scholarly journals 263 Improving the Timing of Operative Management of Closed Hand Fractures – A Closed-Loop Audit of Compliance with BSSH Guidelines in One of The Largest Teaching Hospitals in Europe

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Prokopenko ◽  
Y Verma
Keyword(s):  
Operative Management ◽  
British Society ◽  
Teaching Hospitals ◽  
National Guidelines ◽  
Early Presentation ◽  
Information Leaflets ◽  
Hand Fractures ◽  
First Choice ◽  
Hand Fracture ◽  
Operative Fixation

Abstract Introduction Hand fractures are a common injury resulting in significant morbidity if managed incorrectly. The final outcome is determined by the initial injury but is also affected by timely and appropriate intervention. The British Society for Surgery of the Hand (BSSH) national guidelines recommend that when operative fixation is first choice, surgery should occur within 7-days of injury or within 72-hours when conservative management fails. Method We assessed compliance with BSSH closed hand fracture guidelines retrospectively using electronic patient records. Interventions involved department-wide education of national BSSH guidelines alongside suggestion of a dedicated closed hand fracture list. A sporadic WALANT list staffed by hand fellows was provided. The efficacy of the interventions was re-audited five months later. Results The first and second cycles included 100 and 56 cases respectively. Compliance improved between the two cycles from 59% to 75% when operative management was first choice. Average number of days until operative management was carried out, when operative fixation was first choice, improved from 7.47 to 5.44 between the two cycles. 23/156 (15%) cases underwent operative management on the additional list, where overall compliance was 78%. Conclusions Departmental education and the additional operating list improved compliance to BSSH guidelines. Education of staff involved in the management of closed hand fractures should continue regularly, especially considering the frequent rotation of trainee doctors. Patients should be provided with information leaflets to promote early presentation. The key intervention to improve compliance with national guidelines however remains the provision of a weekly closed hand fracture theatre list.

scholarly journals EP.WE.105Hand trauma during COVID pandemic: a tertiary trauma centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amir Ghareib ◽  
Sylwia Oniska ◽  
Laura Karran ◽  
Jamil Moledina
Keyword(s):  
High Volume ◽  
Trauma Centre ◽  
Active Movement ◽  
Trauma Patients ◽  
University Hospitals ◽  
Hand Fractures ◽  
Good Movement ◽  
Hand Fracture ◽  
June July

Abstract Introduction St. George’s University Hospitals NHS Foundation Trust is a tertiary trauma centre. We receive a high volume of hand referrals from all over the south West London region. Closed hand fractures represent a significant number of our referrals. COVID-19 has put more burden in all health service endangering poor management of these trauma patients. Aim To assess management of close hand trauma patients during COVID pandemic. Methods Retrospective evaluation of closed hand fracture referrals during June, July, and August 2020. Clinical documentations, operative details and follow up visit notes have been reviewed. Results 106 patients have been included. 47 patients treated surgically with 81% of them were in need for metalwork insertion. Most of operations were done within 8 days. Number of hospital visits was variable with a mean of six days for adult and two days for children. Patient who was in need for hand therapy have been seen within the first 8 days of their surgery. At three months follow up, only three cases had infection. Only one case had osteomyelitis and the other two case had infected metalwork. Most of the patents reported good movement in ASSH Total Active Movement of Hand score (TAM) at the end of the three months. Conclusion Despite COVID 19 pandemic our service managed to achieve acceptable results in dealing with these cases. Yet, securing a reasonable number of operating sessions and clinic appointments remains a challenge.

scholarly journals 1018 Did COVID Compromise the Care of Closed Paediatric Hand Fractures?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Dbeis ◽  
G Yim ◽  
A Watts
Keyword(s):  
Health Informatics ◽  
Operative Management ◽  
National Standards ◽  
Post Injury ◽  
Rapid Access ◽  
Hand Fractures ◽  
National Guidance ◽  
A Prospective Study ◽  
Surgery Department ◽  
Mean Time

