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Kevin C Chung - One of the best experts on this subject based on the ideXlab platform.
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Reply: Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy.
Plastic and Reconstructive Surgery, 2018Co-Authors: Jessica I Billig, Kevin C ChungAbstract:BACKGROUND Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing Wrist Arthroscopy for nontraumatic Wrist pain. METHODS Patients who underwent a Wrist Arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. RESULTS A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). CONCLUSIONS Significant gender differences exist in the preoperative care for patients undergoing Wrist Arthroscopy. Men use more imaging, implying more intense preoperative investigation for Wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
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gender disparities in preoperative resource use for Wrist Arthroscopy
Plastic and Reconstructive Surgery, 2018Co-Authors: Jessica I Billig, Jennifer M Sterbenz, Lin Zhong, Kevin C ChungAbstract:BACKGROUND Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing Wrist Arthroscopy for nontraumatic Wrist pain. METHODS Patients who underwent a Wrist Arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. RESULTS A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). CONCLUSIONS Significant gender differences exist in the preoperative care for patients undergoing Wrist Arthroscopy. Men use more imaging, implying more intense preoperative investigation for Wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
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Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy.
Plastic and reconstructive surgery, 2018Co-Authors: Jessica I Billig, Jennifer M Sterbenz, Lin Zhong, Kevin C ChungAbstract:Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing Wrist Arthroscopy for nontraumatic Wrist pain. Patients who underwent a Wrist Arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). Significant gender differences exist in the preoperative care for patients undergoing Wrist Arthroscopy. Men use more imaging, implying more intense preoperative investigation for Wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
Jessica I Billig - One of the best experts on this subject based on the ideXlab platform.
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Reply: Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy.
Plastic and Reconstructive Surgery, 2018Co-Authors: Jessica I Billig, Kevin C ChungAbstract:BACKGROUND Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing Wrist Arthroscopy for nontraumatic Wrist pain. METHODS Patients who underwent a Wrist Arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. RESULTS A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). CONCLUSIONS Significant gender differences exist in the preoperative care for patients undergoing Wrist Arthroscopy. Men use more imaging, implying more intense preoperative investigation for Wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
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gender disparities in preoperative resource use for Wrist Arthroscopy
Plastic and Reconstructive Surgery, 2018Co-Authors: Jessica I Billig, Jennifer M Sterbenz, Lin Zhong, Kevin C ChungAbstract:BACKGROUND Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing Wrist Arthroscopy for nontraumatic Wrist pain. METHODS Patients who underwent a Wrist Arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. RESULTS A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). CONCLUSIONS Significant gender differences exist in the preoperative care for patients undergoing Wrist Arthroscopy. Men use more imaging, implying more intense preoperative investigation for Wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
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Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy.
Plastic and reconstructive surgery, 2018Co-Authors: Jessica I Billig, Jennifer M Sterbenz, Lin Zhong, Kevin C ChungAbstract:Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing Wrist Arthroscopy for nontraumatic Wrist pain. Patients who underwent a Wrist Arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). Significant gender differences exist in the preoperative care for patients undergoing Wrist Arthroscopy. Men use more imaging, implying more intense preoperative investigation for Wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
Gabrielle J M Tuijthof - One of the best experts on this subject based on the ideXlab platform.
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Navigation forces during Wrist Arthroscopy: assessment of expert levels
Knee Surgery Sports Traumatology Arthroscopy, 2016Co-Authors: M. C. Obdeijn, Lisanne L. Boer, Sophie J. Baalen, Tim Horeman, Philippe Liverneaux, Gabrielle J M TuijthofAbstract:PurposeTo facilitate effective and efficient training in skills laboratory, objective metrics can be used. Forces exerted on the tissues can be a measure of safe tissue manipulation. To provide feedback during training, expert threshold levels need to be determined. The purpose of this study was to define the magnitude and the direction of navigation forces used during arthroscopic inspection of the Wrist.MethodsWe developed a set-up to mount a cadaver Wrist to a 3D force platform that allowed measurement of the forces exerted on the Wrist. Six experts in Wrist Arthroscopy performed two tasks: (1) Introduction of the camera and visualization of the hook. (2) Navigation through the Wrist with visualization of five anatomic structures. The magnitude (Fabs) and direction of force were recorded, with the direction defined as α being the angle in the vertical plane and β being the angle in the horizontal plane. The 10th–90th percentile of the data were used to set threshold levels for training.ResultsThe results show distinct force patterns for each of the anatomic landmarks. Median Fabs of the navigation task is 3.8 N (1.8–7.3), α is 3.60 (−54–44) and β is 260 (0–72).ConclusionUnique expert data on navigation forces during Wrist Arthroscopy were determined. The defined maximum allowable navigation force of 7.3 N (90th percentile) can be used in providing feedback on performance during skills training. The clinical value is that this study contributes to objective assessment of skills levels.
