Background: Covid and required social distancing has accelerated the use of video conferencing. W... more Background: Covid and required social distancing has accelerated the use of video conferencing. We hypothesized that residents and faculty would be less receptive to the video lecture format and prefer traditional didactic methods. Methods: A 16-question anonymous survey was distributed nationally to orthopaedic residents and faculty. The survey collected basic demographic information such as, level in training, gender, and age. We then asked the respondent to rate their agreement or disagreement with 8 statements on a Likert scale (1-5) about video conferencing regarding orthopedic education. Likert scale responses were evaluated using basic descriptive statistics. Respondents were divided into groups of faculty and residents. Residents were subdivided into junior residents (PGY-1s and PGY-2s) and senior residents (PGY-3s, PGY-4s, and PGY-5s). A Wilcoxon rank sum test was used for the Likert scale type questions and a Fisher’s exact test was used for the pros/cons questions to eval...
This study evaluated the incidence of symptomatic radioulnar synostosis/heterotopic ossification ... more This study evaluated the incidence of symptomatic radioulnar synostosis/heterotopic ossification after distal biceps tendon repair in patients receiving indomethacin prophylaxis. We hypothesized that indomethacin use postoperatively would decrease the occurrence of symptomatic synostosis. A single-center retrospective record review identified 124 patients undergoing distal biceps repair between 2011 and 2014. Patients were analyzed for administration of indomethacin, contraindications to administration, age, time to surgery, fixation method, medical comorbidities, and development of symptomatic synostosis. Oral indomethacin (75 mg, once daily) was prescribed postoperatively for 10 to 42 days per each attendings' protocol. After analysis, 112 patients met the inclusion criteria, with 7 undergoing a 1-incision distal biceps repair and 105 undergoing a 2-incision repair. Of those, 104 received indomethacin postoperatively, with a synostosis rate of 0.96% compared with 37.50% for th...
To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarp... more To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis. In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification. We randomly assigned 42 observers to review radiographs alone and also informed 50 of the patient's symptoms and examination. Information about symptoms and examination was randomized. Interobserver reliability was determined with the s* statistic. Because of the hierarchical data structure, cros...
Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist frac... more Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8–12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. Materials and methods In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient se...
Flexor tendon injuries are commonly treated by orthopedic, plastic, and hand surgeons. Bunnell re... more Flexor tendon injuries are commonly treated by orthopedic, plastic, and hand surgeons. Bunnell referred to zone 2 injuries as being in "no-man's land," plagued by poor results after surgical repair. Over the last 30 years, a better understanding of the biology of flexor tendon injuries, advanced surgical techniques, and perhaps most important, improved rehabilitation protocols, have afforded consistently good to excellent results after surgical repair at all levels of injury. Complications such as restrictive adhesions, joint contracture, and repair rupture, although less frequent, can compromise functional recovery.
The methods used to treat intrasynovial flexor tendon injuries are the result of decades of clini... more The methods used to treat intrasynovial flexor tendon injuries are the result of decades of clinical experience coupled with advances in understanding the biomechanical, physiologic, and cellular milieu of the repair. Successful treatment requires optimizing the factors that can be controlled and ameliorating those that cannot be controlled.
This study investigated the outcomes of extra-articular distal radius fractures and simple intra-... more This study investigated the outcomes of extra-articular distal radius fractures and simple intra-articular radial styloid fractures stabilized with a novel threaded cannulated device. This was a retrospective study of 24 distal radius fractures treated with the T-Pin device (Union Surgical LLC, Philadelphia, Pennsylvania), with a minimum of 1 year of postoperative follow-up. Outcome data included wrist range of motion, grip strength, and pinch strength. Radiographs were analyzed to determine volar tilt and radial height. At final follow-up, patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. At an average of 2 years after surgery (range, 1-4 years), flexion was 89%, extension was 96%, supination was 99%, and pronation was 100% of contralateral wrist motion. Grip strength was 93% (range, 40%-137%) and lateral pinch strength was 99% (range, 48%-130%) of the contralateral upper extremity. The average final DASH score was 4.4 (range, 0-35). One patien...