Abstract Aim To assess the effect of a ‘rapid-access’ musculoskeletal unit, established in March 2020, as part of the Royal Devon & Exeter hospital COVID response, with direct assessment of hand trauma by the Plastic Surgery department staff, on treatment timelines and national guidance compliance for closed paediatric hand fractures. Method This was a retrospective review from 1st January to 31st December 2019 and a prospective study from the 1st April to 15th June 2020. The retrospective cases were collated by health informatics. The prospective data was recorded on the department’s database. Exclusion criteria: nail bed injuries with tuft fractures, ligament injuries only, open fractures and patients aged 18 at time of surgery. Results In 2019 the majority (73%) of patients (n = 26) were referred within 48hrs but waited a median of 5 days to be seen in clinic by a hand surgeon resulting in significant delays in treatment. After service reconfiguration in 2020, all patients (n = 6) were operated on within 72 hours of the decision to operate - mean time to surgery 1.5 days (range 0-3 days). The mean time from referral to clinic was 1.33 days (range 0-6 days). 4 patients were operated on within 7 days of injury. Of the 2 patients operated on > 7 days, 1 was referred 32 days post injury and 1 failed conservative management. Conclusions The introduction of a ‘rapid-access’ musculoskeletal unit with early senior review and a dedicated theatre has created ‘gold-standard’ compliance with national standards for the operative management of closed paediatric fractures.

Understanding Child Neglect. Current Perspectives in Dentistry

2010 ◽  
Vol os17 (3) ◽  
pp. 105-109 ◽  
Author(s):  
Richard Balmer ◽  
Emily Gibson ◽  
Jenny Harris
Keyword(s):  
Child Protection ◽  
Child Neglect ◽  
Clinical Excellence ◽  
British Society ◽  
National Guidelines ◽  
Child Protection Services ◽  
The Subject ◽  
Recognition And Response ◽  
Agency Management ◽  
Dental Neglect

The aim of this paper is to update the reader on the subject of dental neglect in children. Recent national guidelines produced by the National Institute for Health and Clinical Excellence and the British Society of Paediatric Dentistry have raised the profile of this condition by providing specific, evidence-based recommendations for recognition and response to dental neglect. Dental neglect may be a sign of general neglect or may be considered maltreatment in itself. The specific dental and non-dental features are described and actions secondary to a diagnosis of dental neglect are discussed. Three types of intervention are described: preventive dental team management, preventive multi-agency management, and referral to child protection services. With increasing awareness of this condition and through access to the expertise of other specialist agencies in this field, the primary care practitioner can play a key role in safeguarding the welfare of children.

scholarly journals Acute hand injury splinting – the good, the bad and the ugly

2018 ◽  
Vol 100 (2) ◽  
pp. 92-96
Author(s):  
T Richards ◽  
R Clement ◽  
I Russell ◽  
D Newington
Keyword(s):  
Hand Surgery ◽  
Hand Injury ◽  
Initial Assessment ◽  
Frontline Staff ◽  
Initial Management ◽  
Junior Staff ◽  
Hand Fractures ◽  
Hand Fracture ◽  
The Uk ◽  
Annual Treatment Cost

Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting. This article aims to provide guidance for frontline staff on the management of hand fractures, with particular emphasis on the appropriate nonoperative care to avoid any unnecessary morbidity.

The epidemiology of fractures of the hand and the influence of social deprivation

2010 ◽  
Vol 36 (1) ◽  
pp. 62-65 ◽  
Author(s):  
R. E. Anakwe ◽  
S. A. Aitken ◽  
J. G. Cowie ◽  
S. D. Middleton ◽  
C. M. Court-Brown
Keyword(s):  
Operative Treatment ◽  
Social Deprivation ◽  
Mechanism Of Injury ◽  
Trauma Unit ◽  
Hand Fractures ◽  
Hand Fracture ◽  
To Receive ◽  
The Relationship ◽  
Gender Specific ◽  
Little Finger

This study investigates the relationship between the epidemiology of hand fractures and social deprivation. Data were collected prospectively in a single trauma unit serving a well-defined population. The 1382 patients treated for 1569 fractures of the metacarpals or phalanges represented an incidence of hand fracture of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Deprivation was not directly associated with the incidence of hand fracture. Common mechanisms of injury are gender specific. Fractures of the little finger metacarpal were common (27% of the total) and were associated with social deprivation in men ( P = 0.017). For women, fractures where the mechanism of injury was unclear or the patient was intoxicated and could not recall the mechanism showed a clear association with deprivation. Affluent patients were more likely to receive operative treatment. Social deprivation influences both the pattern and management of hand fractures.

scholarly journals Assessment of soft tissue reconstruction of the thumb after injuries

2020 ◽  
Vol 7 (3) ◽  
pp. 617
Author(s):  
Shawky Shaker Gad ◽  
Tarek Fouad Keshk ◽  
Ahmed Tharwat Nassar ◽  
Hassan Gaber Zaki Bassiouny
Keyword(s):  
Soft Tissue ◽  
Teaching Hospitals ◽  
Late Time ◽  
Soft Tissue Reconstruction ◽  
Dominant Hand ◽  
Groin Flap ◽  
Strategic Approach ◽  
First Choice ◽  
Tissue Reconstruction ◽  
A Prospective Study

