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Background and Objectives: Providing high-quality care for patients in hand surgery is an everyday endeavor. However, the quality of life (QoL) and working conditions of hand surgeons ensuring these high-quality services need to be investigated. The aim of this study was to evaluate the QoL and working conditions of Swiss hand surgeons. Materials and Methods: A national survey with Swiss hand surgeons was conducted. Standardized questionnaires were completed anonymously online. Core topics included working conditions, QoL, satisfaction with the profession, and aspects of private life. Results: A total of 250 hand surgeons were invited to participate, of which 110 (44.0%) completed the questionnaire. Among all participants, 43.6% stated that they are on call 4–7 days per month, versus 8.2% never being on call. Overall, 84.0% of the residents, 50.0% of the senior physicians, 27.6% of the physicians in leading positions, and 40.6% of the senior consultants/practice owners, as well as 55.1% of the female and 44.3% of the male respondents, felt stressed by their job, even during holidays and leisure time. Out of all participants, 85.4% felt that work affects private relationships negatively. Despite the reported stress, 89.1% would choose hand surgery as a profession again. Less on-call duty (29.1%) and better pay (26.4%) are the most prioritized factors for attractiveness of a position at a hospital. Conclusions: The QoL of Swiss hand surgeons is negatively affected by their workload and working hours. Residents, senior physicians and female surgeons suffer significantly more often from depression, burnout or chronic fatigue in comparison to leading positions, senior consultants/practice owners and male surgeons. Better pay or less on-call duty would make the work more attractive in acute care hospitals.

Background: Due to the drastic reduction of the eye lens dose limit from 150 mSv per year to 20 mSv per year since 2018, the prospective investigation of the estimated dose of the eye lens by radiological imaging procedures at the surgical site during trauma surgery in the daily work process was carried out. This was also necessary because, as experience shows, with changes in surgical techniques, there are also changes in the use of radiological procedures, and thus an up-to-date inventory can provide valuable information for the assessment of occupationally induced radiation exposure of surgical personnel under the current conditions. Methods: The eye lens radiation exposure was measured over three months for five trauma surgeons, four hand surgeons and four surgical assistants with personalized LPS-TLD-TD 07 partial body dosimeters Hp (0.07). A reference dosimeter was deposited at the surgery changing room. The dosimeters were sent to the LPS (Landesanstalt für Personendosimetrie und Strahlenschutzausbildung) measuring institute (National Institute for Personal Dosimetry and Radiation Protection Training, Berlin) for evaluation after 3 months. The duration of the operation, occupation (assistant, surgeon, etc.), type of surgery (procedure, diagnosis), designation of the X-ray unit, total duration of radiation exposure per operation and dose area product per operation were recorded. Results: Both the evaluation of the dosimeters by the trauma surgeons and the evaluation of the dosimeters by the hand surgeons and the surgical assistants revealed no significant radiation exposure of the eye lens in comparison to the respective measured reference dosimeters. Conclusions: Despite the drastic reduction of the eye lens dose limit from 150 mSv per year to 20 mSv per year, the limit for orthopedic, trauma and hand surgery operations is well below the limit in this setting.

An 82-year-old male presents with severe Dupuytren’s contracture of his small finger involving his metacarpophalangeal joint (MPJ). He had a substantial flexion contracture of the MPJ up to 80° of flexion deformity (Fig. 17.1). He had intact neurovascular examination. His past medical history was significant for hypertension, obstructive sleep apnea, and multiple hand osteoarthritic joints. Functional limitation urged him to seek a medical consult with Physical Medicine and Rehabilitation and eventually a surgical consult with a hand surgeon.

