Background
We report on the non-operative treatment of Mayo Type II olecranon fractures.
Methods... more Background We report on the non-operative treatment of Mayo Type II olecranon fractures.
Methods Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained.
Results At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care.
Conclusions In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.
Objectives Primary: to assess the utility of our distal radius fracture repair model as a tool fo... more Objectives Primary: to assess the utility of our distal radius fracture repair model as a tool for
examining residents' surgical skills. Secondary: to compare the residents' ability to achieve
specific biomechanically measured fracture stability with traditional test scores. Design Our
laboratory pioneered a model that measures biomechanical qualities of a repaired distal
radius fracture. Before participation, all residents to be tested completed specified
knowledge examinations.
Unfortunately, traditional standardized testing did not predict mechanical performance.
Staples can be used in a variety of surgical procedures on the hand. They provide excellent retra... more Staples can be used in a variety of surgical procedures on the hand. They provide excellent retraction of skin flaps for which sutures would normally be placed, and their use often decreases the need for manual retraction.
To compare outcomes of treatment for scapholunate instability between acute (< 6 wk from injur... more To compare outcomes of treatment for scapholunate instability between acute (< 6 wk from injury) and chronic (> 6 wk) injuries, between complete and partial tears, and among surgical techniques; identify risk factors for surgical failure; and compare ligament reconstruction with repair with or without capsulodesis in the chronic period. We performed a retrospective chart review of 82 primary scapholunate interosseous ligament surgeries, with median follow-up of 150 days. A total of 27 patients underwent surgery in the acute period and 50 in the chronic period. (In 5 patients we were unable to determine acuity or chronicity of injury.) In the chronic period, 16 patients underwent repair with or without capsulodesis, 27 underwent ligament reconstruction, and 7 underwent other procedures. Surgical intervention in the acute setting involved more complex injuries, most commonly used direct repair, and produced a significantly lower failure rate than chronic intervention. In the chr...
Background Performance assessment in skills training is ideally based on objective, reliable, and... more Background Performance assessment in skills training is ideally based on objective, reliable, and clinically relevant indicators of success. The Objective Structured Assessment of Technical Skill (OSATS) is a reliable and valid tool that has been increasingly used in orthopaedic skills training. It uses a global rating approach to structure expert evaluation of technical skills with the experts working from a list of operative competencies that are each rated on a 5-point Likert scale anchored by behavioral descriptors. Given the observational nature of its scoring, the OSATS might not effectively assess the quality of surgical results. Questions/purposes (1) Does OSATS scoring in an intraarticular fracture reduction training exercise correlate with the quality of the reduction? (2) Does OSATS scoring in a cadaveric extraarticular fracture fixation exercise correlate with the mechanical integrity of the fixation? Methods Orthopaedic residents at the University of Iowa (six postgraduate year [PGY]-1s) and at the University of Minnesota (seven PGY-1s and eight PGY-2s) undertook a skills training exercise that involved reducing a simulated intraarticular fracture under fluoroscopic guidance. Iowa residents participated three times during 1 month, and Minnesota residents participated twice with 1 month between their two sessions. A fellowship-trained ortho-paedic traumatologist rated each performance using a modified OSATS scoring scheme. The quality of the articular reduction obtained was then directly measured. Regression analysis was performed between OSATS scores and two metrics of articular reduction quality: articular surface deviation and estimated contact stress. Another skills training exercise involved fixing a simulated distal radius fracture in a cadaveric specimen. Thirty residents, distributed across four PGY classes (PGY-2 and PGY-3,
Percutaneous release of the A1 pulley has been used for treatment of trigger fingers with success... more Percutaneous release of the A1 pulley has been used for treatment of trigger fingers with success. However, lack of direct visualization raises concerns about the completeness of the release and about potential injury to the tendons or neurovascular structures. The purpose of this study was to assess the efficacy and safety of percutaneous release of the A1 pulley in a cadaveric model using a commonly available instrument, a #15 scalpel blade. Fourteen fresh frozen cadaveric hands (54 fingers, thumbs excluded) were used. Landmarks were established for the A1 pulley based upon cutaneous features. Percutaneous release was performed using a #15 blade. The specimens were then dissected and examined for any tendon or neurovascular injury, and completeness of A1 pulley release was evaluated. There were 39 (72%) complete releases of the A1 pulley with 14 partial and 1 missed (failed) release. There was a 22% incidence of release of the proximal edge of the A2 pulley. However, there was no case of release of more than 25% of the A2 pulley length, nor was bowstringing of flexor tendons seen in these specimens. Eleven digits showed longitudinal scoring of the flexor tendons and 3 had partial tendon lacerations. No neurovascular injuries were noted. Percutaneous release of the A1 pulley using a #15 blade was associated with good efficacy and an acceptable margin of safety in this series. Percutaneous release of trigger digits may assume a greater role in the treatment of patients with trigger finger because of cost containment pressures. The data from this study suggest that the technique used in this study is both safe and effective. With use of proper anatomical guidelines, risk to neurovascular structures is low, although longitudinal scoring of the tendon can occur.
