title: Surgeon perceptions and patient outcomes regarding proximal ulna fixation: a multicenter experience.
abstract: BACKGROUND
  Our objective was to determine surgeon- and patient-based perceptions concerning proximal ulna fixation, including rates of implant removal and overall satisfaction.
  
  
  METHODS
  Orthopedic surgeons were surveyed about surgical experience managing proximal ulna fractures and their perception regarding implant removal/revision. A retrospective chart review identified all patients who underwent fixation for proximal ulna fractures and osteotomies between January 2004 and December 2008.
  
  
  RESULTS
  In total, 583 surgeons responded to the survey (80%). Of these, 67% believed that their implant removal rate was the same as other surgeons whereas 31% believed that their rate was lower. Seventy-one percent believed that patients required hardware removal less than 30% of the time. Ninety-eight percent believed that they were the same surgeons to remove the implant. In total, 138 consecutive patients were surveyed about their proximal ulna implant. Plating was performed in 80 (58%), and tension banding was performed in 55 (40%). The overall rate of implant removal was 64.5% (89 of 138) at 18.8 months. A second surgeon performed the removal in 68 patients (76%). Of the 49 patients without implant removal, 11 (22%) reported satisfaction with the implant and 19 (39%) reported a functional impairment because of the implant. If guaranteed a safe surgery, 36 (73%) would have the implant removed.
  
  
  CONCLUSIONS
  Surgeons underestimate the rates of proximal ulna implant removal and patient dissatisfaction. Because 76% of the implant removals were performed by a second surgeon, in sharp contrast to the surgeon-perceived rate of 2%, we challenge surgeons to become more aware of this problem in their practices.
authors.affiliation: Department of Orthopaedic Surgery, Center for Hand and Elbow Specialists, Washington, DC 20007, USA. sge1@gunet.georgetown.edu
authors.forename: Scott G
authors.initials: SG
authors.lastname: Edwards
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Lattanza
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Iorio
authors.forename: Christopher
authors.initials: C
authors.lastname: Daniels
authors.forename: Sameer
authors.initials: S
authors.lastname: Lodha
authors.forename: Mia
authors.initials: M
authors.lastname: Smucny
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000601:surgery*; D055815:Young Adult