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Abstract
Complications are a recognized hazard of surgery. The term is confusing; it has multiple meanings, including surgical error and adverse surgical outcomes. I propose the latter two terms are used. Grading of 'complications' is difficult but made easier by grading errors and outcomes separately, though they are not always linked. The exact grades are not established.Error avoidance requires efforts at a personal (surgeon) level, including training, learning and preparation, and at a systems level. Understanding human factors is important.The perspective of patients about adverse outcomes is not well understood. There is evidence that, unsurprisingly, patient perspectives may be different to surgeon perspectives. There are a range of surgeon responses to error and adverse outcomes; many are negative. These need to be understood better in order to protect patients and surgeons in the immediate aftermath and in the potentially prolonged 'recovery time', both for patients and surgeons.Level of evidence: V.
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2
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Spies CK, Giddins G. Re: Giddins G. The distal radioulnar joint after distal radial fractures: when and how do we need to treat pain, stiffness or instability? J Hand Surg Eur. 2023, 48: 230-45. J Hand Surg Eur Vol 2023; 48:1244-1245. [PMID: 37417003 DOI: 10.1177/17531934231186333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
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3
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Lane JC, Wilkinson AL, Giddins G, Horwitz MD. Preventable hand injuries: A national audit. JPRAS Open 2023; 38:305-312. [PMID: 38039295 PMCID: PMC10684376 DOI: 10.1016/j.jpra.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/01/2023] [Indexed: 12/03/2023] Open
Abstract
Little is known of the scale of avoidable injuries presenting to medical services on a national level in the UK. This study aimed to assess the type and incidence of preventable wrist and hand injuries (as defined by the core research team) at a national level in the UK. 28 UK hospitals undertook a service evaluation of all hand trauma cases presenting to their units over a 2 week period in early 2021 identifying demographical and aetiological information about injuries sustained. 1909 patients were included (184 children) with a median age of 40 (IQR 25-59) years. The commonest five types of injury were fractures of the wrist; single phalangeal or metacarpal fractures; fingertip injuries; and infection, with the most common mechanisms being mechanical falls and manual labour. This is the first extensive survey of preventable hand injuries in the UK, identifying a need for further work into prevention to reduce healthcare burden and cost. 50% of injuries presenting to hand surgeons are preventable, with the most common injuries being single fractures of the wrist, phalanx and metacarpal. Few preventable injuries were related to alcohol or narcotic intoxication. Further research is needed to identify how to initiate injury prevention measures for hand injuries, particularly focussed towards hand fracture prevention.
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Affiliation(s)
- Jennifer C.E. Lane
- Barts Bone & Joint Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, E1 2AT, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | | | - Grey Giddins
- Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | - Maxim D. Horwitz
- Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH London, UK
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4
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Vargesson N, Hooper G, Giddins G, Hunter A, Stirling P, Lam W. Thalidomide upper limb embryopathy - pathogenesis, past and present management and future considerations. J Hand Surg Eur Vol 2023; 48:699-709. [PMID: 37226469 PMCID: PMC10466950 DOI: 10.1177/17531934231177425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
This review article provides a comprehensive overview of thalidomide upper limb embryopathy including updates about its pathogenesis, a historical account of the management of the paediatric thalidomide patient, experience with management of the adult patient, as well as creating awareness about early onset age-related changes associated with limb differences. Despite its withdrawal from the market in November 1961, novel discoveries have meant thalidomide is licensed again and currently still in use to treat a variety of conditions, including inflammatory disorders and some cancers. Yet, if not used safely, thalidomide still has the potential to cause damage to the embryo. Recent work identifying thalidomide analogues that retain clinical benefits yet without the harmful effects are showing great promise. Understanding the problems thalidomide survivors face as they age can allow surgeons to support their unique healthcare issues and translate these principles of care to other congenital upper limb differences.
