Christopher J. Dy

Christopher J. Dy
Washington University in St. Louis | WUSTL , Wash U · Department of Orthopaedic Surgery

MD, MPH

About

146
Publications
19,922
Reads
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2,721
Citations
Citations since 2016
72 Research Items
1989 Citations
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20162017201820192020202120220100200300
20162017201820192020202120220100200300
Additional affiliations
August 2015 - present
Washington University in St. Louis
Position
  • Professor (Assistant)
August 2014 - July 2015
Washington University in St. Louis
Position
  • Clinical Fellow (Hand and Upper Extremity Surgery)
June 2012 - May 2014
Hospital for Special Surgery
Position
  • Health Services Research Fellow

Publications

Publications (146)
Article
Full-text available
Background: Carpal tunnel release (CTR) is a surgical treatment option for patients with carpal tunnel syndrome (CTS) symptoms that are unresponsive to conservative treatment. Most patients experience symptomatic relief after CTR regardless of the surgical technique. However, direct comparisons of the safety and effectiveness between CTR surgical...
Article
Background: The use of ultrasound in the diagnosis of cubital tunnel syndrome (CuTS) is an attractive alternative to electrodiagnostic (EDX) studies, but its utility is binary with poor severity correlation. We hypothesize that increasing ulnar nerve cross-sectional area (CSA) and power Doppler measurement of intraneural vascularity may predict th...
Article
Background: We aimed to explore patients' perioperative experience after trapeziectomy and ligament reconstruction tendon interposition (LRTI) through semi-structured patient interviews to identify deficiencies in our preoperative patient counseling. Methods: We conducted semi-structured interviews with 14 patients who had undergone LRTI either...
Article
Background and objectives: There is growing interest in containing cost and decreasing waste in the operating room. As part of a quality improvement initiative, we redesigned the supply kit used for 2 common surgical procedures (carpal tunnel release and trigger finger release) performed under local anesthesia. Methods: A hand surgeon, a medical...
Article
Introduction Automated measurement of digital range of motion (ROM) may improve the accuracy of reporting and increase clinical efficiency. We hypothesize that a 3-D camera on a custom gantry will produce ROM measurements similar to those obtained with a manual goniometer. Methods A 3-D camera mounted on a custom gantry, was mechanized to rotate 2...
Article
»: Traumatic brachial plexus injuries are relatively rare but potentially devastating injuries with substantial functional, psychological, and economic consequences. »: Prompt referral (ideally within 6 weeks of injury) to a center with a team of experts experienced in the diagnosis and management of these injuries is helpful to achieving optima...
Article
Full-text available
Background: The purpose of this study was to assess the expression of molecular markers and epineural blood flow after differing degrees of nerve injury to identify potential tools to predict nerve recovery in a rat sciatic nerve model. Methods: A total of 72 rats were divided into nine groups. Each group was subjected to one of three crush inju...
Article
Foot drop is a common clinical condition which may substantially impact physical function and health-related quality of life. The etiologies of foot drop are diverse and a detailed history and physical examination are essential in understanding the underlying pathophysiology and capacity for spontaneous recovery. Patients presenting with acute foot...
Article
Foot drop is a common condition that may impact physical function and health-related quality of life. A detailed clinical history and physical examination are critical components of the initial evaluation of patients presenting with foot drop. Patients with refractory foot drop without spontaneous recovery of motor deficits, delayed presentation gr...
Article
Full-text available
Background:. Although extensive research shows an association between distal radius fractures and the development of median nerve related pathologies such as carpal tunnel syndrome, none directly track how the resulting angular deformity relates to likelihood of development of median nerve pathology. Methods:. Median nerve strain was measured with...
Article
Full-text available
Purpose: Recent efforts have been made by the American Society for Surgery of the Hand to encourage female inclusion in expert panels. We hypothesized that female representation on expert panels has increased over the past decade and that a directed intervention by the American Society for Surgery of the Hand would be associated with an increased p...
