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Annual Meeting Posters Abstract Book I - Hand Annual Meeting Posters Abstract Book I - Hand 73RD ANNUAL MEETING OF THE ASSH SEPTEMBER 13 – 15, 2018 BOSTON, MA 822 W Washington Blvd Chicago, IL 60607 Phone: (312) 880-1900 Fax: (847) 384-1435 Web: www.assh.org Email: [email protected] All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain. AM Poster 001: Dorsal Plating for Comminuted Intra-Articular Middle Phalangeal Base Fractures Category: Hand Hand and Wrist;Diseases and Disorders;General Principles Level 4 Evidence Travis Doering, MD Andrew Greenberg, MD David V. Tuckman, MD Hypothesis Intra-articular middle phalangeal base fractures with volar instability are rare injuries with scant literature on optimal management. Our purpose is to describe our method of dorsal plating and report post-operative outcomes. Methods A retrospective case review of 5 patients with intra-articular middle phalangeal base fractures with volar proximal interphalangeal joint instability, measuring subjective, clinical, and radiographic outcomes. Results Patient age averaged 38.2 years (range 23-56), and 80% of whom were male. Sporting injuries were the most common mechanism (80%). Time to surgery averaged 7 days, and post-operative follow up duration averaged 19.6 months (median 8 months). All fractures were intra-articular at the PIP joint with volar instability. There were no complications and no patients required secondary surgery. Grip strength was maintained and range of motion was good, based on the American Society for Surgery of the Hand Total Active Motion score. Average Quick Disability of the Arm, Shoulder, and Hand was 0.5 (range 0-2.3), 100% of patients were satisfied, and average visual analogue pain score was 1.2. Patients returned to work at a median of 4 days. There was radiographic union at an average of 6.6 weeks (range 6-7) in all fractures. Summary Points Dorsal plating using a 1.5mm modular hand plate is a viable option for rigid fixation of intra- articular middle phalangeal base fractures with volar instability. This fixation method allows for early range of motion without complications in this case series. All fractures united, patients had minimal functional deficits, and were able to maintain good range of motion. Bibliography 1: Kiefhaber TR, Stern PJ. Fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am. 1998;23(3):368-80. 2: Rosenstadt BE, Glickel SZ, Lane LB, Kaplan SJ. Palmar fracture dislocation of the proximal interphalangeal joint. J Hand Surg Am. 1998;23(5):811-20. 3: Peimer CA, Sullivan DJ, Wild DR. Palmar dislocation of the proximal interphalangeal joint. J Hand Surg Am. 1984;9A(1):39-48. 4: Meyer ZI, Goldfarb CA, Calfee RP, Wall LB. The Central Slip Fracture: Results of Operative Treatment of Volar Fracture Subluxations/Dislocations of the Proximal Interphalangeal Joint. J Hand Surg Am. 2017;42(7):572.e1-572.e6. 5: Meyer ZI, Wall LB. The Central Slip Fracture: Results of Operative Treatment of Volar Fracture Subluxations/Dislocations of the Proximal Interphalangeal Joint. J Hand Surg Am. 2017;42(7):572.e1-572.e6. AM Poster 002: Comparison of Local-Only Anesthesia Versus Sedation in Patients Undergoing Staged Bilateral Carpal Tunnel Release Category: Hand Hand and Wrist;Nerve Level 2 Evidence Garrhett G. Via, BS Hisham M. Awan, MD Sonu Jain, MD Kanu Goyal, MD Hypothesis It was hypothesized that after experiencing both types of anesthesia described, a greater proportion of patients would prefer wide-awake, local-only carpal tunnel release. Methods Staged bilateral carpal tunnel release utilizing an open or endoscopic technique was scheduled to achieve completion in 30 patients, as driven by a priori power analysis. To date, 27 of the 30 desired patients (3 pending) have received both operations at an outpatient surgery center where the releases were performed by one of three board-certified hand surgeons. Patients chose initial hand laterality and were randomized regarding initial anesthesia method: local-only or sedation. Data collection via questionnaires began at consent and continued to 6 weeks post- operatively from the second procedure. Primary outcome measures included patient satisfaction with each procedure and patient anesthesia preference. Secondary outcomes included, but were not limited to, the Beck Anxiety Inventory, QuickDASH, surgical times and costs, pain assessment, and surgeon comfort. Results At final follow-up 6-weeks post-operatively, 26 out of 27 patients reported high satisfaction with local-only anesthesia and 26 out of 27 with sedation. 