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Affiliation(s)
- Neil Vargesson
- School of Medicine Medical Sciences & Nutrition. Institute of Medical Sciences. University of Aberdeen. Aberdeen, UK
| | | | | | - Alastair Hunter
- Department of Trauma and Orthopaedics, University College London Hospitals, London, UK
| | - Paul Stirling
- Fife Hand Clinic, Queen Margaret Hospital, Dunfermline, UK
| | - Wee Lam
- Royal Hospital for Children and Young People, Edinburgh, UK
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5
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Abstract
The importance of distal radioulnar joint problems associated with distal radial fractures is recognized increasingly. But there remains considerable disagreement about how to treat these problems both acutely and chronically. This review outlines the knowledge about the natural history of ulnar-sided wrist problems with distal radials fractures. In particular, the recent increased understanding of the almost inevitable joint instability associated with distal radial fractures is highlighted, including the unreliability of clinical assessment and hence why there has been so much misunderstanding. Provided there is reasonable bony alignment, most ulnar-sided wrist problems can be treated non-operatively initially (typically for over a year) in anticipation of substantial improvement with time. The exception is early marked subluxation of the distal radioulnar joint (DRUJ) blocking forearm rotation, which needs urgent (typically closed) reduction.
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6
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Peyronson F, Ostwald CS, Hailer NP, Giddins G, Vedung T, Muder D. Nonoperative Versus Operative Treatment for Displaced Finger Metacarpal Shaft Fractures: A Prospective, Noninferiority, Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:98-106. [PMID: 36455163 DOI: 10.2106/jbjs.22.00573] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
UPDATE This article was updated on January 18, 2023, because of a previous error, which was discovered after the preliminary version of the article was posted online. On page 103, in the first column of Table III, the continuous outcomes, which had been given as "Median" and "(range)", are now given as "Mean" and "(95% CI)", respectively.
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Affiliation(s)
- Fredrik Peyronson
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Cecilia Stalberg Ostwald
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Orthopedics, Falun Hospital, Falun, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University Hospital, Uppsala, Sweden
| | | | - Torbjörn Vedung
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University Hospital, Uppsala, Sweden.,Elisabeth Hospital, Aleris Healthcare AB, Uppsala, Sweden
| | - Daniel Muder
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Orthopedics, Falun Hospital, Falun, Sweden
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7
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Grindlay DJC, Davis TRC, Kennedy D, Larson D, Furniss D, Cowan K, Giddins G, Jain A, Trickett RW, Karantana A. A proposed methodology for uncertainty extraction and verification in priority setting partnerships with the James Lind Alliance: an example from the Common Conditions Affecting the Hand and Wrist Priority Setting Partnership. BMC Med Res Methodol 2022; 22:292. [DOI: 10.1186/s12874-022-01777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
To report our recommended methodology for extracting and then confirming research uncertainties – areas where research has failed to answer a research question – derived from previously published literature during a broad scope Priority Setting Partnership (PSP) with the James Lind Alliance (JLA).
Methods
This process was completed in the UK as part of the PSP for “Common Conditions Affecting the Hand and Wrist”, comprising of health professionals, patients and carers and reports the data (uncertainty) extraction phase of this. The PSP followed the robust methodology dictated by the JLA and sought to identify knowledge gaps, termed “uncertainties” by the JLA. Published Cochrane Systematic Reviews, Guidelines and Protocols, NICE (National Institute for Health and Care Excellence) Guidelines, and SIGN (Scottish Intercollegiate Guidelines Network) Guidelines were screened for documented “uncertainties”. A robust method of screening, internally verifying and then checking uncertainties was adopted. This included independent screening and data extraction by multiple researchers and use of a PRISMA flowchart, alongside steering group consensus processes.
Selection of research uncertainties was guided by the scope of the Common Conditions Affecting the Hand and Wrist PSP which focused on “common” hand conditions routinely treated by hand specialists, including hand surgeons and hand therapists limited to identifying questions concerning the results of intervention, and not the basic science or epidemiology behind disease.
Results
Of the 2358 records identified (after removal of duplicates) which entered the screening process, 186 records were presented to the PSP steering group for eligibility assessment; 79 were deemed within scope and included for the purpose of research uncertainty extraction (45 full Cochrane Reviews, 18 Cochrane Review protocols, 16 Guidelines). These yielded 89 research uncertainties, which were compared to the stakeholder survey, and added to the longlist where necessary; before derived uncertainties were checked against non-Cochrane published systematic reviews.
Conclusions
In carrying out this work, beyond reporting on output of the Common Conditions Affecting the Hand and Wrist PSP, we detail the methodology and processes we hope can inform and facilitate the work of future PSPs and other evidence reviews, especially those with a broader scope beyond a single disease or condition.
