Eric Hofmeister - Academia.edu (original) (raw)

Papers by Eric Hofmeister

The Journal of Hand Surgery

The archives of bone and joint surgery, 2016

BACKGROUND As an early step in the development of a decision aid for idiopathic trigger finger (T... more BACKGROUND As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. METHODS One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). RESULTS On ...

Archives of Orthopaedic and Trauma Surgery, 2021

Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist frac... more Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8–12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. Materials and methods In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient se...

The Journal of hand surgery, Jan 10, 2016

Stable fixation of distal humerus fracture fragments is necessary for adequate healing and mainte... more Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the...

The Journal of hand surgery, Jan 27, 2016

To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarp... more To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis. In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification. We randomly assigned 42 observers to review radiographs alone and also informed 50 of the patient's symptoms and examination. Information about symptoms and examination was randomized. Interobserver reliability was determined with the s* statistic. Because of the hierarchical data structure, cros...

The Journal of Hand Surgery, 2014

Science of Variation Group Purpose This study tested the null hypothesis that there are no differ... more Science of Variation Group Purpose This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). Methods One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. Conclusions There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. Clinical relevance Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

The Journal of Hand Surgery, 2013

Purpose It is our impression that there is substantial, unexplained variation in hand surgeon rec... more Purpose It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions The findings of this study suggest that-at least in a survey setting-surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies.

The Journal of Hand Surgery, 2014

To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck f... more To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. Methods Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. Results Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. Conclusions Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures.

The Journal of Hand Surgery, 2014

Purpose To test the null hypothesis that there are no differences in the priorities and preferenc... more Purpose To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons. Methods One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids. Conclusions Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TFdifferences that might be addressed by a decision aid. Clinical relevance Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

The Journal of Bone and Joint Surgery-American Volume

The Foot

Many dis~r~pa~lcies and convicting data have been published on the anatomical identification, loc... more Many dis~r~pa~lcies and convicting data have been published on the anatomical identification, location, incidence and size of the peroneal tubercle. All such studies have been performed on freeze-dried bone, and no studies have measured the size of the peroneal tubercle in cadavers. Using 35 cadaver specimens, we found that the incidence of a peroneal tubercle was 94%, which is greater than previously reported. The average length was 10.3 mm, width 5.6 mm, height 4.0 mm: and average distance to the cal~allealcuboid joint was 17.2 mm. The incidence of hypertrophy of the peroneal tubercle was 3%. We also review the literature on the incidence and size of the peroneal tubercle, function of the peroneal tubercle, related structures, pathology associated with the peroneal tubercle, and treatment of these abnormalities.

The Journal of hand surgery, Jan 9, 2017

Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost c... more Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price ("price-aware" group), or a version without prices ("price-naïve" group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. For cases offering implants wit...

Front Line Extremity and Orthopaedic Surgery, 2014

Military medicine, 1995

A 64-year-old male with chronic immune-mediated thrombocytopenic purpura (cITP) underwent three-v... more A 64-year-old male with chronic immune-mediated thrombocytopenic purpura (cITP) underwent three-vessel coronary artery bypass grafting after preoperative treatment with steroids and intravenous immunoglobulin with no prophylactic splenectomy performed. On the morning of surgery the platelet count was 110 x 10(3)/mm3, up from an initial 18 x 10(3)/mm3. The patient tolerated the procedure well, with no intraoperative or postoperative complications. This case demonstrates that with appropriate perioperative management, patients with cITP can safely undergo major cardiac surgery.

Orthopedics, 2009

Volar lunate fractures are rare injuries, usually seen as a result of high-energy trauma and ofte... more Volar lunate fractures are rare injuries, usually seen as a result of high-energy trauma and often in association of other carpal injuries. We present 2 unusual cases of coronal volar lunate fractures. The first case involved a proximal pole scaphoid fracture in association with a volar lunate fracture. During surgical exposure, the lunate fracture was found to be rotated 180 degrees volarly. This displaced lunate fracture, although appearing small on radiographs, consisted of the entire volar half of the capitate facet of the distal lunate. Both the scaphoid and lunate fractures were anatomically reduced with fixation across the fractures. The second case was the result of a high-energy injury and included a transscaphoid, transtriquetral, translunate facture dislocation with a comminuted radial styloid fracture and a small ulnar styloid fracture. Operative reduction and internal fixation was performed of the scaphoid and lunate. The triquetral and comminuted radial styloid fractur...