Restoring digital function after flexor tendon injury continues to be one of the great challenges... more Restoring digital function after flexor tendon injury continues to be one of the great challenges in hand surgery. Advances in our understanding of tendon anatomy, nutrition, healing, and postoperative rehabilitation have generated an evolution of techniques that have enhanced the results of flexor tendon repair. Despite the many gains, problems of stiffness, scarring, and functional impairment persist in frustrating the most experienced hand surgeons and compliant patients. Treatment of flexor tendon injuries requires a thorough knowledge of hand anatomy, atraumatic surgical technique, and a structured program of postoperative rehabilitation.
This case report describes the course of a 26-year-old male who developed a dense motor palsy of ... more This case report describes the course of a 26-year-old male who developed a dense motor palsy of the radial nerve after receiving a seasonal influenza vaccination. The palsy developed within 12 to 16 hours of inoculation and demonstrated no clinical recovery until 5 months postinjury. Electromyographic and nerve conduction studies obtained at six weeks postinjury were consistent with complete motor denervation. Sensory function was preserved. The injury was successfully treated nonoperatively with physical therapy and wrist splinting, and the palsy gradually resolved over the next several months.
The Journal of bone and joint surgery. American volume, 1994
The rates of survival of the amputated part and the functional outcomes were studied retrospectiv... more The rates of survival of the amputated part and the functional outcomes were studied retrospectively after seventy-three replantations and eighty-nine revascularizations in the upper extremity in 120 children. All operations were performed between January 1974 and December 1988 after partial and complete amputations at various levels. The ages of the patients ranged from three days to sixteen years. The average duration of follow-up was thirty-six months (range, fourteen months to seven years) for the patients who had had a replantation and thirty months (range, fourteen months to eight years) for the patients who had had a revascularization. The rate of survival of the amputated part was significantly higher (p < 0.0002) after revascularization (seventy-eight parts [88 per cent]) than after replantation (forty-six parts [63 per cent]). There was no association, for either group, between survival and the preoperative duration of ischemia, the level of the injury, the digit that h...
Background: Covid and required social distancing has accelerated the use of video conferencing. W... more Background: Covid and required social distancing has accelerated the use of video conferencing. We hypothesized that residents and faculty would be less receptive to the video lecture format and prefer traditional didactic methods. Methods: A 16-question anonymous survey was distributed nationally to orthopaedic residents and faculty. The survey collected basic demographic information such as, level in training, gender, and age. We then asked the respondent to rate their agreement or disagreement with 8 statements on a Likert scale (1-5) about video conferencing regarding orthopedic education. Likert scale responses were evaluated using basic descriptive statistics. Respondents were divided into groups of faculty and residents. Residents were subdivided into junior residents (PGY-1s and PGY-2s) and senior residents (PGY-3s, PGY-4s, and PGY-5s). A Wilcoxon rank sum test was used for the Likert scale type questions and a Fisher’s exact test was used for the pros/cons questions to eval...
This study evaluated the incidence of symptomatic radioulnar synostosis/heterotopic ossification ... more This study evaluated the incidence of symptomatic radioulnar synostosis/heterotopic ossification after distal biceps tendon repair in patients receiving indomethacin prophylaxis. We hypothesized that indomethacin use postoperatively would decrease the occurrence of symptomatic synostosis. A single-center retrospective record review identified 124 patients undergoing distal biceps repair between 2011 and 2014. Patients were analyzed for administration of indomethacin, contraindications to administration, age, time to surgery, fixation method, medical comorbidities, and development of symptomatic synostosis. Oral indomethacin (75 mg, once daily) was prescribed postoperatively for 10 to 42 days per each attendings' protocol. After analysis, 112 patients met the inclusion criteria, with 7 undergoing a 1-incision distal biceps repair and 105 undergoing a 2-incision repair. Of those, 104 received indomethacin postoperatively, with a synostosis rate of 0.96% compared with 37.50% for th...
To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarp... more To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis. In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification. We randomly assigned 42 observers to review radiographs alone and also informed 50 of the patient's symptoms and examination. Information about symptoms and examination was randomized. Interobserver reliability was determined with the s* statistic. Because of the hierarchical data structure, cros...
Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist frac... more Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8–12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. Materials and methods In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient se...
Flexor tendon injuries are commonly treated by orthopedic, plastic, and hand surgeons. Bunnell re... more Flexor tendon injuries are commonly treated by orthopedic, plastic, and hand surgeons. Bunnell referred to zone 2 injuries as being in &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;no-man&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s land,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; plagued by poor results after surgical repair. Over the last 30 years, a better understanding of the biology of flexor tendon injuries, advanced surgical techniques, and perhaps most important, improved rehabilitation protocols, have afforded consistently good to excellent results after surgical repair at all levels of injury. Complications such as restrictive adhesions, joint contracture, and repair rupture, although less frequent, can compromise functional recovery.
The methods used to treat intrasynovial flexor tendon injuries are the result of decades of clini... more The methods used to treat intrasynovial flexor tendon injuries are the result of decades of clinical experience coupled with advances in understanding the biomechanical, physiologic, and cellular milieu of the repair. Successful treatment requires optimizing the factors that can be controlled and ameliorating those that cannot be controlled.
This study investigated the outcomes of extra-articular distal radius fractures and simple intra-... more This study investigated the outcomes of extra-articular distal radius fractures and simple intra-articular radial styloid fractures stabilized with a novel threaded cannulated device. This was a retrospective study of 24 distal radius fractures treated with the T-Pin device (Union Surgical LLC, Philadelphia, Pennsylvania), with a minimum of 1 year of postoperative follow-up. Outcome data included wrist range of motion, grip strength, and pinch strength. Radiographs were analyzed to determine volar tilt and radial height. At final follow-up, patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. At an average of 2 years after surgery (range, 1-4 years), flexion was 89%, extension was 96%, supination was 99%, and pronation was 100% of contralateral wrist motion. Grip strength was 93% (range, 40%-137%) and lateral pinch strength was 99% (range, 48%-130%) of the contralateral upper extremity. The average final DASH score was 4.4 (range, 0-35). One patien...
Restoring digital function after flexor tendon injury continues to be one of the great challenges... more Restoring digital function after flexor tendon injury continues to be one of the great challenges in hand surgery. Advances in our understanding of tendon anatomy, nutrition, healing, and postoperative rehabilitation have generated an evolution of techniques that have enhanced the results of flexor tendon repair. Despite the many gains, problems of stiffness, scarring, and functional impairment persist in frustrating the most experienced hand surgeons and compliant patients. Treatment of flexor tendon injuries requires a thorough knowledge of hand anatomy, atraumatic surgical technique, and a structured program of postoperative rehabilitation.
This case report describes the course of a 26-year-old male who developed a dense motor palsy of ... more This case report describes the course of a 26-year-old male who developed a dense motor palsy of the radial nerve after receiving a seasonal influenza vaccination. The palsy developed within 12 to 16 hours of inoculation and demonstrated no clinical recovery until 5 months postinjury. Electromyographic and nerve conduction studies obtained at six weeks postinjury were consistent with complete motor denervation. Sensory function was preserved. The injury was successfully treated nonoperatively with physical therapy and wrist splinting, and the palsy gradually resolved over the next several months.
The Journal of bone and joint surgery. American volume, 1994
The rates of survival of the amputated part and the functional outcomes were studied retrospectiv... more The rates of survival of the amputated part and the functional outcomes were studied retrospectively after seventy-three replantations and eighty-nine revascularizations in the upper extremity in 120 children. All operations were performed between January 1974 and December 1988 after partial and complete amputations at various levels. The ages of the patients ranged from three days to sixteen years. The average duration of follow-up was thirty-six months (range, fourteen months to seven years) for the patients who had had a replantation and thirty months (range, fourteen months to eight years) for the patients who had had a revascularization. The rate of survival of the amputated part was significantly higher (p < 0.0002) after revascularization (seventy-eight parts [88 per cent]) than after replantation (forty-six parts [63 per cent]). There was no association, for either group, between survival and the preoperative duration of ischemia, the level of the injury, the digit that h...
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Papers by John Taras