Faculty Bibliography

INTRODUCTION/BACKGROUND:Overprescribing contributes to the misuse and overuse of narcotics. We hypothesized that implementation of postoperative prescribing guidelines would consistently reduce the amount of opioids prescribed after ambulatory hand surgery. METHODS:A divisional protocol was instituted in November 2018. A retrospective cohort study was designed to examine the policy's effects on postoperative prescribing. Postoperative opioid prescriptions for patients undergoing ambulatory hand surgery were evaluated 1 year before and 1 year after policy initiation. All prescriptions were converted into the total oral morphine equivalent (OME) prescribed. RESULTS:A total of 1,672 surgeries were included. Six hundred sixty-one cases were in preimplementation group, and 1,011 cases were in the postimplementation group. The median of total OME decreased significantly after distribution of prescribing guidelines from 75 in the preimplementation group to 45 in the postimplementation group (p < .001) with significant reductions seen for carpal tunnel release (p < .001), trigger finger release (p < .001), distal radius open reduction internal fixation (p < .001), and finger closed reduction and pinning (p < .001). When categorized by procedure type, the median of total OME decreased from 75 to 30 for soft tissue procedures (p < .001) and from 120 to 100 for bony procedures (p < .001). CONCLUSION/CONCLUSIONS:Divisional prescribing guidelines lead to consistent short-term to mid-term reductions in the amount of opioid medication prescribed postoperatively.

Aim of this work is to improve the bond between a strain sensor and a device on which the strain shall be determined. As strain sensor, a CMOS-integrated chip featuring piezoresistive sensor elements was used which is capable of wireless energy and data transmission. The sensor chip was mounted on a standardized tensile test specimen of stainless steel by a bonding process using reactive multilayer systems (RMS). RMS provide a well-defined amount of heat within a very short reaction time of a few milliseconds and are placed in-between two bonding partners. RMS were combined with layers of solder which melt during the bonding process. Epoxy adhesive films were used as a reference bonding process. Under mechanical tensile loading, the sensor bonded with RMS shows a linear strain sensitivity in the whole range of tested forces whereas the adhesive-bonded sensor has slightly nonlinear behavior for low forces. Compared to the adhesive-bonded chips, the sensitivity of the reactively bonded chips is increased by a factor of about 2.5. This indicates a stronger mechanical coupling by reactive bonding as compared to adhesive bonding.

SUMMARY/CONCLUSIONS:Operative management of sternoclavicular fracture-dislocations is recommended in the setting of symptomatic nonunion. Treatment options include open reduction internal fixation, fragment excision, and ligamentous reconstruction. We present a 29-year-old man with a medial clavicle fracture nonunion that previously failed open reduction internal fixation and was treated with sternoclavicular joint reconstruction using tendon allograft.