Competencies for advanced clinical practice (ACP) hand therapists in first-line management of closed hand fractures: Results of a United-Kingdom (UK) stakeholder consensus study.

Introduction: In the United Kingdom [UK], Advanced Clinical Practice (ACP) roles are being developed to improve access to high-quality patient care, where healthcare services are struggling to meet steadily increasing service demands. Increasingly, ACP hand therapists are assessing and treating acute closed hand fractures. However, the knowledge and skills required of these roles has not been identified or standardised.

Minimum Important Change for the Patient Evaluation Measure in patients with finger fractures and joint injuries.

The Minimum Important Change of the Patient Evaluation Measure for patients recovering from a finger fracture or joint injury was estimated to aid the design of future trials. Data from the Patient Outcomes for Finger Fractures and Joint Injuries prospective cohort study were used. Sixty participants were included.

Patient reported outcome measures: from the classics to AI.

With its basis in the development of intelligence testing, classical test theory paved the way to develop patient-reported outcome measures - tools capable of quantifying otherwise immeasurable traits. In hand surgery, many of the popular outcome measures were developed using classical test theory. However, these techniques are increasingly being superseded by novel mathematical approaches.

Comparison of individually packed metalwork and on-the-tray metalwork: A review of clinical risks.

The use of metalwork, such as screws and plates, is common in orthopaedic trauma surgery, with a recent trend towards individually packed metalwork owing to concerns about sterilization efficacy and traceability. Despite this, there is no clinical evidence proving clinical risk from repeat sterilization of metalworks used in orthopaedic trauma of either increased infection rates or loosening or implant failure. On the contrary, the use of individually packed metalworks presents several practical challenges, including higher costs, increased risks of contamination, longer operative times and a larger carbon footprint.

Management of metacarpal shaft fractures.

Aims: The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality.

Methods: A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017.

A systematic review of management options for symptomatic scaphometacarpal impingement after trapeziectomy.

Pain after trapeziectomy is a vexing problem, most commonly due to scaphometacarpal impingement. A number of treatment strategies have been described and are examined in this systematic review. In total, 27 studies describing revision surgery for unsatisfactory results after trapeziectomy were included.

Does Dressing Choice Affect Infection Rate in Percutaneous K-Wiring of the Hand and Wrist? - A Systematic Review.

Percutaneous Kirschner wire (K-wire) fixation of hand and wrist fractures is a common trauma procedure, yet there remains little consensus on the best management of wires postoperatively. If wire's ends are left external to the skin, it remains unknown which dressing regimen best reduces infection risk. We felt that a systematic review was required to assess the current consensus on this question within the published literature.

Surgical Interventions for Chronic Ulnar Collateral Ligament Injuries of the Thumb: A Systematic Review.

There is no consensus for the appropriate surgical management of symptomatic chronic ulnar collateral ligament (UCL) injuries of the thumb. The aim of this study is to systematically review the treatment of chronic thumb metacarpophalangeal (MCP) joint UCL injuries to determine the optimal approach to treatment. A systematic review of PubMed, Medline, Embase and ePub Ahead of Print was performed in accordance with Preferred Reporting of Items in Systematic Review and Meta-Analysis (PRISMA) guidelines.

Remote Symptom Monitoring With Ecological Momentary Computerized Adaptive Testing: Pilot Cohort Study of a Platform for Frequent, Low-Burden, and Personalized Patient-Reported Outcome Measures.

Background: Remote patient-reported outcome measure (PROM) data capture can provide useful insights into research and clinical practice and deeper insights can be gained by administering assessments more frequently, for example, in ecological momentary assessment. However, frequent data collection can be limited by the burden of multiple, lengthy questionnaires. This burden can be reduced with computerized adaptive testing (CAT) algorithms that select only the most relevant items from a PROM for an individual respondent.

'It's just a finger isn't it…': patients' perspectives of recovery following finger fractures and participation in surgical trials - a qualitative interview study.

Objectives: To (1) generate detailed, person-centred data about the experience of finger injury and treatment and (2) understand the patients' perspectives of research involvement with a view to informing better designed future studies in hand injury.

Design: Qualitative study using semistructured interviews and framework analysis.

Participants: 19 participants who were part of the Cohort study of Patients' Outcomes for Finger Fractures and Joint Injuries study in a single secondary care centre in the UK.

The Nottingham Palmar Plate Arthroplasty for Metacarpophalangeal Joint Noninflammatory Arthritis.

