Approaches to Distal Upper-Extremity Trauma

Dasari, Chanukya R.; Sandhu, Manjot; Wisner, David H.; Wong, Michael S.

doi:10.1097/sap.0000000000000804

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…Such training patterns may also relate to trends in clinical practice because orthopaedic surgeons repair nearly 10 times as many fractures and dislocations of the carpus and forearm than their plastic surgery colleagues. 15 Only approximately half of plastic surgery residents decide to pursue fellowship training, whereas at least 90% of orthopaedic residents enter fellowship. 16 , 17 Our data show that residents completing plastic surgery programs complete on average more than 400 hand cases and 28 nerve repairs compared with orthopaedic residents who complete approximately 240 hand cases and 3 nerve repairs.…”

Section: Discussionmentioning

confidence: 99%

Variability in Hand Surgery Training Among Plastic and Orthopaedic Surgery Residents

Testa¹,

Orman²,

Bergen³

et al. 2022

JAAOS Glob Res Rev

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Background: A career in hand surgery in the United States requires a 1-year fellowship after residency training. Different residency specialty programs may vary in case volume. The purpose of this study was to characterize variation in hand surgery training within and between orthopaedic and plastic surgery residents. Methods: Publicly available hand surgery case logs for graduating orthopaedic and plastic surgery residents during the 2010 to 2011 to 2018 to 2019 academic years were obtained through the Accreditation Council of Graduate Medical Education. Student t -tests were used to compare mean case volumes among several categories between plastic surgery (PRS) and orthopaedic surgery (OS) residents. Intraspecialty variation was assessed by comparing the 90th and 10th percentiles in each category. Results: A total of 6,254 orthopaedic and 1,070 plastic surgery graduating residents were included. The mean hand surgery case volume for orthopaedic residents (OS 247.0) was significantly lower than that for plastic surgery residents (PRS 412.0) ( P < 0.0001). Orthopaedic residents performed more trauma cases (OS 133.2, PRS 54.5; P < 0.0001) but fewer nerve repairs (OS 3.3, PRS 28.5 P < 0.0001) and amputations (OS 6.4, PRS 15.8; P < 0.0001). Nerve decompression case volumes were similar between the two specialties (OS 50.2, PRS 47.3; P = 0.34). Case volumes among orthopaedic residents varied considerably in amputations and among plastic surgery residents in replantation/revascularization procedures. Conclusions: Orthopaedic surgery residents performed significantly more trauma cases than plastic surgery residents did, but fewer overall cases, nerve repairs, and amputations, while nerve decompression volumes were similar between specialties. This information may help inform residency and fellowship directors regarding areas of potential training deficiency.

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Section: Discussionmentioning

confidence: 99%

Variability in Hand Surgery Training Among Plastic and Orthopaedic Surgery Residents

Testa¹,

Orman²,

Bergen³

et al. 2022

JAAOS Glob Res Rev

View full text Add to dashboard Cite

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“…15 Despite this, many hand surgeons still rely on plaster splinting including the forearm and interphalangeal joints for the management of metacarpal fractures. 4,5,7…”

Section: Discussionmentioning

confidence: 99%

“…15 Despite this, many hand surgeons still rely on plaster splinting including the forearm and interphalangeal joints for the management of metacarpal fractures. 4,5,7 In athlete-related metacarpal injuries, there is a focus on a quick return to sport. 14,15 Fractures treated with splinting and early ROM all returned to pre-fracture activity within an average of twenty-two days 17 and were shown to have equivalent total active motion versus surgically managed fractures in long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…3,13,14 Among specialties in the United States providing care for metacarpal fractures, there is a significant difference in management as orthopedic surgeons are found to be less likely than plastic surgeons to perform surgery versus closed reduction and splinting. 7 In Canada, there is general agreement by plastic surgeons on operative criteria as demonstrated by Retrouvey et al though there is much greater variability when it comes to no-operative management. 4 They list unstable fractures, open fractures, malrotation, and angulation out of line with normal joint movement as primary criteria for operative management.…”

Section: Introductionmentioning

confidence: 98%

“…The current management of metacarpal fractures is not uniform. [1][2][3][4][5][6][7] There is considerable variability in the criteria for surgery, 4,[8][9][10] as well as the type of non-operative treatment made available for these injures. 5,[10][11][12][13] Metacarpal and phalangeal fractures account for 10% of all fractures, many in athletes or people of working age.…”

Section: Introductionmentioning

confidence: 99%

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Functional Hand-Based Splint in the Treatment of Metacarpal Fractures