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Development of a Wrist Arthroscopy simulator
Chirurgie de la Main, 2015Co-Authors: M. C. Obdeijn, Philippe Liverneaux, Christophe Mathoulin, Geert Streekstra, L. Blankevoort, Gabrielle J M TuijthofAbstract:Introduction Wrist Arthroscopy is taking up an important place in hand surgery. The purpose of this study was to build a Wrist Arthroscopy simulator to train the key navigation and probing skills required for a diagnostic Wrist Arthroscopy. Methods Our starting point was to keep the simulated environment as close as possible to the real-life situation by using normal equipment and replacing the joint by a physical anatomical model that can be mounted on a force platform to track performance. The specific requirements for the simulator were determined by questioning a panel of experts. These were translated into technical demands regarding the intra-articular structures and the skin. Especially the skin substitute was tested to provide the same elastic and resistance properties as human skin. A prototype was built and tested for face validity by asking the opinion of 14 experts. Results All 14 participants found the simulator a good tool to teach Wrist Arthroscopy. The aspects that were paid most attention to in the design demonstrated face validity - realism of the lubricated top layer (mean 7.7 SD 1.6), realistic size of the joint structures (mean 7.7 SD 1.6) and realistic arthroscopic image (mean 7.9 SD 1.2). The flexibility of the prototype (mean 6.0 SD 2.3) and the color of the structures (mean 5.4 SD 1.9) were rated lower. The structures that the experts missed most were the TFCC and the volar ligaments. Discussion Training of skills is a prerequisite for good clinical care and should start outside the operating room for patient safety reasons. By introducing a validated Wrist Arthroscopy simulator, we have added a necessary and relevant training tool. Conclusions The concept to use a physical model for Wrist Arthroscopy training is well perceived, and indicates the potential for continued development.
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The use of navigation forces for assessment of Wrist Arthroscopy skills level.
Journal of wrist surgery, 2014Co-Authors: M. C. Obdeijn, Tim Horeman, Philippe Liverneaux, Sophie Jacobine Van Baalen, Gabrielle J M TuijthofAbstract:To provide an efficient learning process, feedback on performance is crucial. In the clinical setting, tools such as the Objective Structured Assessment of Technical Skills (OSATS) are used for assessment of skills.1 2 3 This type of assessment, by its nature, is subjective and time-consuming.4 Moreover, they do not assess important elements that are related to safe tissue manipulation, which is mandatory in the beginning of a training process.4 In skills laboratories objective measurement of various aspects of surgical and endoscopic skills is possible, as well as monitoring trainees' progress.2 A precondition is the identification of metrics that represent the learning curve of the trainees. The literature presents quite a variety of metrics, of which time to task completion has been shown to be a strong predictor of task efficiency.3 Tracking of motion has also been investigated.5 Cutoff values for the scores of motion analysis devices have yet to be defined, making them suitable only for formative assessment.2 Oropesa et al concluded that most training systems for laparoscopy assess performance using task time and motion-derived parameters such as path length, speed, economy of movements, and motion smoothness.3 These efficiency parameters are objective and reproducible and related to measurable physical metrics. However, an effective or efficient performance of the task does not necessarily mean a safely performed task. A prerequisite for a safe Wrist Arthroscopy is the gentle introduction of the scope and secondary instruments, as well as a smooth and adequate manipulation of the instruments during the arthroscopic sweep through the Wrist. Cartilage especially needs to be respected during Arthroscopy, as it is a tissue with poor healing potential. Thus, force-related parameters could be valuable to assess the technical skills of trainees in Wrist Arthroscopy. The literature presents a few studies on measurements of forces during Arthroscopy. Tashiro et al measured both motion and force data.6 The forces and torques were measured using a six-degrees–of-freedom sensor attached to a dummy knee. The authors conclude that motion and force data were equally able to distinguish between levels of experience in a joint inspection and probing task. In a more complicated task (meniscectomy), all force parameters were similar for each group, suggesting