Background: This study is to formulate a strategic approach for soft tissue reconstruction of the thumb and study of different modalities of soft tissue reconstruction of the thumb and try to clarify advantage and discuss complication of each modality.Methods: This is a prospective study done on 20 patients with thumb defects and deformities, presented at Menoufia University and Al-Ahrar Zagazig Teaching Hospitals during the period from January 2017 to July 2019. They were 14 Males and 6 females classified according to age, sex, type of trauma, dominant hand, type of flap used for reconstruction.Results: The most type of injury was trauma in all technique accept digital artery perforator (DAP) flap and groin flap of the half patients were trauma (50%) and other half were post burn (50%).  Most patients were early timing of interference in all techniques accept replantation was immediate time of interference (100%) and groin flap was late time of interference (100%). Most patients in Moberg flap had minimal scare complication (60%). Whereas half patients had minimal scare complication in replantation, little flap and DAP flap (50%, 50% and 50%). While half patients had volar contracture, graft complication in thumb cross finger and groin flap (50% and 50%).Conclusions: Replantation is the first choice for thumb amputations proximal to the base of the distal phalanx. It is impossible or fails, other methods of thumb reconstruction. Thumb cross finger flap is an excellent reconstructive technique for larger volar and tip defects of the thumb, up to 2-3 cm2.

scholarly journals Use of Direct Oral Anticoagulants in Patients With Antiphospholipid Syndrome: A Systematic Review and Comparison of the International Guidelines

2021 ◽  
Vol 8 ◽  
Author(s):  
Daniele Pastori ◽  
Danilo Menichelli ◽  
Vittoria Cammisotto ◽  
Pasquale Pignatelli
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Case Series ◽  
British Society ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Serious Adverse Events ◽  
First Choice

Antiphospholipid antibody syndrome (APS) requires long-term anticoagulation to prevent recurrent thrombosis. Direct oral anticoagulants (DOACs) have been increasingly used in APS patients, but contradictory guidelines recommendations on their use do exist. We performed a systematic review of literature including studies investigating the role of DOACs in APS patients. At this aim, PubMed and Cochrane databases were searched according to PRISMA guidelines. We identified 14 studies which investigated the use of DOACs in patients with APS, of which 3 randomized clinical trials (RCTs), 1 post-hoc analysis of 3 RCTs, 7 case series and 3 cohort studies (2 prospective and 1 retrospective). Among DOACs, rivaroxaban was the most used (n = 531), followed by dabigatran (n = 90) and apixaban (n = 46). Regarding guidelines indications, the 2019 European Society of Cardiology (ESC) and American Society of Hematology (ASH) guidelines recommend against the use of DOACs in all APS patients. The European League Against Rheumatism (EULAR), British Society for Haematology (BSH), and International Society on Thrombosis and Haemostasis (ISTH) guidance provided more detailed indications stating that warfarin should be the first-choice treatment but DOACs may be considered in patients (1) already on a stable anticoagulation with a DOAC, (2) with low-quality anticoagulation by warfarin, (3) unwilling/unable to undergo INR monitoring, (4) with contraindications or serious adverse events under warfarin. Patients with arterial APS or triple positivity should be treated with warfarin while venous APS with single or double positivity may be candidate to DOACs, but high-quality studies are needed.

scholarly journals 348 Virtual Patient Assessment for Hand Fracture Management: A Departmental Analysis of Financial and Clinical Implications

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Roberts ◽  
J Totty ◽  
R Pinder
Keyword(s):  
Clinical Performance ◽  
Quality Care ◽  
Cost Savings ◽  
Virtual Patient ◽  
British Society ◽  
Patient Assessment ◽  
Pilot Model ◽  
Hand Fractures ◽  
Fracture Management ◽  
Short Period

