All licensed doctors are required to revalidate from June 2012. The GMC states that patient feedback should form part of doctors provided evidence. A standardised GMC PSS has been shown to offer a reliable basis for the assessment of professionalism among UK doctors and has been suggested as a tool for revalidation. We aim to show its use in the secondary care setting to be simple and effective, offering further evidence for doctors undergoing revalidation. Having sought permission from the Trust the GMC PSS was used in the manner directed for 3 doctors in a Trauma and Orthopaedic fracture clinic. The data was analysed using an automated system and the results made available to individual clinicians in a simple to present format. 3 clinicians used the survey across 13 clinic sessions. The mean number of clinics it took to generate sufficient responses was 3.25 (range 2–5). We found the survey easy to use, HCAs handed forms to patients before consultation. Survey results were collected as patients left clinic and analysed by the Patient Services Department. The GMC PSS, although designed principally for use in Primary care appears to be a useful tool in secondary care.
The evolving importance of extremity trauma is clear from the quantity of its reporting. The paucity of life threatening cavity trauma is highlighted. Casualty survival off the battlefield is increasing perhaps due to the impact of personal protective equipment. The combination of changing ballistics and increasing survivability leads to an apparent increase in limb threatening and complex hand trauma being encountered by military surgeons. Despite being rarely reported in isolation, the proportion of complex hand trauma is broadening with an increase in open fractures and mutilated soft tissue injuries resultant from high and low energy transfer ballistics. Hand trauma is also shown to occur in deployed troops during activities unrelated to war fighting. Sporting activities and inappropriate use of equipment are responsible for soft tissue and bony injury with considerable morbidity. The literature was analysed with regard to the classification of hand trauma. Articles relating to recent conflicts were notable for their lack of classification of these injuries. The bulk of papers retrieved concerning military hand trauma management were published prior to the conflicts of the last decade. It is within these papers that classification and treatment priorities including the nature of debridement and fracture stabilisation are discussed and highlighted as core knowledge.
Despite a culture of ensuring that today’s trauma surgeons learn from mistakes made by their predecessors, in the field of hand trauma this is not the case. A comprehensive review of changing orthopaedic conflict related injury patterns with special regard to hand trauma and the key learning points from historical literature are highlighted. Proposals for improving management are discussed with regard to improved training opportunities and dialogue between military trauma surgeons.
To review the changing pattern of orthopaedic injury encountered by deployed troops with special regard to the importance of hand trauma sustained in conflict and non- war fighting activities. Literature review relating to recent military operations (1990–2007) encompassing 100 conflicts worldwide. A subsequent search was performed to identify papers relating to hand injuries from 1914 to the present day. Papers were graded by Oxford Centre for Evidence-based Medicine Levels of Evidence. Two hundred and ten published works were analysed. Review of the literature revealed a lack of statistical analysis and a tendency towards the anecdotal. These works were primarily level five evidence comprising reviews, correspondence, sub-unit experiences and individual nation database analyses. The importance of extremity trauma is clear. The combination of changing ballistics and increasing survivability off the battlefield leads to a previously under emphasised increase in complex hand trauma. Hand trauma is also shown to occur in deployed troops during activities unrelated to war fighting. Articles concerning military hand trauma management were mainly published prior to the conflicts of the last decade. Within these papers injury classification and treatment priorities are highlighted as core knowledge for trauma surgeons. This paper provides a review of conflict related injury patterns with special regard to hand trauma. The key learning points from historical literature are highlighted. Proposals for improving management of these injuries from battlefield to home nation are discussed with regard to training opportunities and dialogue to ensure past lessons are not forgotten.
It has been shown that extremity injuries form a large proportion of the operative surgical workload in conflict situations. Injuries to the hands are an important subgroup and hand surgery has a long association with military surgery. While most hand injuries do not require surgical intervention, those that do, require that military surgeons should be well versed in the principles of hand surgery. The concepts of staging and/or damage control surgery are well applied to this region. The nature of military medical support necessarily changes in the transition from war fighting to a post-conflict phase. We examine the activity in the sole British Military Hospital serving a multi-national divisional area in Iraq over 2004. During this post conflict phase, the spectrum of hand trauma is characterised. The overwhelming majority of hand trauma resulted in soft tissue injury. There was a clear predisposition to hand trauma for males, manual workers, combat soldiers and engineers/mechanics. X-ray imaging is heavily used in this environment. Even where soldiers are returned to duty they are often restricted in the duties that they can perform. The results of this study reinforce the relevance of basic principles of hand trauma management, particularly in challenging environments. These knowledge and skill requirements should be emphasised for the war surgeon and the emergency physician. Hand surgery is an evolving speciality that continues to find clear and direct applications for the military surgeon.