that beginners take care to execute safe tissue manipulation. Chami et al measured forces and torques during knee arthroscopies in the operating room by fitting a six-degrees-of-freedom force torque sensor to the arthroscopic hook.4 7 Their results on “efficiency of movement” and “consistency of performance” indicate that it is possible to assess experience objectively using force measurements.4 Our purpose was to investigate further the usefulness of force parameters in monitoring safe tissue manipulation. To this end, we previously studied the forces used by experts during Wrist Arthroscopy in a cadaver with a custom-made force platform. (Table 1, Fig. 1). (Obdeijn MC, Horeman T, de Boer LL, van Baalen SJ, Liverneaux P, Tuijthof GJM. Navigation forces during Wrist Arthroscopy: Assessment of expert levels. Submitted Aug 2013 KSSTA.) These data were used as reference for safe manipulation for this study, where we investigated the following questions: Fig. 1 Experimental setup. A, cadaver Wrist; B, camera; C, tripod; D, vertical traction device; E, force platform; F, force platform holder; G, laptop registering the data input from the three cameras and the scopic image. Table 1 Demographic data of the experts What are the forces used by novices during a Wrist Arthroscopy? What aspects of these navigation forces (e.g., in terms of magnitude or direction) are significantly different between novices and experts in Wrist Arthroscopy? What aspects of these navigation forces (e.g., in terms of magnitude or direction) show a distinct learning curve?
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Development and validation of a computer-based learning module for Wrist Arthroscopy.
Chirurgie de la main, 2014Co-Authors: M. C. Obdeijn, Philippe Liverneaux, Gabrielle J M Tuijthof, Christophe Mathoulin, J.v. Alewijnse, Marlies P. SchijvenAbstract:The objective of this study was to develop and validate a computer-based module for Wrist Arthroscopy to which a group of experts could consent. The need for such a module was assessed with members of the European Wrist Arthroscopy Society (EWAS). The computer-based module was developed through several rounds of consulting experts on the content. The module's learning enhancement was tested in a randomized controlled trial with 28 medical students who were assigned to the computer-based module group or lecture group. The design process led to a useful tool, which is supported by a panel of experts. Although the computer based module did not enhance learning, the participants did find the module more pleasant to use. Developing learning tools such as this computer-based module can improve the teaching of Wrist Arthroscopy skills.
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Trends in Wrist Arthroscopy
Journal of wrist surgery, 2013Co-Authors: M. C. Obdeijn, Gabrielle J M Tuijthof, Chantal M.a.m. Van Der Horst, Christophe Mathoulin, Philippe LiverneauxAbstract:Background Wrist Arthroscopy plays a role in both the diagnosis and the treatment of Wrist pathology. It has evolved in the last three decades. Questions The present status of Wrist Arthroscopy was investigated by answering the following questions: -What is its current position in the treatment Wrist pathologies according to the literature? -What is its current position according to hand surgeons? Methods Analysis of the number of publications on Wrist Arthroscopy was performed and compared with the number of publications on other Arthroscopy topics to assess the current position of Wrist Arthroscopy. The members of the EWAS (European Wrist Arthroscopy Society) and the members of eight national hand surgery societies were questioned on Wrist Arthroscopy in daily practice. Results From 1975 till now, 925 papers on Wrist Arthroscopy were found. The publications on Wrist Arthroscopy increased from an average of 8/year (1986) to 26/year (2012). More than half (56.9%) of the respondents of the EWAS perform fewer than 5 Wrist arthroscopies per month, and only 7 (10.8%) indicate the performance of more than 10 Wrist arthroscopies per month. Seventy-four percent of the orthopedic hand surgeons perform Wrist Arthroscopy (in 48.5% for therapeutic indications) against 36.8% of plastic surgery hand surgeons (in 23.1% for therapeutic indications). Conclusion Wrist Arthroscopy has taken up a place in the armamentarium of the hand surgeon. The place of Wrist Arthroscopy in daily practice is related to the background of the hand surgeon.
Pedro K. Beredjiklian - One of the best experts on this subject based on the ideXlab platform.
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An Evaluation of the Reliability of Wrist Arthroscopy in the Assessment of Tears of the Triangular Fibrocartilage Complex.
