A Message from the President, Dr. Nash Naam
Nash Naam, MD
It saddened and shocked me to the core to witness violence and hatred directed at a group of the most patriotic Americans, Asian Americans. America is the melting pot for all people from every faith, creed, ethnicity or national origin. We are all Americans, and we all love our country and our families. To see this hatred and violence directed at our friends, neighbors, partners and colleagues makes us all less than what we really are. We are a country built on embracing everyone and respecting everyone no matter where they came from or what ethnicity they belong to. Our diversity is the core value behind our greatness. We at the American Association for Hand Surgery strive to be inclusive and welcoming to everyone with no regard to national origin, ethnicity or religion. We embrace all Americans who contribute day in and day out to the progress and the greatness of our country. There is no place for hate or discrimination in our midst.
Many of our members and our leaders are Asian Americans who contribute significantly not only to our progress and growth, but also to advancing science and hand care education across the globe. We salute them and tell them that we have your back. We will not allow any discrimination or any hatred directed at anyone or any group of our members, our colleagues or our patients. We celebrate our inclusivity by reaffirming our commitment to diversity, respect, appreciation and equality. This is how we grow and how we prosper as united Americans. As I would paraphrase something President Lincoln said, "With Malice to none and Love for all".
Nash Naam, MD
From the Editor's Desk
John Fowler, MD
Editor, Hand Association News
Spring is upon us and with the change in season comes some changes with this publication. Hand Association News is undergoing some exciting changes to improve the content of the Newsletter and bring in fresh ideas. Hand Association News welcomes five new Junior Editors (Drs. Jennifer Kargel, Jillian McLaughlin, Lacey Pflibsen, Naveed Nosrati, and Jonathan Lundy). The new Junior Editors have brought many outstanding ideas for new articles, member spotlights, videos, and topics. The overall goal of these changes are provide improved content and a better product for AAHS members.
The virtual annual meeting was a resounding success and I want to offer my congratulations and thanks to Drs. Adams and Rekant, Dr. Naam, and the AAHS staff for pulling it off. There are so many unknowns when trying to plan a meeting with a new format and I think that the weekly sessions worked very well. Former Obama Chief of Staff, Rahm Emmanuel, said, "You never want a serious crisis to go to waste. I mean, it's an opportunity to do things that you think you could not do before." The COVID-19 crisis has forced our society and many organizations to rethink how to do things and it has become an opportunity to make improvements and changes that may not have been possible before the crisis. Many times in medicine, and in general, we tend to do things a certain way simply because that is the way they were done before. Hopefully we can use this horrible time in human history to innovate and make beneficial changes.
Thank you for reading Hand Association News and I hope you enjoy the new content and columns.
John Fowler, MD
Editor, Hand Association News
Meet a Member! Meet Dr. Andrew Zhang
Dr. Andrew Zhang
In this Spring edition of the Hand Association News, we are introducing the "Meet a Member" column, designed to highlight one of our many wonderful AAHS members. It is an opportunity to learn more about our colleagues outside of medicine and to help us connect as a national and global community. Members should feel free to write in to nominate interviewees and suggest questions!
Please meet Dr. Andrew Zhang! Interview by Dr. Jennifer Kargal.
Dr. Andrew Zhang is an associate professor in the department of plastic surgery at the University of Texas Southwestern Medical Center, located in Dallas, TX. He has been a member of the American Association for Hand Surgery since 2013. He completed his medical school and residency training in plastic surgery at Stanford, where he also completed his fellowship in hand surgery. As a board-certified plastic surgeon and hand surgeon, his scope of practice includes trauma-related and reconstructive hand surgery and reconstructive microsurgery. In addition to a busy clinical practice, he serves as the residency program director for integrated and independent plastic surgery programs at UT Southwestern.
How did you initially become interested in the field of hand surgery?
