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.

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. Join the conversation

Using the actual Twitter website or app is not the best option for participating, as you will be required to continually refresh your feed to follow the conversation. Try one of these easy alternatives:

  • Option 1 (highly recommended): Visit tchat.io and enter the hashtag #JHSJC to follow the conversation in real-time. The site will automatically add the #JHSJC hashtag to each of your tweets and make it easier for you to participate. An alternative to tchat.io is tweetchat.com. Be sure to allow access your Twitter account.
  • Option 2: Follow the #JHSJC hashtag as a saved search in a Twitter client such as Tweetbot (download for Mac, iPhone or iPad), which has the ability to continually stream when you are connected.

Step 3. Participate

Speak your mind!

  • If you’re following options 1 or 2 above, the #JHSJC hashtag will automatically be added to your tweets, so there’s nothing else you need to do.
  • If you’re using the Twitter website or app, be sure to include @JHandSurg and #JHSJC in your Tweets.

Questions? Contact us at jhs@assh.org.

APRIL #JHSJC

April’s #JHSJC will take place on:

Date: April 13, 2021
Time: 9:00 PM EDT

 

Article #1:
Rate of Bone Mineral Density Testing and Subsequent Fracture-Free Interval After Distal Forearm Fracture in the Medicare Population
By Kisan Parikh, MD, Daniel Reinhardt, MD, Kimberly Templeton, MD, Bruce Toby, MD, and Jacob Brubacher, MD
DOI: https://doi.org/10.1016/j.jhsa.2020.11.020

Volume 46, Issue 4, Pages 267-277
Full article here: https://www.jhandsurg.org/article/S0363-5023(20)30715-2/fulltext
Free podcast available here: https://www.jhandsurg.org/pb/assets/raw/Health%20Advance/journals/yjhsu/April_2021.mp3

Summary
The authors used the 5% Medicare Standard Analytic File to identify patients with distal forearm fractures over a ten-year period. They analyzed whether these patients subsequently underwent testing for bone mineral density (BMD) and when that testing occurred. They also identified the patients who subsequently sustained another fragility fracture, specifically of the hip or spine. There were 37,473 patients identified who had not had BMD testing in the 2 years prior to the forearm fracture. Among those, 7% underwent BMD testing within six months of the forearm fracture and a total of 26% eventually underwent testing during the study period. Twenty percent of patients who were not tested, sustained another fragility fracture. Considering those who were and were not tested, the interval between the two fractures was longer in those who had been tested. Those least likely to be tested were males, patients over 85 years old and patients under 65 years of age.

Points for discussion

  • The authors have assumed that BMD testing is a surrogate for whether treatment for osteoporosis has taken place. Is that a reasonable assumption?
  • During the course of the study the actual number of fractures decreased, even as the population was getting older (Table 2), although the proportion of those receiving testing didn’t change in the last four years of the study after initially increasing substantially. Can anything be inferred from those observations, with respect to the need for testing before treatment is started? Is it possible that different methods are being used to identify osteoporosis are being used or that treatment is being started even without testing?
  • The ongoing question is: What is the role that hand surgeons should play in this public health issue, given that they are often the clinicians managing the first fragility fracture?

Article #2:
Outcomes Associated With Scapholunate Ligament Injury Following Intra-Articular Distal Radius Fractures
By Kevin M. Klifto, PharmD, Rachel E. Hein, MD, Christopher S. Klifto, MD, Tyler S. Pidgeon, MD, Marc J. Richard, MD, and David S. Ruch, MD
DOI: https://doi.org/10.1016/j.jhsa.2020.12.005

Volume 46, Issue 4, Pages 309-318
Full article here: https://www.jhandsurg.org/article/S0363-5023(20)30742-5/fulltext

Summary
Over a 14-year period, the authors retrospectively identified 192 patients who had sustained intra-articular fractures of the distal radius and stratified them with respect to whether they had plain radiographic evidence of scapholunate ligament insufficiency using a SL angle greater than 700 as the criterion, at the time of injury. Most (96%) patients were treated with open reduction and internal fixation, but no patient underwent repair or reconstruction of a SL ligament. The radiographic outcomes measured were the SL angle in the contralateral wrist at the time of injury, the SL angle in the injured wrist following reduction, but prior to surgery and radiographic appearance at final follow-up. QuickDASH, VAS pain and the Modified Global Assessment of Function scales were also measured. Two-year follow-up was available for 100 patients. The group with an initially increased SL angle showed a further increase in SL angle and increased SL gaps, however there were no statistically significant differences between the groups on any of the clinical outcome scales at final 2-year follow-up.

Points for discussion

  • There were 24 patients who had pre-injury radiographs of the injured wrist which were considered normal, but for patients who didn’t have those, the contralateral wrist was evaluated. Should the appearance of the contralateral wrist be accepted as a surrogate for the baseline state in the injured wrist? In other words, should that indicate that the pre-injury status was one of normalcy?
  • The diagnosis of SL insufficiency was based on plain radiographs. None of the patients underwent arthroscopy, which may surgeons would consider the reference standard for making the diagnosis. How does that effect the observations and conclusions?
  • The notion that scapholunate ligament injuries are common in the context of intra-articular fractures of the distal radius has been around a long time and many surgeons treat those surgically. Based on these findings (and others previously reported), is that justified? Is a study with 2 years of follow-up long enough?

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Previous #JHSJC Discussion Articles

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)
Read the Transcript!

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)
Read the Transcript!

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)
Read the transcript!

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)