David C. Ring
Department of Surgery and Perioperative Care, Dell Medical School, Austin MA, USA
[ 1 ] - The “July Effect” on Shoulder Arthroplasty: Are Complication Rates Higher at the Beginning of the Academic Year?
Background: The ”July effect” is a colloquialism asserting an increased rate of errors at the start of the academicyear in teaching hospitals. This retrospective population-based study evaluated for the presence of the July effect inperforming shoulder arthroplasty.Methods: Using the Nationwide Inpatient Sample for 2002 through 2011, a total of 178,590 patients undergoingshoulder arthroplasty a...
[ 2 ] - First Use of a Brief 60-second Mindfulness Exercise in an Orthopedic Surgical Practice; Results from a Pilot Study
Background: Mindfulness based interventions may be useful for patients with musculoskeletal conditions in orthopedic surgical practices as adjuncts to medical procedures or alternatives to pain medications. However, typical mindfulness programs are lengthy and impractical in busy surgical practices. We tested the feasibility, acceptability and preliminary effect of a brief, 60-second mindfulnes...
[ 3 ] - Interobserver Variability of Radiographic Assessment using a Mobile Messaging Application as a Teleconsultation Tool
Background: To examine whether interobserver reliability, decision-making, and confidence in decision-making in thetreatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phonecompared to a standard DICOM viewer.Methods: Radiographs of distal radius fractures were presented to surgeons on either a smart phone using a mobilemessenger applicat...
[ 4 ] - Questionable Word Choice in Scientific Writing in Orthopedic Surgery
Background: Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms andlimitations it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words andconcepts consistent with medical evidence. The use of words that might reinforce misconceptions about preferencesensitiveconditions (particularly those associated with age)...
[ 5 ] - Persistent Medial Subluxation of the Ulna with Radiotrochlear Articulation
Two patients-one with a terrible triad fracture dislocation and one with an anterior olecranon fracture dislocation—weretreated for maltracking of the elbow (medial subluxation). The radial head articulated with the lateral trochlea while theulnar trochlear notch was perched over the medial trochlea. The late revision surgery could not correct the subluxationbecause the joints were accustomed t...
[ 6 ] - The Prevalence of Unanticipated Hamate Hook Abnormalities in Computed Tomography Scans: A Retrospective Study
Background:It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could document a subset of undiagnosed and untreated hamate hook fractures which might change our under...
[ 7 ] - Patient Complaints Emphasize Non-Technical Aspects of Care at a Tertiary Referral Hospital
Background:Patient concerns represent opportunities for improvement in orthopaedic care. Thisstudy’s objectiveis to identify the nature and prevalence of unsolicited patient complaints regarding orthopaedic care ata tertiary referral hospital. The primary null hypothesis that there are no demographic factors associatedwith complaint types was tested. Secondarily we determined if the overall com...
[ 8 ] - How do Orthopedic Surgeons Address Psychological Aspects of Illness?
Background: Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons’ attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in ...
[ 9 ] - Axillary Artery Injury Associated with Proximal Humerus Fracture: A Report of 6 Cases
Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. The majority of published blunt traumatic axillary artery injuries are associated with anterior glenohumeral dislocation; a few are associated with isolated proximal humerus fractures or fracture-dislocation. Experience within our institution demonstrates that axillary artery injury is often unreco...
[ 10 ] - Proximity of Vital Structures to the Clavicle: Comparison of Fractured and Non-fractured Side
Background: Previous anatomic and radiological studies have described the relationship of the clavicle to major neurovascular structures in healthy subjects. We were curious about this relationship in patients with a clavicle fracture and if it is different from non-fractured clavicles. Methods: We retrospectively identified all patients with a clavicle fracture between July 2001 and Octobe...
[ 11 ] - Assessment of Decisional Conflict about the Treatment of Trigger Finger, Comparing Patients and Physicians
Background: As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address ...
[ 12 ] - Predictors of Upper-Extremity Physical Function in Older Adults
Background: Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults. Methods: A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Asse...
[ 13 ] - Discrete Pathophysiology is Uncommon in Patients with Nonspecific Arm Pain
Background: Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: 1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific...
[ 14 ] - Sleep Disturbance and Upper-Extremity Disability
Background: Although upper-extremity disability correlates with psychosocial aspects of illness the association with sleep disturbance in upper extremity disability is less certain. To evaluate whether sleep disturbance is associated with upper-extremity disability among patients with upper extremity illness, accounting for sociodemographic, condition-related, and psychosocial factors. Method...
[ 15 ] - Factors Associated with Operative Treatment of De Quervain Tendinopathy
Background: Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy. Methods: We used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist workin...
[ 16 ] - Radial Head Prosthesis Removal:a Retrospective Case Series of 14 Patients
Background: The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis. Methods: This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. The average time between implantation and removal was 23 month...
[ 17 ] - A Pitfall in Fixation of Distal Humeral Fractures with Pre-Contoured Locking Compression Plate
Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixed-angle locking...
[ 18 ] - Surgical Procedures of the Elbow: A Nationwide Cross-Sectional Observational Study in the United States
Background: Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States. Methods: We used the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS) data gathered in 2006-databases that together provide an estimate of all inpatient and ambulatory surgic...
[ 19 ] - Giant Cell Tumor of Tendon Sheath
Background: Giant cell tumor of tendon sheath (GCTTS) is often thought of as a volar finger mass. We hypothesized that GCTTS are equally common on the dorsal and volar aspects of the hand. In addition, we hypothesized that there are no factors associated with the location (volar versus dorsal) and largest measured dimension of a GCTTS. Methods: A total of 126 patients with a pathological dia...
