This is a horror game set in a surreal ever-changing house filled with disorienting elements. We set out to use twine to its fullest by filling the game with fun color design elements, puzzles, and an interesting backstory. The main character wakes up alone and his only companion is a purple lit lantern that seems to interact and change with the enviroment.

Background  Recent advances in the understanding of ulnar-sided wrist pathologies such as ulnar abutment syndrome (UAS) have brought increased attention to the anatomy of the distal radioulnar joint (DRUJ). Previous work established three anatomical variants of the sigmoid notch (parallel, oblique, and reverse oblique). The reverse oblique DRUJ poses theoretical risk of increased contact forces following ulnar shortening osteotomy, a common method of treating UAS. Purpose  As prevalence of reverse oblique morphology has been under-reported, this study aims to better define the prevalence of reverse oblique morphology in the adult population. Methods  Institutional Review Board-approved review of 1,000 radiographs over a 2-year period was performed. Demographic data and radiographic measurements were recorded (ulnar variance, notch inclination, and presence of arthritis). Correlation tests, a test of proportions, a t -test, and linear and logic regression tests were used to examine associations between ulnar variance, sigmoid inclination, sex, age, and presence of arthritis. Results  One thousand radiographs were analyzed revealing prevalence rates of: parallel-68%, oblique-26%, and reverse oblique-6%. Females were significantly more likely to have reverse inclination. No significant correlation was noted for morphology by age. Ulna positive variance was negatively correlated with reverse inclination. DRUJ arthritis was noted in 14% of patients. Higher sigmoid inclination was associated with higher odds of presence of arthritis, adjusting for sex and age. Higher incidence of arthritis was noted among patients with the oblique (20.8%) or reverse oblique (24.6%) compared with parallel (10.5%) morphology. Conclusion  This series of 1,000 radiographs demonstrates a 6% overall prevalence of reverse obliquity. This large dataset allows for better quantification of the prevalence of DRUJ morphologies and determination of correlations that have clinical implications for patients with ulnar-sided wrist pathology. Level of Evidence  This is a Level IV study.

Purpose

A question prompt list (QPL) is a tool that lists possible questions a patient may want to ask their surgeon. Its purpose is to improve patient-physician communication and increase patient engagement. Although QPLs have been developed in other specialties, one does not exist for hand conditions. We sought to develop a QPL for use in the hand surgery clinic using a mixed-methods design.

Methods

We drafted a QPL based on prior work outside of hand surgery and then used an exploratory sequential mixed-methods design (both qualitative and quantitative methods) to finalize the QPL. Qualitative evaluation included both a written questionnaire completed by a patient advisory board, hand therapists, and hand surgeons, as well as cognitive interviews conducted with clinic patients using the tool. Revisions to the QPL were made after each phase of qualitative analysis. The final QPL was then evaluated quantitatively using the system usability score (SUS) questionnaire to assess its usability.

Results

A patient advisory board consisting of 6 patients, 5 hand therapists, and 6 hand surgeons completed the written questionnaire. Thirteen patients completed a cognitive interview of the QPL. We completed a content analysis of the qualitative data and incorporated the findings into the QPL. Twenty patients then reviewed the final QPL pamphlet and completed the SUS questionnaire. The resulting SUS score of 78.8 indicated above-average usability of the QPL tool.

Conclusions

The QPL developed in this study, from the perspective of multiple stakeholders, provides a usable tool to engage and prompt patients in asking questions during their visit with their hand surgeon with the potential to improve communication and patient-centered care.

Clinical relevance

This study provides clinicians with a QPL developed for use in the hand surgery clinic setting, aimed at facilitating more thorough patient-provider discussion.