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Osteolysis Following the Use of Polyetheretherketone Suture Anchors in Hand and Wrist Surgery: A Preliminary Study

Chen, Jeffrey S; Paksima, Nader; Rocks, Madeline C; Lin, Charles C; Catalano, Louis W
PURPOSE/OBJECTIVE:The objective of this study was to investigate and describe the presence of osteolysis after implantation of polyetheretherketone (PEEK) suture anchors in the hand and wrist. METHODS:Patients who underwent hand or wrist surgery using PEEK suture anchor(s) at a large academic institution from January 2019 to January 2021 were identified. Patients without accessible intraoperative fluoroscopic imaging were excluded. Patient demographics, type of procedure, and suture anchor material were recorded. The suture anchor tunnel size was measured on sequential radiographs and recorded as percentage change. Descriptive statistics were used to summarize findings. RESULTS:A total of 26 PEEK suture anchors in 14 patients were included, with an average follow-up of 12.0 months (range, 1.5-24.1 months). Twenty-seven percent of the anchors (7/26) demonstrated osteolysis at final follow-up, as defined by enlargement of tunnel size by >30%. In all anchors, the tunnel size increased by 19.1% on average (range, -7.7% to 56.1%) by final follow-up. CONCLUSIONS:Polyetheretherketone suture anchors may be associated with the development of osteolysis in hand and wrist surgery. The clinical implications of osteolysis in the smaller bones of the hand and wrist remain unclear. TYPE OF STUDY/LEVEL OF EVIDENCE/METHODS:Prognostic IV.
PMID: 37542497
ISSN: 1531-6564
CID: 5619002

Reducing Tourniquet Pressures in Hand Surgery: Are Lower Pressures as Effective?

Azad, Ali; Sager, Brian; Gupta, Salil; Ayalon, Omri; Paksima, Nader
PMID: 37223384
ISSN: 2163-3916
CID: 5543742

Assessing the Adequacy and Readability of Surgical Consents in Orthopedic Surgery

Pflug, Emily M; Giordano, Sebastian A; Hutzler, Lorraine; Bosco, Joseph A; Howard, Jordan; Paksima, Nader
BACKGROUND:Handwritten consent forms for medical treatment are commonly used despite the associated risk of documentation errors. We performed an internal audit of handwritten surgical consent forms to assess the quality of consenting practices within the department of hand surgery at our orthopedic specialty hospital. METHODS:A sample of 1,800 charts was selected. Con- sents were assessed for procedure type, physician details, abbreviations, consistency, and legibility. RESULTS:A total of 1,309 charts met the inclusion crite- ria. Two hundred and eight consents contained at least one illegible word. The name of the consenting physician was not listed or illegible on 114 forms. Medical abbreviations were found on 1.8% of all included forms, and 19 consent forms contained a crossed-out word or correction. CONCLUSIONS:Although the majority of the handwrit- ten consent forms were complete, accurate, and legible, there were notable errors in the consenting process at our institution. Documentation errors have medical and ethical ramifications. Further research into consenting practices is necessary to improve the quality of consent forms and the process of informed consent.
PMID: 36403946
ISSN: 2328-5273
CID: 5371842

Rapidly Growing Solitary Osteochondroma in the Adult Finger A Case Report [Case Report]

Niemeier, Julia K; Guzzetta, Melissa B; Paksima, Nader
Osteochondromas are common benign bone tumors that are most commonly found in children and adolescents. They are usually slow-growing and located at the metaphysis of the long bones. When present in adults in atypical locations or with concerning features, such as thickened cartilage cap and rapid growth, osteochondromas warrant imaging to assess the risk of malignant transformation into chondrosar- coma and may require surgical excision. Here, we describe the unusual case of an adult male with a rapidly growing osteochondroma of the proximal phalanx that subsequently underwent surgical excision.
PMID: 35643479
ISSN: 2328-5273
CID: 5244782

Opioid Prescribing Patterns Among Orthopedic Hand Surgeons After Implementation of a Divisional Protocol

Pflug, Emily M; Huang, Shengnan; Haquebord, Jacques H; Hutzler, Lorraine; Paksima, Nader
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.
PMID: 34596063
ISSN: 1945-1474
CID: 5244632

What a Waste! The Impact of Unused Surgical Supplies in Hand Surgery and How We Can Improve

Bravo, Dalibel; Thiel, Cassandra; Bello, Ricardo; Moses, Akini; Paksima, Nader; Melamed, Eitan
BACKGROUND/UNASSIGNED:The US health care system is the second largest contributor of trash. Approximately 20% to 70% of waste is produced by operating rooms, and very few of this waste is recycled. The purpose of this study is to quantify the opened but unused disposable supplies and generate strategies to reduce disposable waste. METHODS/UNASSIGNED:-e), a measure of greenhouse gas emissions. RESULTS/UNASSIGNED:-e during the study period. CONCLUSIONS/UNASSIGNED:This study highlights the excessive waste of unused disposable products during hand surgery cases and identifies ways of improvement.
PMID: 35485263
ISSN: 1558-9455
CID: 5217682

