The Trauma Triage clinic (TTC) is a Virtual Fracture clinic which permits the direct discharge of simple, isolated fractures from the Emergency Department (ED), with consultant review of the clinical notes and radiographs. This study details the outcomes of patients with such injuries over a four-year period. All TTC records between January 2014 and December 2017 were collated from a prospective database. Fractures of the radial head, little finger metacarpal, fifth metatarsal, toe phalanges and soft tissue mallet finger injuries were included. Application of the direct discharge protocol, and any deviations were noted. All records were then re-assessed at a minimum of three years after TTC triage (mean 4.5 years) to ascertain which injuries re-attended the trauma clinic, reasons for re-attendance, source of referral and any subsequent surgical procedures. 6709 patients with fractures of the radial head (1882), little finger metacarpal (1621), fifth metatarsal (1916), toe phalanges (920) and soft tissue mallet finger injures (370) were identified. 963 (14%) patients were offered in-person review after TTC, of which 45 (0.6%) underwent a surgical intervention. 299 (4%) re-attended after TTC direct discharge at a mean time after injury of 11.9 weeks and 12 (0.2%) underwent surgical intervention. Serious interventions, defined as those in which a surgical procedure may have been avoided if the patient had not undergone direct discharge, occurred in 1 patient (0.01%). Re-intervention after direct discharge of simple injuries of the elbow, hand and foot is low. Unnecessary deviations from protocol offer avenues to optimise consumption of service resources

Aims

This is a multicentre, prospective assessment of a proportion of the overall orthopaedic trauma caseload of the UK. It investigates theatre capacity, cancellations, and time to surgery in a group of hospitals that is representative of the wider population. It identifies barriers to effective practice and will inform system improvements.

Introduction. Closed avulsion of the Flexor Digitorum Profundus (FDP) from distal phalanx most commonly affects the ring finger when an extensive force is applied to a finger in active flexion. Whilst it is undoubtably reasonable to provide treatment for those who present with symptoms, there may be a cohort of people who sustain an avulsion without noticing. This study aims to quantify the effect of ring finger FDP avulsion on overall grip strength to determine the functional effect of a missed injury. Method. Right handed volunteers, with no abnormality on examination were included (N= 42). Proximal muscle group action was excluded. Grip strength was tested using a Jamar dynamometer with and without splinting of the ring finger to block flexion at the DIPJ and repeated six times alternately to mitigate the effects of fatigue. Results. Most subjects showed a small (0.3–3kg) change in their average grip strength with the splint (N= 29). Some showed a dramatic change in their grip strength (6–11.4) (N=6) others showed no change or slight improvement with the splint (−3–0) (N=7). Data were not normally distributed (kolmogorov-smirnov p=0.023). A wilcoxon signed rank test showed a statistically significant difference in performance with, compared to without, the splint, mean 2.34kg reduction (−3.3 − 11.4) (p <0.0005. Discussion. Horton et al have examined the quadriga effect and shown that the individual strength of other digits is reduced when one FDP is isolated. This implies overall grip strength should be reduced; our data supports this assertion. However despite splinting, the majority of subjects were still within the normal range of power for age. Larger scale studies are required to assess the functional effect of repair vs conservative management

Introduction. Lesions of the upper extremities, and especially of the hands, are the most common form of occupational injury in the agricultural and industrial sectors [1]. When the grip strength and the way of its development are relevant, it would be very useful to be able to rely on an instrumental procedure, in support of the clinical examination, for both clinical and legal purposes. The possibility of differentiating between healthy subjects and patients affected by disabilities of the upper extremities, using parameters based on force-time curves for handgrip tests, was investigated with the aim to obtain objective and comprehensive outcome, useful to support the clinical evaluation. Materials and Methods. The reference group consisted of 151 subjects examined for occupational trauma of the upper limbs, all with a dominant right arm, who had suffered an occupational injury. The 74% of the injuries affected the hand. A further 648 healthy people were enrolled as the control group. Grip strength was measured with an electronic dynamometer. The signals acquired with the dynamometer were subdivided into 5 characteristic phases [2]: first reaction, explosive contraction, isometric contraction, release and relaxation. The maximum force, the ratio between the maximum force exerted by the two arms and an index related to the explosive muscle power and the ability to maintain maximum voluntary contraction were calculated. Percentage variations of each parameter, as compared to a threshold value, were taken into account and an overall value (T) was calculated, representing the sum of these variations. Result and Discussion. This acquisition system was shown to be reliable and easy to use, and the test could be administered simply and fairly rapidly. The findings in the control group were comparable to those reported in the literature [3–4]. A negative value of T invariably identified a subject with a disability. By associating assessment of T with those of the specific indexes, other subjects with a clinical disability were identified. The use of the parameters we describe makes it possible not only to assess the maximum force of the handgrip but also how it is exerted and maintained, thus providing a more reliable method of differentiating between normal function and impairment and what it is more obtaining an objective and comprehensive outcome, which sensitivity is useful to support clinical evaluation. The proposed functional tests could offer the clinician a possible diagnostic aid, providing a method that can describe the motor skill on the basis of objective parameters. In view of its good sensitivity (0.99%) and specificity (0.84%), relatively rapid execution and the low cost of the tools, it could be usefully adopted in the clinical setting

Aim

There is not adequate evidence to establish whether external fixation (EF) of pelvic fractures leads to a reduced mortality. We used the Japan Trauma Data Bank database to identify isolated unstable pelvic ring fractures to exclude the possibility of blood loss from other injuries, and analyzed the effectiveness of EF on mortality in this group of patients.

This is a retrospective study of six children with ununited scaphoid fractures treated conservatively. Their mean age was 12.8 years (9.7 to 16.3). Five had no early treatment. Radiological signs of nonunion were found at a mean of 4.6 months (3 to 7) after injury. Treatment consisted of cast immobilisation until clinical and radiological union. The mean clinical and radiological follow-up was for 67 months (17 to 90). We assessed the symptoms, the range of movement of the wrist and the grip strength to calculate the Modified Mayo Wrist score.

The fracture united in all patients after a mean period of immobilisation of 5.3 months (3 to 7). Five patients were pain free; one had mild pain. All returned to regular activities, and had a range of movement and grip strength within 25% of normal, resulting in an excellent Modified Mayo Wrist score.

Prolonged treatment with cast immobilisation resulted in union of the fracture and an excellent Modified Wrist Score in all patients.

Although the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was designed, and has been validated, as a measure of disability in patients with disorders of the upper limb, the influence of those of the lower limb on disability as measured by the DASH score has not been assessed. The aim of this study was to investigate whether it exclusively measures disability associated with injuries to the upper limb. The Short Musculoskeletal Functional Assessment, a general musculoskeletal assessment instrument, was also completed by participants. Disability was compared in 206 participants, 84 with an injury to the upper limb, 73 with injury to the lower limb and 49 controls.

We found that the DASH score also measured disability in patients with injuries to the lower limb. Care must therefore be taken when attributing disability measured by the DASH score to injuries of the upper limb when problems are also present in the lower limb. Its inability to discriminate clearly between disability due to problems at these separate sites must be taken into account when using this instrument in clinical practice or research.