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  • Single Assessment Numeric Evaluation (SANE) in Hand Surgery: Does a One-Question Outcome Instrument Compare Favorably? The Journal of hand surgery Gire, J. D., Koltsov, J. C., Segovia, N. A., Kenney, D. E., Yao, J., Ladd, A. L. 2020

    Abstract

    PURPOSE: Patient-reported outcome measures are increasingly used to measure patient status, impairments, and disability, but often require lengthy surveys and place a considerable burden on patients. We hypothesized that the Single Assessment Numeric Evaluation (SANE), composed of a single question, would be a valid and responsive instrument to provide a global assessment of hand function.METHODS: The SANE, Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE), and Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) data are routinely collected electronically in our hand and upper-extremity center. To identify our cohort, we used Current Procedural Terminology codes to query our electronic medical record research data repository for the 7 most common hand surgery procedures performed over 2 years from December 2016 to 2018. These procedures included carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, wrist arthroscopy, distal radius fracture fixation, first dorsal compartment release, and cubital tunnel release. Patients undergoing a single isolated procedure with questionnaires obtained in the preoperative and/or postoperative period were included in the analysis. Convergent validity, coverage, and responsiveness for each instrument were assessed.RESULTS: We identified 214 patients for inclusion. The SANE score had a moderate to strong correlation with the QuickDASH and PROMIS-UE. Floor and ceiling effects for the SANE were less than 10% at baseline and follow-up. Overall, the QuickDASH was the most responsive, followed by SANE and PROMIS-UE; all 3 instruments exceeded the acceptable thresholds for responsiveness and demonstrated significant changes before to after surgery. Responsiveness of the SANE varied by procedure and was acceptable for carpal tunnel release, carpometacarpal arthroplasty, wrist arthroscopy, and trigger finger release.CONCLUSIONS: The single-item SANE is a reasonable measure of global function in patients undergoing common hand procedures and demonstrates psychometric properties comparable to those of the PROMIS-UE and QuickDASH outcome scores.CLINICAL RELEVANCE: The SANE score is a reasonable outcome measure of global hand function that may have utility in demonstrating response to treatment in a practice setting and may provide a useful adjunct to multiple-item measures in clinical research studies.

    View details for DOI 10.1016/j.jhsa.2020.03.024

    View details for PubMedID 32482496

  • Surgical Techniques for the Treatment of Acute Carpal Ligament Injuries in the Athlete. Clinics in sports medicine Gire, J. D., Yao, J. 2020; 39 (2): 313?37

    Abstract

    The treatment of athletes with carpal ligament injuries provides many challenges. Our initial goals remain to make a timely and accurate diagnosis, provide treatment options, and create an environment for shared decision making. To optimize outcomes and facilitate return to play, early surgical intervention may be warranted. This article reviews common carpal ligament injury patterns in the athlete with a focus on both classic and newer surgical techniques.

    View details for DOI 10.1016/j.csm.2019.12.001

    View details for PubMedID 32115087

  • Maximization Personality, Disability and Symptoms of Psychosocial Disease in Hand Surgery Patients. Journal of surgical orthopaedic advances Gire, J., Alokozai, A., Sheikholeslami, N., Lindsay, S., Eppler, S. L., Kamal, R. N. 2020; 29 (2): 106?11

    Abstract

    There are different frameworks to describe how people make decisions. One framework, maximization, is an approach where individuals approach choices with a goal of finding the 'best' possible alternative. We sought to determine the relationship between maximization and patient reported disability in patients with hand problems. We performed a cross-sectional study of 119 patients who presented to a hand surgery clinic. Patients completed a questionnaire that included sociodemographics, QuickDASH, Decisional Conflict Scale, Pain Catastrophizing Scale, Patient Health Questionnaire, Health Anxiety Inventory and General Self-Efficacy. Maximization did not correlate with subjective disability in patients with hand problems. Depression, pain catastrophizing and a diagnosis of upper extremity fracture had the greatest independent association with disability.In patients presenting for an initial hand surgery consultation, maximization was not associated with variation in patient reported disability or symptoms of psychosocial disease. Alternative factors influencing patient decision-making and outcomes should be explored. (Journal of Surgical Orthopaedic Advances 29(2):106-111, 2020).