16 patients preferred local-only anesthesia (95% CI = 41% – 78%), 8 preferred sedation (95% CI = 16% – 51%), and 3 had no preference. Although anesthesia fees were approximately $388 (95% CI = $320 – $456) lower with local-only anesthesia (p < 0.01), total surgery costs for carpal tunnel release were not significantly different with respect to the anesthesia cohorts (p = 0.52). Total time in the surgical facility was approximately 24 (95% CI = 14 – 34) minutes quicker with local-only anesthesia (p < 0.01) due to shorter time in the PACU. A scaled comparison of worst post-operative pain following the two procedures revealed no difference between local-only anesthesia and sedation (p = 0.71). Summary Points • Patients reported equal satisfaction with both Methods of anesthesia • 59% of patients preferred local-only anesthesia Bibliography 1: Davison, P. G., Lalonde, D. H., & Cobb, T. (January 01, 2013). The patient's perspective on carpal tunnel surgery related to the type of anesthesia: A prospective cohort study. Hand, 8, 1, 47-53. 2: Sambandam, S. N., Priyanka, P., Gul, A., & Ilango, B. (August 01, 2008). Critical analysis of outcome measures used in the assessment of carpal tunnel syndrome. International Orthopaedics, 32, 4, 497-504. 3: De Ayala, R. J., Vonderharr-Carlson, D. J., Kim D. (October 01, 2005). Assessing the reliability of the Beck Anxiety Inventory scores. Educational and Psychological Measurement, 65, 5, 742 – 756. AM Poster 003: Return to Sport After Hand Fractures in NCAA Athletes: When is Operative Fixation Necessary? Category: Hand Hand and Wrist;Practice Management Level 4 Evidence Christopher N. Carender, Joseph A. Buckwalter, V, Natalie A. Glass Robert W. Westermann, Hypothesis Metacarpal and phalanx fractures are common amongst athletes. There is a paucity of data to guide NCAA team physicians on expected return to play after hand fractures treated operatively or non-operatively. The purpose of this study was to examine the epidemiology and return to play times after hand fractures in NCAA athletes. We hypothesized that surgical management of metacarpal and phalanx fractures may expedite return to play times. Methods The NCAA Injury Surveillance Program database was queried for metacarpal and phalanx fractures during the 2009-2014 seasons in all available contact and non-contact sports. Injury rates per 100,000 athlete-exposures (AE) and return to play times for athletes treated with operative and non-operative management of hand fractures were calculated. Student’s t-test and Wilcoxon Rank sum tests were used for continuous variable and Chi-Squared tests and Fisher Exact Test were used for categorical variables to determine significance, set to p<0.05. Results Sports with the highest rates of phalanx and metacarpal fractures included Men’s Football, Men’s Ice Hockey, Men’s Wrestling, and Women’s Field Hockey (Table 1). Multiple sports had participants with no hand fractures over the study period. Male student-athletes with metacarpal fractures treated operatively returned to play at a mean of 31.8±29.4 days versus 13.8±23.6 days for those treated non-operatively (Table 2). 92% of male student-athletes were able to return to sport in the same season without operative management versus 67% with operative management. Female student-athletes had a cohort too small for statistical analysis. Return to play times for male student-athletes with phalanx fractures were not significantly different between operative and non-operative groups (16.1±21.5 days versus 7.1±13.3 days) (Table 2). Rates of return to sport within the same season for male student-athletes following phalanx fractures were similar for operative and non-operative groups, with 97.9% returning with non-operative treatment, and 90.9% returning with operative treatment. Summary Points • Hand fractures are relatively common among NCAA student-athletes participating in contact sports • Sports with the highest rates of phalanx and metacarpal fractures included Men’s Football, and Women’s Field Hockey • Operative fixation of equivocally unstable metacarpal or phalangeal fractures may subject athletes to excessive and unnecessary time-loss from participation • Additional studies are needed, as the effect of fracture type and stability on return to play time in this study is unknown • The return to play times illustrated within this study can be used to counsel athletes, athletic trainers, and coaches. AM Poster 004: Eaton’s Plasty For the Treatment of the Traumatic Luxation of the Trapezium-Metacarpal Joint. Category: Hand Hand and Wrist N/A - not a clinical study Ana Maria Far-Riera, MD Carlos Perez-Uribarri, MD Introduction Trapezium-metacarpal dislocations are infrequent lesions. Its treatment continues in controversy.There is no consensus in the management of acute injury. Some authors propose an early stabilization by ligamentous reconstruction, while others advocate a closed reduction and immobilization. In chronic symptomatic lesions open surgery and ligamentous reconstruction are recommended.We have not found any recommendation for instability after the failure of closed stabilization. Hypothesis Treatment proposal for acute instability of trapezium-metacarpal joint dislocation after failure of closed stabilization. Methods We present a case of a 15-year-old male who presented a post-traumatic TMC dislocation self- reduced 4 weeks earlier. On the x-ray we can see a dorsoradial subluxation which prevents him from performing key pinch.
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