Longitudinal study of patients’ health-related quality of life using EQ-5D-3L in 11 Swedish National Quality Registers

ObjectiveTo compare problems reported in the five EQ-5D-3L dimensions and EQ VAS scores at baseline and at 1-year follow-up among different patient groups and specific diagnoses in 11 National Quality Registers (NQRs) and to compare these with the general population.DesignLongitudinal, descriptive study.Participants2 66 241 patients from 11 NQRs and 49 169 participants from the general population were included in the study.Primary and secondary outcome measuresProportions of problems reported in the five EQ-5D-3L dimensions, EQ VAS scores of participants’ own health and proportions of participants and mean/median EQ VAS score in the Paretian Classification of Health Change (PCHC) categories.ResultsIn most of the included registers, and the general population, problems with pain/discomfort were the most frequently reported at baseline and at 1-year follow-up. Mean EQ VAS score (SD) ranged from 45.2 (22.4) among disc hernia patients to 88.1 (15.3) in wrist and hand fracture patients at baseline. They ranged from 48.9 (20.9) in pulmonary fibrosis patients to 83.3 (17.4) in wrist and hand fracture patients at follow-up. The improved category of PCHC, improvement in at least one dimension without deterioration in any other, accounted for the highest proportion in several diagnoses, corresponding with highest improvement in mean EQ VAS score.ConclusionsThe study documented self-reported health of several different patient groups using the EQ-5D-3L in comparing with the general population. This demonstrated the important role of patient-reported outcomes in routine clinical care, to assess and follow-up health status and progress within different groups of patients. The EQ-5D-3L descriptive system and EQ VAS have an important role in providing a ‘common denominator’, allowing comparisons across NQRs and specific diagnoses.Trial registration numberClinicalTrials.gov (NCT04359628).

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.

1394 Operation Notes Performa: The Way to Optimise Hand Trauma Service

Aim To assess the effect of the introduction of British Society for Surgery of the Hand (BSSH) guided operation note Performa on the hand trauma service in St. George’s University Hospitals. Method First cycle was done in October 2019. This included retrospective evaluation of accuracy of documentation for closed hand fracture audit. Reassessment was done in September 2020 after introduction of surgical Performa guided by the latest BSSH guidelines. Results 27 patients have been included in the first cycle compared with 81 patients in the second cycle. While 82% of first cycle patients underwent operation, only 40% of second cycle patients were treated surgically. Overall documentation has improved by a mean of 40% in all parameters. This includes documentation of discussion of shared decision making regarding conservative and surgical management, documentation of level of competency of the operating surgeon and mobilisation advice given to patients before their first appointment with a hand therapist. This led to improvement in overall patient outcome including rate of infection falling from 14% to 1% and reoperation rate from 23% to 1%. Conclusions Op notes Performa is a useful tool in the armamentarium of hand trauma management. It helps junior trainees to memorise critical information to document especially in the ones usually missed like detailed post-operative advice.

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

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.

Compare the Effectiveness of Hematoma Block versus Intravenously Sedation for Reduction of Colles Fracture

Objective: To compare the effectiveness of hematoma block versus intravenous sedation in reduction of colles fractures. Study Design: Randomized control trial Place and Duration: Conducted at the Emergency department of Lady Reading Hospital Peshawar for duration of six months i.e January 2020 to June 2020. Methodology: One hundred and twenty patients of both gender presented with distal radius fracture were enrolled in this study. After taking written informed consent from all the patients’ detailed demographics including age, sex, BMI, site of fracture, cause of fracture and radiographic assessment were recorded. All the patients were equally divided into two groups. Group I (Hematoma Block) consist of 60 patients and group II (Intravenous Sedation) contains 60 patients. Pain was recorded on visual analogue scale VAS at the start and after procedure of reduction. Data was analyzed by SPSS 24.0. Results: Majority were females 40 (66.7%) in group I and 41 (68.3%) in group II and the rest were males 20 (33.3%) and 19 (31.7%). Mean age of the patients in group was 27.48±19.64 years with mean BMI 25.12±9.46 kg/m2 and in group II mean age was 26.72±9.48 years with mean BMI 24.48±17.61 kg/m2. In group I 35 (58.3%) had left side fracture while in group II 32 (53.3%) cases had left hand fracture. Falling was the most common cause of colles fracture found in 45 (75%) patients of group I and 42 (70%) patients in group II followed by accident 13 (21.7%) and 15 (25%) in group I and II. Before reduction means pain score by using VAS among both groups was 8.60±8.23 and 8.03±5.23, during induction mean VAS score reduced to 3.77.±5.42 and 3.09±4.44 and after reduction mean VAS score was lower in hematoma block 1.01.±2.22 as compared to group II 2.06.±4.14. Post-treatment complications were higher in group II as compared to group I. Conclusion: In this research we concluded that hematoma block is a safe and effective as compared to intravenous sedation for the decrease of colles fracture pain in patients. Keywords: Colles Fracture, Hematoma Block, Intravenous sedation, VAS, Pain Reduction