The Journal of hand surgery, 2018Co-Authors: Andrew G. Park, Kevin F. Lutsky, Jonas L. Matzon, Charles F. Leinberry, Talia Chapman, Pedro K. BeredjiklianAbstract:Purpose Wrist Arthroscopy is generally considered the reference standard in the diagnosis of triangular fibrocartilage complex (TFCC) injuries. There is a paucity of data examining the reliability of Wrist Arthroscopy as a diagnostic modality for TFCC injuries. The goal of this study was to evaluate the interobserver and intraobserver reliability of the diagnosis of TFCC pathology during Wrist Arthroscopy. Methods Twenty-five intraoperative digital videos were captured by the senior author during diagnostic and surgical Arthroscopy of the Wrist joint for known or suspected articular pathology. The senior author (P.K.B.) confirmed TFCC resilience on visual inspection and ballottement (trampoline effect) to make the diagnosis. Two videos were excluded for poor quality and inadequate visualization. Three hand surgeons subsequently reviewed the remaining 23 videos in a blinded fashion at 2 time points separated by 4 weeks. The reviewers determined if the trampoline test was positive and if a TFCC tear was present. Tears were classified using a morphologic classification. Statistical measures of reliability including percentage agreement and κ coefficients were calculated. Results Agreement between observers for the presence or absence of a tear was 66.7%. The average intraobserver agreement regarding the presence or absence of a tear was 67.4% The kappa value for interobserver agreement was 0.33, whereas the intrarater agreement was 0.88. The 3 reviewers identified an average of 11.3 positive trampoline tests. Agreement between observers for a positive trampoline test was 65.2%. The average percentage of intraobserver agreement regarding a positive trampoline test was 49.3%. In cases where all 3 reviewers agreed on the presence of a TFCC tear, the agreement regarding tear location was 76.6%. Conclusions Wrist Arthroscopy remains instrumental in the treatment of TFCC tears. However, given that inter-rater reliability in the assessment of these tears is probably too low, reconsideration should be given to Arthroscopy as the reference standard in the diagnosis of these tears. Type of study/level of evidence Diagnostic III.
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Complications of Wrist Arthroscopy.
The Journal of hand surgery, 2004Co-Authors: Pedro K. Beredjiklian, David J. Bozentka, Y.leo Leung, Bruce A. MonaghanAbstract:Abstract Purpose To determine the incidence and nature of complications after Arthroscopy of the Wrist joint. Methods The outpatient records and surgical reports of 211 patients who had Wrist joint Arthroscopy were reviewed to determine type of procedure, type of anesthetic, portals used, and incidence and nature of postsurgical complications. Results We identified a total of 11 complications in our patient group (5.2%). Of these, 2 patients (0.9%) developed major complications and 9 patients (4.3%) developed minor complications. Five complications 45% were identified in the immediate postsurgical period and 6 (55%) were delayed complications. All of the minor complications resolved at latest follow-up evaluation with conservative care. Conclusions Wrist Arthroscopy is a safe procedure with a low rate of major and minor complications. In spite of its limitations Wrist Arthroscopy remains an invaluable tool in the diagnosis and treatment of Wrist joint disorders.
David J. Slutsky - One of the best experts on this subject based on the ideXlab platform.
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Current innovations in Wrist Arthroscopy.
The Journal of hand surgery, 2012Co-Authors: David J. SlutskyAbstract:It has become clear that the stability of the scapholunate joint does not depend wholly on the scapholunate interosseous ligament, but rather on both primary and secondary stabilizers, which form a scapholunate ligament complex. Each case of scapholunate instability is unique and should be treated with tissue-specific repairs, which may partly explain why one procedure cannot successfully restore joint stability in every case. Wrist Arthroscopy has a pivotal role in both the assessment and treatment of the scapholunate ligament complex derangements. Tears of the foveal attachment of the triangular fibrocartilaginous complex can be an underdiagnosed cause of distal radioulnar joint instability, because the foveal fibers cannot be visualized using the standard radiocarpal Arthroscopy portals. Distal radioulnar joint Arthroscopy allows for direct visualization and assessment of these fibers, which in turn has spawned a number of open and arthroscopic repair methods. Wrist Arthroscopy has gained wider acceptance as a method to fine-tune articular reduction during open and percutaneous fixation of distal radius fractures, and simplifies intra-articular osteotomies for malunion. It can facilitate percutaneous bone grafting of scaphoid nonunions and has a role in the diagnosis and treatment of associated soft tissue lesions. These and other recent developments will be discussed in the following article.
