Intimate partner violence (IPV) causes significant morbidity and its unlikely to be reported compared to other forms of gender-based violence (GBV). For early detection, understanding Orthopaedic injuries from GBV is vital. This study assesses the pattern of musculoskeletal injuries from GBV and determines the factors associated with it. It is a retrospective observational study of patients aged ≥18 years, with GBV-related acute Orthopaedic injuries. Data was reviewed from January 2021 to December 2021, including, demographic information, soft tissue and bony injuries, relationship to assailant, substance abuse and the day and time of injury. Frequencies and percentages for categorical data were analysed. Chi-square test was used to calculate association. T-test was used to compare groups for continuous & categorical variables. Multivariate analysis was conducted to find the odds ratio and a p-value <0.05 was statistically significant. 138 patients were included, the mean age at presentation being 35.02 years (SD=11). 92.75% of GBV victims were females. Most were unemployed (66.7%). 30.43% (n-42) had a soft tissue injury; superficial laceration being the most common (23.1%), flexor tendon injury (10.87%), hand abscess (5.8%), and extensor tendon injury (5.07%). 71.02 % (n=98) sustained appendicular fractures. 51.45% (n=71) sustained upper limb fractures; distal radius fractures (10.86%) and distal 3rd ulnar fractures (9,42%). 19.57% (n=27) had lower limb fractures; 7.25% (n=10) had lateral malleolus ankle fractures. 63.7% (n=80) of cases were by an intimate partner on weekends (50.73%). 62.31% occurred between 16h00 and 0h00. 41.1% (n=65) reported alcohol abuse. 63.04% had surgery. GBV likely occurs in early middle-aged females by intimate partners influenced by alcohol over the weekends between 16h00 to 0h00. Distal radius/distal 3rd ulnar fractures are the most common bony injuries. Superficial wrist laceration is the commonest soft tissue injury. These findings may assist with early detection and intervention to prevent adverse outcomes in GBV

There is no agreement as to the superiority or specific indications for cast treatment, percutaneous pinning or open fracture fixation for Bennett's fractures of the thumb metacarpal. We undertook this study to compare the outcomes of treatment for patients treated for Bennett's fracture in the medium term. We reviewed 33 patients treated in our unit for a bennett's fracture to the thumb metacarpal with closed reduction and casting. Each patient was matched with a patient treated surgically. Patients were matched for sex, age, Gedda grade of injury and hand dominance. Patients were reviewed at a minimum of 5-years and 66-patients were reviewed in total. Patients were examined clinically and also asked to complete a DASH questionnaire score and the brief Michigan hand questionnaire. Follow up plain radiographs were taken of the thumb and these were reviewed and graded for degenerative change using the Eaton-Littler score. Sixty-six patients were included in the study, with 33 in the surgical and non-surgical cohorts respectively. The average age was 39 years old. In each cohort, 12/33 were female, 19/33 were right-handed with 25% of individuals injuring their dominant hand. In each coort there were 16 Grade 1 fractures, 4 Grade 2 and 13 Grade 3 fractures. There was no difference between the surgically treated and cast-treatment cohorts of patients when radiographic arthritis, pinch grip, the brief Michigan Hand Questionnaire and pain were assessed at final review. The surgical cohort had significantly lower DASH scores at final follow-up. There was no significant difference in the normalised bMHQ scores. Our study was unable to demonstrate superiority of either operative or non-operative fracture stabilization. Patients in the surgical cohort reported superior satisfaction and DASH scores but did not demonstrate any superiority in any other objectively measured domain