Palmar (volar) plate interposition arthroplasty for osteoarthritis (OA) of the metacarpophalangeal (MCP) joints of the fingers is a well-established technique. Its use has diminished since its initial description and introduction because of poor results in patients with inflammatory arthropathy and a difficult surgical technique. We report the surgical technique and mid-term results of the novel Nottingham interposition arthroplasty for noninflammatory MCP joint OA.

A 4-year study of the use of the short metacarpal cast in the management of metacarpal shaft fractures.

We report on our experience of using a short, moulded metacarpal cast over a 4-year period in the non-surgical management of metacarpal shaft fractures. Between 6 April 2015 and 6 April 2019, 117 patients were treated using this method. The majority were male, and the mean age was 24.

Sensitivity and Specificity of Radiographs in the Diagnosis of Little and/or Ring Carpometacarpal Joint Injuries.

 Little and ring finger carpometacarpal joints (CMCJs) injuries are commonly missed due to misinterpretation of radiographs. We aimed to determine the sensitivity and specificity of four different radiographic views.  Radiographs (posteroanterior [PA], lateral [LAT], pronated oblique [POL], and supinated oblique [SOL] views) showing normal findings or little/ring finger CMCJ injuries were shown to two cohorts of orthopaedic trainees and a cohort of emergency nurse practitioners.

The non-operative management of bony mallet injuries.

Over a 4-year period, 218 mallet fractures in 211 adult patients were treated using a custom-made thermoplastic splint. Clinical results were collected prospectively, including the visual analogue score for pain, the range of motion and extensor lag, and the Patient Evaluation Measure (PEM). The joints were congruent in 168 and subluxed in 50.

A comparative review of 1,004 orthopaedic trauma patients before and during the COVID-19 pandemic.

Aims: COVID-19 necessitated abrupt changes in trauma service delivery. We compare the demographics and outcomes of patients treated during lockdown to a matched period from 2019. Findings have important implications for service development.

A comparative study looking at trauma and orthopaedic operating efficiency in the COVID-19 era.

Backgroud: COVID-19 has led to a reduction in operating efficiency. We aim to identify these inefficiencies and possible solutions as we begin to pursue a move to planned surgical care.

Methods: All trauma and orthopaedic emergency surgery were analysed for May 2019 and May 2020.

The development of a novel patient-derived recovery scale for open tibial fractures.

Aims: The aim of this study was to develop a psychometrically sound measure of recovery for use in patients who have suffered an open tibial fracture.

Methods: An initial pool of 109 items was generated from previous qualitative data relating to recovery following an open tibial fracture. These items were field tested in a cohort of patients recovering from an open tibial fracture.

Growth Factor and Intense Pulse Light in Flexor Tendon Repair: A Biomechanical Study at Strength and Gap Resistance.

Background: Flexor tendon injuries are extremely common and they are usually the result of incised traumatic glass or knife injury. The process of tendon healing is a complicated and exceptionally-regimented mechanism that is originated and monitored by a vast number of diverse molecules. One of the most pivotal groups of mediators that are crucial to the healing process are growth factors (GF).

Fractures at the junction of diaphysis and metaphysis of the proximal phalanges in adults.

Unlabelled: We describe the treatment of 101 patients with 113 fractures of the proximal phalanx at the junction of the diaphysis with the proximal metaphysis. Fractures were stabilized using a single extra-articular percutaneous Kirschner wire passed lateral to the metacarpal head into the base of the phalanx base and across the fracture to engage the lateral cortex. Patients were treated semi-electively on a day surgery unit.

Should We Resect Hoffa's Fat Pad during Total Knee Replacement?

Resection of Hoffa's fat pad during total knee arthroplasty is sometimes performed to improve access and view. Opponents of this technique argue that sacrificing the fat pad potentially compromises blood supply to the patellar tendon and it can subsequently shorten. Our objective was to identify any difference in the Insall-Salvati ratio of knees undergoing total knee arthroplasty between a cohort that had Hoffa's fat pad preserved and the one that had Hoffa's fat pad completely excised.

Early versus late surgery for closed ankle fractures.

Purpose: To compare the outcome after early versus late surgery for closed ankle fractures in terms of the length of hospital stay and infection rate.

Methods: Records of 95 men and 119 women aged 14 to 92 (mean, 46) years who underwent open reduction and internal fixation for ankle fractures during three 6-month periods in 2004, 2007, and 2010 were reviewed. 82 and 132 patients underwent surgery <24 hours and >24 hours after presentation, respectively.