26th Annual Smith Day; May 29, 2015
Second Annual Jesse B. Jupiter International Hand Forum; May 30 – May 31, 2015
Royal Sonesta Hotel, Cambridge
Hosted by: Hand & Upper Extremity Service, Massachusetts General Hospital, Boston, MA
Course Director: David Ring, MD, PhD
Honored Sage: Jesse Jupiter, MD
26th Annual Richard J. Smith Day Orator: Graham King, MD
2nd Annual Jesse B. Jupiter International Hand Forum Orator: Michael McKee, MD
Program and Highlights:
Thursday, May 28, 2015:
Written by Jos Mellema
The Boston Hand Club Dinner took place at the Royal Sonesta Hotel right along the Charles River with astonishing views of Boston’s skyline. Hand surgeons from New England and beyond came together to network and hear an oration from this year Smith Day Lecturer, Dr Graham King.
After a wonderful dinner and while coffee was served, Graham King, Professor in the Departments of Surgery, Medical Biophysics and Biomedical Engineering at the University of Western Ontario, Chief of Surgery and Director of the Roth McFarlane Hand and Upper Limb Centre at St. Joseph’s Health Centre, started speaking about his experience as a surgeon implant designer. He discussed his success and failures. His drive to improve patient care by designing implants led to an impressive journey that improved his knowledge about the wrist and elbow and that of many others.
Friday, May 29, 2015:
Written by Stein Janssen
A warm welcome by David Ring started the 26th Smith day; a promising schedule with forty-seven talks and to top it all, the Smith Oration by Graham King from Canada. Four minute presentations alternated with discussions by leaders in the field of hand surgery not only helped maintain the attention span but also nourished the minds of younger attendees.
Original studies covering topics ranging from the elbow to the tip of the finger were presented by bright researchers and thought provoking topics fueled the subsequent discussions. In addition to Graham King, we were lucky to have Mike McKee, Bob Hotchkiss, Dan Rikkli (Swiss), Terry Axelrod, and Karl Prommersberger (German) with us to put studies in a clinical, historical, and international perspective. Many former fellows were with us as well. Presentations from University of Vermont and Yale in addition to all the Boston metropolitan programs made it a truly regional program.
The day was concluded by the Smith orator Dr Graham King, cordially introduced by Jesse Jupiter who reminded us of the uniqueness of the man the day is named for. Graham King spoke about the current status and future directions for development of total elbow prostheses. This great talk set the stage for the coming International Jesse Jupiter Hand forum.
Saturday, May 30, 2015 – Day 1
Written by Mariano Menendez
The first day of the Second Annual Jesse B. Jupiter International Hand Forum was dedicated to upper extremity trauma from the clavicle to the elbow. Consistent with last year’s structure, brief 5-minute presentations from eminent national and international surgeons were followed by captivating debate sessions.
The day started off with Mike Robinson’s talk on diaphyseal clavicle fractures, which centered around when to operate (and when not to) and the role of shared-decision making tools (e.g. decision aids), and was followed by an interesting presentation by Mike McKee on lateral clavicle fractures with particular emphasis on treatment options and the use of patient-reported outcome measures such as DASH and PROMIS Physical Function. The last talk of the first morning block was on the management of extra-articular scapular fractures, by George Athwal.
Focusing now on proximal humerus fractures, David Ring discussed the results of the recent PROFHER trial ––which evaluated the effectiveness of operative versus non-operative treatment of displaced surgical neck fractures–– and also discussed ways to prevent varus collapse. Up next was Mike Robinson’s talk on the complex management of valgus impacted fractures, followed by George Athwal’s interesting presentation on the role of hemiarthroplasty and reverse total shoulder arthroplasty for patients with displaced fractures of the proximal humerus.
The next set of talks by Terry Axelrod and Scott Steinmann focused on humeral diaphyseal fractures, with special emphasis on the management of radial nerve palsies (initial versus delayed repair), the role of operative and non-operative treatment, and the management of nonunions as well as issues of exposed hardware. Right after that, David Ring shared with the audience some interesting thoughts regarding the management and quality of life in patients with diaphyseal clavicle and humerus nonunions.
