gms | German Medical Science

Objectives: Open fractures are an injury technically difficult to manage and associated with significant morbidity. The treatment of long bone open fractures in the UK are defined by national guidelines developed between orthopaedic and plastic surgery societies. By comparison, little is known regarding the epidemiology of open hand fractures in the UK. Little is also known about their current management, including their outcome and rehabilitation plans. This prospective multicentre study aimed to define incidence and clinical management of open hand fractures in the UK. The secondary aim of the study was to develop national standards of care in hand trauma.

Method: All hand surgery units in the UK were invited to participate through the Reconstructive Surgical Trials Network and the British Society for Surgery of the Hand. All adult patients presenting with an open hand fracture between July and September 2015 were included. Patients were followed up for 3 months. Anonymised data was prospectively collected for initial management in the emergency department, time and type of surgical fixation, rehabilitation and final outcome.

Results: 100 plastic and orthopaedic surgery collaborators at 38 hand surgical centres contributed a total of 413 fractures in 327 patients to the study. 61 patients (18.7%) presented with 2 or more fractures. The most commonly injured bone was the middle phalanx (28.5%), and the index finger (25.8%). The mean time to hand surgical review was surgery was 12 hours (SD 24.9) and the mean time to surgery following review was 25 hours (SD 33.9). The mean duration of admission was 2 days (0-63). The most common surgical procedure undertaken was kirschner wire fixation (44.5%). 87.5% received prophylactic antibiotics, 35.8% received an x ray and 57.9% received a personal rehabilitation plan before discharge. The overall complication rate was 20.9%, with 28.2% of patients returning to work before 6 weeks.

Conclusion: This is the first national prospective multicentre hand audit using a collaborative approach. We have identified significant variation in the delivery of hand trauma care. These data will inform future research and set a benchmark for future assessment of patient care following the introduction of national guidelines.

This work was submitted on behalf of the UK national hand trauma collaboration.