Chapter
Iatrogenic peripheral nerve injuries in orthopedic surgery can result from direct nerve injury during surgery or indirect injury through compression, stretch, or thermal damage. The mechanism, type, and time to diagnosis of a nerve injury shape prognosis and treatment options. Orthopedic surgeons must understand the evaluation and treatment options...
Chapter
The treatment of pelvic and acetabular fractures is a challenging area of orthopedic surgery, owing to the significant technical learning curve, and complexity of surgical dissection and exposures. An important step toward achieving a good long-term clinical outcome in these patients is an anatomical reduction of these injuries. This requires an el...
Chapter
In this chapter, we outline the intrapelvic and extra-pelvic anatomy of the ilioinguinal, iliohypogastric, genitofemoral, femoral, lateral femoral cutaneous, obturator, and sciatic nerve, as well as their anatomic variants and common points of compression. We further discuss the diagnosis, management, and expected clinical outcomes of injury to eac...
Chapter
The majority of lower extremity peripheral nerve injury results from high-energy trauma and motor vehicle collisions, resulting in fractures about the knee including those of the distal femur and tibial plateau, as well as fractures of the tibial shaft. This chapter describes, in detail, the anatomy of the common peroneal, superficial peroneal, dee...
Chapter
The overall complication rates after knee arthroscopy, ligament reconstruction, and other sports medicine procedures are relatively low. However, iatrogenic injury to the nervous structures about the knee is possible if care is not taken with surgical approaches and technique. Injuries to the saphenous nerve and peroneal nerve in particular have be...
Article
Background: Power Doppler ultrasonography has been used as an adjunct in the diagnosis of peripheral nerve compression neuropathy. To better characterize its sensitivity and specificity, the authors performed a systematic review of its use in carpal and cubital tunnel syndrome diagnosis. Methods: The authors systematically reviewed published lit...
Book
Peripheral nerve issues are potential sequalae of orthopedic surgery, even after cases in which technically excellent surgery was performed. These injuries can impede the expected recovery of function after the primary surgery. Given the manifold challenges associated with recovery of peripheral nerve injuries, this book is designed as a multidisci...
Article
Background: The COVID-19 pandemic has substantially impacted the delivery of health care, both through direct care associated with COVID-19 and through more pervasive effects. Our goal was to evaluate whether the number of orthopaedic consultations for firearm injuries differed during the early months of the COVID-19 pandemic compared with the sam...
Article
Purpose Wide-Awake Local Anesthetic No Tourniquet (WALANT) hand surgery avoids many medical risks associated with traditional anesthesia options. However, patients may be hesitant to choose the WALANT approach because of concerns about being awake during surgery. The purpose of this study was to characterize patients’ thoughts and concerns about be...
Article
Background Given the modest functional outcomes seen after surgical reconstruction and subsequent therapy, increasing attention is being directed to patient satisfaction and psychological aspects of recovery after brachial plexus injury (BPI). Purpose To better understand the recovery course after surgical reconstruction for BPI, we used qualitati...
Article
Similar to many other medical training programs, fellowship interviews for hand surgery will be conducted virtually for a second consecutive year. We provide strategies for applicants to ideally portray themselves and to learn about fellowship programs. We include approaches for fellowship programs to identify candidates that match their values as...
Chapter
The leading cause of adult brachial plexus injuries is trauma resulting from a closed traction injury secondary to a high-velocity motor vehicle accident. Ninety percent of patients suffer supraclavicular lesions. A widened shoulder-neck angle at the time of injury with an adducted shoulder predisposes upper trunk injury, while shoulder abduction p...
Article
Reliable and robust peripheral nerve regeneration after a nerve injury and repair remains an elusive goal. A variety of strategies have been proposed to mitigate the effects of Wallerian degeneration (through molecular therapies), enhance axonal regeneration across the repair site (through electrical stimulation and gene therapy), and explore alter...
Article
Adult brachial plexus injuries result in profound functional deficits, debilitating pain, substantial mental health implications, and extensive economic impacts. Their initial evaluation includes a detailed physical examination, electrodiagnostic studies, advanced imaging, and patient counseling. A team-based approach, led by a peripheral nerve sur...
