Development and Validation of a Novel Decision Aid for WALANT Hand Surgeries: Investigating Patient Preferences

INTRODUCTION: This study aims to develop a novel decision aid packet (DAP) for hand surgery patients deciding between Wide-Awake-Local-Anesthesia-No-Tourniquet (WALANT) and traditional anesthesia. METHODS: Development: The DAP was developed following International Patient Decision Aid Standards. Validation: Alpha Testing Seven hand surgeons experienced in WALANT and traditional surgeries belonging to the WALANT Research Consortium in the U.S. commented on the DAP through three rounds of editing utilizing the Delphi method. Seven patient advocates provided readability feedback. Beta Testing Orthopedic hand surgery patients were assigned to the control or experimental group. The experimental group was given the DAP pre-surgery. Both groups completed a validated regret scale at follow-up. A paired t-test was conducted to analyze the difference between average scores on the regret scale and pre- and post-DAP knowledge tests (p RESULTS: The experimental group (n=58) demonstrated a 145% increase (p DISCUSSION: Increased knowledge test scores following the DAP suggest that patients are better informed after DAP usage. Low decisional conflict scores suggest that the DAP increases patients’ confidence. Lower average regret scale scores among the experimental group indicate a relationship between DAP administration and reduced post-surgical regret. The greater patient preference for WALANT following DAP usage, alongside the lower postoperative regret, elucidates a general preference in informed patients towards the WALANT modality

Tendon Rupture and Tendonitis in Low-Profile Dorsal versus Volar Plating for Distal Radius Fractures: A Systematic Review and Meta-Analysis

Tendon Rupture and Tendonitis in Low-Profile Dorsal versus Volar Plating for Distal Radius Fractures: A Systematic Review and Meta-Analysis Background: Dorsal plating of distal radius fractures has historically been associated with high rates of hardware removal, tendonitis, and tendon rupture. Newer generation low-profile dorsal plates are thinner (\u3c1.6mm thick) with improved characteristics. We examine whether low-profile dorsal plates still have higher rates of tendon complications than volar locking plates. Methods: We searched Ovid MEDLINE, Web of Science, and EMBASE for published literature describing tendon complications in association with plating of distal radius fractures. Inclusion criteria encompasses any primary study of low-profile dorsal plates that included data on tendon complications. Studies that included both low-profile dorsal and volar plating arms were included in the meta-analysis. Results: Nine studies were selected for inclusion. All studies were retrospective cohorts or case series with a total of 446 low-profile dorsal plates. Five studies were included in the meta-analysis with a total of 806 subjects; 584 received volar plates and 222 received low-profile dorsal plates. Meta-analysis showed no significant difference in rates of tendonitis or tendon rupture. Discussion:  The included studies were all of level III or IV evidence. To our knowledge, this review provides the largest comparison of low-profile dorsal and volar locked distal radius plates to date. Pooled analysis results provide further comparison of low-profile dorsal versus volar plating