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Article ; Online: Arthroscopic Trapeziectomy.

Tosti, Rick

Techniques in hand & upper extremity surgery

2022 Volume 26, Issue 4, Page(s) 267–270

Abstract: Several methods of resection arthroplasty for the thumb basal joint exist, yet one commonality of these procedures is the removal of the trapezium. My preference is to achieve total trapeziectomy through a less invasive approach and encourage immediate ... ...

Abstract	Several methods of resection arthroplasty for the thumb basal joint exist, yet one commonality of these procedures is the removal of the trapezium. My preference is to achieve total trapeziectomy through a less invasive approach and encourage immediate mobilization in order to expedite return to function. Herein I present a step by step method of arthroscopic total trapeziectomy without suspensionplasty.
MeSH term(s)	Humans ; Carpometacarpal Joints/surgery ; Osteoarthritis/surgery ; Trapezium Bone/surgery ; Thumb/surgery ; Arthroplasty/methods
Language	English
Publishing date	2022-12-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2075789-X
ISSN	1531-6572 ; 1089-3393
ISSN (online)	1531-6572
ISSN	1089-3393
DOI	10.1097/BTH.0000000000000397
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Article ; Online: Finger Necrosis After Cutaneous Wart Intralesional Injection with Candida albicans Antigen: A Case Report.

Graham, Jack G / Tosti, Rick

JBJS case connector

2023 Volume 13, Issue 1

Abstract: Case: A 25-year-old man presented 18 hours after Candida albicans antigen injection into a left index finger cutaneous wart by his dermatologist. He experienced a rapid-onset inflammatory response, which was indistinguishable from gangrenous infection. ... ...

Abstract	Case: A 25-year-old man presented 18 hours after Candida albicans antigen injection into a left index finger cutaneous wart by his dermatologist. He experienced a rapid-onset inflammatory response, which was indistinguishable from gangrenous infection. Urgent incision and drainage was performed; however, no purulent collection was noted and no organism isolated. At 1-year follow-up, he made a full recovery. Conclusion: Intralesional C. albicans antigen injection in digital cutaneous warts may cause an exaggerated immune response resulting in partial necrosis of the finger pulp. The clinical presentation may be difficult to distinguish from coexisting infection, but in some cases, observation may be an appropriate course of action.
MeSH term(s)	Male ; Humans ; Adult ; Candida albicans ; Injections, Intralesional ; Treatment Outcome ; Warts/drug therapy ; Antigens, Fungal/therapeutic use
Chemical Substances	Antigens, Fungal
Language	English
Publishing date	2023-03-22
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2160-3251
ISSN (online)	2160-3251
DOI	e22.00748
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Article ; Online: Technique for Minimally Invasive, Arthroscopic-assisted Distal Radius Fracture Fixation.

Lau, Vincent / Tosti, Rick / Rivlin, Michael

Techniques in hand & upper extremity surgery

2024 Volume 28, Issue 2, Page(s) 101–105

Abstract: Distal radius fractures are common injuries that often require surgical intervention. Commonly, these fractures are fixed using open reduction internal fixation with plating and screws. This often requires a more extensive soft tissue dissection and ... ...

Abstract	Distal radius fractures are common injuries that often require surgical intervention. Commonly, these fractures are fixed using open reduction internal fixation with plating and screws. This often requires a more extensive soft tissue dissection and exposure. In contrast for certain cases, percutaneous headless compression screws may be appropriate. We present a technique for minimally invasive arthroscopic-assisted reduction and percutaneous screw fixation with an extremity traction device. A case is provided to demonstrate the technique as a viable option for the treatment of intra-articular distal radius fractures.
MeSH term(s)	Humans ; Radius Fractures/surgery ; Arthroscopy/methods ; Fracture Fixation, Internal/methods ; Fracture Fixation, Internal/instrumentation ; Minimally Invasive Surgical Procedures/methods ; Bone Screws ; Intra-Articular Fractures/surgery ; Traction/methods ; Male ; Wrist Fractures
Language	English
Publishing date	2024-06-01
Publishing country	United States
Document type	Journal Article ; Case Reports
ZDB-ID	2075789-X
ISSN	1531-6572 ; 1089-3393
ISSN (online)	1531-6572
ISSN	1089-3393
DOI	10.1097/BTH.0000000000000461
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Article ; Online: Wide Awake Local Anesthesia No Tourniquet Endoscopic Cubital Tunnel Release.

