We conducted a prospective review of patients treated specifically for phalangeal fractures over a period of 6 months. Data was sourced from patient records, Emergency Dept records and theatre records. X-rays were reviewed by the senior authors using the AGFA IMPAX Web1000 v5.1 System.

A total of 654 patients presented to our hospital during the study. Of these, 257 (39%) patients were referred to the plastics and hand surgical team on-call. Remaining 397 (61%) patients were seen and treated at the local accident and emergency. Our review identified a patient group of 75 out of 654 (11.5%) patients who required operation.

Mechanism of injury: Direct impact: n=60 (80%), Hyperextension n=11 (15%), Hyper-flexion injury n=4 (5%).

The average patient age for a phalangeal fracture was 37.3 years. 47 (63%) patients were in the age group 20–40 years. The mean age for a phalangeal fracture in males was 35.9 (16–75) years and 42.2 (23–70) years in females. The gender distribution of these patients reveals that 58/75 (77%) patients were males. This indicates that males were at an increased relative risk of 3.4 for sustaining a hand fractures than females.

The fractures were studied with respect to their complexity, digit(s) involved, phalanx and the site on the phalanx, pattern of fracture and finally the involvement of the MCP or the IP joints.

Our study revealed that fifty-two (69%) of the fractures were closed while twenty-three (31%) were open. Injuries to the distal phalanges accounted for the most of the open fractures (15/23, 67%). The little finger and the ring finger were the common fingers to be involved.

The fractures were treated with various standard techniques of operative fixation. Postoperatively patients were mobilised as soon as possible and fitted with a removable thermoplastic splint to allow daily active and passive exercises. Hand therapists followed unit protocol including at least one visit per week, with follow up for four to six weeks. Final review was undertaken by a clinician in a dedicated Hand clinic six weeks post fixation.

Our work provides data on incidence and demographic distribution of phalangeal injuries presenting acutely to an NHS Trust covering a population area of 500,000. In our trust it is standard protocol for all such injuries to be reviewed by the Hand team to institute optimal hand therapy for patients. The study enabled us to develop a patient care pathway which will improve both patient and resource management

Introduction: Carpal tunnel syndrome is the most commonly occurring peripheral nerve entrapment syndrome and perhaps also the commonest peripheral nerve to be released. Increasingly there is a suggestion that carpal tunnel syndrome (CTS) is a bilateral disease with the reported incidence of between 16% and 87% and hence the enthusiasts favour bilateral simultaneous carpal tunnel decompression (CTD). Our hypothesis is that there is an increased likelihood of over-treating these patients with this approach of simultaneous carpal tunnel decompression.

Materials and Methods: A retrospective study was conducted to review records of 245 patients who underwent CTD at the Regional Hand Surgery Unit between April 2005 and August 2007. Patients who were referred with symptoms of bilateral CTS and underwent open CTD on at least one wrist were included in the study. The two groups hence formed were Group A comprising patients who underwent consecutive CTD where as Group B comprised patients who underwent only unilateral CTD before discharge. All patients booked for surgery were provided with a resting splint preoperatively. They were reviewed on one or more occasion before listing for decompression on the other side or discharged.

Results: A total of 131 met the inclusion criterion. Group A includes 76 (58%) patients and had symptoms on both sides and signs in 64 (84%) patients. Nerve conduction tests confirmed median nerve compression in 59/60 (98%) patients. Group B includes 55 (42%) patients and had symptoms suggestive of CTS on both sides and signs in 45 (82%) patients. Nerve conduction studies confirmed nerve compression in 38/41 (93%) patients. All patients were followed up for minimum of 6 months before being discharged from further review. At the end of the study, 48/131 (37 %) patients were successfully discharged after a minimum of six months follow up without an operation on the contralateral side.

Discussion: Our study has confirmed the bilateral nature of the disease. Current literature supports simultaneous CTD as it has been shown to be economic to the patient, employers and the healthcare industry. Studies have shown that symptoms are usually severe on one side and sometimes treatment of one hand may lead to the improvement, exacerbation or absence of effect in the other hand regardless of electromyographic findings. 45/131 (37 %) patients in our study were successfully discharged without an operation on the contralateral side after a minimum of six months follow up. Hence, this supports our hypothesis that by following an approach of simultaneous bilateral CTD, there is a increased likelihood of over-treating these patients and exposing them to the potential complications.