Hand (New York, N.Y.), 2006

The purpose of this study was to determine the results of combined anterior and posterior interos... more The purpose of this study was to determine the results of combined anterior and posterior interosseous neurectomy (AIN/PIN) in patients with chronic wrist pain secondary to dynamic instability, and to determine the predictability of selective AIN/PIN blocks with respect to pain relief, grip strength, and outcome of the neurectomy. A prospectively accrued chronic wrist pain registry was undertaken. Inclusion criteria were patients with arthroscopically confirmed dynamic wrist instability who had undergone a diagnostic AIN/PIN injection, followed by a single dorsal incision neurectomy. All patients completed Disabilities of the Arm, Shoulder and Hand outcome questionnaires preoperatively and at intervals postoperatively. Pre- and postoperative range of motion, grip strength, and percentage pain relief were recorded. Over a 3-year period, 50 wrists (48 patients) were enrolled: average follow-up was 28 months (range: 24-42 months). The average improvement in grip strength after denervat...

Techniques in hand & upper extremity surgery, 2004

The increased awareness of scaphoid fractures and their complications has prompted early aggressi... more The increased awareness of scaphoid fractures and their complications has prompted early aggressive treatment to prevent the sequelae of nonunions and degenerative changes in the carpus. Despite this, many fractures require prolonged immobilization, often resulting in diminished motion and time lost in sports or employment. In an effort to diminish the time to union and decrease prolonged immobilization, percutaneous fixation techniques have been described and recently popularized by several authors. The indications and contraindications, technique, complications, and rehabilitation of treatment of both dorsally and volarly placed percutaneous screw fixation of stable scaphoid fractures will be the focus of this paper.

American journal of orthopedics (Belle Mead, N.J.), 2001

Although snakebite injuries to the hand are common, intra-articular envenomation has rarely been ... more Although snakebite injuries to the hand are common, intra-articular envenomation has rarely been reported. In this article, we describe a patient who was bitten by a rattlesnake and whose left-index-finger distal interphalangeal joint sustained intra-articular envenomation that resulted in aseptic chondrolysis and severe joint destruction 1.5 years later. Multiple cultures and biopsies were negative, and histology was consistent with nonspecific degenerative changes secondary to necrosis of the articular cartilage from retained toxins. The patient chose arthrodesis; 24 months postoperatively, he was pain-free and had returned to work.

Hand clinics, 1998

Multiple studies have demonstrated that muscle poorly tolerates ischemia. When the ischemic state... more Multiple studies have demonstrated that muscle poorly tolerates ischemia. When the ischemic state is unduly prolonged, the successfully replanted or revascularized limb undergoes deleterious biochemical reactions that cascade to vessel intimal damage, increased vessel permeability, and lowering of pH. The resultant tissue edema leads to increasing compartment pressures, which not only impede the recovery of function, but also can lead to irreversible muscle necrosis, increased risk of infection, and sepsis if not reversed in a timely fashion. The development of compartment syndrome jeopardizes not only the injured limb, but life itself secondary to the biochemical toxins produced by the ischemic extremity. A thorough understanding of the biochemistry of ischemia and reperfusion provides insight into the role of fasciotomy in the replanted or revascularized extremity. The scientific basis for fasciotomy in the revascularized or replanted limb is discussed as well as the potential &qu...

HAND, 2007

The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined w... more The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined with corticosteroids are often used for both diagnosis and therapy. The purpose of this study was to determine if a midcarpal injection of lidocaine could serve as a diagnostic tool in patients with chronic wrist pain. Specifically, the relationship of pain relief from the injection and improvement of grip strength were compared to the presence of intracarpal pathology as confirmed by wrist arthroscopy. Forty-five patients with chronic wrist pain underwent a midcarpal injection of lidocaine with or without corticosteroids. Forty of the 45 underwent comcomitant steroid injections; a majority of the 40 patients reported relief of pain for two or more weeks. Improvement of pain and improvement of grip strength were determined. Each of these patients subsequently underwent a radiocarpal and midcarpal arthroscopy, and the pathologic findings of arthroscopy were compared to the improvement of p...