Tosti, Rick / Rekant, Mark S

The Journal of hand surgery

2022 Volume 47, Issue 10, Page(s) 1022.e1–1022.e5

Abstract: As demands for faster return to function, improvement in surgical scarring, and minimal disruption to personal schedule have increased, so also have the demands increased for minimally invasive procedures under the wide awake, local anesthetic, no ... ...

Abstract	As demands for faster return to function, improvement in surgical scarring, and minimal disruption to personal schedule have increased, so also have the demands increased for minimally invasive procedures under the wide awake, local anesthetic, no tourniquet method. However, owing to the subcutaneous yet constrained position of the ulnar nerve at the elbow, wide-awake endoscopic cubital tunnel release has remained a technical challenge. We describe a 2-stage local anesthetic injection method that safely introduces local anesthetic within the cubital tunnel and simultaneously achieves comfort, sufficient visualization, and the ability to decompress multiple compression sites through a minimal incision.
MeSH term(s)	Anesthesia, Local ; Anesthetics, Local ; Cubital Tunnel Syndrome/surgery ; Decompression, Surgical/methods ; Humans ; Ulnar Nerve/surgery
Chemical Substances	Anesthetics, Local
Language	English
Publishing date	2022-06-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2022.04.004
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Article ; Online: A Novel Classification of Intraoperative Ulnar Nerve Instability to Aid Transposition Surgery.

Pohl, Nicholas / Brush, Parker / Aita, Daren / Kistler, Justin / Jones, Christopher / Tosti, Rick / Fletcher, Daniel

Journal of shoulder and elbow surgery

2024

Abstract: Hypothesis: The purpose of this study was to compare inter-and intraobserver agreement of a novel intraoperative subluxation classification for patients undergoing ulnar nerve surgery at the elbow. We hypothesize there will be strong inter- and ... ...

Abstract	Hypothesis: The purpose of this study was to compare inter-and intraobserver agreement of a novel intraoperative subluxation classification for patients undergoing ulnar nerve surgery at the elbow. We hypothesize there will be strong inter- and intraobserver agreement of the four-category classification system and reviewers will have substantial confidence while reviewing the classification system. Methods: Four blinded fellowship-trained orthopedic hand surgeons reviewed 25 videos in total on two separate viewings, 21 days apart. Variables collected were ulnar subluxation classification (A, B, C or D) and a confidence metric. Subsequent to primary data collection, classification grading was stratified into A/B or C/D subgroups for further analysis. Cohen's kappa scores were used to evaluate all variables collected in this study. The interpretation of kappa scores included ≤0.0 as no agreement, 0.01-0.20 as none to slight, 0.21-0.40 as fair, 0.41-0.60 as moderate, 0.61-0.80 as substantial, and 0.81-1.0 as almost perfect agreement. Results: Interobserver agreement of subluxation classification as a four-category scale demonstrated a moderate agreement on first viewing, second viewing, and when both viewings were combined (kappa=0.51, 0.51, and 0.51 respectively). Seventy-five percent (3 out of 4) of reviewers had moderate intraobserver agreement for ulnar nerve subluxation classification while one reviewer had substantial intraobserver classification (kappa= 0.72). Overall, there was high confidence in 65% of classification scores in the second round of viewing, which improved from 58% in the first viewing round. When ulnar subluxation classification selections were regrouped into classes A/B or C/D, 100% of reviewers had substantial interobserver (kappa=0.74 - 0.75) and substantial to almost perfect intraobserver (kappa=0.71 to 0.91) agreement. Conclusions: The four-category classification was reproducible within and between reviewers. Agreement appeared to increase when simplifying the classification to two categories, which may provide guidance to surgical decision making. The validation of a reproducible classification scheme for intraoperative ulnar subluxation may aid with decision making and further postoperative outcomes research.
Language	English
Publishing date	2024-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2024.02.030
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Zs.A 3973: Show issues