Chapter
Radiocarpal dislocations are rare, but serious injuries. The shearing and rotation forces associated with these injuries lead to extrinsic carpal ligament damage and associated fractures of the distal radius and carpus. Prompt reduction and stabilization via surgical repair are critical to providing satisfactory outcomes. These injuries are often c...
Article
Background: There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons' rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus. Methods: We con...
Article
Operative intervention for distal radius fractures is typically reserved for patients with displaced fractures that may result in bothersome compromises in function, although patient-specific factors (age, activity level, and preference) are considered. Operative intervention is associated with earlier improvement in function but exposes the patien...
Article
Electrodiagnostic studies may help orthopaedic surgeons to identify and confirm nerve pathology, determine severity of disease, localize the lesion, identify concomitant or alternative pathology, and prognosticate potential outcomes with nonoperative or operative treatment. Surgeons should recognize the indications for electrodiagnostic studies, pr...
Article
Background: After traumatic brachial plexus injuries (BPI), the sudden loss of physical function is often accompanied by psychological distress. Given the complex nature and relative infrequency of the injury, BPI patients will often use online resources for information about their injury as well as emotional support. Questions/Purpose: Recognizing...
Article
Background The concept of utilizing a nerve conduit for augmentation of a primary nerve repair has been advocated as a method to prevent neural scarring and decrease adhesions. Despite clinical use, little is known about the effects of a nerve conduit wrapped around a primary repair. To better understand this, we investigated the histologic and fun...
Article
Background: The expansion of state Medicaid programs under the U.S. Affordable Care Act has led to a dramatic increase in the number of Americans with health insurance coverage. Prior analyses of a limited number of states have suggested that greater utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) should be expected a...
Article
Full-text available
Aims Brachial plexus injury (BPI) is an often devastating injury that affects patients physically and emotionally. The vast majority of the published literature is based on surgeon-graded assessment of motor outcomes, but the patient experience after BPI is not well understood. Our aim was to better understand overall life satisfaction after BPI, w...
Chapter
In this chapter, Dr. Khalifeh, Dr. Dibble, Dr. Dy, and Dr. Ray discuss the subspecialty of Peripheral Nerve. Surgery is a mainstay of treatment for common disorders of the peripheral nervous system, including compressive neuropathies, nerve tumors, peripheral nerve sources of pain, and paralyzing nerve injury. The management of peripheral nervous s...
Article
Background We investigated the use of a conduit splinting technique to mitigate tension at the coaptation site of a rodent nerve defect model to determine the optimal reconstruction method for segmental nerve defects. Methods A rat sciatic nerve segmental defect model was created by excising 5mm of the sciatic nerve unilaterally. Four groups of 10...
Article
Purpose To test the effectiveness of a novel locking pin cap to attach a K-wire rigidly to a volar locking plate and resist fracture displacement compared with commercially available alternatives. Methods Two different methods of fracture fixation were tested on a total of 12 Sawbones models with volar shear distal radius fracture (6/group). The f...
Article
Full-text available
Treatment of pan-brachial plexus injuries has evolved significantly over the past 2 decades, with refinement and introduction of new surgical techniques, particularly free functional muscle transfer. The extent to which contemporary brachial plexus surgeons utilize various techniques as part of their treatment algorithm for pan-plexus injuries and...
Article
Background Emotional and social characteristics may influence rehabilitation and recovery after traumatic brachial plexus injury.PurposesWe sought to investigate if traumatic brachial plexus injury patients have different levels of social support and employ distinct coping strategies from uninjured control subjects. In addition, we studied which co...
Article
Full-text available
Purpose Enthusiasm for peripheral nerve transfers increased over the past several years, but further studies are still needed to establish the role of these procedures in peripheral nerve reconstruction. The primary goal of this study was to describe the frequency of nerve transfer surgery among newly trained orthopedic surgeons. Methods We querie...