As a medical student, I had the benefit of having Dr. Robert Chase as one of my anatomy professors at Stanford. During that class, he gave an amazing lecture on hand surgery and it blew me away. When I approached him later to ask more about the field, he gave me a book entitled “The Hand” by the neurologist Frank Wilson. After reading that book, I was inspired to explore the field. Later on in medical school, during my clinical rotations, I fell in love with the field of surgery and throughout my training in medical school, residency, and then fellowship, that path through various specialties and subspecialties led me to hand surgery. I love that, in hand surgery, I’m able to work on all different tissue types at any given time.
Did you have any struggles or set-backs growing up that you had to overcome to reach these goals?
I was born in China and immigrated to the United States when I was 17 years old. At that time, I did not speak English and had to learn very quickly how to communicate with others.
How did you do that?
Well, I’m not sure that I'd recommend this now but I learned a lot of the English language at that time by watching "Married with Children."
You now practice at UT Southwestern in Dallas, TX and have been there for approximately five years. What has made you feel that Dallas is a good fit for you, at this point in your professional career?
As an academic surgeon, I was looking for growth opportunities and new challenges. The environment provided by UT Southwestern offered this in abundance. I am the residency program director for the integrated and independent plastic surgery programs here, and I get to operate at a level 1 trauma and regional referral center. There are many opportunities here for growth as a surgeon and as an academician.
What are your goals for the future?
One of the things I love about being at an academic center is the opportunity to identify challenges and make improvements in patient care and medical education. My goals are to continue pursuing these passions and leadership opportunities, to work towards developing new tools and treatments to improve education as well as the lives of our patients.
Well, you clearly have a lot on your plate at work with big plans for the future. Can you tell us a little about your family and support structure that helps keep you balanced in the midst of that?
I have a beautiful wife of 18 years, and we've known each other since medical school. She is outgoing and outspoken, sings opera, and speaks seven languages, so I guess it's true that “opposites attract.” She definitely keeps me grounded. We have two teenage daughters who are 15 and 13 years old. They have helped me learn how to give space and allow room for them to make some of their own decisions. As surgeons, we like to control our environment, but I've learned that with them it isn't always feasible or realistic. It's a balance trying to be supportive and encourage open dialogue while still providing boundaries and rules, but I’m learning.
What else do you do to maintain work/life balance?
It's important to make time and reserve energy to devote to things outside of work—your spouse, your kids, and yourself. During covid restrictions, one positive outcome is that as my daughters have been remotely learning, I've had the opportunity to spend more time with them at home. I've also been focusing more on exercising and paying attention to nutrition. It's helped me keep my mind focused and sharp, and I feel that these are important to maintain mental health. One of the things I have really missed due to covid is the ability to spend time together with close friends, which can lead to us feeling more isolated. To remedy this, I have been trying to reach out more to those friends and connect over the phone, having longer and more meaningful conversations rather than the quick texts or calls that preceded covid. In this way, we’re still able to maintain those relationships, even if it looks a little different right now.
With the potential end of covid somewhere along the horizon, what are you most looking forward to doing?
Definitely traveling! I love to travel to new places to experience the culture while learning about the history of a place. I really do enjoy traveling to see new sites, meet new people, and sample new cuisine.
What's your favorite travel destination so far?
There are many, but I'd have to say one of our last trips which was a cruise to the Baltic region, where we got to travel to places like Estonia, Finland, Sweden, and Russia. Oh, and most recently, we traveled to Acadia national park in Maine, which was an amazing place to experience nature.
Speaking of favorites, you know we have to bring it back to hand surgery at some point. It's what we do as hand surgeons! What's your favorite procedure in hand surgery?
That's an easy one. It's an open fasciectomy for Dupuytren's contracture. The dissection is meticulous and the anatomy is so well-laid out. It is also extremely satisfying to excise the cord and straighten the finger at the end.
Thank you so much for sharing your time and your insights with the AAHS community. Do you have any additional thoughts, perhaps lessons learned during your career or advice for new hand surgeons entering the field?
