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.

September 14, 9PM EDT

We will be having a second #JHSJC discussion for our European colleagues on September 15 at 8PM GMT (4PM EDT). Please join us for one or both events!

Article #1
Geospatial Inefficiencies Associated With Digital Replantations at High-Volume Centers and Optimal Allocation Model for Centralization of Replantations
By Andrew L. O’Brien, MD, MPH, Adrian Diaz, MD, MPH, Ryan C. Jefferson, MD, Timothy M. Pawlik, MD, PhD, and Amy M. Moore, MD 
DOI: https://doi.org/10.1016/j.jhsa.2021.04.011

Volume 46, Issue 9, Pages 731-739.E5
Full article here: https://www.jhandsurg.org/article/S0363-5023(21)00216-1/fulltext
Free podcast available here: https://www.jhandsurg.org/pb/assets/raw/Health%20Advance/journals/yjhsu/september_2021.mp3


The study used data from the California Office of Statewide Health Planning and Development hospital discharge and planning database to identify single digit replantations between the years 2005 and 2016. The location where the replantation was performed, the travel time required to reach the institution, and success rates were determined. In addition, the authors used a modeling approach to establish the optimal allocation of cases that would minimize travel time and maximize cases in an institution on the assumption that a higher volume of cases would result in a greater probability of success.  The overall rate of replantation success was 70%. Ninety-three hospitals performed at least one replantation, but only 4 were considered “high-volume” centers by the authors definition. Twenty-one percent of cases presented to a low-volume hospital when a high-volume hospital was closer. The optimization model showed that concentrating cases in 8 centers would resulting in greater volume for those institutions and shorter distances traveled by patients.

Points for discussion

  • Leaving aside for the moment any controversy regarding the indications for single-digit amputation, what possible impact, if any, would that focus have on the observations? Is the relatively small number of cases – an average of 500/year from a population of 40 million – an indication of a biased sample?
  • Given the recent evidence suggesting that minimizing time until revascularization may not be as important as once thought (here), should the priority for transporting patients be that they be taken to the nearest hospital or to the institution with the greatest expertise, even if that is further away?
  • The study showed that race and payer type was associated with the institution to which the patient was taken. What role do hospital systems and payers play in the way cases are distributed?

Article #2
The Epidemiology of Carpal Tunnel Revision Over a 1-Year Follow-Up Period
By Lauren E. Wessel, MD, Alex Gu, MD, Paul A. Asadourian, BS, Jeffrey G. Stepan, MD, Duretti T. Fufa, MD, and Daniel A. Osei, MD
DOI: https://doi.org/10.1016/j.jhsa.2021.04.003

Volume 46, Issue 9, Pages 758-764
Full article here: https://www.jhandsurg.org/article/S0363-5023(21)00208-2/fulltext


The study used an administrative database to identify patients who underwent a carpal tunnel release (CTR) followed by a revision CTR within one year. The study was conducted using records from between 2015 and 2017 and was made feasible by the recent introduction of laterality-specific coding in the database that allowed the distinguishing of surgery done bilaterally from surgery repeated in the same limb. Patient demographic characteristics were collected as well as procedure-level details, most importantly, the use of open or endoscopic CTR. Among just over 4500 patients, there was a 4.8% revision rate within one year from the initial surgery. The revisions occurred, on average, about 4 months after the index procedure. Patient factors associated with a higher likelihood of requiring revision CTR included diabetes mellitus, tobacco use, psychiatric condition, cervical disease, and history of cubital tunnel release. The rate of revision surgery in patients initially treated with endoscopic CTR was about 30% higher (OR 1.3, 95% CI 1.2-1.6). The authors concluded that both patient factors and surgical strategy contributed to the risk of requiring revision surgery.

Points for discussion

  • The authors identify some of the limitations of this study design/data source including the absence of information of condition severity, the role of workers’ compensation and surgeon experience. Are those variables that are likely to have changed the qualitative findings?
  • The patient level factors increasing the risk of revision surgery are probably more or less, unmodifiable. The use of open or endoscopic CTR is a choice. Usually, when there is no clear evidence supporting one surgical strategy over another, patient choice should be the main factor determining what treatment should encompass. If one treatment has a 30% higher risk of failing – assuming that is the reason for requiring revision surgery – can the treatments truly be considered essentially equivalent, as has been assumed by existing clinical practice guidelines?
  • Previous studies in JHS have shown endoscopic CTR to be more costly than open CTR, primarily because of the costs associated with disposable equipment (here). If costs are greater and risks of failure are higher, is endoscopic CTR still a viable treatment strategy?


Previous #JHSJC Discussion Articles

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)
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)