Differences in wrist mechanics during the golf swing based on golf handicap.

OBJECTIVES: Variation in swing mechanics between golfers of different skill levels has been previously reported. To investigate if differences in three-dimensional wrist kinematics and the angle of golf club descent between low and high handicap golfers. DESIGN: A descriptive laboratory study was performed with twenty-eight male golfers divided into two groups, low handicap golfers (handicap = 0-5, n = 15) and high handicap golfers (handicap ≥ 10, n = 13). METHODS: Bilateral peak three-dimensional wrist mechanics, bilateral wrist mechanics at ball contact (BC), peak angle of descent from the end of the backswing to ball contact, and the angle of descent when the forearm was parallel to the ground (DEC-PAR) were determined using an 8 camera motion capture system. Independent t-tests were completed for each study variable (α = 0.05). Pearson correlation coefficients were determined between golf handicap and each of the study variables. RESULTS: The peak lead arm radial deviation (5.7 degrees, p = 0.008), lead arm radial deviation at ball contact (7.1 degrees, p = 0.001), and DEC-PAR (15.8 degrees, p = 0.002) were significantly greater in the high handicap group. CONCLUSION: In comparison with golfers with a low handicap, golfers with a high handicap have increased radial deviation during the golf swing and at ball contact.

Current practice of microsurgery by members of the American Society for Surgery of the Hand.

PURPOSE: First, to determine the percentage of members of the American Society for Surgery of the Hand (ASSH) that use microsurgical techniques as part of their surgery practice, and second, to identify factors limiting their use of these techniques. METHODS: A 34-item, anonymous, Web-based survey was sent to all active ASSH members. Twelve items concerned demographics and 22 items addressed prior microsurgical training, current use of these techniques, factors currently limiting their use of these techniques, and potential methods to address these limiting factors. RESULTS: Responses were received from 561 of 1,238 of the ASSH members contacted (45% response rate). Most had residency training in orthopedics (N=460, 82%) or plastic surgery (N=79, 14%), followed by a hand fellowship in an orthopedic (N=363, 62%) or combined program (N=170, 30%). More than 54% (N=304) practiced privately, 33% (N=184) practiced in tertiary institutions, and the remainder practiced at regional centers. Of those responding, 505 (90%) stated that hand surgery constituted more than 50% of their practice, whereas for 527 (94%) respondents microsurgery comprised less than 25%. Most members (N=398, 71%) accepted emergency patients, of which 223 (56%) at a referral center. Three hundred sixteen respondents (56%) performed replantations, of whom 196 (62%) performed fewer than 5 per year. Four hundred fifteen respondents (74%) observed a decrease in replantation attempts over the past decade. This was attributed to refinement of indications (N=17, 83%), fewer patients with amputations (N=116, 28%), and declining reimbursement (N=344, 4%). Reasons for not personally performing replantations included busy elective schedules (N=125, 51%), inadequate confidence in performing replantations (N=96, 39%), and disappointment in results (N=56, 23%). Thirty percent (N=74) stated they would reconsider performing replantations if reimbursement was greater. Practice rates of examined microsurgical procedures ranged from 22% to 57%, although most had received microsurgical training. Despite rating their fellowship as excellent (N=393, 70%) or good (N=135, 24%), only 315 (56%) considered their present microsurgical skills to be above average. Many respondents believed that they would benefit from continuous training through continuing education courses. CONCLUSIONS: Educational, economic, and practical factors discourage the clinical application of microsurgical technique by hand surgeons. This unfavorable environment should be addressed by policy-making organizations and continuous surgical training. TYPE OF STUDY/LEVEL OF EVIDENCE: Other/Survey.

Oncologic and aesthetic results following breast-conserving therapy with 0.5 cm margins in 100 consecutive patients.

The purpose of this study was to evaluate the oncologic and aesthetic results of patients undergoing breast-conserving therapy with 0.5 cm surgical margins and determine the factors that influence the need for reconstruction. One hundred consecutive patients who underwent breast-conserving surgery with 0.5 cm surgical margins followed by radiotherapy for invasive cancer and ductal carcinoma in situ (DCIS) were followed prospectively and evaluated for recurrence and aesthetic result. Thirteen patients underwent reexcision to achieve a 0.5 cm margin. Factors including breast size, location of the tumor, specimen size and volume, tumor size and volume, and TNM stage, if axillary dissection or reexcision were required, were included in the analysis. Aesthetic evaluation consisted of both patient rating and an independent observer rating on a 10-point scale that assessed volume, shape, symmetry, areola/nipple, and scar. Of the 100 patients that underwent breast-conserving therapy, the overall aesthetic results revealed that 8% of the patients scored themselves seven or less, another 8% were scored seven or less by the independent observer, and another 7% were scored seven or less by both the patient and the observer. Of these patients, only one proceeded to have a reconstructive procedure. Analysis of variance revealed a significant correlation between tumor size (cm(2)) and an aesthetic score of seven or less (p = 0.023), and specimen volume (cm(3)) and an aesthetic score of seven or less (p = 0.039). Chi-squared analysis revealed a significant difference (chi(2) = 4.39, p < 0.5) in the aesthetic result in patients with stage IIA disease. Other independent factors such as age, breast size, location of the tumor, axillary dissection, and reexcision did not influence the overall aesthetic result. A Pearson correlation of patient and independent observer ratings showed a positive correlation (r = 0.4; 95% confidence interval [CI] 0.19-0.57) between the two groups. There were zero local recurrences of breast cancer during the study period. Our results demonstrate that following breast-conserving therapy with a minimum of 0.5 cm resection margins, it is possible to achieve excellent oncologic and aesthetic results. Patients with large tumors that require a large volume of resection or with stage IIA disease should be considered for reconstructive evaluation.