[ 20 ] - Small Finger Metacarpal Shaft Wedged between Ring and Small Metacarpal Bases: a Report of 2 Cases
We present two patients with a displaced fracture of the small finger metacarpal base, where the shaft of the small finger metacarpal was wedged between the bases of the ring and small finger metacarpals. The striking appearance on radiographs led to initial recommendations for surgery, but both patients preferred non-operative treatment and did well in the short term without surgery
[ 21 ] - In-Hospital Outcomes after Hemiarthroplasty versus Total Hip Arthroplasty for Isolated Femoral Neck Fractures
Background: Previous studies suggest total hip arthroplasty may have some benefits compared to hemi-arthroplasty for displaced intracapsular femoral neck fractures in patients more than 60 years of age. The primary research question of our study was whether in-hospital adverse events, post-operative length of stay (LOS) and mortality in patients 60 year of age or older differed between tot...
[ 22 ] - Progression of Carpal Tunnel Syndrome According to Electrodiagnostic Testing in Nonoperatively Treated Patients
Background: This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS) over time according to median nerve distal motor latency (DML) on two electrodiagnostic tests. Methods: This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of...
[ 23 ] - Predictors of Missed Research Appointments in a Randomized Placebo-Controlled Trial
Background: The primary aim of this study was to determine predictors of missed research appointments in a prospective andomized placebo injection-controlled trial with evaluations 1 to 3 and 5 to 8 months after enrollment. Methods: This study represents a secondary use of data from 104 patients that were enrolled in a prospective randomized ontrolled trial of dexamethasone versus lidocai...
[ 24 ] - Quantitative 3-dimensional Computerized Tomography Modeling of Isolated Greater Tuberosity Fractures with and without Shoulder Dislocation
Background: The aim of this study was to assess differences in fracture morphology and displacement betweenisolated greater tuberosity (GT) fractures (i.e. fractures of the greater tuberosity without other fractures of the proximalhumerus) with and without shoulder dislocation utilizing quantitative 3-dimensional CT imaging.Methods: Thirty-four CT-scans of isolated greater tuberosity fractures ...
[ 25 ] - Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery
Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity,mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and canlower reimbursement. A better understanding of the patient and treatment characteristics associated with readmissionmay help inform program improvement initiatives....
[ 26 ] - Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture
Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoralneck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years,is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoralneck and those with fractures of the intertroc...
[ 27 ] - It’s Not About The Biceps
In the biomedical paradigm all symptoms and limitations are ascribed to discrete pathophysiology. However, abiopsychosocial health model that accounts for the important influence of mind-set and circumstances on illness maybe preferable in the vast majority of cases. Some of the shortcomings of the biomedical model include an overrelianceon tests and treatments. One major issue of the biomedica...
[ 28 ] - Do Patient Preferences Influence Surgeon Recommendations for Treatment?
Background: When the best treatment option is uncertain, a patient’s preference based on personal values should bethe source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation intreatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patientpreferences.Methods: A total of 184 surgeons revie...
[ 29 ] - Unplanned Operations and Adverse Events after Surgery for Diaphyseal Fracture of the Clavicle
Background: We used a database of patients treated at three hospitals to study the primary null hypothesis that thereare no factors associated with unplanned reoperations or adverse events after surgical repair for diaphyseal claviclefracture. Additionally we addressed the following secondary study questions: 1. What is the prevalence of unplannedreoperations or adverse events...
[ 30 ] - Factors Associated with Requesting Magnetic Resonance Imaging during the Management of Glomus Tumors
Background: The characteristic clinical presentation of glomus tumors and the low negative predictive value of themagnetic resonance imaging (MRI) raise the question whether MRI improves their management. Therefore, this studyaimed to investigate whether MRI improved the management of glomus tumors.Methods: In total, 87 patients with a histologically confirmed glomus tumor wer...
[ 31 ] - Correlation of Single Assessment Numeric Evaluation (SANE) with other Patient Reported Outcome Measures (PROMs)
Background: The Single Assessment Numeric Evaluation (SANE) is a simple, one-question patient-reported outcomemeasure (PROM). We systematically reviewed correlations between SANE and more extensive PROMs.Methods: We identified studies with correlation coefficients between SANE and other shoulder, knee, and anklespecificPROMs. We calculated mean, median and range across studies...
[ 32 ] - The Prevalence of Calcifications at the Origin of the Extensor Carpi Radialis Brevis Increases with Age
Background: Enthesopathy of the extensor carpi radialis brevis origin [eECRB] is a common idiopathic, noninflammatorydisease of middle age that is characterized by excess glycosaminoglycan production and frequentlyassociated with radiographic calcification of its origin. The purpose of our study was to assess the relationship ofcalcification of the ECRB and advancing age.<br /...
[ 33 ] - Misinformation in News Coverage of Professional and College Athlete Musculoskeletal Ailments
Background: The general population’s understanding of musculoskeletal health is likely influenced by media reports of the ailments of prominent athletes. We assessed factors independently associated with debatable or potentially misleading medical statements in mainstream sports media coverage of the ailments of professional and college athletes.Methods: We identified and assessed 200 Int...
[ 34 ] - Avascular Necrosis of the Scaphoid Preiser Disease
No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology,classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previoustrauma, and without radiographs were excluded. Based on the radiographs at diagnosis, we classified 13 scaphoids asHerbert Lanzetta stage II, four...
[ 35 ] - Tampa Scale for Kinesiophobia Short Form and Lower Extremity Specific Limitations
Background: We compared the amount of variation in Patient-Reported Outcomes Measurement Information SystemPhysical Function (PROMIS PF) Computer Adaptive Test (CAT) accounted for by The Tampa Scale for Kinesiophobia(TSK) and its short form (TSK-4) independent of other factors. Questionnaire coverage, reliability, and validitywere compared for both TSK and TSK-4 using mean sca...
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