Purpose With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons. Methods A systematic review of the available literature was performed using the keyword terms “COVID-19”, “Coronavirus”, “surgeon”, “health-care workers”, “protection”, “masks”, “gloves”, “gowns”, “helmets”, and “aerosol” in several combinations. The following databases were assessed: Pubmed, Cochrane Reviews, Google Scholar. Due to the paucity of available data, it was decided to present it in a narrative manner. In addition, participating doctors were asked to provide their guidelines for PPE in their countries (Austria, Luxembourg, Switzerland, Germany, UK) for consideration in the presented practice recommendations. Results World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination. Conclusion Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosol-generating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard. Level of evidence IV.

Following carpal tunnel release (CTR), patients may be indicated for subsequent hand surgery (contralateral CTR and/or trigger finger release [TFR]). While surgeons typically take pride in patient loyalty, the rate of returning to the same hand surgeons has not been previously characterized. Patients undergoing CTR were isolated from 2010-2021 PearlDiver M151 dataset. Subsequent CTR or TFR were identified and characterized as being performed by the same or different surgeon, with patient factors associated with changing to a different surgeon determined by multivariable analyses. In total, 1,121,922 CTR patients were identified. Of these, subsequent surgery was identified for 307,385 (27.4%: CTR 289,455 [94.2%] and TFR 17,930 [5.8%]). Of the patients with a subsequent surgery, 257,027 (83.6%) returned to the same surgeon and 50,358 (16.4%) changed surgeons. Multivariable analysis found factors associated with changing surgeon (in order of decreasing odds ration [OR]) to be: TFR as the second procedure (OR 2.98), time between surgeries greater than 2-years (OR 2.30), Elixhauser-Comorbidity Index (OR 1.14 per 2-point increase), and male sex (OR 1.06), with less likely hood of changing for those with Medicare (OR 0.95 relative to commercial insurance) (p<0.001 for each). Pertinent negatives included: age, Medicaid, and having a 90-day adverse event after the index procedure. Over fifteen percent of patients who required a subsequent CTR or TFR following CTR did not return to the same surgeon. Understanding what factors lead to outmigration of patients form a practice may help direct efforts for patient retention.

Performance of robot-assisted endovascular surgery (ES) remains highly dependent on an individual surgeon’s skills, due to common adoption of master-slave robotic structure. Surgeons’ skill modeling and unstructured surgical state perception pose prohibitive challenges for an autonomous ES robot. In this paper, a novel convolutional neural network (CNN)-based framework is proposed to address these challenges for navigation of an ES robot based on surgeons’ skill learning. An operating action probability estimator is proposed by integrating a two-dimensional CNN, with which the features of a surgical state image are extracted and then directly mapped to the action probability. A one-dimensional CNN with multi-input is developed to recognize the guide wire operating force condition. An eye-hand collaborative servoing algorithm is proposed to combine the outputs of these two networks and to control the robot under a closed-loop architecture. A real-world ES robot is employed for data collection and task performance evaluation in laboratory condition. Compared with the state of the art, the CNN-based method shows its capability of adapting to different situations and achieves similar success rate and average operating time. Robotic operation performs similar operating trajectory and maintains similar level of operating force with manual operation. The CNN-based method can be easily extended to many other surgical robots.

Dear Editor, The article on teaching right-handed surgeons to use the scissors with the left hand and letters on the tricks left handers use with right-handed scissors are one small part of problems of using equipment, particularly in surgery. During eighteen months as a houseman and SHO in general surgery I was expected to be able to tie knots with either hand equally well or to remove clips with both too. The monocular teaching attachment, (eyepiece or camera), should be fitted on the same side as the surgeon's dominant eye so the same field of view is seen by others.