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Article: Pulmonary Complications and Mortality in Patients with SARS-CoV-2 Undergoing Elective and Emergent Hand Surgery.

Adams, Alexander J / Dohse, Nicolas / Miller, Andrew / Tosti, Rick

Journal of hand and microsurgery

2023 Volume 15, Issue 5, Page(s) 371–375

Abstract: ... ...

Abstract	Background
Language	English
Publishing date	2023-01-23
Publishing country	United States
Document type	Journal Article
ISSN	0974-3227
ISSN	0974-3227
DOI	10.1055/s-0043-1760765
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Article ; Online: Identifying High Direct Variable Costs of Open Carpal Tunnel Release Patients Using Time-Driven Activity-Based Costing.

Thomas, Terence L / Goh, Graham S / Tosti, Rick / Beredjiklian, Pedro K

The Journal of hand surgery

2023 Volume 48, Issue 5, Page(s) 427–434

Abstract: Purpose: To improve value in health care delivery, a deeper understanding of the cost drivers in hand surgery is necessary. Time-driven activity-based costing (TDABC) more accurately reflects true resource use compared with traditional accounting ... ...

Abstract	Purpose: To improve value in health care delivery, a deeper understanding of the cost drivers in hand surgery is necessary. Time-driven activity-based costing (TDABC) more accurately reflects true resource use compared with traditional accounting methods. This study used TDABC to explore the facility cost of carpal tunnel release and identify preoperative characteristics of high-cost patients. Methods: Using TDABC, we calculated the facility costs of 516 consecutive patients undergoing open carpal tunnel release at an orthopedic specialty hospital between 2015 and 2021. Patients in the top decile cost were defined as high-cost patients. Multivariable logistic regression was used to determine preoperative characteristics (age, sex, body mass index, race, ethnicity, Elixhauser comorbidity index, American Society of Anesthesiology score, preoperative Disabilities of the Arm, Shoulder and Hand score, Short-Form 12, and anesthesia type) independently associated with high-cost patients. Results: Surgery-related personnel costs were the main driver (38.0%) of total facility costs, followed by preoperative personnel costs (21.3%). There was a 1.8-fold variation in facility cost between patients in the 90th and 10th percentiles ($774.69 vs $431.35), with the widest cost variations belonging to medication costs ($17.67 vs $1.85; variation, 9.6-fold) and other supply costs ($213.56 vs $65.56; variation, 3.3-fold). Using multivariable regression, predictors of high cost were patient age and use of general anesthesia. Total facility costs correlated strongly with the total operating room time and incision to closure time. Conclusions: Efforts to decrease operating room time may translate into reduced personnel costs and greater cost savings. Multidisciplinary initiatives to control medication expenses for patients at risk of high costs may narrow the existing variation in costs. Type of study/level of evidence: Economic and Decision Analysis II.
MeSH term(s)	Humans ; Costs and Cost Analysis ; Carpal Tunnel Syndrome/surgery ; Hand ; Time Factors ; Anesthesia, General ; Health Care Costs
Language	English
Publishing date	2023-02-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2023.01.015
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Article ; Online: Surveying the Use and Perceptions of Wrist Arthroscopy Among Upper Extremity Surgeons.

Wang, William L / Tosti, Rick / Osterman, A Lee

Orthopedics

2022 Volume 45, Issue 5, Page(s) 310–313

Abstract: This study describes current trends in the skill acquisition and practice patterns for wrist arthroscopy among upper extremity surgeons. A survey was sent to the membership of the American Association for Hand Surgery (AAHS). A total of 104 responses ... ...

