Sonu A. Jain’s research while affiliated with The Ohio State University and other places

Background We investigated whether any interspecialty variation exists, regarding perioperative health care resource usage, in carpal tunnel releases (CTRs). Methods The 2010 to 2021 PearlDiver Mariner Database, an all-payer claims database, was queried to identify patients undergoing primary CTRs. Physician specialty IDs were used to identify the specialty of the surgeon—orthopedic versus plastic versus general surgery versus neurosurgery. Multivariate logistic regression analysis was used to identify whether there was any interspecialty variation between the use of health care resources. Results A total of 908 671 patients undergoing CTRs were included, of which 556 339 (61.2%) were by orthopedic surgeons, 297 047 (32.7%) by plastic surgeons, 44 118 (4.9%) by neurosurgeons, and 11 257 (1.2%) by general surgeons. In comparison with orthopedic surgeons, patients treated by plastic surgeons were less likely to have received opioids, nonsteroidal anti-inflammatory drugs, oral steroids, and preoperative antibiotic prophylaxis but were more likely to have received steroid injections and electrodiagnostic studies (EDSs) preoperatively. Patients treated by neurosurgeons were more likely to have received preoperative opioids, gabapentin, oral steroids, preoperative antibiotic prophylaxis, EDSs, and formal preoperative physical/occupational therapy and less likely to have received steroid injections. Patients treated by general surgeons were less likely to receive oral steroids, steroid injections, EDSs, preoperative formal physical therapy, and preoperative antibiotic prophylaxis, but were more likely to be prescribed gabapentin. Conclusions There exists significant variation in perioperative health care resource usage for CTRs between specialties. Understanding reasons behind such variation would be paramount in minimizing differences in how care is practiced for elective hand procedures.

Background Surgical approaches to the volar radiocarpal joint have historically entailed wide exposure, possibly contributing to poor wound healing and wrist denervation. To avoid wound complications and wrist denervation, minimally invasive and percutaneous approaches to the volar radiocarpal joint have been proposed. To help guide these minimally invasive or percutaneous approaches to the joint, we sought to characterize the relationship between the volar wrist flexion creases and the volar radiocarpal joint. We propose that the wrist flexion creases will be a reliable method for localizing the joint. Methods Ten cadaveric upper-extremity specimens consisting of fingertip to mid forearm were obtained. Measurements from the proximal and distal wrist flexion creases were taken via fluoroscopy and gross dissection. Results The wrist flexion creases were located distal to the volar radiocarpal joint in all specimens. The volar radiocarpal joint was located 7 and 16 mm proximal to the proximal and distal wrist flexion creases, respectively. The radiographic anatomy correlated well with the underlying deep anatomy. Conclusions The wrist flexion creases can serve as a reliable superficial landmark for the identification of the volar radiocarpal joint. These landmarks aid clinicians in performing or interpreting a physical examination or in performing minimally invasive or percutaneous approaches to the volar radiocarpal joint.

Peripheral nerve injuries may substantially impair a patient's function and quality of life. Despite appropriate treatment, outcomes often remain poor. Direct repair remains the standard of care when repair is possible without excessive tension. For larger nerve defects, nerve autografting is the gold standard. However, a considerable challenge is donor site morbidity. Processed nerve allografts and conduits are other options, but evidence supporting their use is limited to smaller nerves and shorter gaps. Nerve transfer is another technique that has seen increasing popularity. The future of care may include novel biologics and pharmacologic therapy to enhance regeneration.

Purpose To determine the effect of time to surgery on outcomes following open reduction and internal fixation (ORIF) of both-bone forearm fractures (BBFFs). Methods Ninety-nine patients who underwent ORIF of BBFFs in a single academic medical center over a 16-year time period were retrospectively reviewed. Demographic and clinical data including age, sex, current smoking status, time from injury to surgery (tsurg), presence of open injury, polytrauma status, and complications were obtained. Radiographs of the affected extremity were reviewed for fracture morphology, reduction quality, and time to union (or presence of nonunion). In addition to descriptive statistics, Chi-square and Wilcoxon–Mann–Whitney tests were used to compare categorical and interval, respectively, with a significance level of 0.05. Results A tsurg > 48 h was associated with increased rate of delayed unions (tsurg < 48 h: 25% vs tsurg > 48 h: 59%, p = 0.03), but not complications (tsurg < 48 h: 44% vs tsurg > 48 h: 47%, p = 0.79). Open BBFFs were not associated with increased rates of delayed unions (closed: 16% vs open: 19%, p = 0.77) or complications (closed: 42% vs open: 53%, p = 0.29). A trend toward increased time to union with tsurg > 48 h was also seen, but did not reach significance (tsurg < 48 h: 13.5 weeks vs tsurg > 48 h: 15.7 weeks, p = 0.11). Conclusion A tsurg > 48 h is associated with an increased rate of delayed union, but not complications, after ORIF of BBFFs. Level of evidence Therapeutic Level III (Retrospective Cohort).

