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.

JANUARY #JHSJC

January’s #JHSJC will take place on:

Date: January 12, 2021
Time: 9:00 PM EST

Article #1
Epidemiology and Treatment of Radial Head Fractures: A Database Analysis of Over 70,000 Inpatient Cases
By Alexander Klug, MD, Yves Gramlich, MD, Dennis Wincheringer, MD, Reinhard Hoffmann, MD, and Kay Schmidt-Horlohé, MD
https://doi.org/10.1016/j.jhsa.2020.05.029

Volume 46, Issue 1, Pages 27-35
Full article: https://www.jhandsurg.org/article/S0363-5023(20)30350-6/fulltext

Summary
The study originated from Germany where the authors studied an inpatient database that was comprehensive in that data was available from all hospital and medical institutions in the country during the study interval of ten years. The goal was to evaluate whether there were changes in the surgical management of radial head fractures over this period. Over 70, 100 patients were included. The main findings were that surgical management increased with time. Open reduction and internal fixation using locking plate implants and the use of radial head arthroplasty (RHA) both increased and the incidence of radial head excision decreased. The increase in RHA was notable in patients over 65 years of age. Subsequent revisions were more commonly reported after RHA, especially in recent years.

Points for discussion

  • The database included all inpatient encounters in the country during the 10-year period of the study. Does the focus on inpatients only introduce bias into the observations?
  • Are the main findings of increasing rates of open reduction and internal fixation using locking plate technology and the increasing use of radial head arthroplasty consistent with evidence from the literature? Is that the appropriate approach to managing this injury?
  • The study also showed increasing rates of revision RHA. How does that fit in with the finding that the rate of “explantation” decreased? Does that mean that the arthroplasties required some other kind of revision?

Article #2
A Matched Comparison of Postoperative Complications Between Smokers and Nonsmokers Following Open Reduction Internal Fixation of Distal Radius Fractures
By Anoop R. Galivanche, BS, Shannon FitzPatrick, MD, Christopher Dussik, MD, Rohil Malpani, BS, Afamefuna Nduaguba, MD, Arya G. Varthi, MD, and Jonathan N. Grauer, MD
https://doi.org/10.1016/j.jhsa.2020.09.020

Volume 46, Issue 1, Pages 1-9.E4
Full article: https://www.jhandsurg.org/article/S0363-5023(20)30571-2/fulltext
Free podcast on the article: https://www.jhandsurg.org/pb/assets/raw/Health%20Advance/journals/yjhsu/January_2021.mp3

Summary
The authors used the NSQIP database to evaluate the association between smoking and post-operative complications incurred within 30 days of open reduction and internal fixation for distal radius fractures. There were 16, 158 cases identified, among whom just over 3,000 were smokers. In addition to comparing the incidences of the various outcomes, the authors also used propensity score matching to compare the groups. That process involved directly matching individuals in the two groups for a variety of basic demographic characteristics, much like what would be done in a case-control study. The finding s were, not unexpectedly, that there was a greater incidence of most of the undesirable outcomes among smokers including any adverse event, serious adverse events, surgical site infections and re-operation within 30 days. The increased rate of return to the operating room within 30 days was only seen in the analysis that used the matched groups. Mortality was the same in the two groups.

Points for discussion

  • The use of propensity score matching was an additional feature of this study separating it from others based on NSQIP, at least in JHS. Should this be a required aspect of all studies looking at this kind of question and based on this data source?
  • Most papers that talk about smoking describe it as a potentially modifiable risk factor, but in this context, is that really realistic or should the added risks associated with smoking just be used as a point of discussion with patients contemplating surgery for this injury?
  • The findings of an association between smoking and an increased incidence of adverse events, both minor and serious, as well as increased rate of infection and return to the operating room within 30 days are consistent with many other studies. Given the fact that the advantages of ORIF for many distal radius fractures have not been clearly established, should smoking be considered a relative contraindication for surgery?

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Previous #JHSJC Discussion Articles

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)