Background: Opioid-prescribing patterns have been implicated as a contributing factor to the opioid epidemic, yet few evidence-based guidelines exist to assist health-care providers in assessing and possibly modifying their prescribing practices. Methods: Five orthopaedic hand surgeons at a level-I trauma center developed a postoperative prescribing guideline for 25 common hand and upper-extremity outpatient procedures, which were delineated into 5 tiers. Postoperative opioid prescriptions in a 3-month period after implementation of the protocol were compared with those from a 3-month period before implementation of the protocol. Results: There were 231 patients in the pre-implementation group and 287 patients in the post-implementation group. Each individual opioid protocol tier showed a significant decrease in the mean morphine milligram equivalents (MME) prescribed, ranging from a minimum decrease of 97.8% to a maximum decrease of 176.0%. After implementation, adherence to protocol was achieved in 55.1% of patients; the MME amounts prescribed were below protocol for 28.6% and above for 16.4%. The number of additional opioid prescriptions in the 1-month postoperative period was significantly less in the post-implementation group than in the pre-implementation group (p < 0.001). The total number of pills prescribed was reduced by a theoretical equivalent of over three thousand 5-mg oxycodone pills for the 287 patients in the 3-month period. Conclusions: By utilizing a simple consensus protocol, we have demonstrated success diminishing the number of opioids prescribed without leading to an increase in the number of secondary prescriptions written by our providers. These findings are encouraging and suggest that fewer opioids were left in the possession of patients, leaving fewer pills vulnerable to misuse, abuse, and diversion.

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Background: Range of motion (ROM) measurements of the fingers are frequently obtained during hand physical examinations. While traditionally measured by manual goniometry, smartphone photography introduces an alternative method of ROM measurement that also has potential telemedicine applications. The purpose of this study was to evaluate the reliability of smartphone photography measurements as an alternative to traditional goniometry, using the patient with Dupuytren disease as a model. Methods: Patients with a confirmed Dupuytren contracture were prospectively enrolled in this study. Range of motion measurements of the affected joints were obtained prior to any invasive treatments. Two sets of photographs were taken by both a clinical staff member and a nonclinical individual unaffiliated with the study. Both sets of photos were analyzed for degree of contracture via software analysis and compared against traditional goniometer measurements. Results: The study prospectively enrolled 50 consecutive patients with Dupuytren disease, comprising 123 affected joints. The mean contractures of all affected joints as measured by manual goniometry, trained photograph goniometry, and untrained photograph goniometry were 38.5, 35.3, and 35.5, respectively. The mean difference in contracture measurement was 3.2° between manual and trained photograph goniometry and 3.0° between manual and untrained photograph goniometry. There was no statistically significant difference between trained and untrained photo set measurements. Photograph measurements between separate raters demonstrated high consistency (intraclass correlation coefficient = 0.92). Conclusions: Smartphone photography provides contracture measurements equivalent to the accepted error of a finger goniometer (3.2° compared with 5°). The accuracy of smartphone photography in measuring contractures offers potential telemedicine applications for both clinical and research needs.

Women and URM make up an increasing percentage of ASSH members. International members and presenters have also increased. Although diversity has improved over the past several years, the ASSH should continue to efforts toward greater inclusion and representation.