IntroductionOptimal treatment of chronic distal radioulnar joint (DRUJ) arthritis and instability remains unresolved in the literature. Specifically, no systematic comparison of two common options, Sauve-Kapandji (SK) and Darrach's, is available.MethodsA meta-analysis was performed utilizing the PUBMED and EMBASE databases and yielded a total of 47 available studies. Objective outcomes, such as wrist range of motion (ROM), forearm ROM, grip strength, and subjective outcomes, including pain and rate of return to work, were recorded. Statistical analysis was done using t test and chi-square test.ResultsFor both the SK and Darrach’s procedures, forearm ROM was significantly better postoperatively in both pronation (p = 0.0001 for both groups) and supination (p = 0.0001 for both groups). Wrist flexion decreased in the SK group (p = 0.0007), but no difference was found for wrist extension (p = 0.09). The Darrach's group showed a significance improvement in wrist extension (p = 0.0001). Grip strength was improved in the SK group (p < 0.0001), but not in the Darrach's group (p = 0.7831). No difference existed between the SK and Darrach's groups in proportion of patients who were pain-free. The SK group had higher numbers of patients return to work (p = 0.0057). There was not enough data from the studies to make any meaningful analysis in term of treatment failure and complications.Conclusions Overall, both the SK and Darrach's procedures helped improve pain, wrist ROM, and forearm ROM in patient with chronic DRUJ disorders. The SK procedure can have advantages over the Darrach's procedures in terms of grip strength and rate of return to work.

Background Endoscopic and open carpal tunnel releases (ECTR and OCTR) are safe and effective operations. We compared the approaches in terms of postoperative opioid refills and occupational therapy (OT) referrals. Methods We conducted a retrospective study of patients with carpal tunnel syndrome (CTS) treated with ECTR or OCTR. Patients with isolated idiopathic CTS were included; patients undergoing simultaneous bilateral carpal tunnel release (CTR), revision CTR, and additional procedures at time of CTR were excluded. Outcomes included number of patients requiring an opioid refill and/or an OT referral within 6 months of surgery. Results A total of 1125 patients met inclusion criteria. Endoscopic release was performed in 634 (56%) cases and open release in 491 (44%). Unadjusted analysis revealed no difference in number of patients requiring refills (6.0% vs 7.1%, P = .44), mean number of refills among those requiring one (1.29 vs 1.23, P = .69), total oral morphine equivalents (45.1 vs 44.7, P = .84), number of patients calling regarding pain (12.8% vs 14.7%, P = .36), OT referrals (12.1% vs 11.4%, P = .71), or average number of OT visits (4.5 vs 4.2, P = .74) for endoscopic and open techniques, respectively. Adjusted analysis revealed lower age, lower body mass index, and history of muscle relaxant as predictors of opioid refills, and in contrast to the unadjusted analysis, operating surgeon and surgical technique were predictors of referral to OT. Conclusion Endoscopic CTR and OCTR did not differ in terms of unadjusted postoperative patient calls for pain, number of opioid refills, or OT referrals. After correcting for individual surgeon practice, endoscopic was associated with decreased odds of requiring postoperative OT.