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8
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Tang JB, Giddins G. Challenge the Current Wisdom of Hand Surgery. Hand Clin 2022; 38:ix-x. [PMID: 35985762 DOI: 10.1016/j.hcl.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
| | - Grey Giddins
- The Hand to Elbow Clinic, 29a James Street West, Bath BA1 2BT, UK.
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9
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Giddins G. Discussions About Obstetric Brachial Plexus Injuries. Hand Clin 2022; 38:329-335. [PMID: 35985757 DOI: 10.1016/j.hcl.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although patients with obstetric brachial plexus injuries (OBPI) have been recognized and treated for greater than 100 years there is much that is not understood or is mis-understood. I address 6 areas for discussion: the cause of OBPI and whether it matters to nerve surgeons; the value of the Narakas grading; whether surgeons should perform primary nerve surgery, especially in patients with incomplete OBPI; the cause and treatment of shoulder tightness; the cause and treatment of elbow contracture; and whether patients with OBPI need surgery in adulthood.
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Affiliation(s)
- Grey Giddins
- The Hand to Elbow Clinic, Bath, United Kingdom; Royal United Hospital, Bath, United Kingdom; University of Bath, Bath, United Kingdom.
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10
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Duggleby L, Gourbault L, Parsons T, Boden E, Barton T, Giddins G. How many acute orthopaedic injuries are preventable? Injury 2022; 53:2790-2794. [PMID: 35676165 DOI: 10.1016/j.injury.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/11/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Injury prevention is important. Injury as a result of an accident carries with it huge cost to the individual and society including health services costs. Understanding the mechanism of injury is important to identify those injuries that are preventable. The aim of this study was to assess how many acute orthopaedic injuries were preventable should reasonable human interventions have been taken METHODS: This prospective study was performed in a UK district general hospital that serves a population of 500,000 people. All patients referred to the Orthopaedic department over 4 weeks between 16th November and 14th December 2020 were reviewed. Data was collected about the mechanism of injury, patient demographics, injury type, injury location, treatment and length of stay in hospital. The mechanisms of injury were analysed thematically. RESULTS We assessed 605 patient attendances. 502 patients sustained 516 acute traumatic injuries. Preventable injuries were common, accounting for 23.9% of all referrals. The upper limb was most commonly injured with the hand and forearm being injured 33% of the time. Of the preventable injuries 35% were treated operatively. Thematic analysis identified common mechanisms of: occupational related, stairs, RTA, cycling, alcohol related, trampoline, DIY and assault. CONCLUSION This study identifies that a large proportion of acute orthopaedic injuries are potentially preventable meaning this is an important area for further study. Occupation injuries were identified as an area in which there is the greatest scope to reduce the number of preventable accidents.
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Affiliation(s)
| | | | | | | | | | - Grey Giddins
- Royal United Hospital, Combe Park, Bath BA1 3NG UK
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11
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Abstract
Mallet injuries, either tendinous or bony, are common. They are often studied together and typically treated in the same way with extension splintage for 6 to 8 weeks. Yet the evidence clearly shows there are different injuries that present in the same way. Tendinous mallet injuries present in older patients usually following a low energy injury; they are often painless. The commonly injured fingers are the middle and ring. The injuries are almost always single digit without concomitant injuries. There is an extensor lag of a mean of 310 (range 3°-590) in the patients treated in my unit. In contrast, bony mallet injuries occur at a younger age (mean 40 years) and are always due to high energy injuries. The injuries are always painful. The commonly injured fingers are the ring and little fingers. There are multiple injuries in 3% (range 2%-5%) and in 4% to 8% of cases, there are concomitant (nondigital) injuries according to data in my unit. Radiologically there is an appreciably smaller extensor lag; mean 130 (range 0°-400). In particular, bony mallet injuries are extension compression, not avulsion, fractures which should not logically be treated with an extension splint which will reproduce the direction of injury.
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Affiliation(s)
- Grey Giddins
- The Hand to Elbow Clinic, Bath, Bath, United Kingdom; Royal United Hospital, Bath, United Kingdom; University of Bath, Bath, United Kingdom.