The Journal of Hand Surgery

The archives of bone and joint surgery, 2016

BACKGROUND As an early step in the development of a decision aid for idiopathic trigger finger (T... more BACKGROUND As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. METHODS One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). RESULTS On ...

Archives of Orthopaedic and Trauma Surgery, 2021

Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist frac... more Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8–12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. Materials and methods In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient se...

The Journal of hand surgery, Jan 10, 2016

Stable fixation of distal humerus fracture fragments is necessary for adequate healing and mainte... more Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the...

The Journal of hand surgery, Jan 27, 2016

To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarp... more To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis. In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification. We randomly assigned 42 observers to review radiographs alone and also informed 50 of the patient's symptoms and examination. Information about symptoms and examination was randomized. Interobserver reliability was determined with the s* statistic. Because of the hierarchical data structure, cros...

The Journal of Hand Surgery, 2014

Science of Variation Group Purpose This study tested the null hypothesis that there are no differ... more Science of Variation Group Purpose This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). Methods One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. Conclusions There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. Clinical relevance Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

The Journal of Hand Surgery, 2013

Purpose It is our impression that there is substantial, unexplained variation in hand surgeon rec... more Purpose It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions The findings of this study suggest that-at least in a survey setting-surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies.

The Journal of Hand Surgery, 2014

To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck f... more To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. Methods Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. Results Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. Conclusions Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures.

The Journal of Hand Surgery, 2014

Purpose To test the null hypothesis that there are no differences in the priorities and preferenc... more Purpose To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons. Methods One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids. Conclusions Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TFdifferences that might be addressed by a decision aid. Clinical relevance Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

The Journal of Bone and Joint Surgery-American Volume

The Foot

Many dis~r~pa~lcies and convicting data have been published on the anatomical identification, loc... more Many dis~r~pa~lcies and convicting data have been published on the anatomical identification, location, incidence and size of the peroneal tubercle. All such studies have been performed on freeze-dried bone, and no studies have measured the size of the peroneal tubercle in cadavers. Using 35 cadaver specimens, we found that the incidence of a peroneal tubercle was 94%, which is greater than previously reported. The average length was 10.3 mm, width 5.6 mm, height 4.0 mm: and average distance to the cal~allealcuboid joint was 17.2 mm. The incidence of hypertrophy of the peroneal tubercle was 3%. We also review the literature on the incidence and size of the peroneal tubercle, function of the peroneal tubercle, related structures, pathology associated with the peroneal tubercle, and treatment of these abnormalities.

The Journal of hand surgery, Jan 9, 2017

Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost c... more Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price ("price-aware" group), or a version without prices ("price-naïve" group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. For cases offering implants wit...

Front Line Extremity and Orthopaedic Surgery, 2014

Military medicine, 1995

A 64-year-old male with chronic immune-mediated thrombocytopenic purpura (cITP) underwent three-v... more A 64-year-old male with chronic immune-mediated thrombocytopenic purpura (cITP) underwent three-vessel coronary artery bypass grafting after preoperative treatment with steroids and intravenous immunoglobulin with no prophylactic splenectomy performed. On the morning of surgery the platelet count was 110 x 10(3)/mm3, up from an initial 18 x 10(3)/mm3. The patient tolerated the procedure well, with no intraoperative or postoperative complications. This case demonstrates that with appropriate perioperative management, patients with cITP can safely undergo major cardiac surgery.

Orthopedics, 2009

Volar lunate fractures are rare injuries, usually seen as a result of high-energy trauma and ofte... more Volar lunate fractures are rare injuries, usually seen as a result of high-energy trauma and often in association of other carpal injuries. We present 2 unusual cases of coronal volar lunate fractures. The first case involved a proximal pole scaphoid fracture in association with a volar lunate fracture. During surgical exposure, the lunate fracture was found to be rotated 180 degrees volarly. This displaced lunate fracture, although appearing small on radiographs, consisted of the entire volar half of the capitate facet of the distal lunate. Both the scaphoid and lunate fractures were anatomically reduced with fixation across the fractures. The second case was the result of a high-energy injury and included a transscaphoid, transtriquetral, translunate facture dislocation with a comminuted radial styloid fracture and a small ulnar styloid fracture. Operative reduction and internal fixation was performed of the scaphoid and lunate. The triquetral and comminuted radial styloid fractur...

