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Hozack BA, Liss FE, Fram B, Rivlin M, Ilyas AM, Jones CM. Optimal Position of the Bone Anchor for the Internal Brace Suspensionplasty Technique for Thumb Basal Joint Arthroplasty. J Hand Surg Am 2024; 49:380.e1-380.e6. [PMID: 36100487 DOI: 10.1016/j.jhsa.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Ligament reconstruction and tendon interposition is a common technique for thumb basal joint arthroplasty. Recently, a variation of this technique, a suture suspensionplasty, has been introduced. The goal of our study was to assess the optimal position of the bone anchor in the thumb metacarpal. We hypothesized that an anchor placed in the radial aspect of the thumb metacarpal base would provide improved stability and resist subsidence more effectively than an ulnar-based thumb anchor. METHODS Eight fresh-frozen cadaver arms were imaged fluoroscopically in anteroposterior and lateral views centered over the thumb carpometacarpal joint before and after trapeziectomy and after the placement of radial-based and ulnar-based bone anchors. The intermetacarpal angle between the thumb and index metacarpals was measured on all images after the application of a standard force. Radial abduction, opposition, subsidence, palmar abduction, and adduction were measured. Subsidence was calculated as the percentage loss of the trapezial space. RESULTS Both radially and ulnarly placed internal brace constructs allowed more radial abduction, opposition, and palmar abduction than the pretrapeziectomy constructs. They both also reduced subsidence by approximately 20% to 29% compared with the posttrapeziectomy constructs. Comparing radial to ulnar constructs, motion and subsidence were similar. CONCLUSIONS There was immediate stability of the thumb with respect to axial load and subsidence after anchor placement, and this was independent of the anchor position. The position of the bone anchor in the thumb metacarpal base did not affect the range of motion. Although the device can limit subsidence, it does not appear to restrict any range of motion of the thumb, irrespective of anchor position. CLINICAL RELEVANCE This cadaver study can help hand surgeons understand the effect of positioning of bone anchors when performing a specific suture suspensionplasty technique.
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Affiliation(s)
- Bryan A Hozack
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Frederic E Liss
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Brianna Fram
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Michael Rivlin
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Asif M Ilyas
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Christopher M Jones
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Ring D, Graham JG, Plusch KJ, Hozack BA, Ilyas AM, Matzon JL. Rethinking Repeat Surgery for Median Neuropathy at the Carpal Tunnel. J Hand Surg Glob Online 2023; 5:715. [PMID: 37790834 PMCID: PMC10543805 DOI: 10.1016/j.jhsg.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- David Ring
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Jack G Graham
- Division of Hand & Wrist Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Kyle J Plusch
- Division of Hand & Wrist Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Bryan A Hozack
- Division of Hand & Wrist Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Asif M Ilyas
- Division of Hand & Wrist Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jonas L Matzon
- Division of Hand & Wrist Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Hozack BA, Campbell BR, Kistler JM, Matzon JL, Jones CM, Rivlin M. Proximity of the Ulnar Neurovascular Structures in Endoscopic Carpal Tunnel Release Surgery: A Cadaveric Study. J Hand Surg Am 2023:S0363-5023(23)00352-0. [PMID: 37530689 DOI: 10.1016/j.jhsa.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE To evaluate the proximity of the ulnar neurovascular structures to the endoscopic blade during endoscopic carpal tunnel release (CTR). METHODS Ten fresh-frozen cadaver hands were used to perform endoscopic CTR using devices from two manufacturers. The skin was excised from the palm, and the endoscopic carpal tunnel blade was deployed at the distal edge of the transverse carpal ligament (TCL). The blade's proximity to the ulnar neurovascular bundle, deep ulnar motor branch, superficial palmar arch, and median nerve was recorded. Following release of the TCL, the device was turned ulnar to the maximal extent to determine if direct injury to the ulnar neurovascular bundle was possible. RESULTS The average longitudinal distance from the end of the TCL to the superficial palmar arch was 13.3 mm (range, 8.4-20.9) and to the ulnar motor branch was 10.8 mm (range, 4.0-15.0). The average transverse distance from the end of the TCL to the ulnar neurovascular bundle was 5.9 mm (range, 3.1-7.8) and to the median nerve was 3.3 mm (range, 0-6.5). In two of our specimens, the median nerve subluxated volarly over the cutting device. When placing the blade at the distal edge of the TCL, injury to the deep motor branch of the ulnar nerve, ulnar neurovascular bundle, or superficial palmar arch was not possible in any specimens using the tested devices, even when turning the blade directly toward these structures. CONCLUSIONS There is a low likelihood of direct injury to the ulnar neurovascular bundle during endoscopic CTR. CLINICAL RELEVANCE These results suggest that injury to the ulnar neurovascular bundle is unlikely during endoscopic CTR if the distal aspect of the transverse carpal ligament can be clearly identified prior to release. Control of the median nerve is also important to prevent subluxation over the cutting device.