    View details for PubMedID 32584225

  • Percutaneous Versus Open Treatment of Posterior Pelvic Ring Injuries: Changes in Practice Patterns Over Time JOURNAL OF ORTHOPAEDIC TRAUMA Gire, J. D., Jiang, S. Y., Gardner, M. J., Bishop, J. A. 2018; 32 (9): 457?60
  • Percutaneous versus Open Treatment of Posterior Pelvic Ring Injuries: Changes in Practice Patterns Over Time. Journal of orthopaedic trauma Gire, J. D., Jiang, S. Y., Gardner, M. J., Bishop, J. A. 2018

    Abstract

    OBJECTIVE: To determine how the utilization of open versus percutaneous treatment of posterior pelvic ring injuries in early career orthopaedic surgeons has changed over time.METHODS: Case log data from surgeons testing in the trauma subspecialty for Part II of the ABOS examination from 2003 to 2015 were evaluated. CPT codes for percutaneous fixation (27216) and open fixation (27218) of the posterior pelvic ring were evaluated using a regression analysis.RESULTS: A total of 377 candidates performed 2,095 posterior ring stabilization procedures (1,626 percutaneous, 469 open). Total case volume was stable over time (beta=-1.7 (1.1), p=.14). There was no significant change in the number of posterior pelvic ring fracture surgery cases performed per candidate per test year (beta= 0.1 (0.1), p=.50). The proportion of posterior pelvic ring cases performed percutaneously increased significantly from 49% in 2003 to 79% in 2015 (beta= 1.0 (0.4), p=.03). There was a significant decrease in the number of open cases reported per candidate (beta= -0.07 (0.03), p=.008).DISCUSSION AND CONCLUSION: Early career orthopaedic surgeons are performing more percutaneous fixation of the posterior pelvic ring and less open surgery. The impact of this change in volume on surgeon proficiency is unknown and warrants additional research.

    View details for PubMedID 29912737

  • Are Early Career Orthopaedic Trauma Surgeons Performing Less Complex Trauma Surgery? JOURNAL OF ORTHOPAEDIC TRAUMA Gire, J. D., Gardner, M. J., Harris, A. H., Bishop, J. A. 2016; 30 (10): 525-529

    Abstract

    There has recently been an increase in the number of fellowship trained orthopaedic trauma surgeons, raising concerns that the surgical experience of early career surgeons may be diluted. We sought to evaluate the change in complex trauma case volume of orthopaedic trauma surgeons sitting for Part II of the American Board of Orthopaedic Surgeons certification examination.The case log data from all surgeons taking Part II of the American Board of Orthopaedic Surgeons examination over a 13-year period (2003-2015) was evaluated. Any surgeon who examined in the trauma subspecialty was included. We defined pelvis, acetabulum, and periarticular fracture surgeries as complex trauma procedures and evaluated changes in case volume over time.We included 468 candidates who examined as trauma subspecialists and performed 90,261 procedures. The number of candidates testing in trauma per year ranged from 15 to 65 and increased significantly over time [? = 4.05 (0.37), P < 0.0001]. Their case volume was stable over time [? = -1.7 (1.1), P = 0.16]. The number of acetabulum fracture surgeries performed decreased significantly over time from a mean of 10.1 cases in 2003 to 5.2 cases in 2015 [? = -0.34 (0.08), P = 0.0015]. There was no significant change in the number of pelvic fracture surgeries [? = -0.1 (0.1), P = 0.285]. There was a trend toward less periarticular fracture surgeries [? = -0.3 (0.1), P = 0.072].Although pelvic ring and periarticular fracture case volume have remained stable, early career surgeons have experienced a significant decrease in acetabular fracture case volume. The implications of this decreased surgical experience warrant careful consideration as the orthopaedic trauma workforce evolves.