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12
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Abstract
During hand surgery, tendons may be at risk of damage. This biomechanical study aims to assess the risk of tendon rupture due to passage of Kirschner wires or hypodermic needles. Porcine extensor tendons were divided into four groups. Group 1: a control group was tested to ensure that repeated stress alone did not cause failure. Group 2a: 1.1-mm Kirschner wires were hand pushed through tendons 50 times and then stressed to 40 N, repeated until tendon failure. In Group 2b, K-wires were passed while rotating using a drill. Group 3: the experiment was repeated using a 20 G hypodermic needle. Group 2a tendons required a median of 2450 passes (1150-3500) to propagate failure, Group 2b a median of 2250 (1200-3850) and Group 3a median of 200 passes (150-450). The risk of tendon rupture from wires or hypodermic needles in procedures appears very low.
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13
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Affiliation(s)
- Justine Silber
- Birmingham Medical School, University
of Birmingham, Edgbaston, UK,
| | - Grey Giddins
- Department of Orthopaedic Surgery,
Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Maxim D. Horwitz
- Department of Hand Surgery, Chelsea and
Westminster Hospital, London, UK
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14
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Brady C, Lee A, Gardiner M, Baker R, Giddins G, Wade RG. The outcomes of zone 1 flexor digitorum profundus tendon injury: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34876371 DOI: 10.1016/j.bjps.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/20/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Chevonne Brady
- Department of Plastic Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, United Kingdom.
| | - Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Matthew Gardiner
- Department of Plastic Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, United Kingdom; Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Richard Baker
- Department of Plastic Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, United Kingdom
| | | | - Ryckie G Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom; Faculty of Medicine and Health Sciences, University of Leeds, Leeds, United Kingdom
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15
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Abstract
We report six cases of complications from use of a thermal wand at wrist arthroscopy. Complications included skin necrosis, extensor tendon lesions and thermal articular cartilage damage, one with a catastrophic outcome. Thermal wands have the potential for substantial soft tissue damage causing severe harm to patients. The damage could be related to the design of the wands. User error poses an additional risk. These risks need to be appreciated and should be minimized. The complications indicate the need for careful use of the thermal wands to minimise risk including using only short bursts of thermal energy, the use of high flow irrigation with an outflow and trying to ensure that the collar of the device and not just the tip is within the joint. In addition, the design of thermal wands for use in the wrist may need to be reviewed.Level of evidence: IV.
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16
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17
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Giddins G, Joyce T. Early catastrophic failure of Neuflex® metacarpophalangeal joint implants at the hinge in two patients. J Hand Surg Eur Vol 2021; 46:419-420. [PMID: 32967519 DOI: 10.1177/1753193420957892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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18
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Hardman L, Elamin S, Giddins G, Gardiner M, Reay E. P114 STING. Steroid Injections DurinG Covid-19. A cross speciality call. BJS Open 2021. [PMCID: PMC8030188 DOI: 10.1093/bjsopen/zrab032.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction An important clinical question during the Covid -19 pandemic is the safety of steroid use. Guidelines published by rheumatology, physiotherapy, orthopaedic and pain medicine societies have advised on the restricted use of corticosteroids for musculoskeletal and rheumatic conditions. For clinicians across the specialities there is a challenge to safely conducting best practice, yet ensuring patients have access to the significant functional benefits of steroid injections. Methods The STING prospective service evaluation will collect data on steroid injections undertaken during this part of the pandemic. Clinicians will be able to input information on patient demographics, background Covid risk and steroid injection specifics. At follow up at 4-6 weeks complications and Covid specific outcomes will be recorded, as well as patient perceived symptom improvement. Each unit collecting data will have assigned collaborator(s), with a senior consultant validating the data. Data will be collected and managed using Research Electronic Data Capture (REDCap). Data collection and management will adhere to Caldicott II principles and GDPR. Results Results will be analysed through RedCap and compared to national Covid incidence. Local complication and patient reported outcomes will be compared between specialities, environments and steroid specifics (volume, location etc.). Conclusion A pan-speciality look at steroid injection use during the pandemic will be useful primarily to contribute to understanding the safety of steroid use. Secondarily to look at cross speciality differences in administration, PROMs and to appreciate patient groups who may be excluded from steroid treatment. Join the team! Head to RSTN to get involved.
