JHS Journal Club

Created in 2018, the JHS Journal Club is a Twitter-based journal club that allows you to interact with other Journal of Hand Surgery readers and discuss interesting articles in JHS. You’ll participate in live meetings via Twitter, sharing thoughts with readers from around the world.

**As of January 2022, we will no longer be using our former platform to hold the discussion (tchat.io). We will be using a new platform, TwChat. Instructions are below!**

How to Participate

Step 1. Sign up for Twitter if you haven’t already. If you’re unfamiliar with Twitter, check out Twitter Guide: Getting Started.

Step 2. Visit http://twchat.com/hashtag/jhsjc

Step 3. Click the “Sign in” button on the right side. You’ll then be asked to sign in with your Twitter credentials (or you may need to give twchat.com authorization to access your Twitter account. To do that, please select the “Authorize app” button). Please sign in or authorize.

Step 4. If this is your first time, you’ll be asked to provide your email on the next page and then agree to the terms and service (you should only have to do this once). Hit “Save.” (You may need to put http://twchat.com/hashtag/jhsjc back into your browser again if you are not automatically directed.)

Step 5. Join the discussion! You can enter your message in the chat box and hit enter. Your comments will appear below (they will also appear on your personal Twitter feed). Please be sure to use the #JHSJC hashtag in each message!

Questions? Contact us at jhs@assh.org.

The next #JHSJC event will take place on January 11th at 9 PM EST. We will have a second discussion for our European colleagues on January 12 at 8 PM GMT (3 PM EST).

Article #1
Evaluation of Risk Factors for Loss of Acceptable Alignment for Distal Radius Fractures That Are Nondisplaced or Minimally Displaced on Initial Presentation
By Kimberly E. Souza, MD, Patrick J. Kellam, MD, Andrew R. Stephens, BS, and Nikolas H. Kazmers, MD, MSE
DOI: https://doi.org/10.1016/j.jhsa.2021.08.006

Volume 47, Issue 1, Pages 54-61
Full article here: https://www.jhandsurg.org/article/S0363-5023(21)00518-9/fulltext


The authors report a retrospective review of 110 patients, over a 5-year period, who were diagnosed with undisplaced or minimally displaced distal radius fractures (AO classification 23-A2, 23-A3, B-1, and C1-3), who met the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline (CPG) for nonsurgical treatment. All patients were followed radiographically for a minimum of 5 weeks. Overall, 33 (30%) had displacement beyond the AAOS CPG criteria for acceptable alignment at 6 weeks. A multivariable analysis demonstrated that the presence of dorsal comminution and age over 60 years were significantly associated with loss of acceptable alignment. The authors conclude that patients with these characteristics require close supervision.

Points for discussion

  • At 30%, the rate of displacement beyond the evidence-based guideline for acceptable alignment is high. Are the results from this sample likely to be generalizable?
  • The finding of dorsal comminution as a significant factor predicting loss of reduction seems somewhat self-evident. If a patient cares if they incur a malunion (it is understood that this is an issue related to shared decision-making) should that be considered a relative indication for operative management acutely because it represents impending displacement in a substantial proportion of cases?
  • The 2020 AAOS CPG states the following: “Strong evidence suggests that operative treatment for geriatric patients (most commonly defined in studies as 65 years of age and older) does not lead to improved long-term patient reported outcomes compared to non-operative treatment”. If that is true, what ramifications does that have for these findings? In other words, does it matter if deterioration beyond “acceptable alignment” occurs in almost 1/3 of patients?

Article #2
Utilization of Diagnostic Testing for Carpal Tunnel Syndrome: A Survey of the American Society for Surgery of the Hand
By Jessica I. Billig, MD, MS, and Erika D. Sears, MD, MS
DOI: https://doi.org/10.1016/j.jhsa.2021.09.037

Volume 47, Issue 1, Pages 11-18
Full article here: https://www.jhandsurg.org/article/S0363-5023(21)00687-0/fulltext
Free podcast available here:  https://www.jhandsurg.org/pb/assets/raw/Health%20Advance/journals/yjhsu/january_2022.mp3


