 4 tested positive for amyloid. Among patients with multiple TDs, only men tested positive for amyloid and were, on average, younger than those who tested negative (61 and 73 years, respectively). Patients presenting with a combination of CTS and TD did not exhibit increased amyloid discovery.</div></div><div><h3>Conclusions</h3><div>Hand surgeons should consider tenosynovial biopsy in men older than 50 years and women older than 60 years presenting with either bilateral CTS or multiple TDs.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 102.e1-102.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680969","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":"Evaluating the Performance of an Automated Patient-Reported Outcomes Collection Platform in a Postoperative Hand Surgery Population","authors":"Miranda J. Rogers MD, MS ,&nbsp;Jordan Nishimoto BS ,&nbsp;Minkyoung Yoo PhD ,&nbsp;Angela P. Presson PhD ,&nbsp;Andrew R. Stephens MD ,&nbsp;Nikolas H. Kazmers MD, MSE","doi":"10.1016/j.jhsa.2023.05.006","DOIUrl":"10.1016/j.jhsa.2023.05.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Reliable collection of postoperative patient-reported outcome measures (PROMs) is critical to understanding surgical outcomes and the value of care. Automated PROMs collection, triggered by the electronic medical record at the 1-year postoperative anniversary, may provide a simple way to acquire outcomes for patients who have been discharged from clinic. The purposes of this study were to (1) evaluate the percentage of responses with an automated PROMs collection platform and (2) identify whether such a system may introduce selection bias by comparing responders with nonresponders.</div></div><div><h3>Methods</h3><div>Adult patients (aged ≥18 years) undergoing hand and upper-extremity surgeries between August 2017 and January 2019 were included. Preoperative <em>Quick</em> Disabilities of the Arm, Shoulder, and Hand (<em>Quick</em>DASH) scores were collected using tablet computer. Postoperative <em>Quick</em>DASH scores were collected using a single electronic survey request 1 year after surgery via an email with a personalized REDCap link. Univariate and multivariable regression analyses were performed to identify factors that differed between responders and nonresponders.</div></div><div><h3>Results</h3><div>A response rate of 27% (269 of 1010) was observed for the eligible postoperative patients. On multivariable analysis, the following were associated with greater odds of response: older age, Caucasian race (vs unknown), longer surgery duration, attending the first postoperative visit, and responding to the preoperative <em>Quick</em>DASH.</div></div><div><h3>Conclusions</h3><div>The poor response rate that was observed highlights that an automated single email postoperative contact for PROMs collection is insufficient—active follow-up via reminder emails and/or telephone calls is needed. Outcome researchers and clinicians must be aware of potential selection biases, such as age and race, that may exist with automated PROMs collection.</div></div><div><h3>Clinical relevance</h3><div>Single email postoperative contact to obtain postoperative PROMs is insufficient.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 100.e1-100.e10"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680970","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":"Application of Machine Learning to Osteoporosis and Osteopenia Screening Using Hand Radiographs","authors":"Anna Luan MD, MS ,&nbsp;Zeshaan Maan MBBS ,&nbsp;Kun-Yi Lin MD, PhD ,&nbsp;Jeffrey Yao MD","doi":"10.1016/j.jhsa.2024.09.008","DOIUrl":"10.1016/j.jhsa.2024.09.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Fragility fractures associated with osteoporosis and osteopenia are a common cause of morbidity and mortality. Current methods of diagnosing low bone mineral density require specialized dual x-ray absorptiometry (DXA) scans. Plain hand radiographs may have utility as an alternative screening tool, although optimal diagnostic radiographic parameters are unknown, and measurement is prone to human error. The aim of the present study was to develop and validate an artificial intelligence algorithm to screen for osteoporosis and osteopenia using standard hand radiographs.</div></div><div><h3>Methods</h3><div>A cohort of patients with both a DXA scan and a plain hand radiograph within 12 months of one another was identified. Hand radiographs were labeled as normal, osteopenia, or osteoporosis based on corresponding DXA hip T-scores. A deep learning algorithm was developed using the ResNet-50 framework and trained to predict the presence of osteoporosis or osteopenia on hand radiographs using labeled images. The results from the algorithm were validated using a separate balanced validation set, with the calculation of sensitivity, specificity, accuracy, and receiver operating characteristic curve using definitions from corresponding DXA scans as the reference standard.