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19
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Giddins G, Giddins H. Wrist and hand postures when falling and description of the upper limb falling reflex. Injury 2021; 52:869-876. [PMID: 33358532 DOI: 10.1016/j.injury.2020.11.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Falling studies, i.e. assessing what happens when an individual falls, have been conducted in controlled environments but not in field studies for ethical reasons; this potentially limits the validity and applicability of previous studies. We performed field studies on existing YouTube © videos of skateboarders falling. The aims of these studies were to measure the wrist angle at impact on videos of real unprotected falls and to study the dynamics of the upper limbs when falling. METHODS Youtube © videos of skateboarders falling were studied assessing the direction of the fall, the positions of both upper limbs and especially the wrists on impact quantitatively and qualitatively. This study would not be ethical by other means. RESULTS In study one (the more quantitative study) there were 48 men and 50 falls. The mean elbow flexion was 300 (range 00 to 800) and the mean maximal wrist extension was 800 (range 500 to 1100). The second wrist extended less or the same in > 90%. The second wrist only once (of 31) extended > 900 which should minimise the risk of toppling. Falls onto only one wrist gave significantly greater maximal wrist extension. In the second more qualitative study we observed the "upper limb falling reflex" where the response to falling is for the upper limb(s) to align the upper limb with the direction of falling of the body with the elbow mostly but not fully extended. Initially the wrists extend c. 400-500 with the fingers held mildly flexed. Immediately before impact the fingers hyper-extend with some compensatory wrist flexion to c. 300 of extension. The fingertips impact the ground first followed by the hand. CONCLUSION These studies confirm wrist extension at impact around 800 but the wrist(s) may hyper-extend risking toppling. Falls on both wrists minimise the risk of toppling. The "upper limb falling reflex" is defined; it is a rapid dynamic response leading to the fingers impacting the ground first on falling. Abnormalities with the upper limb falling reflex may indicate problems with development in young children and may increase the risk of injury in older people.
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Affiliation(s)
- Grey Giddins
- The Hand to Elbow Clinic, 29a James St West, Bath, BA1 2BT.
| | - Hugo Giddins
- The Hand to Elbow Clinic, 29a James St West, Bath, BA1 2BT
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20
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Karantana A, Davis T, Kennedy D, Larson D, Furniss D, Grindlay DJ, Cowan K, Giddins G, Jain A, Trickett RW. Common hand and wrist conditions: creation of UK research priorities defined by a James Lind Alliance Priority Setting Partnership. BMJ Open 2021; 11:e044207. [PMID: 33771825 PMCID: PMC8006829 DOI: 10.1136/bmjopen-2020-044207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Prioritisation of important treatment uncertainties for 'Common Conditions Affecting the Hand and Wrist' via a UK-based James Lind Alliance Priority Setting Partnership. SETTING This process was funded by a national charitable organisation and based in the UK. PARTICIPANTS Anyone with experience of common conditions affecting the adult hand and wrist, including patients, carers and healthcare professionals. All treatment modalities delivered by a hand specialist, including therapists, surgeons or other allied professionals, were considered. INTERVENTIONS Established James Lind Alliance Priority Setting Partnership methods were employed.Electronic and paper questionnaires identified potential uncertainties. These were subsequently confirmed using relevant, up-to-date systematic reviews. A final list of top 10 research uncertainties was developed via a face-to-face workshop with representation from patients and clinicians. Impact of research was sought by surveying hand clinicians electronically. OUTCOME MEASURES The survey responses and prioritisation-both survey and workshop based. RESULTS There were 889 individually submitted questions from the initial survey, refined to 59 uncertainties across 32 themes. Eight additional uncertainties were added from published literature before prioritisation by 261 participants and the workshop allowed the final top 10 list to be finalised. The top 10 has so far contributed to the award of over £3.8 million of competitively awarded funding. CONCLUSIONS The Common Conditions in the Hand and Wrist Priority Setting Partnership identified important research questions and has allowed research funders to identify grant applications which are important to both patients and clinicians.