Introduction:. During the Christmas period a number of patients are admitted to the Chris Hani Baragwanath Academic Hospital (CHBAH) Hand Unit with explosive injuries to their hands caused by firecrackers. South African legislation restricts the sale and use of fireworks to adults, with a limitation being placed on the size of explosive and type of commercial outlet. Despite this an inordinate amount of explosive hand injuries are admitted over the festive season. Aim:. To evaluate the epidemiological pattern of firecracker injuries to the hand during the Christmas festive period and assess contributing factors. Comparison to a previous study in 2008 will also be evaluated. Method:. Patients with firecracker injuries to the hand were interviewed. Demographic information, events surrounding the incident including alcohol use, and origin of the explosive were recorded. Injuries were classified into minor, moderate and severe based on the amount of soft tissue and bony damage. Treatment and complications was recorded. The data is also compared to previous data obtained in 2008. Results:. 26 patients were admitted. 2 patients were injured with explosives from a legal source. Alcohol use was implicated in 10 of the injuries. 17 amputations were performed at various levels, 9 fractures and 2 dislocations were stabilised with K-wires. Sepsis was more common in severe injuries. The majority of patients were injured from mis-use with several patients suffering injuries following removal of explosives from children or from other people throwing explosives at them or their family. These results are similar to those obtained in 2008. Conclusion:. A large number of patients are injured by firecrackers during the festive period. Injuries are severe. Lack of law enforcement, alcohol and misuse are contributing factors in these injuries. No significant change has occurred in the pattern of injury between 2008 and 2011

Introduction/Aim. Flexor tendon injuries of the hand are common with an incidence of over 3000 per annum in the UK. These injuries can affect hand function significantly. Early treatment with optimal repair is crucial to prevent disability. This study aimed at investigating the re-rupture rate following primary flexor tendon repair at our institution and to identify potential risk factors for re-rupture. Methods. 100 flexor tendons' injuries that underwent primary repair over a one-year period were reviewed retrospectively. Data was collected on age, gender, occupation, co morbidities, injured fingers, hand dominance, smoking status, zone of injury, time to surgery, surgeon grade, type of repair and suture, and antibiotic use on included patients. Causes of re-rupture were examined. We compared primary tendon repairs that had a re-rupture to those that did not re-rupture. Univariate and multivariate analysis was undertaken to identify the most significant risk factors for re-rupture. Results. 11 out of 100 (11%) repaired tendons went on to re-rupture. A significantly higher proportion of tendons re-rupture was noted when the repair was performed on the dominant hand (p-value = 0.009), in Zone 2 (0.001), and when a surgical delay of more than 72 hours from the time of injury occurred (0.01). Multivariate regression analysis identified repairs in Zone 2 to be the most significant predictor of re-rupture. Causes of re-rupture included infection in 5, rupture during rehabilitation exercises in 5 and fall in 1 patient. Conclusions. A re-rupture rate of 11% was noted in our study. Patients with Zone 2 injuries, repair on dominant hand and those with a surgical delay of more than 3 days were at higher risk of re-rupture. Careful consideration of these factors especially zone 2 injuries is crucial to reduce this rate. Providing a fast-track pathway for managing these patients can reduce time to surgery

Purpose. Penetrating injuries of the hand and forearm may cause significant morbidity for a patient. Our aim was to evaluate the accuracy of initial examination of forearm lacerations and pre-operative examination and compare both to the actual findings on surgical exploration. We wanted to identify any factors which may influence the accuracy of the initial examination. Existing literature indicates that there are differences between initial and subsequent examination in terms of picking up injuries. Methods. 65 consecutive patients with penetrating injuries to the hand/forearm were studied. The admitting casualty doctor/s completed an admission form indicating their findings on examination. Factors which may have hampered history taking and examination were noted on the form. The same form was filled in prior to surgery by one of the hand registrars after re-examining the patient prior to surgery. A separate surgical form was filled in by the surgeon indicating the actual findings at surgery. Results. Our results show that as many as 40% of injuries are missed on examination initially by casualty officers but only 10% are missed on re-examination post admission. Factors such as alcohol intoxication and distracting injuries seem to play a role in the casualty examination being difficult. Conclusion. Underlying injuries to structures in the forearm and hand are often missed on initial examination of lacerations involving the forearm and hand. Re-examination post admission of the patient is essential to avoid underestimating the extent and time of surgery required to treat the patient. Factors identified as possibly contributing to this are alcohol intoxication, distracting injuries and language problems in the casualty setting. NO DISCLOSURES