Purpose: To investigate the effect of dynamic stabilizers of the elbow on radiocapitellar joint alignment, before and after the administration of regional anesthesia. Methods: At a single institution, 14 patients were prospectively enrolled in a study using a within-subjects control design. Before performing a supraclavicular regional block, 10 fluoroscopic images (1 anteroposterior and 9 lateral views) of the elbow were obtained for each patient. The lateral images were obtained with the forearm in maximal supination, neutral rotation, and maximal pronation, and these forearm positions were repeated for 3 elbow positions: (1) full extension; (2) flexion to 90°, with 0° of shoulder internal rotation; and (3) flexion to 90°, with 90° of shoulder internal rotation. After obtaining the 10 initial images, a block was performed to achieve less than 3/5 motor strength of the imaged extremity, followed by obtaining the same 10 images in each patient. Radiocapitellar ratio, defined as the minimal distance between the right bisector of the radial head and the center of the capitellum divided by the diameter of the capitellum, was measured in each image. Results: The 14 patients had a mean age of 47.8 ± 15.7 years, and 10 (71.4%) patients were women. A difference between radiocapitellar ratios measured before and after the regional block administration was observed for all lateral images (-1.0% ± 7.2% to -2.2% ± 8.0%), although this difference was less than the minimum clinically important difference. Conclusions: Paralysis of the dynamic stabilizers of the elbow produces a difference in the radiocapitellar joint alignment, but this did not reach the minimum clinically important difference. Clinical relevance: Paralysis of the dynamic stabilizers of the elbow via a supraclavicular nerve block produces no clinically relevant effect on the radiocapitellar alignment of uninjured elbows.

Background: Neuromas causing sensory disturbance can substantially affect nerve function and quality of life. Historically, passive termination of the nerve end and proximal relocation to muscle or bone has been performed after neuroma resection, but this method does not allow for neurologic recovery or prevent recurrent neuromas. The use of processed nerve allografts (PNAs) for intercalary reconstruction of nerve defects following neuroma resection is reasonable for neuroma management, although reported outcomes are limited. The purpose of this study was to assess the outcomes of pain reduction and functional recovery following neuroma resection and intercalary nerve reconstruction using PNA. Methods: Data on outcomes of PNA use for peripheral nerve reconstruction were collected from a multicenter registry study. The registry database was queried for upper extremity nerve reconstruction with PNA after resection of symptomatic neuroma. Patients completing both pain and quantitative sensory assessments were included in the analysis. Improvement in pain-related symptoms was determined via patient self-reported outcomes and/or the visual analog scale. Meaningful sensory recovery was defined as a score of at least S3 on the Medical Research Council Classification scale. Results: Twenty-five repairs involving 21 patients were included in this study. The median interval from injury to reconstruction was 386 days, and the average nerve defect length was 31 mm. Pain improved in 80% of repairs. Meaningful sensory recovery was achieved in 88% of repairs. Conclusion: Neuroma resection and nerve reconstruction using PNA can reduce or eliminate chronic peripheral nerve pain and provide meaningful sensory recovery.

Background: The authors sought to determine whether differences exist in (1) the number of postoperative occupational therapy visits and (2) narcotic use in two carpometacarpal arthroplasty groups. Methods: A retrospective study comparing patients undergoing abductor pollicis longus (APL) suspensionplasty (154 patients) or flexor carpi radialis ligament reconstruction and tendon interposition (FCR LRTI) techniques (40 patients) between January 1, 2012, and August 1, 2018, was performed. Data included demographics, procedure performed, complications, number of postoperative occupational therapy visits, and postoperative morphine equivalent dosage used. Statistical testing used the chi-square test for proportions and the Wilcoxon-Mann-Whitney test for nonnormal data. The significance level was 0.05. Results: The APL suspensionplasty and FCR LRTI groups had similar ages (58.1 ± 7.8 years versus 58.1 ± 7.7 years), sex ratios (73 percent female versus 75 percent female), and preoperative narcotic user proportions (1 percent versus 3 percent). Complication rates following the procedures were similar (21 percent and 18 percent, respectively). The number of postoperative occupational therapy visits following APL suspensionplasty (median, 0; interquartile range, 0 to 4) and FCR LRTI (median, 0; interquartile range, 0 to 4) were not significantly different (p = 0.961). There was less use of narcotics following APL suspensionplasty (median, 375 morphine equivalent dosage; interquartile range, 241.9 to 525 morphine equivalent dosage) compared with FCR LRTI (median, 462.5 morphine equivalent dosage; interquartile range, 375 to 768.8 morphine equivalent dosage), and this difference was significant (p = 0.0007). Conclusions: The APL suspensionplasty technique had less narcotic use and similar complication rates and occupational therapy visits compared to FCR LRTI. Prospective studies comparing postoperative pain control and function with these two carpometacarpal arthroplasty techniques may be beneficial. Clinical question/level of evidence: Therapeutic, III.