James H Herndon

MGB HealthCare

There is a growing consensus that an accomplished curriculum vitae and prior achievement as an academician may not correlate with success as a chairperson of a contemporary academic orthopaedic department. As surgeons, formal professional education, research expertise, and clinical experience often are inadequate to foster the necessary skills and...

Health-care reform, market competition, cost containment, and pressure for productivity have dramatically impacted the practice of orthopaedic surgery and academic surgical training. Orthopaedic leaders and training programs are striving to identify and solve these contemporary challenges. Herein, we focus on 4 areas that currently pose important c...

Background: There was a dramatic increase in the volume of manuscripts submitted to The Journal of Bone & Joint Surgery (JBJS) between 2009 and 2012. This resulted in increased journal administrative costs. To offset this financial burden, in May 2013, JBJS started charging authors an administrative processing fee at the time of submission. The pu...

Many strategies have been introduced to improve safety in health care, but it is not clear that these efforts have reduced errors. This study assessed the experienced safety culture and preferred means of improving safety among orthopaedists. Members of the Science of Variation Group and Ankle Platform were invited to complete an eighty-nine-questi...

This symposium, “Patient Safety: Collaboration, Communication, and Physician Leadership,” is a timely one. Quality of care, including the prevention of errors in our patients, is the major responsibility for all physicians, healthcare providers, and healthcare institutions. The topic is recognized by everyone in healthcare and, I suspect, most pati...

Background: Evidence suggests that when patients have a role in medical decisions they are more satisfied with their health care. Objective: To assess predictors of patient satisfaction, ratings of the provider's informed shared decision-making (ISDM), and disability among patients with orthopedic pain complaints. Research design: A total of 1...

Where Are We Now?For 51 years, orthopaedic residents have been taking the Orthopaedic In-Training Examination (OITE), which is written by members of a committee of the American Academy of Orthopaedic Surgeons. As an objective evaluation of a resident’s knowledge about orthopaedics, the examination has had an important role in determining residency...

Background: Attitudes influence how people make decisions. In an effort to decrease pilot judgment-related accidents, the Federal Aviation Administration teaches new pilots about hazardous attitudes that are believed to be incompatible with safe flight: macho, impulsive, worry, resignation, self-confidence, and antiauthority. If these attitudes ar...

Background: Sprain or dislocation of the proximal interphalangeal joint may be a useful example of the counterintuitive aspects of recovery as the prognosis is excellent, but protectiveness in response to discomfort often hinders the stretching exercises that are a key component of the recovery process. Objective: The aim of this study was to in...

The 2013 Extremity War Injury symposium focused on the sequelae of combat-related injuries, including posttraumatic osteoarthritis, amputations, and infections. Much remains to be learned about posttraumatic arthritis, and there are few circumstances in which a definitive arthroplasty should be performed in an acutely injured and open joint. Althou...

Medical error is a major cause of preventable morbidity and mortality. Resident fatigue is likely to be a significant contributor. We calculated and compared predicted fatigue impairment in surgical residents on varying schedules by using the validated Sleep, Activity, Fatigue, and Task Effectiveness model and Fatigue Avoidance Scheduling Tool; we...

The fundamental mission of graduate medical education is to train young professionals to become future practitioners and academicians. Orthopaedic surgery training programs are primarily directed toward resident education. The subspecialty training of fellows, however, is arguably equally important. Thus, two constituencies that may compete for edu...

Studies of patients with back pain, cancer, and in a general medical practice note that the use of certain phrases by a patient when communicating with their health provider can indicate greater disability and distress than expected for patients with a given disorder. However, it is unclear whether such phrases apply to patients with hand and arm d...

A novel approach to identify at-risk periods among orthopedic surgical residents may direct fatigue risk mitigation and facilitate targeted interventions. A prospective cohort study with a minimum 2-week continuous assessment period. Data on sleep and awake periods were processed using the sleep, activity, fatigue, and task effectiveness model. Rot...

Economic evaluations provide decision makers with a tool for reducing health care costs because they assess both the costs and consequences of health care interventions. This study reviewed the quality of published economic evaluations for shoulder pathologies. A MEDLINE search was conducted to identify articles published from 1980 to 2010 that con...

Defining the epidemiology of adverse events after THA will aid in the development of strategies to enhance perioperative care. We identified (1) risk factors for adverse events in Medicare beneficiaries while hospitalized after THA and (2) trends in the rates of adverse events. Data were abstracted from medical records of 1809 Medicare beneficiarie...