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Affiliation(s)
- Bryan A Hozack
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Benjamin R Campbell
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
| | - Justin M Kistler
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jonas L Matzon
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Christopher M Jones
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Michael Rivlin
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Campbell BR, Wu M, Kistler JM, Hozack BA, Rivlin M, Jones CM. Anatomic Relationship of Hand Intrinsic Tendons at the Metacarpal Head as It Relates to the Diagnosis of Saddle Syndrome: A Cadaveric Study. J Hand Surg Am 2023:S0363-5023(23)00294-0. [PMID: 37480919 DOI: 10.1016/j.jhsa.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The purpose of this cadaveric study was to investigate the intrinsic anatomy surrounding the metacarpal head and the relationship between the interosseous-lumbrical junction (ILJ) and transverse metacarpal ligament (TML) as it pertains to saddle deformity-posttraumatic adhesions at the ILJ that cause impingement during intrinsic activation. METHODS Ten fresh frozen cadaveric arms underwent dissections, identifying the intrinsic musculature within the second through fourth webspaces. The TML and ILJ, or "true tendon," were identified. A separate area of nontendinous fibrous tissue identified proximal to the ILJ was referred to as "pseudotendon." Measurements were made within each webspace to identify distances between these structures in full finger extension and intrinsic plus position to assess for changes during simulated motion. RESULTS The true tendon to TML distance progressively decreased toward the ulnar digits. In the intrinsic plus position, the pseudotendon to TML distance was 0 mm at all webspaces for each specimen. When moving from neutral to intrinsic plus, the true tendon to TML distance decreased the most in the third and fourth webspaces compared with the second, consistent with the trend toward a smaller ILJ to TML gap in the ulnar digits. CONCLUSIONS There is a fibrous pseudotendinous region proximal to the ILJ that abuts the TML in the intrinsic plus position, which may cause impingement when inflamed in the setting of saddle syndrome. Furthermore, a decreased ILJ to TML gap in the ulnar digits may be related to an increased predilection for saddle deformity in those areas. CLINICAL RELEVANCE These results suggest that there is a fibrous region present proximal to the ILJ that may be implicated in the pathology of saddle deformity. Furthermore, decreased distances found between the ILJ and TML in vivo may be an explanation for increased occurrence of saddle syndrome in the third and fourth webspaces in clinical practice.
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Affiliation(s)
- Benjamin R Campbell
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
| | - Meagan Wu
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Justin M Kistler
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Bryan A Hozack
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Michael Rivlin
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Christopher M Jones
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Graham JG, Plusch KJ, Hozack BA, Ilyas AM, Matzon JL. Early Revision Rate Following Primary Carpal Tunnel Release. Journal of Hand Surgery Global Online 2023. [DOI: 10.1016/j.jhsg.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Hozack BA, Kistler JM, Vaccaro AR, Beredjiklian PK. Benzodiazepines and Related Drugs in Orthopaedics. J Bone Joint Surg Am 2022; 104:2204-2210. [PMID: 36223476 DOI: 10.2106/jbjs.22.00516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Benzodiazepines are among the most commonly prescribed drugs worldwide and are often used as anxiolytics, hypnotics, anticonvulsants, and muscle relaxants. ➤ The risk of dependence on and abuse of these medications has recently gained more attention in light of the current opioid epidemic. ➤ Benzodiazepines can increase the risk of prolonged opioid use and abuse. ➤ Given the prevalence of the use of benzodiazepines and related drugs, orthopaedic patients are often prescribed these medications. ➤ Orthopaedic surgeons need to be aware of the prevalence of benzodiazepine and related drug prescriptions in the general population, their current uses in orthopaedic surgery, and the risks and adverse effects of their use.
