Rames, Jess

Background: Kienböck disease most frequently affects 1 wrist and rarely occurs bilaterally. The purpose of this study is to describe the natural history and identify risk factors for development of bilateral Kienböck disease. Methods: After institutional review board approval, 350 patients with surgically managed Kienböck disease from 1976 to 2023 were identified. A retrospective review of the electronic medical record was used to collect demographic, clinical, and radiographic information. Two-tailed student t -test was used for continuous variable, and Fisher’s exact test was used for categorical variables with analysis of power. Results: Ten of 350 patients (2.9%) had bilateral disease. The mean age was 45 (range: 14-62) years, and 6 out of 10 patients were female. The mean follow-up time was 47 (range: 9-274) months. Three of the 10 patients were laborers. Antecedent trauma (n = 2), prior corticosteroid injection (n = 1), and concomitant autoimmune disease (n = 1) were rare events. There was no difference in Lichtman Stage comparing the dominant and nondominant hands, and 72.2% of wrists were ulnar negative. This was higher but not significantly different than the unilateral affected comparison cohort (60%). Sufficient power was demonstrated (0.99). Eighteen of 20 wrists were treated operatively. Two cases required operative revision due to progression of disease. Conclusions: The cause of bilateral versus unilateral Kienböck disease remains unclear. Bilateral disease was not associated with a higher incidence of autoimmune disease, systemic corticosteroid use, or exposure to heavy manual labor. However, thrombosis leading to avascular necrosis of the lunate may be influenced by hypercoagulable and inflammatory diseases. Surgeons should maintain a high index of suspicion for bilateral disease in patients with these comorbidities. Routine screening of the contralateral wrist is unjustified if the patient is asymptomatic.

Background: In Kienböck disease with carpal collapse scaphocapitate fusion (SCF) and proximal row carpectomy (PRC), are mainstays of surgical treatment. This study analyzed objective and patient-reported outcomes after SCF or PRC in laborers versus nonlaborers. Methods: A retrospective cohort study of patients who underwent surgery for Kienböck disease within a single health system from 1976 to 2023 was conducted. Postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores were surveyed from the available population. Labor status, grip, ROM, and return to the operating room were collected and radiographs were analyzed. Results: Sixty-four patients underwent PRC, and 78 underwent SCF. Patients with PRC were significantly older than patients with SCF. Mean follow-up was 29 months (SD, 53 months). There was no significant difference in postoperative ROM or relative grip strength between the cohort groups. Laborers who underwent SCF demonstrated the least disability on DASH scores. There was no significant difference in postoperative DASH scores in PRC when comparing laborers versus nonlaborers. In contrast, the DASH and PRWE scores of patients who underwent SCF postoperatively varied between laborers and nonlaborers (mean ± SD, 11.1 ± 13.9 versus 30.5 ± 24.8, P = 0.005; and 17.5 ± 19.4 versus 42.3 ± 31.4, P = 0.024). Patients who underwent SCF had a greater rate of revision surgery compared with the PRC group (22 of 78 versus 6 of 64; P = 0.026). Wrist fusion rates were 19% for SCF compared with 1.6% for PRC ( P = 0.0007). Conclusions: SCF and PRC demonstrated no difference in postoperative ROM and grip based on labor status. Laborers with SCF had the least postoperative disability on DASH; however, SCF was associated with the need for additional surgical intervention and conversion to total wrist arthrodesis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutc, III.

Background: Residency programs have developed monetary initiatives for students underrepresented in medicine (URiM). Our team sought to provide a centralized resource for URiM students seeking plastic surgery subinternships with funded opportunities. Methods: A cross sectional analysis of URiM scholarships offered by US integrated plastic surgery programs (n = 91) between July and September 2023. The study used residency program web domains. Investigators collected information on the monetary value of scholarship, eligibility criteria, and required application documents. Inferential analyses were conducted to investigate whether programs’ geographic region or Doximity ranking played a role in likelihood of scholarship existence. Results: The study found that approximately 52.7% (n = 48) of programs have in place monetary support for underrepresented visiting medical students (eg, stipend or reimbursement). The average monetary support was $1670. A univariate test demonstrated that programs with lower rankings in both reputation and research were less likely to have a scholarship available than higher ranking programs (P = 0.002; P = 0.02, respectively). Programs located in the Midwest regions were 3.5 times more likely to have a diversity scholarship available (P = 0.034). In our multivariate analysis, reputation ranking and geographic region remained significant. A Pearson chi square test showed the greatest proportions of scholarships among geographically similar programs to be in the Midwest (70%), however, not statistically significant. Conclusions: This study provides a centralized resource for URiM students interested in completing away rotations. Further investigation into development of these scholarship opportunities would be of much benefit and could guide other programs in the funding their own diversity scholarships.