Aziz, Keith T

Intramedullary screw fixation (ISF) of metacarpal fractures is a well-established technique. Prior techniques either involve placement of the intramedullary screw in a retrograde fashion or placement of the guidewire in a retrograde fashion before placing the screw in an antegrade fashion. While effective, previously described techniques have risks of extensor tendon irritation, articular cartilage disruption, and limited access to multiple metacarpals from a single incision. We present a novel antegrade intramedullary screw placement and antegrade guidewire technique for ISF that avoids disruption of the metacarpal head and allows for access to multiple metacarpals through a single incision. Cadaveric evaluation confirmed consistent sparing of the distal carpal row and demonstrated the feasibility of this technique across the index through small finger metacarpals. Compared with previously described methods, this technique offers improved soft tissue preservation, reduced risk of tendon scarring, and enhanced surgical efficiency. Level of Evidence: Level IV—case report; cadaveric study.

Background: Total wrist arthrodesis is a well-established procedure providing pain relief and stability for patients with symptomatic radiocarpal arthritis refractory to nonoperative measures. Little research exists on reimbursement and utilization trends for this procedure. This study aimed to characterize Medicare reimbursement trends for total wrist arthrodesis, along with trends in Medicare utilization and comparison with Medicaid reimbursement. Methods: Medicare reimbursement for Current Procedural Terminology codes 25800, 25805, and 25810 were collected from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule from 2000 to 2025. Rates were inflation-adjusted to 2025 dollars, and percentage changes were calculated. Medicare utilization trends from 2000 to 2022 were analyzed using CMS Part B data. Most recent Medicaid reimbursement was collected from online state fee schedules and compared with 2025 Medicare rates, with additional analyses of variability and adjustment for work Relative Value Units. Results: Inflation-adjusted Medicare reimbursement for total wrist arthrodesis decreased by 49.1% from 2000 to 2025 ( P < .0001), averaging a 1.96% annual decline. Utilization trends remained stable, with wrist arthrodesis with iliac or other autograft (CPT 25810) being the most commonly billed procedure. Medicaid reimbursed 13.6% less than Medicare on average, with substantial state variability, ranging from 44.7% (New Hampshire) to 135.4% (Alaska) of Medicare reimbursement. Conclusion: Reimbursement for total wrist arthrodesis has declined significantly despite stable utilization in the Medicare population. Medicaid reimbursement is consistently lower and highly variable by state, potentially impacting access to care. Given the effectiveness of wrist arthrodesis, policymakers should advocate for equitable reimbursement for this procedure.

Background: Anatomically accurate illustrations are imperative in medical education, serving as crucial tools to facilitate comprehension of complex anatomical structures. While traditional illustration methods involving human artists remain the gold standard, the rapid advancement of Generative Artificial Intelligence (GAI) models presents a new opportunity to automate and accelerate this process. This study evaluated the potential of GAI models to produce craniofacial anatomy illustrations for educational purposes. Methods: Four GAI models, including Midjourney v6.0, DALL-E 3, Gemini Ultra 1.0, and Stable Diffusion 2.0 were used to generate 736 images across multiple views of surface anatomy, bones, muscles, blood vessels, and nerves of the cranium in both oil painting and realistic photograph styles. Four reviewers evaluated the images for anatomical detail, aesthetic quality, usability, and cost-effectiveness. Inter-rater reliability analysis assessed evaluation consistency. Results: Midjourney v6.0 scored highest for aesthetic quality and cost-effectiveness, and DALL-E 3 performed best for anatomical detail and usability. The inter-rater reliability analysis demonstrated a high level of agreement among reviewers (ICC = 0.858, 95% CI). However, all models showed significant flaws in depicting crucial anatomical details such as foramina, suture lines, muscular origins/insertions, and neurovascular structures. These limitations were further characterized by abstract depictions, mixing of layers, shadowing, abnormal muscle arrangements, and labeling errors. Conclusions: These findings highlight GAI’s potential for rapidly creating craniofacial anatomy illustrations but also its current limitations due to inadequate training data and incomplete understanding of complex anatomy. Refining these models through precise training data and expert feedback is vital. Ethical considerations, such as potential biases, copyright challenges, and the risks of propagating inaccurate information, must also be carefully navigated. Further refinement of GAI models and ethical safeguards are essential for safe use.