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Affiliation(s)
- Bryan A Hozack
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Abstract
Background: Surgical treatment of basal joint arthritis commonly consists of trapeziectomy followed by various suspensionplasty techniques to provide stability to the thumb ray. Our study goal was to assess the motion and stability of the thumb ray after trapeziectomy and placement of a suture button (Mini TightRope®, Arthrex, Naples, Florida) in a high- or low-angle trajectory. We hypothesized that a low-angle trajectory would yield the greatest stability while providing maximal motion of the thumb. Methods: Eleven fresh-frozen cadaver arms were imaged fluoroscopically in anterior-posterior and lateral views before and after trapeziectomy, and after placement of low- and high-angle suture buttons. The intermetacarpal angle between the thumb and index metacarpals was measured after application of a standard force. Radial abduction, opposition, subsidence, palmar abduction, adduction, and subsidence were measured. Results: Compared to posttrapeziectomy constructs, low- and high-angle TightRope constructs demonstrated less subsidence, low-angle TightRopes had less palmar abduction, and high-angle TightRope constructs had less radial abduction and adduction. High-angle TightRopes allowed more palmar abduction than low-angle constructs. The high-angle TightRopes trended toward more subsidence than low-angle constructs, although it was not significant. Conclusions: Both TightRope constructs provided improved axial stability after trapeziectomy while not excessively limiting any one motion of the thumb. Compared to the high-angle trajectory, the low-angle TightRope placement provided a more stable construct with respect to subsidence and angular motion. Given the concern for excessive motion of the first metacarpal base with the high-angle construct, we recommend a low-angle trajectory TightRope placement.
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Affiliation(s)
- Bryan A. Hozack
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA,Bryan A. Hozack, Rothman Institute, Thomas Jefferson University Hospitals, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | - Brianna Fram
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Michael Rivlin
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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Hozack BA, Rayan GM. Surgical Treatment for Recurrent Dupuytren Disease. Hand (N Y) 2021; 18:641-647. [PMID: 34963318 DOI: 10.1177/15589447211060447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Revision procedures for recurrent Dupuytren disease (DD) can be difficult and carry a high risk of complications. Our goal was to describe surgical strategies used for cases of recurrence and report on their outcomes. METHODS We reviewed 1 surgeon's operative cases for recurrent DD performed at 1 institution. Prior procedures included collagenase injection, percutaneous needle fasciotomy, or open surgical fasciectomy in the same digit or area of the hand. RESULTS From January 1981 to December 2020, 54 procedures were performed on 33 patients for recurrent DD. Most patients were men (82%), had bilateral involvement (64%) and family history (52%), and some had ectopic disease in their feet (24%). The small finger was involved in 76% of the cases, and the proximal interphalangeal (PIP) joint was involved in 83% of these digits. The procedures included 38 partial fasciectomies (72%), 12 dermofasciectomies (23%), 3 radical fasciectomies (6%), 1 of each needle fasciotomy, ray amputation, and PIP joint arthrodesis (2%). Twenty-three patients (43%) required full thickness skin grafts with an average area of 7.1 cm2 (range: 1-20 cm2). CONCLUSIONS This study highlights the complexity of recurrent DD case management and found the treatment required for 95% of patients in this series was open partial fasciectomy with or without demofasciectomy. Full thickness skin grafting was necessary in nearly half of the cases.
