Faculty Bibliography

BACKGROUND: The purpose of this study was to examine functional outcomes following ORIF of displaced proxi- mal humerus fractures in patients who received brachial plexus blocks compared to those who underwent general anesthesia. METHODS: We retrospectively reviewed prospectively col- lected data on 92 patients. Patients were grouped according to anesthesia type: regional interscalene brachial plexus block, with or without general anesthesia, or general anes- thesia alone. Patients were asked to complete the Disabili- ties of the Arm, Shoulder and Hand (DASH) questionnaire and range of motion assessments at a minimum of 6-month follow-up. Plain radiographic films were obtained to assess fracture healing. RESULTS: Forty-five (48.9%) patients with 45 proximal humerus fractures received a regional anesthetic, while 47 (51.1%) patients with 48 proximal humerus fractures had general anesthesia. No significant differences existed in demographic information or fracture type. DASH scores at the most recent follow-up were significantly better in the regional block group (38.6) compared to the general anes- thesia group (53.1) (p = 0.003). The regional block group had significantly better passive and active forward elevation and external rotation range and equivalent internal rotation (p = 0.002, 0.005, 0.002, and 0.507, respectively). CONCLUSION: Patients who received regional anesthetic via a brachial plexus interscalene blocks had better functional outcomes and range of motion at the most recent clinical follow-up. Regional anesthesia provides patients with pro- longed postoperative pain relief, which may allow for early mobilization, increasing the likelihood that the patient's function and range of motion will return to baseline.

PURPOSE: Information regarding patient preferences is important to develop more diversity in healthcare providers. To our knowledge, no information exists regarding how patients choose their orthopaedic surgeon. The purpose of this study is to determine which demographic factors, if any, affect patient preferences when choosing an orthopaedic surgeon. METHODS: Five hundred new patients presenting to a large, urban, academic orthopaedic clinic from May 2011 to May 2013 were prospectively asked to participate in this study. Patients were asked to complete a survey designed with the help of the Division of Population Health that focused on demographic, professional and physical attributes of theoretical surgeons. Specifically, patient preference of surgeon age, gender, race, religion, importance of education prestige, training program prestige and number of medical publications were evaluated. Patients were then stratified by age, gender, race, religion, educational level and income level to assess whether their own demographics were related to their preferences. The data was then analyzed to determine whether correlations existed between patient preferences and their own demographics. RESULTS: Five hundred patients agreed to participate in the study. There were 195 (39.0%) males and 281 (56.2%) females with an average age of 40.8 years (SD=20.5), 24 patients (4.8%) did not respond to the question. Two hundred and twelve (42.4%) patients were Caucasian, 116 (23.2%) were Hispanic, 53 (10.6%) were African American, 44 (8.8%) were Asian, 32 (6.4%) were listed as other and 43 (8.6%) did not answer. 78.0% of patients had no preference for their surgeon's gender, but for those who did, both men and woman preferred male surgeons (weak positive correlation, not statistically significant, r=0.096, p=0.373). The majority of patients (84.8%) had no preference for the race of their surgeon, but those that had a preference tended to prefer surgeons of their own ethnicity (p<0.001). With increasing patient education level, medical school, residency and fellowship training prestige had more importance as a selection criterion. Increasing patient education level also demonstrated a corresponding importance given to physician education and training as categorized by the perception of residency training program prestige (p=0.04). A majority of patients (84.0%) had no preference for their surgeon's religion, but for those who did there was a strong correlation (r=0.65), between the patients' own religion and that of the physician (p<0.001). There was universal agreement in perception that neither physician age nor years in practice made any difference as selection criteria when choosing an orthopaedic surgeon (p>0.05). Finally patient income level had no effect on specific criteria when choosing a surgeon. CONCLUSION: The vast majority of patients surveyed had no preference in age, gender, race, or religion of their potential surgeon. However, patients who had preferences in these categories tended to choose surgeons of the same age, race and religion. These findings neither support or refute the need for diverse health care providers in the field of orthopaedics.

The aim of this study was to quantify the amount of tendon excursion and load experienced during simulated active and passive rehabilitation exercises. Six cadaver specimens were utilized to examine tendon excursion and load. Lateral fluoroscopic images were used to measure the excursions of metal markers placed in the flexor digitorum superficialis and profundus tendons of the index, middle, and ring fingers. Measurements were performed during ten different passive and active simulated motions. Mean tendon forces were higher in all active versus passive movements. Blocking movements placed the highest loads on the flexor tendons. Active motion resulted in higher tendon excursion than did passive motion. Simulated hook position resulted in the highest total tendon excursion and the highest inter-tendinous excursion. This knowledge may help optimize the management of the post-operative exercise therapy regimen.

BACKGROUND: The quality of reduction of the syndesmosis is an important factor in the outcome of ankle fractures associated with a syndesmotic injury. The purpose of this study was to directly compare the accuracy of syndesmotic reductions obtained using intraoperative standard fluoroscopic techniques against reductions obtained using three-dimensional imaging of the Iso-C3D fluoroscope. METHODS: We prospectively reviewed imaging studies of patients who were diagnosed as having preoperative or intraoperative evidence of syndesmotic diastasis (on the basis of the fluoroscopic Cotton test and/or a manual external rotation stress test) who underwent syndesmotic fixation at one of two level-I trauma centers. Center A used intraoperative computed tomography (CT) imaging to assess reduction (