Article
Full-text available
Purpose Brachial plexus injury (BPI) patients use on-line groups for peer support, often seeking information from Facebook groups devoted to BPI. We hypothesized that a qualitative thematic analysis of posts from BPI Facebook groups would demonstrate the areas in which patients were seeking information regarding treatment of BPI and reveal potentia...
Article
Full-text available
Purpose Increasing emphasis has been placed on multidisciplinary care for patients with traumatic brachial plexus injury (BPI), and there has been a growing appreciation for the impact of psychological and emotional components of recovery. Because surgeons are typically charged with leading the recovery phase of BPI, our objective was to build a gr...
Article
Full-text available
Targeted muscle reinnervation after upper-extremity amputation has demonstrated improved outcomes with myoelectric prosthesis function and postoperative neuropathic pain. This technique has been established in the setting of shoulder disarticulation as well as transhumeral and transradial amputations, but a detailed technique of targeted muscle rei...
Article
Background: The utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) increased after Medicaid expansion under the U.S. Affordable Care Act (ACA), suggesting a potential unmet need for THA and TKA. We examined the timing of THA and TKA in patients after obtaining Medicaid expansion insurance coverage. We hypothesized that p...
Article
The medical device industry has long been subject to criticism for lack of price transparency and minimal regulations surrounding device approval, which have functioned as barriers to providing quality and cost-effective care. Recent health care reforms aimed at overcoming these barriers, including improving market approval regulations, increasing...
Article
Full-text available
Purpose The economic implications of brachial plexus injuries (BPI) in the United States are not well understood. The purpose of our study was to quantify the direct costs associated with surgical treatment of BPI after traumatic injury in adults, which would enable future study of the societal value of surgical reconstruction. Methods Using an ad...
Article
Background Brachial plexus injury (BPI) is a life-altering event, and surgical treatment of BPI is costly ($66 million nationwide in 2006 alone). Despite the sizable costs associated with surgically treated BPI, the incidence of such cases in adults in the USA remains unknown. Questions/Purposes We sought to provide an estimate of the national inc...
Article
The complexity of each brachial plexus injury (BPI) pattern and physiologic limitations of nerve regeneration create challenges for BPI patients and their surgeons. Detailed assessment via physical examination, electrodiagnostic studies, and advanced imaging can aid the surgeon in predicting the prognosis for each patient’s neurologic recovery and...
Article
Background: There is variability in access to and utilization of orthopaedic care, particularly for those with Medicaid insurance. One potential contributor is perceived unwillingness of surgeons and hospitals to accept underinsured patients. We used administrative data to examine the payer mix for select inpatient orthopaedic surgical procedures...
Article
Background: Traumatic brachial plexus injuries (BPIs) disproportionately affect young, able-bodied individuals. Beyond direct costs associated with medical treatment, there are far-reaching indirect costs related to disability and lost productivity. Our objective was to estimate per-patient indirect cost associated with BPI. Methods: We estimate...
Article
Purpose: We hypothesized that patients with preoperative opioid prescriptions and diagnoses of depression and anxiety would be at increased risk for prolonged opioid prescriptions after surgery for brachial plexus injury (BPI). Methods: Using an administrative database of privately insured patients, we assembled a cohort of BPI surgery patients...
Article
Background Supporters of medical liability reform contend that caps on non-economic damages will decrease defensive medicine. Questions/Purposes We examined whether removal of caps on non-economic damages affect one type of defensive medical practice, early imaging for new-onset low back pain. Patients and Methods Using administrative claims data...
Chapter
The policies that dictate the way in which healthcare is administered in the United States today are rooted in a rich history, influenced by a number of stakeholders, and far-reaching in their implications on practice. This chapter will cover an overview of this history beginning with the development of health insurance as a method to finance healt...
Article
Background: Overlapping surgery is attracting increased scrutiny. The American College of Surgeons states that the attending surgeon must be present for all critical portions of a surgical procedure; however, critical portions of surgical procedures are not defined. We hypothesized that a Delphi panel process would measure consensus on critical po...