The study reported the results of a survey sent to members of the American Society for Surgery of the Hand (ASSH) asking them about diagnostic testing around the diagnosis of carpal tunnel syndrome. Slightly fewer than 800 surgeons responded to the survey (23%). The main findings were that 26% required electrodiagnostic testing (EDS) before they saw the patient for a consultation. Over half routinely obtain EDS if these tests were not obtained prior to the consultation and 54% obtained EDS “51-75% of the time” or “>75% of the time” even if the patient presented with classic symptoms and physical examination findings of CTS. When asked about the appropriateness of the 2016 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline (CPG), less than 40% considered them appropriate. Over 40% didn’t know if they were appropriate or didn’t know what the guideline stated. The authors concluded that both more explicit identification of which patients required EDS and more widespread dissemination of the guideline was required.

Points for discussion

  • In the podcast, Dr. Sears mentioned reasons why the sample obtained probably accurately reflected the membership’s attitudes on this topic: it was consistent with the practice settings and clinical backgrounds of the membership at large; it summarized the views of nearly 800 US hand surgeons, even though that was only 23% of the membership contacted. Should these results be considered generalizable to hand surgeons in general?
  • The respondents indicated that there were many reasons for obtaining EDS, the most frequent of which were “confirmation of diagnosis” (66%) (or “additional information when the diagnosis is unclear” (97%)), grading of severity, malpractice concerns and insurance requirements, including those related to workers’ compensation. Leaving aside the insurance issues, what evidence is there that EDS has value with respect to establishing prognosis or confirming the diagnosis of CTS?
  • It is understood that dissemination of evidence takes time. However, it seems inexplicable that more than 40% of respondents would not know what the guideline states about this common condition 5 years after it was released. What reasons would more than 60% of respondents have for not considering the guidelines “appropriate” (a brief description of the guideline development process can be read here).



Previous #JHSJC Discussion Articles

November 2021
Article 1: Midterm Patient-Reported Outcomes in Wrist Denervation for Post-Traumatic Arthritis (https://www.jhandsurg.org/article/S0363-5023(21)00134-9/fulltext)

Article 2: Patterns of Upper Extremity Reconstruction for Patients With Tetraplegia Across the United States: A Retrospective Study (https://www.jhandsurg.org/article/S0363-5023(21)00380-4/fulltext)
Read the Transcript!

October 2021
Article 1: Limited Fasciectomy Versus Collagenase Clostridium histolyticum for Dupuytren Contracture: A Propensity Score Matched Study of Single Digit Treatment With Minimum 5 Years of Telephone Follow-Up (https://www.jhandsurg.org/article/S0363-5023(21)00337-3/fulltext)
Article 2: A Standard Set for Outcome Measurement in Patients With Hand and Wrist Conditions: Consensus by the International Consortium for Health Outcomes Measurement Hand and Wrist Working Group (https://www.jhandsurg.org/article/S0363-5023(21)00363-4/fulltext)
Read the Transcript!

September 2021
Article 1: Geospatial Inefficiencies Associated With Digital Replantations at High-Volume Centers and Optimal Allocation Model for Centralization of Replantations (https://www.jhandsurg.org/article/S0363-5023(21)00216-1/fulltext)
Article 2: The Epidemiology of Carpal Tunnel Revision Over a 1-Year Follow-Up Period (https://www.jhandsurg.org/article/S0363-5023(21)00208-2/fulltext)
Read the Transcript!

June 2021
Article 1:
Structural Versus Nonstructural Bone Grafting for the Treatment of Unstable Scaphoid Waist Nonunion Without Avascular Necrosis: A Randomized Clinical Trial (https://www.jhandsurg.org/article/S0363-5023(21)00097-6/fulltext)

Article 2: Evaluation of PROMIS’ Ability to Detect Immediate Postoperative Symptom Improvement Following Carpal Tunnel Release (https://www.jhandsurg.org/article/S0363-5023(21)00102-7/fulltext)
Read the Transcript!

May 2021
Article 1: Cost Comparison of Botulinum Toxin Injections Versus Surgical Treatment in Pediatric Patients With Cerebral Palsy: A Markov Model (https://www.jhandsurg.org/article/S0363-5023(21)00045-9/fulltext)
Article 2: Assessing the Relationship Between Bone Density and Loss of Reduction in Nonsurgical Distal Radius Fracture Treatment (https://www.jhandsurg.org/article/S0363-5023(21)00087-3/fulltext)
Read the Transcript!