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Hozack BA, Rivlin M, Lutsky KF, Beredjiklian PK. Overall Opioid Consumption Is Not Associated With the Amount of Opioids Administered and Prescribed on the Day of Upper Extremity Surgery. Hand (N Y) 2021; 16:781-784. [PMID: 31965858 PMCID: PMC8647310 DOI: 10.1177/1558944719897419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Orthopedic surgeons need to better understand the effect their opioid-prescribing habits have on patients. The purpose of our study was to evaluate whether the type of procedure or initial amount of opioids prescribed postoperatively leads to increased consumption of opioids. Methods: Consecutive patients undergoing upper extremity surgery were enrolled. The medical record and Pennsylvania Prescription Drug Monitoring Program Web site were used to record all prescriptions of controlled substances consumed intraoperatively, in the recovery room, and in prescriptions filled 6 months postoperatively. Morphine equivalent units (MEUs) were used to quantify the amount of opioids. Results: Two hundred ninety patients were included in the study. The mean MEU administered intraoperatively was 25.1 (0-50). The MEU provided in the recovery room was 2.9 (0-60). The MEU prescribed on the day of surgery was 155.6 (137-178). We used the Pearson correlation coefficient of r = 0, meaning no/weak correlation, and r = 1, meaning a strong correlation. Neither MEUs provided intraoperatively or in recovery, nor MEUs prescribed postoperatively correlated with prescriptions filled (r = 0.13, 0.02, 0.09, respectively). Although patients undergoing bony procedures were prescribed more opioids (P < .001), opioid consumption intraoperatively, in recovery, and in prescriptions filled was not significantly different. Conclusions: The MEUs administered and prescribed on the day of surgery did not affect the amount of prescriptions filled postoperatively. Finally, patients undergoing bony procedures were prescribed more opioids than those undergoing soft tissue procedures, but they did not consume or fill more opioids postoperatively.
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Affiliation(s)
- Bryan A. Hozack
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA,Bryan A. Hozack, Rothman Institute, Thomas Jefferson University Hospitals, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | - Michael Rivlin
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kevin F. Lutsky
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Abstract
PURPOSE OF REVIEW Fragment-specific fixation can be a useful tool in treating distal radius fractures. In order to best utilize these techniques, surgeons require an understanding of the normal anatomy, fracture patterns, approaches, and fixation strategies. RECENT FINDINGS Fragment-specific fixation may be appropriate for certain fracture patterns particularly when monoblock plating techniques are not sufficient. Radial styloid, volar rim, dorsal wall, dorsal-ulnar corner, and impacted intraarticular fragments may be secured with implants designed specifically for each individual fragment. Although more technically demanding, advantages include accurate articular reconstruction, minimal hardware irritation, and reliable functional outcomes.
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Affiliation(s)
- Bryan A Hozack
- Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Rick J Tosti
- Orthopaedic Surgery, Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street Suite G114, Philadelphia, PA, 19107, USA
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Hozack BA, Abboudi J, Gallant G, Jones CM, Kirkpatrick W, Liss FE, Rivlin M, Takei TR, Wang ML, Silverman M, Foltz C, Ilyas AM. Prospective Evaluation of Opioid Consumption Following Cubital Tunnel Decompression Surgery. Hand (N Y) 2019; 14:42-47. [PMID: 30269520 PMCID: PMC6346364 DOI: 10.1177/1558944718800732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Managing postoperative pain is important for patients and surgeons. However, there is concern over opioid dependency. Cubital tunnel decompression is among the most common upper extremity surgeries. Our study aimed to analyze opioid use after cubital tunnel decompression to guide postoperative opioid prescribing. METHODS We prospectively collected opioid consumption for 16 consecutive months (February 2016 to June 2017) for cubital tunnel decompression patients. Data on demographics, insurance type, surgery performed, functional questionnaires (Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]), and electrodiagnostics (electromyography) were collected. Opioid consumption was reported at first postoperative visits. RESULTS One hundred patients consumed a mean of 50 morphine equivalent units (MEUs) (range, 0-300), or 7 oxycodone 5-mg pills, postoperatively. Cubital tunnel release (CuTR) patients consumed fewer than ulnar nerve transposition (UNT) patients (40.4 vs 62.5 MEUs or 5.4 vs 8.3 pills, P = .08). Patients undergoing submuscular UNT consumed more than CuTR (115.0 vs 40.4 MEUs or 15.3 vs 5.4 pills, p = 0.003) and more than subcutaneous UNT patients (37.8 MEU or 5.0 pills, p = 0.03). Medicare patients consumed less than privately insured (42.7 vs 54.1 MEUs, 5.7 vs 7.2 pills, P = .02) and less than workers' compensation patients (76.8 MEU or 10.2 pills, P = .04). Older patients consumed fewer than younger patients ( P = .03). Postoperative QuickDASH score was positively related to opioid intake ( P = .009). CONCLUSIONS Patients consumed 7 oxycodone 5-mg pills after cubital tunnel decompression. Younger, privately insured, and workers' compensation patients, and those with worse functional scores and those undergoing UNT (specifically the submuscular technique) consumed more opioids.
