Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from Level I and II studies cited in the March 18, 2015 Specialty Update on hand surgery:
Distal Radial Fractures
–A study that randomized 50 patients with unstable radial fractures and Kirschner-wire fixation to receive demineralized bone-matrix allograft or no graft found no significant differences in bone density or function throughout one year of follow-up.
–Among 130 patients with a displaced distal radial fracture who were randomized for treatment with either a volar plate or percutaneous pins (with or without external fixation), plate-treated patients had a quicker return to function, but functional results were similar between the two groups at three months and one year.
–A randomized trial of 43 women aged 40 and older with trapeziometacarpal osteoarthritis comparing trapeziectomy with trapeziometacarpal arthrodesis (with plate and screws) was terminated early because of the high complication rate in the arthrodesis group.
Carpal Tunnel Release
–A Cochrane Database systematic review of 28 studies comparing endoscopic and open carpal tunnel release concluded that both techniques provided similar outcomes, but that the current literature on the subject is rife with low-quality studies.
–A meta-analysis of 21 studies comprising 1,859 patients that compared endoscopic and open carpal tunnel release showed that endoscopically treated patients had modestly greater strength at early follow-up but that the difference disappeared after six months.
This Specialty Update also includes many recent findings from papers presented at 2014 meetings of the American Society for Surgery of the Hand and the American Association for Hand Surgery.
In May, more than 300 orthopaedic surgeons attended the National Orthopaedic Leadership Conference in Washington, DC. During the conference, attendees took time to recognize the success of the AAOS Project Value initiative, which was started by former AAOS president John R. Tongue, MD. The initiative’s project team set out to quantify the social and economic benefits of musculoskeletal health care.
Four studies have been published as a result of this effort, three of which were published in JBJS:
- “The Direct and Indirect Costs to Society of Treatment for End-Stage Knee Arthritis,” JBJS, August 21, 2013. This article estimated that TKA has already generated lifetime societal savings to the U.S. economy of $12 billion.
- “Societal and Economic Impact of Anterior Cruciate Ligament Tears,” JBJS, October 2, 2013. Analysis found estimated annual savings from ACL reconstruction of $10 billion.
- “The Societal and Economic Value of Rotator Cuff Repair,” JBJS, November 20, 2013. Estimated lifetime savings to the U.S. economy were calculated to be $3.44 billion.
- “How Does Accounting for Worker Productivity Affect the Measured Cost-Effectiveness of Lumbar Discectomy?” Clinical Orthopaedics and Related Research, December 2013.
AAOS also hosts a website to highlight the notion of value in orthopaedics: www.ANationInMotion.org/value.
It may seem counterintuitive, but runners have a lower risk of knee orthoarthritis than walkers do. A July 2013 study followed more than 75,000 runners and 14,000 walkers and found that runners had a lower overall risk of developing arthritis than walkers. Runners generate greater knee forces than walkers, but due to the longer strides of running, the net result is less overall load on the runners’ knees than on walkers’ knees. Although running doesn’t decrease the cause of ‘wear’ on the knee, it seems better than walking for delaying development of osteoarthritis.