The first afternoon block was on distal humerus fractures, and Dan Rikli was the first to take the stage with his talk on isolared lateral or medial column fractures. He pointed out the importance of pathomechanics when classifying fractures and commented on the role of arthroscopy for treating these fractures. David Ring was up next with his presentation on the management of bicolumnar fractures, which discussed current areas of debate such as parallel versus perpendicular plating, non-operative treatment (“bag of bones”) versus total elbow arthroplasty, and whether such fractures can be fixed without moving the nerve. Mike Robinson ended this block with his talk on the diagnosis and treatment of capitellum and trochlear fractures.
The next 2 talks focused on proximal ulna and radius fractures. Mark Cohen commented on the role of operative and non-operative treatment of isolated radial head fractures and called for better classification systems. Graham King talked about the complex management of elbow dislocations with fractures of the radial head and coronoid process (“the terrible triad injury of the elbow”).
After a number of interesting cases presented by David Ring and Charles Cassidy, we had the honor to listen to Dr. Jupiter’s talk on the challenges of elbow fracture surgery including contracture, heterotopic ossification and nonunions/malunions.
The day came to an end with the Second Annual Jupiter Oration by Mike McKee on how scientific evidence changed clinical practice of clavicle fractures. His randomized trial demonstrated that surgery results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment, but he pointed out to the importance of choosing our patients wisely. Mike McKee ended his talk by calling for more randomized controlled trials and additional research to identify patients at-risk for suboptimal outcomes after surgery for clavicle fractures.
Sunday, May 31, 2015 – Day 2
Written by Jos Mellema
The second day of the Jesse B. Jupiter International Hand Forum was dedicated to upper extremity trauma from the elbow to the fingertip. David Ring started the day off with a summary of discussions from the first day of the forum.
Discussion on proximal ulna and radius fractures was continued in the first section. Mark Baratz reviewed different treatment options for isolated olecranon fractures. This was followed by a talk of Robert Hotchkiss regarding anteromedial facet coronoid fractures. Along the same lines, David Ring presented several cases and emphasized the importance of recognizing olecranon fracture-dislocations and associated injuries.
Adverse outcomes were subject of discussion in a section with presentations by Robert Hotchkiss and David Ring. Most challenging cases were reviewed, such as ulnar neuropathy, stiffness, and heterotopic ossification, which led to a debate on how to handle those cases.
In the next section diaphyseal forearm fractures were discussed and started with case presentations by David Ruch. Terry Axelrod continued the discussion on isolated fractures of the distal end of the forearm (radial fractures and Galeazzi injuries). His expertise on this matter pushed the discussion and caused an extensive discussion regarding the management of those specific fractures.
The section regarding the wrist started with a talk by Dan Rikli about the management of distal radius fractures in elderly people. He suggested that decision-making might be based on more important factors than bone density and fracture classification in this patient group, such as functional/cognitive state, dependency, and nutritional state. David Ruch took the discussion one step further and addressed the following question in his talk: “Can we accurately predict the outcome for patients with intra-articular distal radius fractures?”. This was followed by a presentation by Terry Axelrod who reviewed the management of ulnar styloid and ulnar neck fractures associated with distal radius fractures.
In the final section of the day, Mark Cohen and Mark Baratz addressed a variety of conditions that may occur in the management of upper extremity fractures (median neuropathy, acute carpal tunnel syndrome, and forearm compartment syndrome stiffness of the forearm, wrist, and fingers), which highlighted the number of possible difficulties when facing these fractures.
The Second Annual Jesse B. Jupiter International Hand Forum came to an end after this final section. The organization and participants can look back to an inspirational and interesting couple of days. Although some of the world’s leading experts were part of this years forum, it became clear that many questions remain to be unanswered. Meetings like the Jesse B. Jupiter International Hand Forum help surgeons in their search and endeavors to find answers that make a difference and contribute to improvement in patient care.