Background
We report on the non-operative treatment of Mayo Type II olecranon fractures.
Methods... more Background We report on the non-operative treatment of Mayo Type II olecranon fractures.
Methods Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained.
Results At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care.
Conclusions In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.
Objectives Primary: to assess the utility of our distal radius fracture repair model as a tool fo... more Objectives Primary: to assess the utility of our distal radius fracture repair model as a tool for
examining residents' surgical skills. Secondary: to compare the residents' ability to achieve
specific biomechanically measured fracture stability with traditional test scores. Design Our
laboratory pioneered a model that measures biomechanical qualities of a repaired distal
radius fracture. Before participation, all residents to be tested completed specified
knowledge examinations.
Unfortunately, traditional standardized testing did not predict mechanical performance.
Staples can be used in a variety of surgical procedures on the hand. They provide excellent retra... more Staples can be used in a variety of surgical procedures on the hand. They provide excellent retraction of skin flaps for which sutures would normally be placed, and their use often decreases the need for manual retraction.
To compare outcomes of treatment for scapholunate instability between acute (< 6 wk from injur... more To compare outcomes of treatment for scapholunate instability between acute (< 6 wk from injury) and chronic (> 6 wk) injuries, between complete and partial tears, and among surgical techniques; identify risk factors for surgical failure; and compare ligament reconstruction with repair with or without capsulodesis in the chronic period. We performed a retrospective chart review of 82 primary scapholunate interosseous ligament surgeries, with median follow-up of 150 days. A total of 27 patients underwent surgery in the acute period and 50 in the chronic period. (In 5 patients we were unable to determine acuity or chronicity of injury.) In the chronic period, 16 patients underwent repair with or without capsulodesis, 27 underwent ligament reconstruction, and 7 underwent other procedures. Surgical intervention in the acute setting involved more complex injuries, most commonly used direct repair, and produced a significantly lower failure rate than chronic intervention. In the chr...
Background Performance assessment in skills training is ideally based on objective, reliable, and... more Background Performance assessment in skills training is ideally based on objective, reliable, and clinically relevant indicators of success. The Objective Structured Assessment of Technical Skill (OSATS) is a reliable and valid tool that has been increasingly used in orthopaedic skills training. It uses a global rating approach to structure expert evaluation of technical skills with the experts working from a list of operative competencies that are each rated on a 5-point Likert scale anchored by behavioral descriptors. Given the observational nature of its scoring, the OSATS might not effectively assess the quality of surgical results. Questions/purposes (1) Does OSATS scoring in an intraarticular fracture reduction training exercise correlate with the quality of the reduction? (2) Does OSATS scoring in a cadaveric extraarticular fracture fixation exercise correlate with the mechanical integrity of the fixation? Methods Orthopaedic residents at the University of Iowa (six postgraduate year [PGY]-1s) and at the University of Minnesota (seven PGY-1s and eight PGY-2s) undertook a skills training exercise that involved reducing a simulated intraarticular fracture under fluoroscopic guidance. Iowa residents participated three times during 1 month, and Minnesota residents participated twice with 1 month between their two sessions. A fellowship-trained ortho-paedic traumatologist rated each performance using a modified OSATS scoring scheme. The quality of the articular reduction obtained was then directly measured. Regression analysis was performed between OSATS scores and two metrics of articular reduction quality: articular surface deviation and estimated contact stress. Another skills training exercise involved fixing a simulated distal radius fracture in a cadaveric specimen. Thirty residents, distributed across four PGY classes (PGY-2 and PGY-3,
Percutaneous release of the A1 pulley has been used for treatment of trigger fingers with success... more Percutaneous release of the A1 pulley has been used for treatment of trigger fingers with success. However, lack of direct visualization raises concerns about the completeness of the release and about potential injury to the tendons or neurovascular structures. The purpose of this study was to assess the efficacy and safety of percutaneous release of the A1 pulley in a cadaveric model using a commonly available instrument, a #15 scalpel blade. Fourteen fresh frozen cadaveric hands (54 fingers, thumbs excluded) were used. Landmarks were established for the A1 pulley based upon cutaneous features. Percutaneous release was performed using a #15 blade. The specimens were then dissected and examined for any tendon or neurovascular injury, and completeness of A1 pulley release was evaluated. There were 39 (72%) complete releases of the A1 pulley with 14 partial and 1 missed (failed) release. There was a 22% incidence of release of the proximal edge of the A2 pulley. However, there was no case of release of more than 25% of the A2 pulley length, nor was bowstringing of flexor tendons seen in these specimens. Eleven digits showed longitudinal scoring of the flexor tendons and 3 had partial tendon lacerations. No neurovascular injuries were noted. Percutaneous release of the A1 pulley using a #15 blade was associated with good efficacy and an acceptable margin of safety in this series. Percutaneous release of trigger digits may assume a greater role in the treatment of patients with trigger finger because of cost containment pressures. The data from this study suggest that the technique used in this study is both safe and effective. With use of proper anatomical guidelines, risk to neurovascular structures is low, although longitudinal scoring of the tendon can occur.