April 2021
Article 1: Rate of Bone Mineral Density Testing and Subsequent Fracture-Free Interval After Distal Forearm Fracture in the Medicare Population (https://www.jhandsurg.org/article/S0363-5023(20)30715-2/fulltext)

Article 2: Outcomes Associated With Scapholunate Ligament Injury Following Intra-Articular Distal Radius Fractures (https://www.jhandsurg.org/article/S0363-5023(20)30742-5/fulltext)
Read the Transcript!

March 2021
Article 1: Impact of Insurance Type on Self-Reported Symptom Severity at the Preoperative Visit for Carpal Tunnel Release (https://www.jhandsurg.org/article/S0363-5023(20)30644-4/fulltext)
Article 2: Variation in Use of Electrodiagnostic Testing: Analysis From the Michigan Collaborative Hand Initiative for Quality in Surgery (https://www.jhandsurg.org/article/S0363-5023(20)30711-5/fulltext)
Read the Transcript!

February 2021
Article 1: The Association Between Electrodiagnostic Severity and Treatment Recommendations for Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(20)30536-0/fulltext)
Article 2: Relevance of Diagnosed Depression and Antidepressants to PROMIS Depression Scores Among Hand Surgical Patients (https://www.jhandsurg.org/article/S0363-5023(20)30610-9/fulltext)
Read the Transcript!

January 2021
Article 1: Epidemiology and Treatment of Radial Head Fractures: A Database Analysis of Over 70,000 Inpatient Cases (https://www.jhandsurg.org/article/S0363-5023(20)30350-6/fulltext)
Article 2: A Matched Comparison of Postoperative Complications Between Smokers and Nonsmokers Following Open Reduction Internal Fixation of Distal Radius Fractures (https://www.jhandsurg.org/article/S0363-5023(20)30571-2/fulltext)
Read the Transcript!

December 2020
Article 1: Establishing Validity of a Comprehensive Hand Surgical Training and Educational Platform (STEP) (https://www.jhandsurg.org/article/S0363-5023(20)30434-2/fulltext)
Article 2: Clinical, Radiological, and Electrodiagnostic Diagnosis of Pronator Syndrome Concurrent With Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(20)30341-5/fulltext)
Read the Transcript!

November 2020
Article 1: Distal Biceps Tendon Rupture Surgery: Changing Incidence in Finnish and Swedish Men Between 1997 and 2016 (https://www.jhandsurg.org/article/S0363-5023(20)30440-8/fulltext)
Article 2: Declining Trend in Medicare Physician Reimbursements for Hand Surgery From 2002 to 2018 (https://www.jhandsurg.org/article/S0363-5023(20)30478-0/fulltext)
Read the Transcript!

October 2020
Article 1: The Influence of Cost Information on Treatment Choice: A Mixed-Methods Study (https://www.jhandsurg.org/article/S0363-5023(20)30316-6/fulltext)
Article 2: Thumb Carpometacarpal Arthritis: Prognostic Indicators and Timing of Further Intervention Following Corticosteroid Injection (https://www.jhandsurg.org/article/S0363-5023(20)30185-4/fulltext)
Read the Transcript!

September 2020
Article 1: Telemedicine After Upper Extremity Surgery: A Prospective Study of Program Implementation (https://www.jhandsurg.org/article/S0363-5023(20)30315-4/fulltext)
Article 2: Canadian Plastic Surgery Resident Operative Experience in Hand Surgery (https://www.jhandsurg.org/article/S0363-5023(20)30272-0/fulltext)
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June 2020
Article 1: The Prognostic Value of Preoperative Patient-Reported Function and Psychological Characteristics on Early Outcomes Following Trapeziectomy With Ligament Reconstruction Tendon Interposition for Treatment of Thumb Carpometacarpal Osteoarthritis (https://www.jhandsurg.org/article/S0363-5023(19)31540-0/fulltext)
Article 2: Industry Funding and Self-Declared Conflict of Interest in Hand Surgery Publications (https://www.jhandsurg.org/article/S0363-5023(20)30114-3/fulltext)
Read the Transcript! 