Abstract	This study describes current trends in the skill acquisition and practice patterns for wrist arthroscopy among upper extremity surgeons. A survey was sent to the membership of the American Association for Hand Surgery (AAHS). A total of 104 responses were available for analysis. Of those respondents who did not use wrist arthroscopy, lack of educational training was cited as the most common reason. Of those who did use arthroscopy, fellowship training was credited as the primary source. However, most of those who completed an instructional course felt immediately able to perform arthroscopy. Triangular fibrocartilage complex tears were recorded as the most common indication. Surgeons frequently evaluated the midcarpal joint, but did not frequently use arthroscopy for distal radio-ulnar joint or carpometacarpal joint pathology. Ultimately, this highlights an area of improvement for residency and fellowship education. [
MeSH term(s)	Arthroscopy ; Humans ; Surgeons ; Surveys and Questionnaires ; Upper Extremity ; Wrist ; Wrist Injuries/surgery ; Wrist Joint/surgery
Language	English
Publishing date	2022-04-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	424447-3
ISSN	1938-2367 ; 0147-7447
ISSN (online)	1938-2367
ISSN	0147-7447
DOI	10.3928/01477447-20220425-01
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Article ; Online: [No title information]

Tosti, Rick / Fowler, John R

Hand clinics

2020 Volume 36, Issue 3, Page(s) xiii

Language	English
Publishing date	2020-06-26
Publishing country	United States
Document type	Editorial ; Introductory Journal Article
ZDB-ID	1315374-2
ISSN	1558-1969 ; 0749-0712
ISSN (online)	1558-1969
ISSN	0749-0712
DOI	10.1016/j.hcl.2020.05.001
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Article ; Online: All-Inside Versus Outside-in Repair of Triangular Fibrocartilage Complex Peripheral Tears.

Fones, Lilah / Cole, Keegan P / Kwok, Moody / Gallant, Greg G / Tosti, Rick

The Journal of hand surgery

2023

Abstract: Purpose: Triangular fibrocartilage complex (TFCC) peripheral tears with persistent wrist pain can be treated with arthroscopic surgical repair owing to vascularization of the peripheral region. The safety and efficacy of all-inside repair has been shown ...

Abstract	Purpose: Triangular fibrocartilage complex (TFCC) peripheral tears with persistent wrist pain can be treated with arthroscopic surgical repair owing to vascularization of the peripheral region. The safety and efficacy of all-inside repair has been shown in prior case series. The purpose of this study was to compare two methods of arthroscopic peripheral TFCC repair: all-inside vertical mattress and outside-in horizontal mattress. Methods: A 5-year retrospective review was performed on patients treated from 2016 to 2021 with wrist arthroscopy and TFCC repair for Palmer 1B tears. Patients with ulnar extrinsic ligament repair, distal radioulnar joint instability, concomitant ulnar shortening osteotomy, and extensor carpi ulnaris instability were excluded. Patient therapy and office visit records were reviewed. Outcomes including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); range of motion; grip strength; immobilization time; complications; and need for revision procedures were compared. Results: Fifty-two patients were included in the study, 32 in the outside-in group and 20 in the all-inside group. The average follow-up length was 24.8 weeks, with similar range of motion and strength in both groups. The average postoperative QuickDASH score was 13 in the outside-in group and 9 in the all-inside group at 43.5 months, compared with the preoperative QuickDASH scores of 47 and 50, respectively. Mean immobilization time was longer for outside-in than for all-inside (5.25 vs 2.0 weeks, respectively). Conclusions: All-inside arthroscopic peripheral TFCC repair showed range of motion, grip strength, complications, revisions, and postoperative improvement in QuickDASH scores similar to those with the outside-in technique. Type of study/level of evidence: Therapeutic IV; retrospective comparative study.
Language	English
Publishing date	2023-06-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2023.05.004
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