I've learned over the years that it is important to be open-minded about things and to take the time to think through the problem before making a decision. Rather than being reactive, this has allowed me to remove some of the emotion from the decision-making process and make better and sometimes innovative decisions in clinical care and administrative arenas. For those new to the field, I'd tell them there is a lot to learn in this specialty, and while that can be overwhelming sometimes, you should take the opportunity to reach out to your peers and mentors to talk things through. They can provide insight and tips, and they love to connect with you.
Ask an Expert!
Welcome to our newest section: Ask an Expert! To start this section off we would like to ask you for a suggestion.
Do you have a burning question for one of our experts?
Is there a tough case you just need some advice with?
Not sure how to properly code a case?
Has there been a topic that you have been looking for clarity on?
If you have a question for us please send it in to firstname.lastname@example.org. Make sure to include your question, and if it is a case any pertinent information or imaging. Once we have your responses we'll pick a few each newsletter and present it here. Looking forward to all the great questions!
Remembering Past President and Hand Surgery Quarterly Editor, Dr. James Hoehn
Dr. James Hoehn
AAHS is saddened to share that one of its Past Presidents and Editor of Hand Surgery Quarterly (now Hand Association News) passed away on Christmas Eve, December 24, 2020.
Dr. Hoehn was known as a trailblazer in the field and was an outstanding leader in cultivating the field of plastic surgery. He focused on hand surgery throughout his career, serving as AAHS President from 1983 to 1984, and traveled the world to share his knowledge and expertise. He was a beloved husband, father, and good friend to all who knew him. Dr. Hoehn led a full life of purpose and was a good leader, with an unending passion for learning and meeting challenges, particularly for the sake of the advancement of plastic surgery. He served as Hand Surgery Quarterly Editor from 1995 to 2001.
To read more about Dr. Hoehn and his many contributions to AAHS, please see the following resources.
- Hand Surgery Quarterly issues 1995 to 2001: https://handsurgery.org/newsletter
- The First Twenty-Five Years, History of the American Association for Hand Surgery by Dr. Alan Freeland, page 27: https://handsurgery.org/multimedia/files/25-Years-History-Book.pdf
- Remembering ASPS Past President James Hoehn, MD, 1938-2020: https://www.plasticsurgery.org/for-medical-professionals/publications/psn-extra/news/remembering-asps-past-president-james-hoehn-md-1938-2020
Around the Hand Table
For those who remember Around the Hand Table from past newsletters, the Hand Association News Editors are happy to announce we have revived and modernized this column! The first Around the Hand Table article is a focus on the AAHS Distal Radius Fractures Webinar, which was moderated by Dr. Joshua Abzug at the University of Maryland School of Medicine and original aired May 17, 2020. Watch this entire webinar or brush up on specific topics related to the treatment of distal radius fractures. Use the guide below which lists presentation start times, presenters, and lecture synopses to efficiently navigate to specific sections.
3:39 - David Bozentka, MD, University of Pennsylvania, provides an overview of radiographic parameters and clinical assessment of distal radius fractures. His lecture reviews operative indications and associated clinical findings to optimize patient outcomes.
10:36 - Glenn Gaston, MD, OrthoCarolina, discusses how the radiographic findings impact his preferred approach to treatment. Through a diverse case-based review, he discusses key reduction maneuvers and instrumentation to optimize success.
23:25 - A. Lee Osterman, MD, The Philadelphia Hand to Shoulder Center, reviews the literature and indications for the use of wet and dry arthroscopy in the treatment of distal radius fractures and associated injuries. A variety of cases discuss peals and pitfalls, emphasizing the role of arthroscopy in distal radius fracture treatment.
37:19 - Ray Pensy, MD, University of Maryland, discusses how complex distal radius fractures can be more easily visualized with the use of traction views allowing for more adequate surgical planning and how external fixation technique can assist in the surgical treatment.
