Validation of a Smartphone-Based Institutional Electronic Data Capture System for Thumb Carpometacarpal Joint Arthroplasty.

BACKGROUND: The Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of care (OME) is a prospectively collected database enabling capture of patient and surgeon-reported data in a more efficient, comprehensive, and dependable manner than electronic medical record (EMR) review. We aimed to assess and validate the OME as a data capture tool for carpometacarpal (CMC) arthroplasty compared to traditional EMR-based review. Specifically, we aimed to: (1) compare the completeness of the OME versus EMR data; and (2) evaluate the extent of agreement between the OME and EMR data-based datasets for carpometacarpal (CMC) arthroplasty. METHODS: The first 100 thumb CMC arthroplasties after OME inception (Febuary, 2015) were included. Blinded EMR-based review of the same cases was performedfor 48 perioperative variables and compared to their OME-sourced counterparts. Outcomes included completion rates and agreement measures in OME versus EMR-based control datasets. RESULTS: The OME demonstrated superior completion rates compared to EMR-based retrospective review. There was high agreement between both datasets where 75.6% (34/45) had an agreement proportion of >0.90% and 82.2% (37/45) had an agreement proportion of >0.80. Over 40% of the variables had almost perfect to substantial agreement (κ > 0.60). Among the 6 variables demonstrating poor agreement, the surgeon-inputted OME values were more accurate than the EMR-based review control. CONCLUSIONS: This study validates the use of the OME for CMC arthroplasty by illustrating that it is reliably able to match or supersede traditional chart review for data collection; thereby offering a high-quality tool for future CMC arthroplasty studies.

Bowler's thumb: ultrasound diagnosis of a neuroma of the ulnar digital nerve of the thumb.

Bowler's thumb is a rare traumatic neuropathy of the ulnar digital nerve of the thumb. We present a case of bowler's thumb in a 21-year-old male recreational bowler who presented with a painful mass on the ulnar side of the right thumb. Magnetic resonance (MR) imaging of the hand was inconclusive. However, subsequent ultrasound (US) showed asymmetric enlargement of the ulnar digital nerve of the thumb with marked epineural thickening corresponding to the palpable mass, confirming the clinical diagnosis of bowler's thumb. Although this condition is typically diagnosed clinically, imaging can help to clarify clinical findings. In our experience, MR imaging is a clinician's preferred choice when further evaluating physical findings of digital nerve pathology despite the lack of evidence to support MR as a primary imaging modality for these patients. This case illustrates the role that US can play as an initial imaging modality for the evaluation of small peripheral nerves.