There is a trend toward decreasing length of hospital stay (LOS) after TKA although it is unclear whether this trend is detrimental to the overall postoperative course. Such information is important for future decisions related to cost containment. We determined whether decreases in LOS after TKA are associated with increases in readmission rates....

Evaluation of hospital readmissions after total hip arthroplasty may help improve patient safety and cost reduction. This study investigates the rates and reasons for readmission as well as length of hospital stay (LOS) for 1802 total hip arthroplasty patients from 2002 to 2007. Data were abstracted from the Medicare Patient Safety Monitoring Syste...

Patient safety has attained a higher profile since the Institute of Medicine's report, To Err Is Human: Building a Safer Health System , was distributed in 20001. This report suggested that many hospital errors were related to flaws within the health-care delivery system. Many organizations—aviation, nuclear power, the military, and some industries...

A 65-year-old woman was admitted to the day-surgery unit of this hospital for release of a trigger finger of the left ring finger. A carpal-tunnel release was performed. After the procedure, the surgeon realized he had performed the wrong operation.

Previous in vivo and in vitro studies of forearm supination-pronation suggest that distal radioulnar joint kinematics may be affected by elbow flexion. The primary hypotheses tested by this study were that, in vivo, ulnar variance changes with elbow flexion and forearm rotation, and the arc of forearm rotation changes in relationship to elbow flexi...

Adverse events from 2033 total knee arthroplasty patients were documented by nonphysician abstractors. The annual rate of adverse events from 2002 to 2004 was 9.2%, 6.4%, and 5.8%, respectively. Congestive heart failure (odds ratio, 2.1; 95% confidence interval, 1.2-3.5; P < .01) and chronic obstructive pulmonary disease (odds ratio, 1.8; 95% confi...

Predictors of success of orthopaedic residents on the American Board of Orthopaedic Surgery (ABOS) examination are controversial. We therefore evaluated numerous variables that may suggest or predict candidate performance on the ABOS examination. We reviewed files of 161 residents (all graduates) from one residency program distributed into two stud...

There has been widespread interest in medical errors since the publication of To Err Is Human: Building a Safer Health System by the Institute of Medicine in 2000. The Patient Safety Committee of the American Academy of Orthopaedic Surgeons has compiled the results of a member survey to identify trends in orthopaedic errors that would help to direc...

The diagnosis and treatment of injuries involving rupture of the interosseous ligament remain challenging. Few studies have considered the effects of rupture of the interosseous ligament on deep forearm muscle function. The objective of this study was to quantify the attachment areas of the deep forearm muscles on the interosseous ligament. The ori...

New technology is one of the primary drivers for increased healthcare costs in the United States. Both physician and industry play important roles in the development, adoption, utilization and choice of new technologies. The Federal Drug Administration regulates new drugs and new medical devices, but healthcare technology assessment remains limited...

Recent trends have focused attention on improving patient safety in the United States healthcare system. Lapses in patient safety create undue, often preventable, morbidity. These include adverse drug events, adverse surgical events and nosocomial infections. From an organizational perspective, these events are both inefficient and expensive. Many...

The academic orthopaedic department has the primary goal of providing clinical services, educating orthopaedic surgeons, providing advancements through research and technology development, and creating and maintaining the administrative infrastructure that monitors and enables the department's overall mission. Simultaneous reductions in revenues an...

Inverse dynamic optimization is a popular method for predicting muscle and joint reaction forces within human musculoskeletal joints. However, the traditional formulation of the optimization method does not include the joint reaction moment in the moment equilibrium equation, potentially violating the equilibrium conditions of the joint. Consequent...

Research into the orthopaedic applications of gene therapy has resulted in progress toward managing chronic and acute genetic and nongenetic disorders. Gene therapy for arthritis, the original focus of research, has progressed to the initiation of several phase I clinical trials. Preliminary findings support the application of gene therapy in the t...

This article describes the clinical application of gene therapy to a nonlethal disease, rheumatoid arthritis (RA). Intraarticular transfer of IL-1 receptor antagonist (IL-1Ra) cDNA reduces disease in animal models of RA. Whether this procedure is safe and feasible in humans was addressed in a phase I clinical study involving nine postmenopausal wom...

The most common cause of total joint replacement failure is peri-implant bone loss causing pain and prosthesis loosening. This process, known as osteolysis or aseptic loosening, is characterized by macrophage phagocytosis of particulate implant wear debris. In an incompletely defined step, particulate biomaterial debris induces macrophages to relea...

Health care technology (defined as all drugs, devices, and medical and surgical procedures used in medical care as well as the organizational and supportive systems within which such care is provided) is widely regarded as an important driver of escalating health care spending in the United States. Many new health care technologies are adopted and...

> Rising health-care costs and increased constraints on health-care economic resources have led to growing interest in economic evaluation in health care. > Economic analysis provides a powerful tool for evaluation of health-care technologies and treatment strategies. > A working knowledge of health-care economic principles is essential for physici...

To determine the incidence of distal radius fractures and the characteristics of those fractures and to identify the key risk factors. Prospective cohort study, mean follow-up of 9.8 years. Four clinical centers, one each in Baltimore, Maryland; Minneapolis, Minnesota; Pittsburgh, Pennsylvania; and Portland, Oregon. Nine thousand seven hundred four...

Advances in understanding the biology of rheumatoid arthritis (RA) have opened new therapeutic avenues. One of these, gene therapy, involves the delivery to patients of genes encoding anti-arthritic proteins. This approach has shown efficacy in animal models of RA, and the first human, phase I trial has just been successfully completed. Hand surger...

The objective was to develop and utilize a minimally invasive testing system to determine the force in the interosseous ligament under axial compressive loads across the range of motion of the human forearm. Eleven fresh frozen human cadaveric forearms were used (51-72 years). Current studies investigating interosseous ligament forces altered the s...

There continues to be an increasing number of healthcare delivery systems as a result of marketplace changes that include declining reimbursement and increasing costs for healthcare. However, the majority of these systems fail. Failures are a consequence of poor management, lack of a common mission and business rationale, individual's interests tha...

In the last fifteen years, there have been great changes in the American health-care system. Driven by an increasingly persistent concern about double-digit increases in expenditures, large employers have led a mass migration from indemnity insurance to managed care1. The transition process has not been particularly smooth, however, leading to a ba...

Thumb metacarpophalangeal arthritis may affect overall hand function more than expected because pain and instability compromise pinch and grip strength. Implant arthroplasty represents one option in the treatment of deformity, destruction, and instability at the metacarpophalangeal joint level. Appropriate use of implant arthroplasty requires caref...

Gene therapy clinical trials raise important safety issues that complicate their design and require extensive preclinical testing. Human protocols for the treatment of arthritis and most other orthopaedic and rheumatologic indications are complicated additionally by the perception that they are largely acquired, nonlethal conditions. Taking these c...

Limb transplantation has long been of interest to surgeons. The legend of the pysician twins Saint Cosmos and Saint Damian, who transplanted a whole leg in a.d. 348, has come down to us from antiquity. The first successful transplantation of an allograft of a forearm and hand from a cadaver was performed in Lyons, France, in 1998.1 The second succe...

The objective of our study was to measure 3-dimensional force vectors (magnitude and direction) acting in the forearm when load is applied to the hand and to measure the actual force in the interosseous ligament (IOL). Fourteen cadaveric forearms were loaded to 136 N of compression while special load cells measured force vectors in the forearm. Com...

Gene therapy offers new possibilities for the clinical management of orthopaedic conditions that are difficult to treat by traditional surgical or medical means. To bring the potential of this novel technology into the clinic, a research program was initiated that aimed to identify orthopaedically useful genes and develop methods for delivering the...

To assess the role of a tendon spacer that fills the trapezial void, the trapeziums were excised and anterior oblique ligaments were reconstructed in 25 monkeys. In addition to the ligament reconstruction, 20 of the monkeys had the trapezial void filled with a tendon allograft. The trapezial space was investigated at 0, 3, 6, 15, and 40 weeks using...

Gene therapy offers new possibilities for the clinical management of orthopaedic conditions that are difficult to treat by traditional surgical or medical means. To bring the potential of this novel technology into the clinic, a research program was initiated that aimed to identify orthopaedically useful genes and develop methods for delivering the...

A retrospective review was performed that compared the results of 2 different surgical treatments for ulnar impaction syndrome in 22 patients over a 6-year period. Ulnar shortening osteotomy and wafer distal ulna resection (wafer resection procedure) were each performed in 11 patients based on the preference of 3 individual hand surgeons. All patie...

Previous approaches to measuring forces in the forearm have made the assumption that forces acting in the radius and ulna are uniaxial near the wrist and elbow. To accurately describe forces in the forearm and the forces in the interosseous ligament, we have developed a new methodology to quantitatively determine the 3-D force vectors acting in for...

Collectively, over 35 million Americans suffer from the various arthritidies with an annual cost estimated to be greater than 18 billion dollars annually [1]. Rheumatoid arthritis (RA) is a progressive, autoimmune disease that primarily affects diarthro-dial joints. It has a world-wide incidence of approximately four per 10000 in the population age...

