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 to your Tweets.

Questions? Contact us at jhs@assh.org.

 

October #JHSJC

Participate in the October JHS journal club!

Date: October 16
Time: 9 pm EDT

 

Article #1:

The Effectiveness of Mini–C-Arm Fluoroscopy for the Closed Reduction of Distal Radius Fractures in Adults: A Randomized Controlled Trial
By Steven K. Dailey, MD, Ashley R. Miller, MD, Rafael Kakazu, MD, John D. Wyrick, MD, Peter J. Stern, MD

October 2018: Volume 43, Issue 10, Pages 927–931
https://www.jhandsurg.org/article/S0363-5023(17)30746-3/fulltext

Summary

The objective of the study was to compare the quality of reductions for distal radius fractures, obtained either using mini- C-arm fluoroscopy during the reduction or “standard reduction techniques that did not use fluoroscopy and which evaluated the reduction with regular radiographs made with an orthosis in place. Patients in both groups underwent the same protocol for carrying out a closed reduction and the final results were based on the radiographs obtained once the orthosis was in place as judged by two residents who were blinded to the method of reduction. Secondary outcomes included the number of reduction attempts and orthoses required (recorded by the residents doing the reductions) as well as the subjective difficulty of doing the reduction, which was recorded on a visual analog scale. Sixty-three patients were randomized. The main findings were that the number of reduction attempts was greater in the fluoroscopy group and the subjective difficulty was also higher in that group. The radiographic parameters used to judge reduction quality were the same in the two groups. Time spent in the emergency department was very long – over 6 hours for both groups – but shorter in the group that used fluoroscopy.

Points for discussion

  • Table 1 suggests that the distribution of fracture types was not necessarily the same for the two groups. The “standard” group had more “23-A3” types and the fluoroscopy group more “23-C2”? What, if any, effect might that have had on the findings?
  • What are the sources of potential bias or error in the data collection?
  • What is the overall meaning of the findings that the reductions were on average thought to be harder – both as recorded by the residents and with respect to the number of reductions required – but that the radiographic parameters used to judge the quality of the reduction were all the same? Does that mean that fluoroscopy should be used or that it is unnecessary?

 

Article #2:

Pain Management After Carpal Tunnel Release Surgery: A Prospective Randomized Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone
By Asif M. Ilyas, MD, Andrew J. Miller, MD, Jack G. Graham, BS, Jonas L. Matzon, MD

October 2018: Volume 43, Issue 10, Pages 913–919
https://www.jhandsurg.org/article/S0363-5023(18)30652-X/fulltext

 Summary

The study reports the findings of a prospective, blinded, randomized trial comparing ibuprofen, acetaminophen and oxycodone for post-operative analgesia in patients undergoing carpal tunnel release. One hundred five patients were entered into the study. The outcome measures were the daily “worst pain”, reported on a visual analog scale and the total number of pills consumed. Adverse effects were also tracked. The patients were stratified by the method of carpal tunnel release, either open or endoscopic. The worst daily pain scores were approximately the same for patients receiving all three analgesics and were generally, slightly higher for open than for endoscopic carpal tunnel release. Similarly, the number of pills taken was also around the same (no statistically significant difference), although a larger number were taken by patients in both surgical groups who were assigned to ibuprofen. Four of the 5 adverse reactions were in the oxycodone group and all were minor in nature. The authors conclude that nonopioids should be used for pain management after carpal tunnel release and that 5-10 pills should be prescribed

 Points for discussion

  • How does the stratification of surgical treatment, i.e. endoscopic versus open carpal tunnel release affect the observations, if at all?
  • Patients who requested a change to their post-operative analgesic were excluded from the study because the surgeons were unblinded as a result of having to provide an alternative prescription. Was that the correct strategy? Could that have had an influence on the findings?
  • Is the study biased by the setting in which it was conducted? Does that have any ramifications with respect to generalization of the conclusions?
  • The requirements for adequate power were not met for all of the subgroups because it was necessary to stratify by surgical approach (endoscopic vs. open). Is that a concern or should the findings be fully accepted?
  • In the same way, the RCT strategy notwithstanding, the overall sample size is small. Is that likely to have affected the observations? In other words, if the same study were done in thousands of patients, like in a cancer trial, is it likely that the findings would be different from what was observed in this study with a few dozen patients in each group?