</div></div><div><h3>Results</h3><div>There was a total of 687 images in the normal category, 607 images in the osteopenia category, and 130 images in the osteoporosis category for a total of 1,424 images. When predicting low bone density (osteopenia or osteoporosis) versus normal bone density, sensitivity was 88.5%, specificity was 65.4%, overall accuracy was 80.8%, and the area under the curve was 0.891, at the standard threshold of 0.5. If optimizing for both sensitivity and specificity, at a threshold of 0.655, the model achieved a sensitivity of 84.6% at a specificity of 84.6%.</div></div><div><h3>Conclusions</h3><div>The findings represent a possible step toward more accessible, cost-effective, automated diagnosis and therefore earlier treatment of osteoporosis/osteopenia.</div></div><div><h3>Type of study/level of evidence</h3><div>Diagnostic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 43-50"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649507","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":"Reliability of Wrist Arthroscopy in the Diagnosis and Treatment of Triangular Fibrocartilage Complex Tears","authors":"Elizabeth A. Graesser MD ,&nbsp;Lindley B. Wall MD ,&nbsp;Sanjeev Kakar MD ,&nbsp;Jeffrey Yao MD ,&nbsp;Marc J. Richard MD ,&nbsp;R. Glenn Gaston MD ,&nbsp;Charles A. Goldfarb MD","doi":"10.1016/j.jhsa.2024.07.002","DOIUrl":"10.1016/j.jhsa.2024.07.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Wrist arthroscopy is considered the gold standard for diagnosis of intra-articular wrist conditions including triangular fibrocartilage complex (TFCC) tears; however, the ability to reliably diagnose TFCC pathology during wrist arthroscopy is unclear. The purpose of this study was to assess the reliability of the diagnosis of TFCC tears on wrist arthroscopy videos.</div></div><div><h3>Methods</h3><div>Five hand surgeons reviewed 43 cases on a secure web-based platform at two time points separated by 4–6 weeks. Each case included a deidentified clinical vignette and wrist radiographs with ulnar variance measurements and an arthroscopy video of ulnar wrist pathology, averaging 42 seconds. Surgeons were queried on the presence of TFCC tear and Palmer and Atzei classifications. Interobserver/intraobserver reliabilities were determined using kappa coefficients.</div></div><div><h3>Results</h3><div>The interobserver reliability regarding the presence/absence of TFCC tear was fair-good, with kappa coefficients of 0.596 in the first round of case review and 0.708 in the second round. The overall intraobserver reliability for the presence/absence of TFCC tear was also fair-good, with a kappa coefficient of 0.567. For cases with central TFCC tears, the interobserver reliability regarding the presence of TFCC tear was perfect, with a kappa coefficient of 1.0. When central tears were excluded, the kappa coefficients decreased to 0.322 and 0.368 in each round. The interobserver reliability for the Palmer and Atzei classifications was low, with kappa coefficients of 0.220 and 0.121 in the first round and 0.222 and 0.123 in the second round.</div></div><div><h3>Conclusions</h3><div>Experienced wrist arthroscopy surgeons demonstrated fair-good interobserver reliability for the diagnosis of TFCC tear on wrist arthroscopy. However, when central TFCC tears were excluded, interobserver reliability was poor. These findings demonstrate a need for a focus on education for wrist arthroscopy anatomy.</div></div><div><h3>Clinical relevance</h3><div>This investigation demonstrated poor agreement in surgeon identification and classification of TFCC tears, aside from central TFCC tears. The low reliability has a direct bearing on treatment considerations for TFCC tears.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 2-9"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903624","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}

{"title":"Revision Total Elbow Arthroplasty","authors":"Louis C. Grandizio DO ,&nbsp;A. Michael Luciani MD ,&nbsp;Jessica L. Koshinski BS ,&nbsp;William H. Seitz Jr MD","doi":"10.1016/j.jhsa.2024.09.006","DOIUrl":"10.1016/j.jhsa.2024.09.006","url":null,"abstract":"<div><div>Despite improvements in our understanding of elbow biomechanics and implant design, early revision are higher following total elbow arthroplasty (TEA) compared with hip and knee arthroplasty. Revision TEA remains a standard but technically challenging procedure with the potential for substantial morbidity. This review discusses the diagnosis and management of the failed primary TEA. Current concepts related to surgical treatment with revision TEA indicated for prosthetic joint infection, periprosthetic fracture, and aseptic osteolysis will be reviewed. In addition, strategies and adjunctive procedures for dealing with bone loss in the revision setting will be discussed.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 77-87"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513206","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":"Referral Patterns Associated With Delayed Care for Traumatic Brachial Plexus Injuries","authors":"Brian W. Yang MD ,&nbsp;Rafa Rahman MD, MPH ,&nbsp;Casey Urban BS ,&nbsp;Christian Victoria MPH ,&nbsp;Steve K. Lee MD","doi":"10.1016/j.jhsa.2023.05.007","DOIUrl":"10.1016/j.jhsa.2023.05.