Telemedicine during the COVID-19 Pandemic: A Hand Surgery Perspective

Moses, Michael J; Buchalter, Daniel B; Azad, Ali; Hacquebord, Jacques H; Paksima, Nader; Yang, S Steven
PMID: 34789099
ISSN: 2424-8363
CID: 5049242

Musculoskeletal Ultrasonography of the Extremities: Clinical and Ultrasonographic Correlation

Azad, Ali; De Tolla, Jadie; Walter, William; Paksima, Nader; Melamed, Eitan
Ultrasonography as a diagnostic and therapeutic tool has become a resource for musculoskeletal injuries. It can be a useful imaging modality for clinical correlation of physical examination findings as well as an aid for image-guided procedures. Understanding the settings in which it is a helpful adjunct will have implications on efficiency and cost utility. The objectives of this chapter are to provide a background of ultrasonography as a musculoskeletal imaging modality, provide clinical correlation for ultrasonographic findings for common upper extremity pathology, review the diagnostic efficacy of ultrasonography for image-guided procedures, and provide insight into the cost utility of ultrasonography guidance for therapeutic injections.
PMID: 33438941
ISSN: 0065-6895
CID: 4746862

Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine

Shulman, Brandon S; Rettig, Michael; Yang, S Steven; Sapienza, Anthony; Bosco, Joseph; Paksima, Nader
PURPOSE/OBJECTIVE:Wide-awake local anesthesia no tourniquet (WALANT) is an increasingly popular surgical technique. However, owing to surgeon preference, patient factors, or hospital guidelines, it may not be feasible to inject patients with solutions containing epinephrine the recommended 25 minutes prior to incision. The purpose of this study was to assess pain and patient experience after short hand surgeries done under local anesthesia using a tourniquet rather than epinephrine for hemostasis. METHODS:Ninety-six consecutive patients undergoing short hand procedures using only local anesthesia and a tourniquet (LA-T) were assessed before and after surgery. A high arm pneumatic tourniquet was used in 73 patients and a forearm pneumatic tourniquet was used in 23. All patients received a local, unbuffered plain lidocaine injection. No patients received sedation. Pain related to local anesthesia, pneumatic tourniquet, and the procedure was assessed using a visual analog scale (VAS). Patient experience was assessed using a study-specific questionnaire based on previous WALANT studies. Tourniquet times were recorded. RESULTS:Mean pain related to anesthetic injection was rated 3.9 out of 10. Mean tourniquet related pain was 2.9 out of 10 for high arm pneumatic tourniquets and 2.3 out of 10 for forearm pneumatic tourniquets. Patients rated their experience with LA-T favorably and 95 of 96 patients (99%) reported that they would choose LA-T again for an equivalent procedure. Mean tourniquet time was 9.6 minutes and only 1 patient had a tourniquet inflated for more than 20 minutes. Tourniquet times less than 10 minutes were associated with less pain than tourniquet times greater than 10 minutes (P < .05); however, both groups reported the tourniquet to be on average less painful than the local anesthetic injection. CONCLUSION/CONCLUSIONS:Short wide-awake procedures using a tourniquet are feasible and well accepted. Local anesthetic injection was reported to be more painful than pneumatic tourniquet use. Tourniquets for short wide-awake procedures can be used in settings in which preprocedure epinephrine injections are logistically difficult or based on surgeon preference. TYPE OF STUDY/LEVEL OF EVIDENCE/METHODS:Therapeutic IV.
PMID: 31924434
ISSN: 1531-6564
CID: 4257802

Outcomes of dorsal plating for selected distal radius fractures

Paksima, Nader; Driesman, Adam; Johnson, Julie; Kim, Christopher; Egol, Kenneth
To determine the functional outcome and complications following dorsal plating for unstable fractures of the distal radius. We searched our IRB-approved Distal Radius Fracture Databases and identified all patients who were treated with a dorsally applied plate. Thirty-four distal radius fractures in 33 patients with a mean age of 50 years and average follow-up of 14 months were treated with a dorsal locking plate from 2007 to 2015. Fifteen and six patients had dorsal shearing fracture pattern and delayed presentation, respectively. There were no loss of reduction, malunion, or nonunion. Average VAS pain score was 2.1/10. Eight patients (23%) required hardware removal, one of which was due to extensor tendon rupture (3%) and five due to extensor tendon irritation (15%). Dorsal locked plating of distal radius fractures with newer low-profile implants is a viable option for particular fractures types, such as the dorsal rim shear type fractures.
ISSN: 0001-6462
CID: 4509282