Article
Background: Although Medicaid expansion has improved access to primary care services, its impact on surgical specialty utilization remains unclear. The aim of this study is to determine whether Medicaid expansion is associated with increased utilization rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Illinois (which expa...
Article
Background: Although overlapping surgery is used to maximize efficiency, more empirical data are needed to guide patient safety. We conducted a retrospective cohort study to evaluate the safety of overlapping inpatient orthopaedic surgery, as judged by the occurrence of perioperative complications. Methods: All inpatient orthopaedic surgical pro...
Article
Background Scaphoid fractures treated non-operatively and operatively may be complicated by nonunion. Questions/Purposes We sought to test the primary hypothesis that the incidence density of scaphoid fracture treatment is higher than previously estimated, to determine the frequency and risk factors for nonunion treatment, and to determine whether...
Article
Purpose: Reactive depression and anxiety are common after major life changes such as brachial plexus injuries (BPI). The purpose of this study was to evaluate the incidence and risk factors for coded depression and coded anxiety among patients with BPI using a national database of commercial insurance claims. Methods: We used the Truven MarketSc...
Article
Background: The physical and psychological impact of brachial plexus injury (BPI) has not been comprehensively measured with BPI-specific scales. Our objective was to develop and test a patient-derived questionnaire to measure the impact and outcomes of BPI. Methods: We developed a questionnaire in 3 phases with preoperative and postoperative pa...
Article
Purpose: To determine whether the arthroscopic hook and trampoline tests are accurate and reliable diagnostic tests for foveal triangular fibrocartilage complex (TFCC) detachment. Methods: Wrist arthroscopy was performed on 10 cadaveric upper extremities. Arthroscopic hook and trampoline tests were performed and videos recorded (baseline). The d...
Article
Purpose: Although volar plating of the distal radius is performed frequently, the necessity of distal bicortical fixation in the metaphyseal and epiphyseal areas of the distal radius has not been proven. This study aimed primarily to quantify the ability of unicortical distal screws to maintain operative reduction of adult distal radius fractures...
Article
Purpose: Despite the importance of timely evaluation for patients with brachial plexus injuries (BPIs), in clinical practice we have noted delays in referral. Because the published BPI experience is largely from individual centers, we used a population-based approach to evaluate the delivery of care for patients with BPI. Methods: We used statew...
Conference Paper
Full-text available
Introduction: Ulnar-sided wrist pain manifesting with wrist instability is a therapeutic and diagnostic challenge. The complex anatomy at both the radioulnar and ulnocarpal joints makes injuries to this area particularly difficult to treat, and current treatments have proven to be heterogeneous in results. Peripheral detachment of the triangular fi...
Article
Patients with brachial plexus injury (BPI) and their family members contribute to Internet discussion groups dedicated to BPI. We hypothesized that a thematic analysis of posts from BPI Internet discussion groups would reveal common themes related to the BPI patient experience, providing topics for patient education and counseling. Internet discus...
Conference Paper
Full-text available
Disclosures: none Introduction: The diagnosis and management of ulnar sided wrist pain is a challenge for the physician due to the complex joint articulations and ligamentous structures involved in the area. A main focus of this discussion is on DRUJ dysfunction as a source of this pain, and surgical techniques have focused on restoring this joint...
Article
Background: The goals of this study were to assess how preoperative and postoperative patients use their uninjured arm to compensate for adult brachial plexus injury (BPI) and to determine whether the Disabilities of Arm, Shoulder, and Hand (DASH) Questionnaire measures this compensation. Methods: Ten preoperative and 13 postoperative patients were...
Article
Full-text available
Purpose: To assess ulnocarpal joint stability after treatment of a peripheral triangular fibrocartilage complex (TFCC) injury with all-inside arthroscopic suture repair (SR), extensor retinaculum capsulorrhaphy with the Herbert sling (HS), and a combination of both (SR+HS). Methods: Twelve fresh-frozen, age-matched, upper-extremity specimens int...