Purpose Surgery offers exciting opportunities but comes with demanding challenges that require attention from both surgical program administrators and aspiring surgeons. The hashtag #NoTrainingTodayNoSurgeonsTomorrow on 𝕏 (previously Twitter) underscores the importance of ongoing training. Our scoping review identifies educational challenges and opportunities for the next generation of surgeons, analyzing existing studies and filling gaps in the literature. Methods Following the PRISMA guidelines, MEDLINE/PubMed was searched in February 2022, using the MeSH terms “surgeons/education,” for articles in English or German on general, abdominal, thoracic, vascular, and hand surgery and traumatology targeting medical students, surgical residents, future surgeons, and fellows. Results The initial search yielded 1448 results. After a step-by-step evaluation process, 32 publications remained for complete review. Three main topics emerged: surgical innovations and training ( n  = 7), surgical culture and environment ( n  = 19), and mentoring ( n  = 6). The articles focusing on surgical innovations and training mainly described the incorporation of structured surgical training methods and program initiatives. Articles on surgical culture examined residents’ burnout, well-being, and gender issues. Challenges faced by women, including implicit bias and sexual harassment, were highlighted. Regarding mentoring, mentees’ needs, training challenges, and the qualities expected of both mentors and mentees were addressed. Conclusion At a time of COVID-19-driven surgical innovations, the educational and working environment of the new generation of surgeons is changing. Robotic technology and other innovations require future surgeons to acquire additional technological and digital expertise. With regard to the cultural aspects of training, surgery needs to adapt curricula to meet the demands of the new generation of surgeons, but even more it has to transform its culture.

Background In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. Questions/purposes (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? Methods We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0–3) and adequate (4–6) health literacy as done by the tool’s creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. Results Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, −4; 95% CI, −7 to −1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; mean difference, −2; 95% CI, −4 to −1]; p < 0.001) and condition (2 ± 2 versus 3 ± 3; mean difference, −1; 95% CI, −3 to 0; p = 0.022). Nonwhite patients asked fewer questions than did white patients (5 ± 4 versus 9 ± 7; mean difference, −4; 95% CI, −7 to 0; p = 0.032). No other patient characteristics were associated with the number of questions asked. Surgeons only occasionally (29%; 24/84) asked patients if they had questions during the encounter, but when they did, most patients (79%; 19/24) asked questions. Conclusions Limited health literacy is a barrier to effective patient engagement in hand surgery care. In the increasingly tangled health-information environment, it is important to actively involve patients with limited health literacy in the decision-making process by encouraging question-asking, particularly in practice settings where most decisions are preference-sensitive. Instead of assuming that patients understand what they are told, orthopaedic surgeons may take “universal precautions” by assuming that patients do not understand unless proved otherwise. Level of Evidence Level II, therapeutic study.

Background The goal of this study was to evaluate differences in carpal tunnel release volume, reimbursement, practice styles, and patient populations between male and female surgeons from 2013 to 2021. Materials and Methods The Medicare Physician & Other Practitioners database was queried from 2013 to 2021. Procedure volume, reimbursement, surgeon information, and patient demographic characteristics were collected for any surgeon who performed at least 10 open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) procedures that year. The Welch t test, the Kruskal-Wallis test, and multivariable linear regressions were conducted to compare male and female surgeons and analyze geographic and annual differences. Results From 2013 to 2021, the proportion of carpal tunnel releases performed by female surgeons increased for OCTR by 4.5% (7.1% to 11.6%) and for ECTR by 3.3% (4.8% to 8.1%). Female OCTR surgeons on average had fewer beneficiaries per surgeon (443.37 vs 354.20, P<.001), performed fewer billable services per beneficiary (6.37 vs 5.35, P=.03), and performed fewer unique billable services (91.13 vs 77.79, P<.001) compared with male surgeons. Female OCTR surgeons also saw a lower percentage of White patients (88.14 vs 86.48, P=.003) and a higher percentage of female patients (60.06 vs 61.70, P<.001) and dual-enrolled Medicare-Medicaid patients (10.54 vs 11.22, P=.046). Conclusion Female representation among OCTR and ECTR surgeons increased across the country. Male OCTR surgeons billed for more services and performed more services per beneficiary and also treated a higher proportion of White patients and dual Medicare-Medicaid enrollees compared with female surgeons. Future studies are required to identify reasons for and ways to address these disparities. [Orthopedics. 2025;48(1):57–63.]