Journal of Hand Surgery - June 2022 - S502

S502
Journal of Hand Surgery (Eur) 47(Supplement 1)
dysplasia (17) than thumb hypoplasia (15), or thumb
duplication (4) and those with bilateral than unilateral
anomalies. Most surgeons used a combination of
limb features (grade of difference, laterality); nonlimb
features (growth disturbance, cafe-au-lait
spots, cardiac and renal anomalies); and the presence
of the VACTERL association as indicators to
seek a diagnosis of FA.
Conclusions: FA is a life changing diagnosis that has
significant implications for the child, their parents,
and current and future siblings. Early diagnosis
increases treatment options and improves outcomes.
The diagnostic challenge derives from a very low
incidence of the disease and wide clinical heterogeneity.
Previous study has shown that the hand surgeon
commonly encounters FA children prior to the
clinical onset of their disease and before encounters
with other clinical services. The hand surgeon therefore
has an important gatekeeper role that can be
enhanced by establishment of local and perhaps
national standardisation of referral and diagnostic
pathways - suggestions for which will be presented.
A-2391 Methylprednisolone Taper: An effective
solution for Postoperative Pain and Reduced Opioid
Consumption after Distal Radius Fracture
Eric Wagner, Alexander Dawes, Corey Spencer,
John Hurt, Roy Toston, Kevin Farley, Collier Campbell
and Charles Daly Michael Gottschalk
USA
Purpose: Perioperative glucocorticoids have been
effectively used as a pain management regimen for
reducing pain after orthopedic surgeries. We hypothesize
that a Methylprednisolone taper course following
surgery will reduce pain and opioid consumption
in the early postoperative period.
Methods: This study is a randomized control trial
(NCT03661645) for patients undergoing surgical fixation
for distal radius fracture. Prior to surgery,
patients were randomly assigned to receive preoperative
dexamethasone only or preoperative dexamethasone
followed by a 6-day oral methylprednisolone
taper (MPT). Patient pain and opioid consumption
were collected for 7 days postoperatively utilizing a
patient-reported pain journal.
Results: 56 patients were enrolled from November
2018 to March 2020 with follow-up data. 28 patients
each were assigned to both the control and treatment
groups. There were no differences in age,
Body Mass Index, dominant side affected, smoking
status, diabetes, or current narcotic use. No differences
were seen in pre- or postoperative patientreported
outcomes. With an observable reduction
starting on POD2, patients who received a MPT
course consumed substantially less opioids during
the first seven days (7.87.2 pills compared to
15.511.5 pills; 50% reduction). These patients
also consumed significantly less oral morphine
equivalents than the control group (83.4 vs 38.8).
A significant difference in pain VAS scores between
the two groups is noted starting on POD1, with 48%
of the treatment group reporting no pain by POD6. No
adverse events, including infection or complication to
wound or bone healing, were seen in either group.
Conclusion: This prospective randomized controlled
trial demonstrated early improvement in pain and
reduction in early opioid consumption with a lowdose
methylprednisolone tapered 6-day course
administration following surgical fixation for distal
radius fracture. With no increased risk of adverse
events, MPT appears to be a safe and effective way
to reduce pain.
A-2393 Racial Disparities in the Utilization of
Shoulder Arthroplasty in the United States, Trends
from 2011 to 2017
Kevin Farley2, Alexander Dawes1, Jacob Wilson3,
Roy Toston1, John Hurt1, Michael Gottschalk1 and
Eric Wagner1
1Emory University School of Medicine Atlanta, GA USA
2Oakland University William Beuamont School of Medicine
Royal Oaks, MI USA
3Mayo Clinic Rochester, MN USA
Hypothesis: As the incidence of shoulder arthroplasty
rises at exponential rates, an important consideration
includes race, as racial disparities have
been reported in lower extremity arthroplasty.
Given the paucity of studies examining the temporal
trends in utilization and subsequent disparities in all
types of shoulder arthroplasty, we sought to examine
these disparities.
Methods: Using the National Inpatient Sample (NIS)
database, all anatomic total shoulder arthroplasties
(aTSA) and reverse shoulder arthroplasties (RSA)
were analyzed from 2011 to 2017. The patients
were divided on the Black, Hispanic, and white
groups. Outcomes included incidence, length of
stay, cost, and discharge destination. A multinomial
logistic model was used for the statistical
calculations.
Results: Overall, 91.4% of the patients undergoing
any shoulder arthroplasty operation was white,
while 4.75% were Black and 3.85% were Hispanic.
Age and sex standardization utilization rates (per
100,000) of RSA increased by 139% from 6.94 in
2011 to 16.60 in 2017. Black patients saw a rise
Journal of Hand Surgery - June 2022

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