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Affiliation(s)
- Bryan A. Hozack
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Jack Abboudi
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Gregory Gallant
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Christopher M. Jones
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - William Kirkpatrick
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Frederic E. Liss
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Michael Rivlin
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - T. Robert Takei
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Mark L. Wang
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Matthew Silverman
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Carol Foltz
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson
University Hospital, Philadelphia, PA, USA,Asif M. Ilyas, Rothman Institute at Thomas
Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA
19107, USA.
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Abstract
OBJECTIVE Evaluate the accuracy of the Pennsylvania Prescription Drug Monitoring Program (PA PDMP) in patients undergoing upper extremity procedures. The authors hypothesized that the PA PDMP would provide an accurate account of the prescriptions that were filled. DESIGN The authors prospectively collected post-operative pain prescription information of patients undergoing outpatient upper extremity surgery over a 2-week period. Patient-reported prescription-filling of opioid was cross-referenced with the PA PDMP information. SETTING The study was performed at one private institution. PATIENTS One hundred and thirty-nine consecutive patients undergoing upper extremity procedures. MAIN OUTCOME MEASURE(S) The PA PDMP information was cross-referenced with the post-operative prescription in the medical record to confirm the patient filled the surgeon's prescription. RESULTS Of the 111 patients who reported filling their prescription, 107 (96.4 percent) of these were confirmed on the PA PDMP Web site (96.4 percent sensitivity; 95% confidence interval [CI]: 91.0-99.0 percent). None of 28 patients who did not fill their prescription appeared in the database search, resulting in 100 percent specificity (95% CI: 87.7-100 percent). Consequently, the overall accuracy of the PA PDMP was shown to be 97.1 percent (95% CI: 92.8-99.2 percent). CONCLUSIONS The authors' results suggest that the PA PDMP and its many supplementary databases are accurate as it relates to monitoring opioid prescriptions.
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Affiliation(s)
- Bryan A Hozack
- Department of Orthopaedics, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Rivlin
- Department of Orthopaedics, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jack Graham
- Department of Orthopaedics, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kevin F Lutsky
- Department of Orthopaedics, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pedro K Beredjiklian
- Department of Orthopaedics, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Feldman GJ, Peters CL, Erickson JA, Hozack BA, Jaraha R, Parvizi J. Variable expression and incomplete penetrance of developmental dysplasia of the hip: clinical challenge in a 71-member multigeneration family. J Arthroplasty 2012; 27:527-32. [PMID: 22177793 DOI: 10.1016/j.arth.2011.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 10/16/2011] [Indexed: 02/01/2023] Open
Abstract
Developmental dysplasia of the hip is a crippling condition that affects children and adults. Identical twin studies support a strong causative genetic component. Although clinical tests for newborns can detect gross malformations, it is the subtle malformations that are often not detected, resulting in early onset osteoarthritis of the hip in adults. As a first step in identifying the causative mutation, we have recruited the largest documented affected family with 71 members spanning generations. Clinical and radiographic signs of developmental dysplasia of the hip are described, and the diagnostic challenge of identifying affected family members is discussed.Variable expression of disease allele is evident in several members of the family and greatly contributes to the diagnostic challenge facing clinicians.
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Affiliation(s)
- George J Feldman
- Thomas Jefferson University and the Rothman Institute of Orthopaedics, Philadelphia, PA, USA
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