May 2020
Article 1: Borderline Nerve Conduction Velocities for Median Neuropathy at the Carpal Tunnel (https://www.jhandsurg.org/article/S0363-5023(20)30002-2/fulltext)
Article 2: Proximal Row Carpectomy Versus 4-Corner Fusion: Incidence, Conversion to Fusion, and Cost (https://www.jhandsurg.org/article/S0363-5023(20)30004-6/fulltext)
Read the Transcript!

April 2020
Article 1: Risk of Infection in Trigger Finger Release Surgery Following Corticosteroid Injection (https://www.jhandsurg.org/article/S0363-5023(20)30032-0/fulltext)
Article 2: Physical and Occupational Therapy Use and Cost After Common Hand Procedures (https://www.jhandsurg.org/article/S0363-5023(19)31390-5/fulltext)
Read the Transcript!

March 2020
Article 1: Convolutional Neural Network for Second Metacarpal Radiographic Osteoporosis Screening (https://www.jhandsurg.org/article/S0363-5023(19)31543-6/fulltext)
Article 2: The Value of Intraoperative 3-Dimensional Fluoroscopy in the Treatment of Distal Radius Fractures: A Randomized Clinical Trial (https://www.jhandsurg.org/article/S0363-5023(19)31506-0/fulltext)
Read the Transcript!

February 2020
Article 1: Factors Associated With Reoperation and Conversion to Wrist Fusion After Proximal Row Carpectomy or 4-Corner Arthrodesis (https://www.jhandsurg.org/article/S0363-5023(19)31435-2/fulltext)
Article 2: Variation in Offer of Operative Treatment to Patients With Trapeziometacarpal Osteoarthritis (https://www.jhandsurg.org/article/S0363-5023(19)31429-7/fulltext)
Read the Transcript!

January 2020
Article 1: Development and Validation of a Prognostic, Risk-Adjusted Scoring System for Operative Upper-Extremity Infections (https://www.jhandsurg.org/article/S0363-5023(19)31422-4/fulltext)
Article 2: Establishing a National Registry for Hand Surgery (https://www.jhandsurg.org/article/S0363-5023(19)31386-3/fulltext)
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December 2019
Article 1: The Impact of Pre-Referral Advanced Diagnostic Testing on Wait Time to See a Hand Surgeon for Common Upper-Extremity Conditions (https://www.jhandsurg.org/article/S0363-5023(19)31393-0/fulltext)
Article 2: Reduction of Opioid Use After Upper-Extremity Surgery through a Predictive Pain Calculator and Comprehensive Pain Plan (https://www.jhandsurg.org/article/S0363-5023(19)31389-9/fulltext)
Read the Transcript!

November 2019
Article 1: Complications of Corrective Osteotomies for Extra-Articular Distal Radius Malunion (https://www.jhandsurg.org/article/S0363-5023(17)31618-0/fulltext)
Article 2: Outcomes and Direct Costs of Needle Aponeurotomy, Collagenase Injection, and Fasciectomy in the Treatment of Dupuytren Contracture (https://www.jhandsurg.org/article/S0363-5023(18)31491-6/fulltext)
Read the Transcript!

October 2019
Article 1: The Effect of Intraoperative Corticosteroid Injections on the Risk of Surgical Site Infections for Hand Procedures (https://www.jhandsurg.org/article/S0363-5023(18)31764-7/fulltext)

Article 2: Early Practice Patterns of Hand Surgeons: An American Board of Orthopaedic Surgery Database Study (https://www.jhandsurg.org/article/S0363-5023(18)31684-8/fulltext)
Read the Transcript!

September 2019
Article 1: The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma (https://www.jhandsurg.org/article/S0363-5023(18)31262-0/fulltext)

Article 2: Failure Rates of Base of Thumb Arthritis Surgery: A Systematic Review (https://www.jhandsurg.org/article/S0363-5023(18)30698-1/fulltext)
Read the transcript!

