4. A Comparison of Clinical Management Systems
Shawn Hayden, MD, PhD
Advisor: James Herndon, MD, MBA
Discussor: John Emans, MD

Shawn Hayden

John Emans

Dr. Shawn Hayden presented his work evaluating the current require- ments of a Clinical Management System (CMS) , and then comparing commercially available systems against this benchmark. He subdivided the four main aspects of a CMS (the electronic health record, the technology functions, the practice management, and the consumer functions) in order to better allow for comparison. Dr. Hayden found that no companies exceeded the benchmark, one met it in all four categories, two met it in three categories, and three companies met it in two categories. He highlighted the importance of standards for comparing potential systems as well as the need for newer improved systems to allow physician groups to better comply with increasingly stringent regulations.

Dr. John Emans, in his discussion of this work, pointed out the importance and relevance for younger physicians to educate themselves in the new advances as they go out into practice. He noted that with the new requirements for rigorous coding practices and compliance with HIPPA, information systems will become crucial for physicians with regards to privacy of patient information, billing of procedures and visits, and practice management.

5. Reconstruction of Symptomatic Chronic Achilles Tendon Disorders with Flexor Hallucis Longus Transfer
Domingo Cheleuitte, MD
Advisor: Michael G. Wilson, MD
Discussor: George Theodore, MD

Domingo Cheleuitte

George Theodore

Dr. Domingo Cheleuitte retrospectively reviewed 29 patients with 32 feet treated by a single surgeon with FHL transfer for symptomatic chronic Achilles tendon disorders. At mean follow-up time of 30. 7 months, the patients ’mean MODEMS score was 79 and the mean AOFAS ankle-hindfoot score was 87, with patients having chronic tears averaging higher scores than those with tendinitis. There was no significant difference between patients who had undergone prior Achilles surgery and those in whom this index surgery was the primary. Patients receiving workers ’compensation had significantly lower scores. Dr. Cheleuitte did note that there was a 44% wound complication rate of the patients in this study.

Dr. George Theodore highlighted the fact that while solutions for chronic Achilles tendon disorders remain controversial, FHL transfer shows promise as a salvage procedure. He noted that there was a broad range of pathology included in this study and that MRI correlation would allow for better stratification of preop pathology. He also discussed various methods of fixation and proposed that suture anchor could allow for less soft tissue dissection in an area with already compromised blood supply, possibly decreasing the wound problems associated with this surgery.

6. Effect of Subacromial Decompression on the Stability of the Acromioclavicular Joint: Biomechanical Testing in a Cadaveric Model
Ashwin Deshmukh, MD
Advisor: Gary Perlmutter, MD
Discussor: Jon J. P. Warner, MD

Ashwin Deshmukh

J. P. Warner

Based on recent clinical data that raised concern that arthroscopic subacromial decompression may lead to instability of the acromioclavicular joint, Dr. Ashwin Deshmukh used a cadaveric model to study the effects of subacromial decompression on AC joitn compliance. He tested nineteen fresh frozen cadaveric shoulders by using a machine-applied force in the anterior, posterior, and superior directions to assess for AC joint motion using infrared measurement. Dr. Deshmukh reported that the compliance of the AC joint was increased by a statistically significant amount in the anteroposterior and superior directions after the specimens underwent subacromial decompression, compared to the native state. He postulated that these in vitro findings could account for the increased incidence of AC joint instability, tenderness, and lower outcome scores in this patient population.

Dr. Jon Warner, in his discussion of the thesis, commended the work for addressing a relevant clinical question through laboratory research. He noted that coplaning of the clavicle, which was done in this study, does violate the AC joint, but pointed out that this is not always done in practice. He encouraged the further exploration of this topic through randomized study to better understand how surgical technique may affect outcome in patients with acromial spurring.