Functional Hand-Based Splint in the Treatment of Metacarpal Fractures

Background: Post-treatment stiffness remains a significant hurdle following treatment for displaced or minimally displaced metacarpal fractures. Treatment goals should focus on a stable and acceptable reduction, minimal patient morbidity, and optimal mobility. Methods: A retrospective review of all non-operative metacarpal fractures over a five-month period at a tertiary center hand clinic treated with a hand-based splint were reviewed for radiologic and clinical stability. The splint allowed metacarpophalngeal joint, interphalangeal joint, and radiocarpal joint motion. Data collected included age, handedness, type and location of fracture, occupation, and ability to continue working. Radiologic images were reviewed by a radiologist not otherwise involved in patient care. Results: Thirty-three patients were reviewed with a total of 39 fractures of the second, third, fourth, and fifth metacarpals. Nine patients had nondominant hand fractures while 24 were dominant hand injuries. Twenty out of 24 patients employed pre-injury were able to continue working without missing any days. Three patients were lost to the final follow-up. The average splint duration was 24 days. Twenty-seven of 30 patients showed no change in alignment from start of splinting to end, while three showed some change but remained within non-operative criteria. Conclusion: A hand-based functional splint for metacarpal fractures allows for excellent maintenance of fracture reduction, early or immediate return to pre-injury activities, low patient morbidity, and maintains functional motion throughout treatment. It can be applied to any non-operative fracture of the second through the fifth metacarpal.

Incidence and underreporting of osseous wrist and hand injuries on whole-body computed tomographies at a level 1 trauma center

Background To investigate the incidence of osseous wrist and hand injuries on whole-body computed tomographies (WBCT) at an urban maximum-care trauma center, to report the number of missed cases in primary radiology reports, and to develop an algorithm for improved detection of these injuries. Methods Retrospective analysis reviewing all WBCT for a period of 8 months for osseous wrist and hand injuries. (1) Reconstruction of hands/wrists in three planes (thickness 1–2 mm) and analysis by a blinded musculoskeletal radiologist. (2) Scanning of primary radiology reports and comparison to the re-evaluation. (3) Calculation of the diagnostic accuracy of WBCT during primary reporting. (4) Search for factors potentially influencing the incidence (trauma mechanism, associated injuries, Glasgow Coma Scale, artifacts). (5) Development of an algorithm to improve the detection rate. Results Five hundred six WBCT were included between 01/2020 and 08/2020. 59 (11.7%) WBCT showed 92 osseous wrist or hand injuries. Distal intra-articular radius fractures occurred most frequently (n = 24, 26.1%); 22 patients (37.3%) showed multiple injuries. The sensitivity of WBCT in the detection of wrist and hand fractures during primary evaluation was low with 4 positive cases identified correctly (6.8%; 95% CI 1.9 to 16.5), while the specificity was 100% (95% CI 99.2 to 100.0). Forty-three cases (72.9%) were detected on additional imaging after clinical reassessment. Twelve injuries remained undetected (20.3%). Motorcycle accidents were more common in positive cases (22.0% vs. 10.1%, p = 0.006). 98% of positive cases showed additional fractures of the upper and/or lower extremities, whereas 37% of the patients without osseous wrist and hand injuries suffered such fractures (p < 0.001). The remaining investigated factors did not seem to influence the occurrence. Conclusion Osseous wrist and hand injuries are present in 11.7% on WBCT after polytrauma. 93.2% of injuries were missed primarily, resulting in a very low sensitivity of WBCT during primary reporting. Motorcycle accidents might predispose for these injuries, and they often cause additional fractures of the extremities. Clinical re-evaluation of patients and secondary re-evaluation of WBCT with preparation of dedicated multiplanar reformations are essential in polytrauma cases to detect osseous injuries of wrist and hand reliably. Trial registration The study was registered prospectively on November 17th, 2020, at the German register for clinical trials (DRKS-ID: DRKS00023589).

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

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.

Epidemiology of Hand Fractures and Dislocations in England and Wales Professional Cricketers

This study describes hand fracture and dislocation injuries in terms of anatomical distribution, incidence and impact on playing time in registered professional adult male players of all 18 First Class England and Wales County Cricket clubs over a five-year period from 2010–2014. Prospectively collected injury surveillance data for 1st and 2nd Team matches (Twenty20, One day and four-day) and training were analysed. There were 109 hand fractures and 53 dislocations. Hand injury was commonest during fielding (60%, 98/162) compared to batting, bowling or wicket-keeping. Exposed parts of the hand including tips of all digits, the index finger, thumb ray and little finger ray were most frequently injured with 78% (125/160) of all injuries where anatomical location was recorded. Match injury incidence for batsmen was highest in four-day matches (0.071 injuries per 1000 overs batted) but for other player roles it was highest in Twenty20 matches (0.587 per 1000 overs bowled). Player unavailability for selection to play was incurred in 82% (89/109) of hand fractures but only 47% (25/53) of dislocations. This study clarifies the hand fracture and dislocation injury burden for this population.

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

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 &gt; 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.

1334 Improving Patient Flow Through the Hand Trauma Pathway

Aim A full-cycle audit was conducted at our plastic surgery unit, assessing adherence to hand trauma standards by the British Society for Surgery of the Hand. These stipulate that time from referral to clinic for open injuries and closed fractures should be within 24 hours and 72 hours respectively and time to theatre from date of injury (DOI) within 4 and 7 days, respectively. Method Data for the initial audit was collected from Nov 2019-Feb 2020 and for the re-audit from Aug-Dec 2020. Lists were generated of 50 patients with open injuries including flexor tendon, extensor tendon and nerve injuries and 50 hand fractures in both cycles. Data was collected on DOI, date of referral, clinic review and surgery. Results The initial audit results showed poor DOI documentation (open injuries 30%, fractures 54%). For open injuries, 44% met standards for clinical review within 24 hours and 94% for time to theatre. For fractures, 94% met the standard for time to clinic and 90% for time to theatre. The interventions included adding the standards to the clinic booking form and creating a mandatory DOI field on the referral system. The re-audit showed improvement of DOI documentation (open injuries 95%, fractures 100%) and the proportion of open injuries seen within 24 hours to 60%. Conclusions The interventions had a positive impact on our hand trauma pathway. Areas for improvement include reducing the number of patient visits to the service and encouraging early decision-making, particularly for patients reviewed in the emergency department.