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Wrist Arthroscopy: current concepts.
The Journal of hand surgery, 2008Co-Authors: David J. Slutsky, Daniel J. NagleAbstract:Wrist Arthroscopy has steadily grown from a mostly diagnostic tool to a valuable adjunctive procedure in the treatment of myriad Wrist disorders. The number of conditions that are amenable to arthroscopic treatment continues to grow. A detailed knowledge of the topographical and intracarpal anatomy, however, is essential to minimize complications and maximize the benefits. Although Wrist Arthroscopy can identify an anatomic abnormality, it cannot be used to differentiate between an asymptomatic degenerative condition versus a pathologic lesion that is the cause of Wrist pain. A thorough Wrist examination is still integral to any arthroscopic assessment. This article focuses on the methodology behind a normal arthroscopic Wrist examination and discusses some of the more standard arthroscopic procedures along with the expected outcomes.
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Clinical applications of volar portals in Wrist Arthroscopy.
Techniques in hand & upper extremity surgery, 2004Co-Authors: David J. SlutskyAbstract:Volar portals for Wrist Arthroscopy have certain advantages over the standard dorsal portals for visualizing dorsal capsular structures as well as the palmar aspects of the carpal ligaments. The volar radial portal is relatively easy to use and is an ideal portal for evaluation of the dorsal radiocarpal ligament and the palmar aspect of the scapholunate interosseous ligament. The volar midcarpal portal may be considered as an occasional accessory portal for visualizing the palmar aspects of the capitate and hamate in cases of avascular necrosis or osteochondral fractures. The volar ulnar portal is especially useful for the viewing and debridement of palmar tears of the lunotriquetral ligament.
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Wrist Arthroscopy through a volar radial portal.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2002Co-Authors: David J. SlutskyAbstract:Abstract Purpose: To quantitatively describe the neurovascular relationships of a volar radial Wrist Arthroscopy portal and to evaluate whether volar Wrist Arthroscopy identified additional pathology of the dorsal capsular structures and the palmar region of the scapholunate interosseous ligament that was not seen through the dorsal portals. Type of Study: This study was an anatomic study and retrospective chart review. Methods: Cadaver dissections established the neurovascular anatomy of the volar radial portal. Measurements were taken from the portal to the radial artery and its superficial palmar branch; the superficial radial nerve, the median nerve, and its palmar cutaneous branch; and the pronator quadratus. A dorsal capsulotomy was performed to assess the ligamentous interval. A chart review of 30 patients in whom a volar radial portal was used was performed. Intraoperative pathology identified through volar Wrist Arthroscopy that was not visible through a dorsal portal was recorded. Postoperative neurovascular complications were noted. Results: There was a greater than 3 mm safe zone surrounding the portal that was free of any neurovascular structures. There were no complications from the use of the portal. Additional pathology that was not visible from a dorsal portal was identified in 10 cases. This included 1 case of hypertrophic synovitis of the dorsal capsule, 1 patient with an avulsion of the radioscapholunate ligament, 1 patient with a tear restricted to the palmar region of the scapholunate interosseous ligament, and 7 patients with tears of the dorsal radiocarpal ligament. Conclusions: This study provides a safe, standardized approach to the volar radial aspects of the radiocarpal and midcarpal joints. Volar Wrist Arthroscopy identified additional pathology of the palmar scapholunate interosseous ligament and dorsal capsular structures in 30% of the patients. The volar radial portal should be considered for inclusion in the arthroscopic examination of any patient with radial-sided Wrist pain. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 6 (July-August), 2002: pp 624–630
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Volar portals in Wrist Arthroscopy
Journal of the American Society for Surgery of the Hand, 2002Co-Authors: David J. SlutskyAbstract:Volar portals for Wrist Arthroscopy have certain advantages over the standard dorsal portals for visualizing dorsal capsular structures as well as the palmar aspects of the carpal ligaments. The volar radial (VR) portal is relatively easy to use and is an ideal portal for evaluation of the dorsal radiocarpal ligament (DRCL) and the palmar aspect of the scapholunate interosseous ligament. The volar midcarpal portal may be considered as an occasional accessory portal for visualizing the palmar aspects of the capitate and hamate in cases of avascular necrosis or osteochondral fractures. The volar ulnar (VU) portal is especially useful for the viewing and debridement of palmar tears of the lunotriquetral ligament. Copyright © 2002 by the American Society for Surgery of the Hand
