The Journal of hand surgery
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Racism that unjustly marginalizes black people in the United States is not a new concept. It underlies nearly every aspect of American history, leading to the systemic racism that is ingrained in our society today. ⋯ In this article, we will provide a definitional framework, clinical examples, and practical pearls to promote change. To reduce racial and ethnic health care inequities and diversify the field of hand surgery, we must advocate on behalf of black and brown colleagues, staff, students, and/or friends to address racist policies and procedures.
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Surprise billing occurs when insured patients receive unexpected out-of-network charges and fees even when the emergency department, facility, or primary physician who provided care is in their insurance network. This issue is particularly relevant for hand surgery. The multidisciplinary nature of hand care and the number of ancillary services involved result in various levels at which out-of-network billing can be introduced, even when the hand surgeon is in-network for the patient. ⋯ Little is known about surprise billing in hand care; however, we believe that these practices may substantially affect the patient population. We define key elements of surprise billing, review the literature, discuss the relevance and potential of surprise billing in hand surgery in various settings, and provide an overview of the status of health policy surrounding this practice. It is imperative for hand surgery as a field to understand the prevalence, operationalization, and policies of surprise billing better to prevent the exploitation of patients.
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The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. ⋯ General guidelines for perioperative care of the COVID-19-positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.
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Review
The Impact of Coronavirus Disease 2019 (COVID-19) on the Practice of Hand Surgery in Singapore.
The coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving. Tan Tock Seng Hospital and the National Centre for Infectious Disease see the majority of confirmed and suspected cases in Singapore. This article describes the impact of COVID-19 on the practice of hand and reconstructive microsurgery (HRM) in our institution. It details our department's response as the situation escalated and the impact on the HRM elective and emergency workload, including the use of personal protective equipment on the surgical practice of HRM, as well as the effects of the condition on social and academic life.
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Volarly displaced distal radius fractures (VD-DRFs) with small thin volar marginal fragments (VMFs) are challenging to treat with conventional volar locking plates (VLPs) alone. Several alternative surgical options have been reported to treat these fractures, including wire-loop fixation, spring-wire fixation, hook plates, headless compression screws, and tension-band wiring, but the optimal method is yet to be determined. ⋯ After a fracture at the volar rim, even if properly reduced, compression stress is continuously generated on the volar cortical side of the fracture site and tension is generated on the articular side, which leads to VMF displacement, articular surface widening, and carpal subluxation. The loop-wiring technique applies compressive pressure securely to the articular side of the fracture site as well as to the whole fracture site and may be advantageous in terms of secure fixation of small thin volar marginal fragments, stability of the carpus, and bone healing.