Historically human and animal bites to the hand have resulted in significant morbidity in relation to the high risk of contamination and subsequent infection. Our study aimed to assess the outcomes following such injuries in terms of infection requiring further intervention through specialist referral to the hand surgery team at our hospital. 124 consecutive patients attending the A&E department over a three month period in 2011 were included in this retrospective study which provided 126 separate cases due to bilateral injuries (110 animal: 16 human). Data was obtained from the electronic patient management system. The demographics of each patient were recorded followed by type of bite sustained including number and size of lacerations. 79% of patients presented within 24 hours and the majority before 6 hours from injury. The majority of the forearm bites were documented as superficial abrasions and none of these went on to develop problems with infection, so the study concentrated on bite injuries to the hand of which there were 99 cases. Most hand injuries were a single puncture or laceration (64%) but in 9 cases there were greater than 3 separate wounds. 5 cases were directly referred to the Hand surgery team with 4 requiring admission and of these 3 required washout and debdridement in theatres. The remaining 94 cases were managed solely by A&E. Of these 94 cases 87 pts received Abx and 78 pts had a lavage. Overall 68% received both Abx and lavage. Subsequent to discharge from A&E only 3 developed problems with infection later (2 requiring specialist input) they were all dog bites and in keeping with the ‘typical’ bite pattern seen in other pts. The study concluded that bites not involving joint, tendon or bone have only a small chance of causing infection provided good initial treatment

Background. Non-operative cases of mallet finger can be followed up by the hand therapists. Both trust and national policies encourage appropriate indication for follow-up in fracture clinic & cost-effective approach without affecting the patient care. Aims. To reduce unnecessary fracture clinic follow up for Mallet finger injuries. Methods. Management for uncomplicated mallet finger injuries is provided by hand therapy and does not need surgical input. Hand Surgeons in the department agreed to a management protocol for Mallet finger injuries, to streamline patient management and save costs. All Mallet finger injuries less than 6 weeks old not requiring surgery to be referred for hand therapy at the first appointment in fracture clinic and left with an open appointment. Retrospective audit of all patients referred to hand therapy in 2015 (Jan-Dec) done to identify extra appointments. Results. Inclusion criteria: All mallet fingers seen in fracture clinic. Exclusion criteria: > 6-week-old injury at presentation, Patients requiring surgery (joint subluxation). Retrospective first Audit (01/01/2015-31/12/2015):. 55 patients identified fulfilling inclusion criteria. 33 patients had delayed referral to hand therapists (12–107 days). 37 patients had extra fracture clinic appointments totalling 72 appointments. Prospective re-audit (01/10/2016 – 31/12/2016):. 16 patients met inclusion criteria. Number of patients referred in their first fracture clinic: 10 patients. Other 6 patients had mean delay 20 days. Potential cost saving in fracture clinic for the trust over a year of £4730. Extra-fracture clinic in 7 patients, but 3 were clinically indicated (review to check possible subluxation) i.e. only 4 wasted clinic appointments. Conclusions. By restructuring our management for Mallet fingers we have streamlined the service. There is early referral to hand therapy, reduced fracture clinic appointments, decreasing pressure on fracture clinics, enhanced patient experience and cost savings for the trust

The COVID-19 pandemic has disrupted all segments of daily life, with the healthcare sector being at the forefront of this upheaval. Unprecedented efforts have been taken worldwide to curb this ongoing global catastrophe that has already resulted in many fatalities. One of the areas that has received little attention amid this turmoil is the disruption to trainee education, particularly in specialties that involve acquisition of procedural skills. Hand surgery in Singapore is a standalone combined programme that relies heavily on dedicated cross-hospital rotations, an extensive didactic curriculum and supervised hands-on training of increasing complexity. All aspects of this training programme have been affected because of the cancellation of elective surgical procedures, suspension of cross-hospital rotations, redeployment of residents, and an unsustainable duty roster. There is a real concern that trainees will not be able to meet their training requirements and suffer serious issues like burnout and depression. The long-term impact of suspending training indefinitely is a severe disruption of essential medical services. This article examines the impact of a global pandemic on trainee education in a demanding surgical speciality. We have outlined strategies to maintain trainee competencies based on the following considerations: 1) the safety and wellbeing of trainees is paramount; 2) resource utilization must be thoroughly rationalized; 3) technology and innovative learning methods must supplant traditional teaching methods; and 4) the changes implemented must be sustainable. We hope that these lessons will be valuable to other training programs struggling to deliver quality education to their trainees, even as we work together to battle this global catastrophe.

Aims. The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service. Methods. Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019. Results. There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002). Conclusion. The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention