ABSTRACT
BACKGROUND: This study aims to compare the performance of ChatGPT-3.5 (GPT-3.5) and ChatGPT-4 (GPT-4) on the American Society for Surgery of the Hand (ASSH) Self-Assessment Examination (SAE) to determine their potential as educational tools. METHODS: This study assessed the proportion of correct answers to text-based questions on the 2021 and 2022 ASSH SAE between untrained ChatGPT versions. Secondary analyses assessed the performance of ChatGPT based on question difficulty and question category. The outcomes of ChatGPT were compared with the performance of actual examinees on the ASSH SAE. RESULTS: A total of 238 questions were included in the analysis. Compared with GPT-3.5, GPT-4 provided significantly more correct answers overall (58.0% versus 68.9%, respectively; P = 0.013), on the 2022 SAE (55.9% versus 72.9%; P = 0.007), and more difficult questions (48.8% versus 63.6%; P = 0.02). In a multivariable logistic regression analysis, correct answers were predicted by GPT-4 (odds ratio [OR], 1.66; P = 0.011), increased question difficulty (OR, 0.59; P = 0.009), Bone and Joint questions (OR, 0.18; P < 0.001), and Soft Tissue questions (OR, 0.30; P = 0.013). Actual examinees scored a mean of 21.6% above GPT-3.5 and 10.7% above GPT-4. The mean percentage of correct answers by actual examinees was significantly higher for correct (versus incorrect) ChatGPT answers. CONCLUSIONS: GPT-4 demonstrated improved performance over GPT-3.5 on the ASSH SAE, especially on more difficult questions. Actual examinees scored higher than both versions of ChatGPT, but the margin was cut in half by GPT-4.
ABSTRACT
BACKGROUND: Spontaneous rupture of the extensor pollicis longus (EPL) tendon following both nonoperative and operative treatment of distal radius fractures has been well described. PURPOSE: The purpose of this study was to assess long-term outcomes of extensor indicis proprius to EPL tendon transfers for patients following distal radius fracture and EPL tendon repair. STUDY DESIGN: Retrospective case series focusing on long-term clinical outcomes. METHODS: A retrospective review was conducted for patients who sustained a distal radius fracture and subsequently underwent extensor tendon transfer from 2005-2015 at a private practice center. Outcome measures including index finger (IF) metacarpophalangeal (MCP) and thumb interphalangeal (IP) active range of motion (ROM), digital extension against resistance, subjective complaints, and QuickDASH scores were recorded at final follow-up. RESULTS: Seven patients were included in the study. There were six females and one male subject, mean age of 54 ± 13 years at injury of EPL, and 5/7 involved the left upper extremity. For isolated function, 7/7 (100%) patients had isolated, active IF MCP extension, 6/7 (86%) could extend IF MCP and thumb IP against resistance. Mean IF MCP extension was 1° ± 2°, mean IF MCP flexion was 89° ± 2°, mean thumb IP extension was -5° ± 4°, and mean thumb IP flexion was 67° ± 15°. Mean QuickDASH score was 16 ± 14. CONCLUSIONS: This series shows good long-term functional and patient reported outcomes in patients following extensor indicis proprius to EPL tendon transfers at a single center.
ABSTRACT
BACKGROUND: The aim of this study was to validate the use of temperature sensors to accurately measure thermoplastic volar forearm splint wear in a healthy cohort of volunteers using 5- and 15-minute temperature measurement intervals. METHODS: A prospective diagnostic study was performed to evaluate the diagnostic accuracy of temperature sensors in monitoring splint wear in 8 healthy volunteers between December 2022 and June 2023. Temperature sensors were molded into thermoplastic volar forearm splints. Volunteers who were familiar with the study aims were asked to keep an exact log of the time spent wearing the splint ("actual wear time"). Sensors recorded temperatures every 5 or 15 minutes, and separate algorithms were developed to determine the sensor-detected wear time compared with the actual wear time as the gold standard. The algorithms were then externally validated with the total population. RESULTS: The 5-minute and 15-minute algorithms demonstrated excellent sensitivity (99.1% vs 96.6%), specificity (99.9% vs 99.9%), positive (99.4% vs 99.5%) and negative (99.9% vs 99.3%) predictive value, and diagnostic accuracy (99.8% vs 99.3%), respectively. The 5-minute algorithm recorded 99.5% of the total splint hours, whereas the 15-minute algorithm recorded 96.1%. There was no significant difference between the actual time per wear session (5.4 ± 2.7 hours) and the time estimated by the 5-minute algorithm (5.4 ± 2.6 hours; P = .40), but there was a significant difference for the 15-minute algorithm (5.2 ± 2.6 hours; P < .001). CONCLUSION: Temperature sensors can be used to accurately monitor thermoplastic volar forearm splint wear. LEVEL OF EVIDENCE: Diagnostic II.
ABSTRACT
Penetrating lacerations to the hand are a common cause of nerve injury and can lead to debilitating pain and numbness in the distribution of the nerve affected. Owing to an overlap in the cutaneous innervation from different sensory nerves, clinically identifying the injured nerve can be difficult. We present a novel case of isolated injury to the palmar cutaneous nerve from a penetrating knife injury which was detected using 'comparison waveform' nerve conduction studies. Using this technique, we can isolate injuries to the palmar cutaneous branch of the median nerve (PCBmdn) from the median nerve, dorsal radial sensory nerve, and lateral antebrachial cutaneous nerve. In addition, sensory nerve testing identified conduction block as the mechanism of injury, which resolved after surgery at 8 weeks postoperatively. Preoperative nerve conduction study can discern the level of nerve injury to PCBmdn only, thus eliminating the need for median and radial nerve exploration at the forearm, unnecessary incisions, pain, and scarring. The objective of this case report is to illustrate the value of preoperative comparison waveform nerve conduction study, particularly the PCBmdn, in patients presenting with neurologic deficits who have sustained penetrating lacerations to the hand.