From 1994 to 1997, 22 patients (24 wrists) underwent open revision carpal tunnel release for persistent carpal tunnel syndrome after a primary endoscopic release. The age range was from 21 to 77 years. At the time of revision surgery, 22 wrists had an incomplete release of the flexor retinaculum and two patients had median nerve transection (one pa...

Mr. President, fellow members of the American Orthopaedic Association, distinguished guests, ladies, and gentlemen: I want to thank you for the honor you have bestowed upon me. This is a proud moment, and, like my predecessors, I am both humbled and excited by the task you have set for me. The humbling part, by the way, came quickly, as soon as I...

Nondisplaced fractures of the scaphoid heal with cast immobilization in most cases, but operative treatment is being offered with greater frequency to active patients as an approach to reduce the period of cast immobilization. Computed tomography is more useful for evaluating displacement than standard radiography. Displaced fractures are at greate...

There are several emerging trends in perioperative transfusion that are promising in terms of clinical practice. These include modifications in transfusion practice, changes in blood bank procedures and philosophy, the use of autologous transfusion methods, and the development of new artificial blood substitutes. Refinement of current techniques wi...

Elbow arthroplasty most commonly is performed through a posterior approach by detaching or reflecting the triceps off the olecranon. Surgical approaches to the elbow joint that dissociate the triceps from the olecranon have distinct disadvantages. Triceps avulsion, triceps weakness, and wound healing problems have been reported. Such complications...

The surgical outcome in recurrent chronic nerve compression remains unsatisfactory. Clinically, it has been reported that vein grafts can be used to wrap the nerve, following nerve decompression, to improve the functional recovery of the nerve. In order to determine the safety and feasibility of the technique of vein wrapping of nerve, this study a...

The Short Form 36, a survey designed to accurately study subjective findings, was applied to analyze the outcome of distal radius fractures and its' relation to extrinsic and intrinsic factors. The survey was administered to 50 adults (mean age, 49.6 years) requiring fixation of a distal radius fracture with a mean followup of 2.4 years. Treatment...

A combined volar-dorsal approach was used to treat 11 perilunate dislocations and fracture dislocations between 1989 and 1994. The mean average age of the patients was 38 years, and the mean average time between injury and surgery was 13 hours. Outcome was assessed after an average of 30 months. Results were based on measurements of grip strength,...

Assessing the cross-sectional area of a partial laceration of a flexor digitorum profundus tendon based on its width, using magnification and calipers, is often inaccurate. As the threshold for repairing a partial laceration for most surgeons is the involvement of 50% of the tendon area, an accurate method of naked-eye evaluation to detect a 50% (o...

The interosseous membrane is a structure deep in the forearm that joins the radius and the ulna. It is made up of membranous and ligamentous regions. Two main ligamentous structures have been described: a prominent central fiber group, the "central band," and a smaller proximal fibrous band, the "oblique cord." Many authors believe that the central...

The interosseous membrane is a structure deep in the forearm and contains a ligamentous region-the “central band”. In this study, the tensile properties of the central band were determined. The central band structure had a stiffness of 13.1±3.0 N/mm per mm width and an ultimate load of 56.6±15.1 N per mm width (means±standard deviations). The centr...

Human immunodeficiency virus-infected hemophiliacs are at risk for bacterial and opportunistic infections with worsening immunosuppression. Thus, the risk of postoperative infection following orthopaedic surgery is of considerable concern. A survey of United States hemophilia treatment centers was conducted to determine the incidence of postoperati...

Since their introduction in the 1960s, nonmetallic biomaterials, such as silicone rubber and polyethylene, have been used extensively in orthopedic surgery. Alfred Swanson introduced silicone rubber for small flexible joints, and John Charnley pioneered the use of polyethylene as the articulating surface for large, weight-bearing joint replacements...

An in vivo canine model was developed to investigate the histologic and biochemical parameters associated with aseptic loosening. Thirty-eight canines had cementless total hip arthroplasty. Experimental groups were designed specifically to investigate the relative contributions of implant motion and particulate debris (cobalt chrome alloy, titanium...

The appropriate management of partially lacerated digital flexor tendons in zone 2 is controversial. Tenorrhaphy has been advocated by some on the basis of improving tendon gliding function, whereas others have recommended foregoing tenorrhaphy because of the negative impact of repair on the tensile strength of the tendon. In light of this division...

The pronator quadratus sign is associated with fractures of the distal radius and ulna and is believed to be due to accumulation of fluid within the pronator quadratus muscle. This anatomic study based on dye injection and x-ray film examination shows that the pronator quadratus occupies a distinct forearm space without intramuscular communication.