Abstract Introduction The COVID-19 pandemic demanded reduced face-to-face (FTF) contact. Our department integrated virtual assessment into the incoming referral pathway to enable continuation of high-quality care. This study aimed to assess any potential efficiency benefit of this change in service whilst ensuring no compromise to clinical outcomes. Method A prospective analysis was undertaken of all hand fractures referred virtually during a seven-week period starting at the initiation of national lockdown. Cost analysis using NHS reference costs, inflated to 2019/20 prices, was performed. Clinical performance was assessed using the British Society for Surgery for the Hand (BSSH) Standards for Open and Closed Hand Fractures. Results Seventy-six hand fractures were referred; FTF attendance was avoided in 35 cases, with an estimated per-patient cost saving of £179.16. Of the 33 patients who attended FTF, 13 achieved same day non-operative treatment; 20 underwent operative intervention with 95% compliance to BSSH standards. No complications occurred. Conclusions Our pilot model demonstrates potentially significant cost savings of £6270 over a relatively short period, as well as clinical non-inferiority. This supports sustained integration of virtual patient assessment in the ‘new normal’. Further work across all disciplines is needed to define acceptable limits of telemedicine and new avenues for potential benefit.

scholarly journals Successful Treatment of Painful Synchondrosis of Bipartite Patella after Direct Trauma by Operative Fixation: A Series of Six Cases

2017 ◽  
Vol 11 (1) ◽  
pp. 390-396 ◽  
Author(s):  
Sarkhell Radha ◽  
Michael Shenouda ◽  
Sujith Konan ◽  
Jonathon Lavelle ◽  
Samuel Church
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Case Series ◽  
Symptomatic Treatment ◽  
Operative Management ◽  
The Body ◽  
Direct Trauma ◽  
Bipartite Patella ◽  
Operative Fixation ◽  
Anterior Knee

Introduction: The patella is the largest sesamoid bone in the body and may have one (77%) or multiple (23%) ossification centres. Patellar and patellofemoral joint abnormalities are a common cause of anterior knee pain but symptomatic bipartite patella is an uncommon problem. Case Series: We report a series of six cases of painful synchondrosis in bipartite patellae, all in keen athletes following a direct blow to the anterior aspect of the knee. A complete rupture of the synchondrosis with evidence of retropatellar chondral separation was seen on MRI scan in all cases. Successful surgical fixation was undertaken with complete resolution of symptoms in all patients at an average of three months post-operatively. Conclusion: Painful synchondrosis of a bipartite patella in young and active individuals following direct trauma is a relatively rare cause of anterior knee pain, but may be associated with significant morbidity. In cases refractory to non-operative management, successful symptomatic treatment can be achieved by operative fixation.

scholarly journals Uterine Carcinosarcomas versus Leiomyosarcomas: DuaL Institutional Experience from Mansoura and Zagazig Universities

2019 ◽  
pp. 1-10
Author(s):  
Amal Halim ◽  
Niveen Abo-Touk ◽  
Nahla Mokhtar ◽  
Hadeel Elghamery ◽  
Eman Ismail ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Treatment Outcomes ◽  
Abnormal Uterine Bleeding ◽  
University Teaching ◽  
Treatment Modalities ◽  
Teaching Hospitals ◽  
Visceral Metastasis ◽  
Early Presentation ◽  
Institutional Experience ◽  
Uterine Cancers

Objective: Carcinosarcomas (CSs) and leiomyosarcomas (LMSs) are rare uterine cancers with high mortality. This study presents a dual institutional experience from two different university teaching hospitals (Mansoura and Zagazig Universities situated in the Delta of the Nile River in Egypt) with regard to the treatment modalities of those two types of uterine cancers aimed at establishing demographics and treatment outcomes. Patients & Methods: The data from 12 uterine CS and 17 LMS patients treated at the Clinical Oncology Departments of Mansoura and Zagazig Universities from January 2012 to June 2018 were reviewed to evaluate demographics and treatment outcomes. Results: The mean age of the patients was greater than 50 years. Abnormal uterine bleeding (AUB) was the most common presenting symptom. Six CS (50%) patients underwent comprehensive surgical staging, while 4 patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH&BSO). Conversely, TAH&BSO was performed in 15 patients with LMS (88%). Adjuvant radiotherapy was given to 6 CS (50%) and 4 LMS (24%) patients. Meanwhile, adjuvant chemotherapy was received by 5 CS (42%) and 8 LMS (47%) patients. Pelvic failure occurred in only the LMS group. Visceral metastasis occurred in both groups, while bone metastasis was encountered in only the CS group. The overall survival at 5 years was 53% and 32% in patients with CS and LMS, respectively. Conclusion: AUB should be seriously investigated. Both diseases are aggressive despite early presentation and radical multimodality treatment. Local recurrence was reported in only the LMS group. Visceral metastasis occurred in both groups, unlike bone metastasis. New targeted therapies are urgently needed.

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