{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:41:22Z","timestamp":1787755282469,"version":"build-2784847793"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,12,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Overlapping surgery is attracting increased scrutiny. The American College of Surgeons states that the attending surgeon must be present for all critical portions of a surgical procedure; however, critical portions of surgical procedures are not defined. We hypothesized that a Delphi panel process would measure consensus on critical portions of 3 common hand surgical procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used a Delphi process to achieve consensus on the critical portions of carpal tunnel release, ulnar nerve transposition, and open reduction and internal fixation of the distal part of the radius. The panelists were 10 hand surgeons (7 fellowship-trained surgeons and 3 fellows). Following an in-person discussion to finalize steps for each procedure, 2 online rounds were completed to rate steps from 1 (not critical) to 9 (extremely critical). We operationalized consensus as \u226580% of ratings within the same range: 1 to 3 (not critical), 4 to 6 (somewhat critical), and 7 to 9 (critical). Because of a lack of consensus on some steps after round 2, another in-person discussion and a third online round were conducted to rate only steps involving disagreement or somewhat critical ratings using a dichotomous scale (critical or not critical).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Following the first 2 rounds, there was consensus on 19 of 24 steps (including 3 steps being somewhat critical) and no consensus on 5 of 24 steps. At the end of round 3, there was consensus on all but 2 steps (identification of the medial antebrachial cutaneous nerve in ulnar nerve transposition and clinical assessment of joint stability in open reduction and internal fixation of the distal part of the radius), with moderate disagreement (3 compared with 7) for both.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The panel reached consensus on the designation of critical or noncritical for all steps of a carpal tunnel release, all but 1 step of an ulnar nerve transposition, and all but 1 step of open reduction and internal fixation of the distal part of the radius. The lack of consensus on whether 2 of the steps are critical leaves this determination at the discretion of the attending surgeon. The findings of our Delphi panel provide guidance to our division on which portions of the surgical procedure are critical and thus require the attending surgeon\u2019s presence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.00654","type":"journal-article","created":{"date-parts":[[2018,12,5]],"date-time":"2018-12-05T14:14:36Z","timestamp":1544019276000},"page":"e148","source":"Crossref","is-referenced-by-count":10,"title":["The Critical Portions of Carpal Tunnel Release, Ulnar Nerve Transposition, and Open Reduction and Internal Fixation of the Distal Part of the Radius"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-2483","authenticated-orcid":false,"given":"Christopher J.","family":"Dy","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery (C.J.D. and C.A.G.), Division of Public Health Services, Department of Surgery (C.J.D.), and Division of General Medical Sciences (A.L.A. and J.M.D.), Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2632-7701","authenticated-orcid":false,"given":"Alison L.","family":"Antes","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (C.J.D. and C.A.G.), Division of Public Health Services, Department of Surgery (C.J.D.), and Division of General Medical Sciences (A.L.A. and J.M.D.), Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1540-8426","authenticated-orcid":false,"given":"Daniel A.","family":"Osei","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9672-8853","authenticated-orcid":false,"given":"Charles A.","family":"Goldfarb","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (C.J.D. and C.A.G.), Division of Public Health Services, Department of Surgery (C.J.D.), and Division of General Medical Sciences (A.L.A. and J.M.D.), Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3712-7051","authenticated-orcid":false,"given":"James M.","family":"DuBois","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery (C.J.D. and C.A.G.), Division of Public Health Services, Department of Surgery (C.J.D.), and Division of General Medical Sciences (A.L.A. and J.M.D.), Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,12,5]]},"reference":[{"issue":"6","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1097\/SLA.0000000000001208","article-title":"Procedure delegation by attending surgeons performing concurrent operations in academic medical centers: balancing safety and efficiency","volume":"261","author":"Beasley","year":"2015","journal-title":"Ann Surg."},{"key":"bib2-20230810","article-title":"Clash in the name of care","author":"Abelson","year":"2015","journal-title":"The Boston Globe"},{"issue":"23","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.2106\/JBJS.17.00109","article-title":"Overlapping and concurrent surgery: a professional and ethical analysis","volume":"99","author":"Levin","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib4-20230810","first-page":"19","article-title":"American College of Surgeons statements on principles","volume":"101","year":"2016","journal-title":"Bull Am Coll Surg."},{"key":"bib7-20230810","article-title":"International Society of Digital Imaging of the Skin (ISDIS)-International Skin Imaging Collaboration (ISIC) Group. Technique standards for skin lesion imaging: a Delphi consensus statement","author":"Katragadda","year":"2016","journal-title":"JAMA Dermatol."},{"issue":"9","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.7326\/M14-1304","article-title":"The Ann Arbor Criteria for appropriate urinary catheter use in hospitalized medical patients: Results obtained by using the RAND\/UCLA appropriateness method","volume":"162","author":"Meddings","year":"2015","journal-title":"Ann Intern Med."},{"issue":"10","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1001\/jamasurg.2016.1640","article-title":"Defining a research agenda for patient-reported outcomes in surgery: using a Delphi survey of stakeholders","volume":"151","author":"Pezold","year":"2016","journal-title":"JAMA Surg."},{"issue":"1","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/PRS.0b013e318219c171","article-title":"The levels of evidence and their role in evidence-based medicine","volume":"128","author":"Burns","year":"2011","journal-title":"Plast Reconstr Surg."},{"issue":"4","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2013.12.002","article-title":"Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies","volume":"67","author":"Diamond","year":"2014","journal-title":"J Clin Epidemiol."},{"issue":"8","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1055\/s-2002-36497","article-title":"Medial brachial and antebrachial cutaneous nerve injuries: effect on outcome in revision cubital tunnel surgery","volume":"18","author":"Sarris","year":"2002","journal-title":"J Reconstr Microsurg."},{"issue":"3","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s11552-007-9037-3","article-title":"Operative findings in reoperation of patients with cubital tunnel syndrome","volume":"2","author":"Mackinnon","year":"2007","journal-title":"Hand (N Y)."},{"issue":"3","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/jhsu.2000.6467","article-title":"Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures","volume":"25","author":"Lindau","year":"2000","journal-title":"J Hand Surg Am."},{"key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/00003086-200007000-00031","article-title":"Distal radioulnar instability is an independent worsening factor in distal radial fractures","volume":"376","author":"Lindau","year":"2000","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib17-20230810","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0266-7681(98)80134-4","article-title":"The importance of the distal radioulnar joint in distal radial fractures","volume":"23","author":"Stoffelen","year":"1998","journal-title":"J Hand Surg Br."},{"issue":"12","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1097\/BOT.0b013e31828e18a2","article-title":"The effect of acute distal radioulnar joint laxity on outcome after volar plate fixation of distal radius fractures","volume":"27","author":"Kim","year":"2013","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib19-20230810","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s00068-015-0627-4","article-title":"Clinical DRUJ instability does not influence the long-term functional outcome of conservatively treated distal radius fractures","volume":"43","author":"Wijffels","year":"2017","journal-title":"Eur J Trauma Emerg Surg."},{"issue":"9","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"979","DOI":"10.2105\/AJPH.74.9.979","article-title":"Consensus methods: characteristics and guidelines for use","volume":"74","author":"Fink","year":"1984","journal-title":"Am J Public Health."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201812050-00014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:40:32Z","timestamp":1787751632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201812050-00014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,5]]},"references-count":17,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.17.00654","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,5]]}}}