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Traumatic brachial plexus injuries (BPI) are devastating, time-sensitive conditions that often require definitive treatment at academic tertiary care centers. Delays to presentation and surgery have been associated with inferior outcomes. In this study, we evaluate referral patterns associated with delayed presentation and late surgery in traumatic BPI patients.</div></div><div><h3>Methods</h3><div><span>Patients diagnosed with a traumatic BPI at our institution from 2000 to 2020 were identified. Medical charts were reviewed for demographic characteristics, prereferral work-up, and referring provider characteristics. Delayed presentation was defined as greater than 3 months from date of injury to initial evaluation by our brachial plexus specialists. Late surgery was defined as greater than 6 months from date of injury. Multivariable </span>logistic regression was used to identify factors associated with delayed presentation or surgery.</div></div><div><h3>Results</h3><div>A total of 99 patients were included, 71 of whom underwent surgery. Sixty-two patients presented delayed (62.6%), with 26 receiving late surgery (36.6%). There were similar rates of delayed presentation or late surgery by referring provider specialty. Patients whose initial diagnostic EMG was ordered by the referring provider prior to initial presentation at our institution were more likely to have a delayed presentation (76.2% vs 31.3%) and undergo late surgery (44.9% vs 10.0%).</div></div><div><h3>Conclusions</h3><div>Delayed presentation and late surgery in traumatic BPI patients were associated with initial diagnostic EMG ordered by the referring provider.</div></div><div><h3>Clinical relevance</h3><div>Delayed presentation and surgery have been associated with inferior outcomes in traumatic BPI patients. We recommend that providers direct patients with clinical concern of traumatic BPI directly to a brachial plexus center without further work-up before referral and encourage referral centers to accept these patients.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 101.e1-101.e7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9698348","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":"Two-, Three-, or Four-Corner Arthrodesis for Midcarpal Osteoarthritis: A Systematic Review and Meta-Analysis","authors":"Caroline A. Hundepool MD, PhD ,&nbsp;Liron S. Duraku MD, PhD ,&nbsp;Thijs J.M. Quanjel BSc ,&nbsp;L. Paul van Minnen MD, PhD ,&nbsp;Miguel C. Jansen MD ,&nbsp;J. Michiel Zuidam MD, PhD","doi":"10.1016/j.jhsa.2023.04.018","DOIUrl":"10.1016/j.jhsa.2023.04.018","url":null,"abstract":"<div><h3>Purpose</h3><div>Several limited midcarpal arthrodeses have been used in the treatment of midcarpal osteoarthritis as part of scapholunate advanced collapse and scaphoid nonunion advanced collapse. There is no consensus on whether two-carpal arthrodesis (2CA), three-carpal arthrodesis (3CA), bicolumnar arthrodesis, or four-carpal arthrodesis (FCA) results in the best outcomes. The objective of this study was to determine whether there is a difference in outcomes in patients undergoing FCA, 3CA, 2CA, or bicolumnar arthrodesis for midcarpal osteoarthritis.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were performed in multiple databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting the four surgical techniques were included. The primary outcomes were postoperative visual analog scale pain score, the Disabilities of the Arm, Shoulder, and Hand score, and the Mayo Wrist Score. The secondary outcomes were active range of motion, grip strength, and reported complications.</div></div><div><h3>Results</h3><div>Of 2,270 eligible studies, 80 articles were selected, including a total of 2,166 wrists. The visual analog scale pain scores for both the 2CA and FCA groups reached an adequate pain reduction based on the Patient Acceptable Symptom Scale. The Disabilities of the Arm, Shoulder, and Hand score was also comparable between these two groups. The 2CA group also showed a significantly better active range of motion than the FCA group for both flexion-extension and radioulnar deviation arc. The incidence of nonunion was 6.9% in the FCA group compared with 10.0% in the 2CA group.</div></div><div><h3>Conclusions</h3><div>Although the 2CA procedure has a theoretical advantage over the FCA method, the analysis of data showed that generally, these techniques have similar outcomes and complications. Therefore, both (2CA and FCA) are good options for midcarpal osteoarthritis in scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists.</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 93.e1-93.e11"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9951440","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}