An intramedullary rod kit for fixation of a distal radius
fracture includes an intramedullary rod... more An intramedullary rod kit for fixation of a distal radius fracture includes an intramedullary rod. The intramedullary rod includes a diaphySeal Segment including at least one first mounting Section configured to receive a tensioning device, a middle Segment, and a joint Segment including at least one Second mounting Section configured to receive a tine. The diaphySeal Segment, the middle Segment, and the joint Segment define a curved configuration that is Substantially Similar to a curvature of the intramedullary canal of a human radius.
As a surgical treatment for carpal tunnel syndrome, guidance mechanism and cutting mechanism are ... more As a surgical treatment for carpal tunnel syndrome, guidance mechanism and cutting mechanism are subcutaneously inserted in spaced-apart incisions located by well-known landmarks. The guidance mechanism is placed below the transverse carpal ligament, and the cutting mechanism is placed above it. As the cutting mechanism is advanced, it is guided by the guidance mechanism and the knife portion divides the carpal ligament.
An apparatus for anchoring a graft segment to a fixed structure in-vivo includes a sleeve member ... more An apparatus for anchoring a graft segment to a fixed structure in-vivo includes a sleeve member having one or more suture channels extending axially therethrough and an axial opening extending adjacent to the one or more suture channels from a first end of the sleeve member. The apparatus further includes a plug member that is configured for mating engagement within the axial opening of the sleeve member, with such engagement compressing the one or more suture channels to frictionally secure a respective graft suture therein.
Cloud based method to document and measure care of patients receiving treatment from any institut... more Cloud based method to document and measure care of patients receiving treatment from any institution with links into any other electronic health record (EHR).
Summary:
A meaningful set of multi-center data can be collected using a web-based method
Distal ... more Summary: A meaningful set of multi-center data can be collected using a web-based method Distal Radius fracture recovery might best be monitored with GRIP and Digital Motion measurement Differences in primary outcome recovery between sites are present in this study. Differences between commonly employed fixation types are inconclusive and do not match industrial “marketing” messages
Objectives of this study
1) To compare a written exam and a validated qualitative surgical skills... more Objectives of this study 1) To compare a written exam and a validated qualitative surgical skills evaluation with a biomechanical test of distal radius fixation effectiveness 2) To compare effectiveness of distal radius fixation to post-graduate training year
(1) We examined the possible role of program independent video-based scoring of resident surgical... more (1) We examined the possible role of program independent video-based scoring of resident surgical ability and have shown it is possible to capture de-identified video images and deliver these to independent graders. (2) We delineated tools to enable widespread implementation of this competency evaluation program. This method can be standardized and repeated at other institutions.
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Papers by Matthew Putnam
We report on the non-operative treatment of Mayo Type II olecranon fractures.
Methods
Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained.
Results
At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care.
Conclusions
In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.
examining residents' surgical skills. Secondary: to compare the residents' ability to achieve
specific biomechanically measured fracture stability with traditional test scores. Design Our
laboratory pioneered a model that measures biomechanical qualities of a repaired distal
radius fracture. Before participation, all residents to be tested completed specified
knowledge examinations.
Unfortunately, traditional standardized testing did not predict mechanical performance.
We report on the non-operative treatment of Mayo Type II olecranon fractures.
Methods
Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained.
Results
At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care.
Conclusions
In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.
examining residents' surgical skills. Secondary: to compare the residents' ability to achieve
specific biomechanically measured fracture stability with traditional test scores. Design Our
laboratory pioneered a model that measures biomechanical qualities of a repaired distal
radius fracture. Before participation, all residents to be tested completed specified
knowledge examinations.
Unfortunately, traditional standardized testing did not predict mechanical performance.
fracture includes an intramedullary rod. The intramedullary
rod includes a diaphySeal Segment including at least one first
mounting Section configured to receive a tensioning device,
a middle Segment, and a joint Segment including at least one
Second mounting Section configured to receive a tine. The
diaphySeal Segment, the middle Segment, and the joint
Segment define a curved configuration that is Substantially
Similar to a curvature of the intramedullary canal of a human
radius.
A meaningful set of multi-center data can be collected using a web-based method
Distal Radius fracture recovery might best be monitored with GRIP and Digital Motion measurement
Differences in primary outcome recovery between sites are present in this study.
Differences between commonly employed fixation types are inconclusive and do not match industrial “marketing” messages
1) To compare a written exam and a validated qualitative surgical skills evaluation with a biomechanical test of distal radius fixation effectiveness
2) To compare effectiveness of distal radius fixation to post-graduate training year
(2) We delineated tools to enable widespread implementation of this competency evaluation program. This method can be standardized and repeated at other institutions.