Hand (New York, N.Y.), 2006

The purpose of this study was to determine the results of combined anterior and posterior interos... more The purpose of this study was to determine the results of combined anterior and posterior interosseous neurectomy (AIN/PIN) in patients with chronic wrist pain secondary to dynamic instability, and to determine the predictability of selective AIN/PIN blocks with respect to pain relief, grip strength, and outcome of the neurectomy. A prospectively accrued chronic wrist pain registry was undertaken. Inclusion criteria were patients with arthroscopically confirmed dynamic wrist instability who had undergone a diagnostic AIN/PIN injection, followed by a single dorsal incision neurectomy. All patients completed Disabilities of the Arm, Shoulder and Hand outcome questionnaires preoperatively and at intervals postoperatively. Pre- and postoperative range of motion, grip strength, and percentage pain relief were recorded. Over a 3-year period, 50 wrists (48 patients) were enrolled: average follow-up was 28 months (range: 24-42 months). The average improvement in grip strength after denervat...

Techniques in hand & upper extremity surgery, 2004

The increased awareness of scaphoid fractures and their complications has prompted early aggressi... more The increased awareness of scaphoid fractures and their complications has prompted early aggressive treatment to prevent the sequelae of nonunions and degenerative changes in the carpus. Despite this, many fractures require prolonged immobilization, often resulting in diminished motion and time lost in sports or employment. In an effort to diminish the time to union and decrease prolonged immobilization, percutaneous fixation techniques have been described and recently popularized by several authors. The indications and contraindications, technique, complications, and rehabilitation of treatment of both dorsally and volarly placed percutaneous screw fixation of stable scaphoid fractures will be the focus of this paper.

American journal of orthopedics (Belle Mead, N.J.), 2001

Although snakebite injuries to the hand are common, intra-articular envenomation has rarely been ... more Although snakebite injuries to the hand are common, intra-articular envenomation has rarely been reported. In this article, we describe a patient who was bitten by a rattlesnake and whose left-index-finger distal interphalangeal joint sustained intra-articular envenomation that resulted in aseptic chondrolysis and severe joint destruction 1.5 years later. Multiple cultures and biopsies were negative, and histology was consistent with nonspecific degenerative changes secondary to necrosis of the articular cartilage from retained toxins. The patient chose arthrodesis; 24 months postoperatively, he was pain-free and had returned to work.

Hand clinics, 1998

Multiple studies have demonstrated that muscle poorly tolerates ischemia. When the ischemic state... more Multiple studies have demonstrated that muscle poorly tolerates ischemia. When the ischemic state is unduly prolonged, the successfully replanted or revascularized limb undergoes deleterious biochemical reactions that cascade to vessel intimal damage, increased vessel permeability, and lowering of pH. The resultant tissue edema leads to increasing compartment pressures, which not only impede the recovery of function, but also can lead to irreversible muscle necrosis, increased risk of infection, and sepsis if not reversed in a timely fashion. The development of compartment syndrome jeopardizes not only the injured limb, but life itself secondary to the biochemical toxins produced by the ischemic extremity. A thorough understanding of the biochemistry of ischemia and reperfusion provides insight into the role of fasciotomy in the replanted or revascularized extremity. The scientific basis for fasciotomy in the revascularized or replanted limb is discussed as well as the potential &qu...

HAND, 2007

The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined w... more The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined with corticosteroids are often used for both diagnosis and therapy. The purpose of this study was to determine if a midcarpal injection of lidocaine could serve as a diagnostic tool in patients with chronic wrist pain. Specifically, the relationship of pain relief from the injection and improvement of grip strength were compared to the presence of intracarpal pathology as confirmed by wrist arthroscopy. Forty-five patients with chronic wrist pain underwent a midcarpal injection of lidocaine with or without corticosteroids. Forty of the 45 underwent comcomitant steroid injections; a majority of the 40 patients reported relief of pain for two or more weeks. Improvement of pain and improvement of grip strength were determined. Each of these patients subsequently underwent a radiocarpal and midcarpal arthroscopy, and the pathologic findings of arthroscopy were compared to the improvement of p...