Oxley

2021

Plast Surg (Oakv)

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Background: Post-treatment stiffness remains a significant hurdle following treatment for displaced or minimally displaced metacarpal fractures. Treatment goals should focus on a stable and acceptable reduction, minimal patient morbidity, and optimal mobility. Methods: A retrospective review of all non-operative metacarpal fractures over a five-month period at a tertiary center hand clinic treated with a hand-based splint were reviewed for radiologic and clinical stability. The splint allowed metacarpophalngeal joint, interphalangeal joint, and radiocarpal joint motion. Data collected included age, handedness, type and location of fracture, occupation, and ability to continue working. Radiologic images were reviewed by a radiologist not otherwise involved in patient care. Results: Thirty-three patients were reviewed with a total of 39 fractures of the second, third, fourth, and fifth metacarpals. Nine patients had nondominant hand fractures while 24 were dominant hand injuries. Twenty out of 24 patients employed pre-injury were able to continue working without missing any days. Three patients were lost to the final follow-up. The average splint duration was 24 days. Twenty-seven of 30 patients showed no change in alignment from start of splinting to end, while three showed some change but remained within non-operative criteria. Conclusion: A hand-based functional splint for metacarpal fractures allows for excellent maintenance of fracture reduction, early or immediate return to pre-injury activities, low patient morbidity, and maintains functional motion throughout treatment. It can be applied to any non-operative fracture of the second through the fifth metacarpal.

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A Comparison of 30-Day Perioperative Complications for Open Operative Care of Distal Upper-Extremity Fractures Treated by Orthopedic Versus Plastic Surgeons: A Study of the National Surgical Quality Improvement (NSQIP) Database

Wang

et al. 2020

Journal of Hand Surgery Global Online

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Purpose: To determine whether surgeon specialty affects complications after open operative care of distal upper-extremity fractures. Methods: We performed a retrospective cross-sectional study using the American College of Surgeons National Surgical Quality Improvement Database from 2005 to 2016. Patients were included if they received open operative treatment by an orthopedic or a plastic surgeon for distal radius/ulna, carpal, metacarpal, or phalangeal fracture. Univariate analysis and multivariable analysis of perioperative complications were performed to identify differences between the 2 specialties. Major complications assessed were 30-day reoperation and mortality. We also assessed transfusion, thromboembolic, surgical site infections, cardiac, pulmonary, and renal complications. Results: A total of 20,512 patients were included. Most cases performed by orthopedic surgeons (71.2%) were for distal radius/ulna fractures, whereas the majority of cases performed by plastic surgeons were for metacarpal (41.0%) and phalangeal (37.9%) fractures. No difference was identified in most perioperative complications between specialties. Plastic surgeons had a higher incidence of surgical site infections (1.2% vs 0.5%) on univariate analysis. However, when controlling for variables such as patient demographics and comorbidities in multivariable analysis, surgical specialty was not significantly associated with surgical site infection. Rather, surgery on phalangeal bones (adjusted odds ratio [aOR] ¼ 2.745; 95% confidence interval [CI], 1.559e4.833), higher wound class (wound class 3 aOR ¼ 3.630; 95% CI, 2.003e6.577), and smoking (aOR ¼ 1.970; 95% CI,1.279e3.032) were independent risk factors for surgical site infection. Plastic surgeons were found to operate on proportionally more smokers, patients with higher wound class, and phalangeal fractures (37.9% of all fracture cases) compared with orthopedic surgeons Conclusions: Orthopedic and plastic surgeons achieve equivalent outcomes from a safety perspective after open operative treatment of upper-extremity fractures in terms of mortality and 30-day reoperation, which suggests that both specialties can safely perform call-related operative upper-extremity fracture care. Plastic surgeons operated on more smokers, patients with higher wound class, and phalangeal fractures, all of which were associated with increased incidence of surgical site infection, revealing differences in practice composition from their orthopedic colleagues. Type of study/level of evidence: Therapeutic III.

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Approaches to Distal Upper-Extremity Trauma

Cited by 10 publications

References 4 publications

Variability in Hand Surgery Training Among Plastic and Orthopaedic Surgery Residents

Variability in Hand Surgery Training Among Plastic and Orthopaedic Surgery Residents

Functional Hand-Based Splint in the Treatment of Metacarpal Fractures

A Comparison of 30-Day Perioperative Complications for Open Operative Care of Distal Upper-Extremity Fractures Treated by Orthopedic Versus Plastic Surgeons: A Study of the National Surgical Quality Improvement (NSQIP) Database

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