{"title":"Evaluation of Intramedullary Olecranon Screw Fixation for Simple Olecranon Fractures: A Biomechanical Study","authors":"Kelly N. McKnight MD ,&nbsp;Tysen K. Timmer MD ,&nbsp;Mikayla D. Montgomery MD ,&nbsp;Alexander CM. Chong MSAE, MSME ,&nbsp;G. David Potter MD","doi":"10.1016/j.jhsa.2023.05.001","DOIUrl":"10.1016/j.jhsa.2023.05.001","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>The purpose of this study was to biomechanically evaluate the stability of the 6.5 mm intramedullary (IM) olecranon screw compared to locking compression </span>plate fixation<span> for Orthopedic Trauma Association/AO Foundation (OTA/AO) 2U1B1 </span></span>olecranon fractures under cyclic range of motion of the elbow.</div></div><div><h3>Methods</h3><div>Twenty paired elbows were randomized to either IM olecranon screw or locking compression plate fixation of a simulated OTA/AO 2U1B1 fracture. Pullout strength was tested by increasing force applied to the triceps and proximal fragment. Fracture gap displacement was measured using differential variable reluctance transducers as the elbow was cycled through a 135° arc of motion using a servohydraulic testing system.</div></div><div><h3>Results</h3><div>Analysis of variance revealed significant interaction between group and load on fracture distraction after the 500th cycle in three settings: between the plate at 5-pound load and screw at 35-pound load, the screw at 5-pound load and screw at 35-pound load, and between the plate at 15-pound load and screw at 35-pound load. The difference in the rate of failure between plate (2 of 80 samples) and screw (4 of 80 samples) was not statistically significant.</div></div><div><h3>Conclusions</h3><div>For OTA/AO 2U1B1 olecranon fractures, a single 6.5 mm IM olecranon screw demonstrated similar stability when compared to the locking compression plates throughout range of motion testing.</div></div><div><h3>Clinical relevance</h3><div>From a biomechanical perspective, 6.5 mm IM screws and locking compression plates have similar ability to maintain fracture reduction following simulated elbow range of motion exercises in OTA/AO 2U1B1 fractures, giving surgeons another option in the management of these fractures.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 95.e1-95.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10228704","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":"Trends in Racial, Ethnic, and Gender Diversity Among Hand Surgery Fellows From 2007 to 2021","authors":"Aziz Shittu BS ,&nbsp;Christopher J. Murdock MD ,&nbsp;Henson Destine BS ,&nbsp;Delano Trenchfield BS ,&nbsp;Maya Moore BA ,&nbsp;Amiethab Aiyer MD ,&nbsp;Dawn LaPorte MD","doi":"10.1016/j.jhsa.2023.05.005","DOIUrl":"10.1016/j.jhsa.2023.05.005","url":null,"abstract":"<div><h3>Purpose</h3><div>There is a paucity of research on the demographic trends of orthopedic and plastic hand surgery fellows. The purpose of this study was to ascertain the current state of racial and gender demographic trends in hand surgery fellowship from 2007 to 2021.</div></div><div><h3>Methods</h3><div>We analyzed fellowship demographic data from the Accreditation Council for Graduate Medical Education<span> public database from 2007–2008 through 2020–2021. The gender of hand surgery fellows was categorized as male, female, or not reported and their race/ethnicity as White, Non-Hispanic; Asian or Pacific Islander, Hispanic; Black, Non-Hispanic; American Indian or Alaskan Native; other; or unknown. We extracted the number of fellows per year for each category and calculated the percentage equivalents and average percentages. We performed the chi-square test for trend (Cochran-Armitage test) to identify any significant changes in the percentages of gender and race/ethnicity between 2007 and 2021.</span></div></div><div><h3>Results</h3><div>There was a significant increase in the percentage of hand surgery fellows who are women (20.7% to 30.7%) and Asian or Pacific Islander (13.3% to 25.3%). There was no significant change in the percentage of Hispanic or Black, Non-Hispanic fellows.</div></div><div><h3>Conclusions</h3><div>Although there have been some increases, hand surgery fellows continue to be underrepresented by women and minorities, consistent with the demographic of orthopedic and plastic surgery residents. There have been increasing trends in the number of women and minorities in medical schools, which leaves room for improvement from the downstream prospective applicant pool.</div></div><div><h3>Clinical relevance</h3><div>The physician-patient relationship can potentially be strengthened by race and gender concordance; however, many minority and female hand surgery patients do not have physicians who are women or of the same ethnic background. Patient satisfaction, trust, and potential health outcomes may be improved with a physician workforce that reflects the diversity of their patients.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 98.e1-98.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683929","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}