54:09 - Jesse Jupiter, MD, Harvard University, provides an overview of the management of distal radius malunion. He provides insight into the clinical presentation, indications/contraindications to operative management, timing, and preoperative planning necessary to achieve correction of various distal radius malunion types.
AAHS offers a database of previously recorded FREE webinars available on-demand. Take advantage of the opportunity to learn from the experts in the field. For access to these educational opportunities and others, visit the AAHS website.
HAND Article Feature: Volume 16, Issue 1, January 2021 by Dr. Jonathan Lundy
Opioid Versus Nonopioid Analgesia After Carpal Tunnel Release: A Randomized, Prospective Study
Louis C. Grandizio, Hui Zhang, C. Liam Dwyer, Steven H. Goldberg, Joel C. Klena
First Published March 29, 2019; pp. 38-44
Imagine as surgeons being able to eliminate our contribution to the current opioid addiction epidemic. That is exactly what Grandizio and colleagues from Geisinger Medical Center may assist in accomplishing with their single-center, prospective study comparing opioid and nonopioid analgesia after carpal tunnel release (CTR).1 The group enrolled 68 patients between February and August 2018 and, using an internet-based randomization tool, randomized patients into a nonopioid and conventional opioid arm.
The methods involved patients in the nonopioid arm receiving a single dose of a nonsteroidal anti-inflammatory (NSAID; either oral celecoxib or naproxen), oral acetaminophen, and oral pregabalin on the day of surgery prior to CTR. Patients in the opioid arm received no multimodal medications preoperatively. CTR was performed either open or endoscopically with local anesthesia and postoperative dressings carried out similarly in both arms. Postoperative medications in the nonopioid group included oral acetaminophen every 6 hours and naproxen twice daily as needed for pain. Opioid arm patients received 10 tablets of hydrocodone-acetaminophen 5-325mg to be taken every 4-6 hours as needed for pain as well as instructions to use acetaminophen as needed for pain with clear guidance on not exceeding daily dose limits.
Patients recorded daily in a pain journal beginning the day of surgery for 7 days recording opioid use, mean and highest NPRS score, and satisfaction with surgery and pain control based on an 11 point Likert score. A clinic assessment of pain, motion, and similar pain and function scores was performed two weeks postoperatively. The author’s hypothesis was that opioid postoperative pain medication will not result in improved pain scores when measured at two weeks postoperatively. Secondary outcomes measured and compared included PROMIS, QuickDASH, and pain scores via a numeric pain rating scale (NPRS).
The authors found that patients in the nonopioid arm (n=33) had a lower mean NPRS score (1.45 versus 2.86; p=0.0022) than the opioid group (n=35). QuickDASH scores were also significantly lower (31 versus 40; p=0.0410) for nonopioid patients. Patients prescribed opioids took on average 3 pills while patients who actually took opioid pills using an average of 5. In addition, pain journal data showed significantly lower daily mean and highest NPRS scores for nonopioid patients for days 0 to 6 and at 2 weeks from date of surgery.
When considering that after elective and trauma-related hand surgical procedures, 13% of opioid-naïve patients will continue filling opioid prescriptions 90 days after surgery, a program of minimization or elimination of opioid prescribing would have a considerable impact on reducing hand surgeons’ complicity in the opioid epidemic.2 Grandizio and colleagues have shown that with open and endoscopic CTR, not only is elimination possible, but results in better pain scores and satisfaction compared to a traditional opioid postoperative pain control regimen. The use of a multimodal, nonopioid based postoperative pain regimen for CTR and other hand surgical procedures can pave the way for elimination of our contribution to the ongoing opioid addiction crisis.
- Grandizio LC, Zhang H, Dwyer CL, Goldberg SH, Klena JC. Opioid versus nonopioid analgesia after carpal tunnel release: a randomized, prospective study. Hand 2021;16(1):38-44.
- Johnson SP, Chung KC, Zhong L, Shauver MJ, et al. Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures. J Hand Surg Am 2016;41(10):947-953.