July 2019
Article 1: The Relationship Between Pain-Related Psychological Factors and Postoperative Opioid Use After Ambulatory Hand Surgery (https://www.jhandsurg.org/article/S0363-5023(18)30805-0/fulltext)
Article 2: Patient Satisfaction in the Hand Surgery Clinic: An Analysis of Factors That Impact the Press Ganey Survey (https://www.jhandsurg.org/article/S0363-5023(18)30659-2/fulltext)
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June 2019
Article 1: An In-Depth Review of Physician Reimbursement for Digit and Thumb Replantation (https://www.jhandsurg.org/article/S0363-5023(18)30858-X/fulltext)
Article 2: Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger (https://www.jhandsurg.org/article/S0363-5023(18)30534-3/fulltext)
Read the transcript!

May 2019
Article 1: Sonographic Findings Associated With Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(17)31113-9/fulltext)
Article 2: Correlations Among Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair (https://www.jhandsurg.org/article/S0363-5023(18)30794-9/fulltext)

April 2019
Article 1: Evaluation of Version 2.0 of the PROMIS Upper Extremity Computer Adaptive Test in Nonshoulder Upper Extremity Patients (https://www.jhandsurg.org/article/S0363-5023(18)30376-9/fulltext)
Article 2: Defining Quality in Hand Surgery From the Patient’s Perspective: A Qualitative Analysis (https://www.jhandsurg.org/article/S0363-5023(18)30789-5/fulltext)

March 2019
Article 1: False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(18)30599-9/fulltext)
Article 2: Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized Double-Blinded Trial (https://www.jhandsurg.org/article/S0363-5023(18)30793-7/fulltext)

February 2019
Article 1: Opioid Prescriber Education and Guidelines for Ambulatory Upper-Extremity Surgery: Evaluation of an Institutional Protocol (https://www.jhandsurg.org/article/S0363-5023(17)31857-9/fulltext)
Article 2: Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System (https://www.jhandsurg.org/article/S0363-5023(17)32092-0/fulltext)

January 2019
Article 1: Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year: A Register Study With a 2- to 12-Year Follow-Up (https://www.jhandsurg.org/article/S0363-5023(18)30248-X/fulltext)
Article 2: External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures—A 3-Year Follow-Up of a Randomized Controlled Study (https://www.jhandsurg.org/article/S0363-5023(18)30023-6/fulltext)

December 2018
Article 1: Predicting Clinical Outcome After Surgical Treatment in Patients With Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(18)30650-6/fulltext)
Article 2: Cost-Effective Management of Stenosing Tenosynovitis (https://www.jhandsurg.org/article/S0363-5023(17)30874-2/fulltext)

November 2018
Article 1: Outcome of a Hand Orthosis and Hand Therapy for Carpometacarpal Osteoarthritis in Daily Practice: A Prospective Cohort Study (https://www.jhandsurg.org/article/S0363-5023(17)30684-6/fulltext)
Article 2: Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery (https://www.jhandsurg.org/article/S0363-5023(17)31145-0/fulltext)

October 2018
Article 1: The Effectiveness of Mini–C-Arm Fluoroscopy for the Closed Reduction of Distal Radius Fractures in Adults: A Randomized Controlled Trial (https://www.jhandsurg.org/article/S0363-5023(17)30746-3/fulltext)
Article 2: Pain Management After Carpal Tunnel Release Surgery: A Prospective Randomized Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone (https://www.jhandsurg.org/article/S0363-5023(18)30652-X/fulltext)

September 2018
Article 1: A Prospective Comparison of Diagnostic Tools for the Diagnosis of Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(17)31445-4/fulltext)
Article 2: Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties (https://www.jhandsurg.org/article/S0363-5023(16)30694-3/fulltext)

August 2018
Article 1: Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis (https://www.jhandsurg.org/article/S0363-5023(18)30613-0/fulltext)
Article 2: Cost of Surgical Treatment for Distal Radius Fractures and the Implications of Episode-Based Bundled Payments (https://www.jhandsurg.org/article/S0363-5023(18)30629-4/fulltext)

July 2018
Article 1: Immediate Versus Overnight-Delayed Digital Replantation: A Comparative Retrospective Cohort Study of Survival Outcomes (https://www.jhandsurg.org/article/S0363-5023(18)30459-3/fulltext)
Article 2: Arthroscopic Diagnosis of the Triangular Fibrocartilage Complex Foveal Tear: A Cadaver Assessment (https://www.jhandsurg.org/article/S0363-5023(17)30956-5/fulltext)