Open reduction and internal fixation of metacarpal fractures using a thermoplastic splint as a surgical instrument

Adequate positioning of the hand is a critical step in hand fracture operative repair that can impact both the clinical outcome and the efficiency of the operation. In this paper, we introduce the use of a thermoplastic splint with an added thumb stabilizing component as a means to increase the surgeon’s autonomy and to streamline the patient care pathway. The thermoplastic splint is custom fabricated preoperatively by the specialist hand therapist. The splint is used prior, during, and post operation with minimal modification. The thumb component assists maintaining the forearm in a stable pronated position whilst drilling and affixing metal work. This is demonstrated in the video of removal of metal work and open reduction and internal fixation of a metacarpal fracture.

“One Note Higher”: A Unique Pediatric Hand Fracture

Case Presentation: An otherwise healthy, 12-year-old male presented to the emergency department after a fall down the stairs in which he landed on his right hand. Radiographs demonstrated a Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation, also known as an “extra-octave“ fracture. Orthopedic surgery was consulted and the fracture was reduced and placed in a short-arm cast. The patient was discharged and scheduled for orthopedic follow-up. Discussion: A Salter-Harris II fracture at the base of the proximal phalanx of the fifth digit with ulnar deviation is referred to as an “extra-octave” fracture due to the advantage a pianist would gain in reach of their fifth phalanx if not reduced. However, reduction is needed if the fracture is displaced and can be achieved by several described methods including the “90-90” or “pencil” methods followed by cast or splint application. Percutaneous pinning is rarely needed. Complications include flexor tendon entrapment, collateral ligament disruption, and malunion leading to a “pseudo-claw” deformity. We recommend that all extra-octave fractures receive orthopedic follow-up in one to two weeks or sooner if severely displaced.

Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950–2016

Background The hand is the second most fractured region in children. It is therefore important to update fracture epidemiology to be able to identify time trends for adequate health care planning. This study reports pediatric hand fracture incidence 2014–2016 and, using published data, also long-term time trends in 1950–2016. Patients and methods The Swedish city of Malmö, with 328,494 inhabitants in 2016, has only one hospital. We used the hospital radiological archive, medical charts, and diagnosis registry to identify hand fractures in city residents < 16 years in 2014–2016. These data were compared to those from three published studies that evaluated periods in 1950–2006. Differences between two periods were calculated as both unadjusted and age- and sex-adjusted incident rate ratios (IRR) with 95% confidence intervals (95% CI). We used joinpoint regression to estimate time trends during the entire period and present annual percent changes (APC) with 95% CI. Results In 2014–2016 phalangeal fractures accounted for 71% of all hand fractures, metacarpal fractures for 24%, and carpal fractures for 5%. We identified 615 hand fractures (419 in boys and 196 in girls) during 181,617 person-years in 2014–2016, resulting in an unadjusted pediatric hand fracture incidence of 339/100,000 person-years (boys 452/100,000 person-years and girls 220/100,000 person-years). The age-adjusted incidence 2014–2016 was similar to 2005–2006, the most recently evaluated period (IRR in boys 0.9; 95% CI 0.8 to 1.01, and in girls 1.0; 95% CI 0.8 to 1.2). Looking at the entire period 1950–2016, we found that age-adjusted incidence increased in 1950–1979, in boys by APC + 3.8%; 95% CI 3.0 to 4.5 and in girls by + 3.9%; 95% CI 2.8 to 5.0, but decreased in 1979–2016, in boys by − 0.7%; 95% CI − 1.4 to − 0.003, and girls by − 1.3%; 95% CI − 2.4 to − 0.1. Conclusions Phalangeal fractures accounted for about three quarters of all hand fractures. The age-adjusted hand fracture incidence increased in both sexes in 1950–1979 and decreased in 1979–2016. Level of evidence III