    View details for DOI 10.1097/BOT.0000000000000653

    View details for Web of Science ID 000384467000009

  • Are Early Career Orthopaedic Trauma Surgeons Performing Less Complex Trauma Surgery? Journal of orthopaedic trauma Gire, J. D., Gardner, M. J., Harris, A. H., Bishop, J. A. 2016; 30 (10): 525?29

    Abstract

    There has recently been an increase in the number of fellowship trained orthopaedic trauma surgeons, raising concerns that the surgical experience of early career surgeons may be diluted. We sought to evaluate the change in complex trauma case volume of orthopaedic trauma surgeons sitting for Part II of the American Board of Orthopaedic Surgeons certification examination.The case log data from all surgeons taking Part II of the American Board of Orthopaedic Surgeons examination over a 13-year period (2003-2015) was evaluated. Any surgeon who examined in the trauma subspecialty was included. We defined pelvis, acetabulum, and periarticular fracture surgeries as complex trauma procedures and evaluated changes in case volume over time.We included 468 candidates who examined as trauma subspecialists and performed 90,261 procedures. The number of candidates testing in trauma per year ranged from 15 to 65 and increased significantly over time [? = 4.05 (0.37), P < 0.0001]. Their case volume was stable over time [? = -1.7 (1.1), P = 0.16]. The number of acetabulum fracture surgeries performed decreased significantly over time from a mean of 10.1 cases in 2003 to 5.2 cases in 2015 [? = -0.34 (0.08), P = 0.0015]. There was no significant change in the number of pelvic fracture surgeries [? = -0.1 (0.1), P = 0.285]. There was a trend toward less periarticular fracture surgeries [? = -0.3 (0.1), P = 0.072].Although pelvic ring and periarticular fracture case volume have remained stable, early career surgeons have experienced a significant decrease in acetabular fracture case volume. The implications of this decreased surgical experience warrant careful consideration as the orthopaedic trauma workforce evolves.

    View details for PubMedID 27668503

  • The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation SPINE JOURNAL Gire, J. D., Roberto, R. F., Bobinski, M., Klineberg, E. O., Durbin-Johnson, B. 2013; 13 (5): 510-519

    Abstract

    Atlantooccipital dislocation (AOD) results in profound patient morbidity and mortality and is difficult to accurately diagnose using current evaluation techniques.To evaluate the utility of computed tomography (CT) images in the diagnosis of AOD and compare the revised occipital condyle-C1 interval (CCI) and the condylar sum to the current radiographic criteria used to detect AOD.Retrospective review to evaluate the sensitivity, specificity, and the interobserver reliability of eight radiographic criteria as applied to CT imaging.Ten cases of clinical AOD and 10 cases of non-AOD cervical injury.Measured values: revised CCI, Wholey basion-dens interval (BDI), and Harris basion-axis interval (BAI). Calculated values: Sun interspinous ratio, Powers ratio, and condylar sum. Assessment of Lee X-line and atlantooccipital joint asymmetry.A board certified neuroradiologist, two orthopedic spine surgeons, and two medical students reviewed the CT images for each patient in the series and applied the aforementioned criteria.Average sensitivity between all reviewers for CCI, condylar sum, and atlantooccipital asymmetry was highest at 1.0, 1.0, and 0.96, respectively. Basion-dens interval, X-line, Sun ratio, BAI, and Powers ratio had sensitivities of 0.72, 0.54, 0.32, 0.26, and 0.26, respectively. Revised CCI and condylar sum had significantly better sensitivity than any other test (vs. BDI, p=.014, all others, p<.001) except atlantooccipital asymmetry (p>.99). Specificity for all measurements was 0.78 or greater, except X-line at 0.38. Interobserver reliabilities were the greatest for CCI, condylar sum, atlantooccipital asymmetry, and BDI.The revised CCI (>2.5 mm abnormal) and condylar sum (?5 mm abnormal) are highly sensitive and reliable radiographic criteria for the detection of AOD when applied to CT imaging.

    View details for DOI 10.1016/j.spinee.2013.01.023

    View details for Web of Science ID 000318978300010

    View details for PubMedID 23434369

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