Educational Benefits of Working with Advanced Practice Providers (APPs): A Resident Perspective by Lacey Pflibsen
The use of advance practice providers (APP) has an invaluable role in the delivery of quality care in hand surgery. The utilization and implementation in their care can be wildly variable in different institutions and practices. Their role in resident education is sometimes an overlooked aspect of their value and utility in an academic center. As a current resident, I can attest that APPs have been essential in my education.
Part of my education as a resident has been from the APPs in our department.
From helping young residents navigate the OR/clinic, to educating senior residents on how to best utilize them in future practice, they serve a continuum of roles in a teaching hospital. I have been fortunate that our APPs have been in their roles for over a decade and have the clinical and surgical fortitude to prove it. They have been incredibly kind in teaching me hand surgery during my residency.
Each year, education changes its trajectory. As an intern and junior resident, they have been invaluable as intermediate person to ask surgeon related preferences, EMR related questions, patient phone call advice, disability paperwork guidance, basics of the hand exam, etc. During the middle years of training, we have worked cohesively, in tandem, on our busy hand service. They serve as the sounding board for developing post-operative plans. As I have been approaching my chief year in residency, I see how the APPs have trained me for practice. They have helped to share all aspects of the patient load so that I can have my focus on surgical and clinical management. They have also trained me on how to best utilize them in future practice. From doing cases where they make me practice putting my assistant in the right position, to patient evaluation and management in clinic when they double check my postoperative protocol planned, they prepared me for my future hand surgery practice.
It is as I have sat down to write this article that I see the brilliance of my beloved APPs. They have pushed me out of the nest and prepared me for my future. Thank you!
Upcoming Webinars and Online Video Resources from AAHS
To fulfill its mission to advance global hand care and education, the American Association for Hand Surgery (AAHS) has developed a Webinar Series focused on providing hand care to the global community. The AAHS Webinar Series is a FREE educational program for medical professionals around the globe. View Calendar of Events for full webinar schedule and details.
Endo Pharmaceuticals Virtual Injection Certification Course
This virtual injection certification course presented by Endo Pharmaceuticals is an introduction to XIAFLEX® (collagenase clostridium histolyticum) designed for Fellows, Residents, and those new to the product. Attendees will have an opportunity to become XIAFLEX® certified after learning about the clinical data, treatment procedure, and watching videos of experienced injectors perform real patient procedures.
Tuesday, April 13, 2021
AAHS/AAOS CME Webinar: My First Year in Practice: How to Hit the Ground Running
Wednesday, July 7, 2021
Information on additional webinars to be held in 2021 will be available soon. Visit the AAHS website for complimentary access to 18 outstanding webinar recordings for replay.
Recordings from the 2021 AAHS Virtual Meeting held in January and February 2021 as well as the On-Demand Abstract Presentation Library can still be accessed via the AAHS Virtual Portal. Discounted registration for members is also still available if you haven’t registered yet and would like to and claim CME credit.
Join AAHS for its Specialty Session during AAOS 2021!
Join the AAHS as it hosts its "Specialty Session" on Friday, September 3, 2021 during the AAOS Annual Meeting in San Diego, California! Drs. Ngozi Akabudike and Glenn Gaston have prepared an excellent program, "Excellence in Hand & Upper Extremity Surgery: An Update on Dogma and Current Trends" and have secured expert faculty to participate in this half day session. The AAHS Specialty Session program will run from 8:00 AM to 12:30 PM local time on September 3rd. We hope to see you there!
See program details! Registration information will be available soon.
Receive a 15% Discount on 2022 Annual Meeting Registration
The Hand Association’s leadership and Program Chairs are working to put together a stellar event to reunite the hand care community in January!
How can you receive a 15% discount on 2022 Annual Meeting registration?
Recruit a friend or colleague to join AAHS this year!
New members elected in 2021 and existing AAHS members who recruit a friend or colleague to join the Hand Association as a member will receive a 15% discount off 2022 Annual Meeting registration fees!