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Affiliation(s)
- Alexia Karantana
- Centre for Evidence Based Hand Surgery, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tim Davis
- Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, UK
| | - Donna Kennedy
- Pain Research Group, Imperial College London, London, London, UK
| | - Debbie Larson
- Hand Therapy, Spire Norwich Hospital, Norwich, Norfolk, UK
| | - Dominic Furniss
- Genetics and Epidemiology of Common Hand, University of Oxford Nuffield Department of Surgical Sciences, Oxford, UK
| | - Douglas J Grindlay
- Centre for Evidence Based Hand Surgery, School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
| | | | - Grey Giddins
- Orthopaedic Department, Royal United Hospital Bath NHS Trust, Bath, Bath and North East Somer, UK
| | - Abhilash Jain
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
| | - Ryan W Trickett
- Trauma and Orthopaedics, Cardiff and Vale University Health Board, Cardiff, UK
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21
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Affiliation(s)
| | - Grey Giddins
- Editor-in-Chief, The Journal of Hand Surgery (European Volume [2012--2016])
| | - Roy Meals
- Editor-in-Chief, The Journal of Hand Surgery (American Volume [2011--2015])
| | - Jin Bo Tang
- Editor-in-Chief, The Journal of Hand Surgery (European Volume)
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22
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Dias JJ, Brealey SD, Fairhurst C, Amirfeyz R, Bhowal B, Blewitt N, Brewster M, Brown D, Choudhary S, Coapes C, Cook L, Costa M, Davis T, Di Mascio L, Giddins G, Hedley H, Hewitt C, Hinde S, Hobby J, Hodgson S, Jefferson L, Jeyapalan K, Johnston P, Jones J, Keding A, Leighton P, Logan A, Mason W, McAndrew A, McNab I, Muir L, Nicholl J, Northgraves M, Palmer J, Poulter R, Rahimtoola Z, Rangan A, Richards S, Richardson G, Stuart P, Taub N, Tavakkolizadeh A, Tew G, Thompson J, Torgerson D, Warwick D. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet 2020; 396:390-401. [PMID: 32771106 DOI: 10.1016/s0140-6736(20)30931-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/02/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. The use of immediate surgical fixation to manage this type of fracture has increased, despite insufficient evidence of improved outcomes over non-surgical management. The SWIFFT trial compared the clinical effectiveness of surgical fixation with cast immobilisation and early fixation of fractures that fail to unite in adults with scaphoid waist fractures displaced by 2 mm or less. METHODS This pragmatic, parallel-group, multicentre, open-label, two-arm, randomised superiority trial included adults (aged 16 years or older) who presented to orthopaedic departments of 31 hospitals in England and Wales with a clear bicortical fracture of the scaphoid waist on radiographs. An independent remote randomisation service used a computer-generated allocation sequence with randomly varying block sizes to randomly assign participants (1:1) to receive either early surgical fixation (surgery group) or below-elbow cast immobilisation followed by immediate fixation if non-union of the fracture was confirmed (cast immobilisation group). Randomisation was stratified by whether or not there was displacement of either a step or a gap of 1-2 mm inclusive on any radiographic view. The primary outcome was the total patient-rated wrist evaluation (PRWE) score at 52 weeks after randomisation, and it was analysed on an available case intention-to-treat basis. This trial is registered with the ISRCTN registry, ISRCTN67901257, and is no longer recruiting, but long-term follow-up is ongoing. FINDINGS Between July 23, 2013, and July 26, 2016, 439 (42%) of 1047 assessed patients (mean age 33 years; 363 [83%] men) were randomly assigned to the surgery group (n=219) or to the cast immobilisation group (n=220). Of these, 408 (93%) participants were included in the primary analysis (203 participants in the surgery group and 205 participants in the cast immobilisation group). 16 participants in the surgery group and 15 participants in the cast immobilisation group were excluded because of either withdrawal, no response, or no follow-up data at 6, 12, 26, or 52 weeks. There was no significant difference in mean PRWE scores at 52 weeks between the surgery group (adjusted mean 11·9 [95% CI 9·2-14·5]) and the cast immobilisation group (14·0 [11·3 to 16·6]; adjusted mean difference -2·1 [95% CI -5·8 to 1·6], p=0·27). More participants in the surgery group (31 [14%] of 219 participants) had a potentially serious complication from surgery than in the cast immobilisation group (three [1%] of 220 participants), but fewer participants in the surgery group (five [2%]) had cast-related complications than in the cast immobilisation group (40 [18%]). The number of participants who had a medical complication was similar between the two groups (four [2%] in the surgery group and five [2%] in the cast immobilisation group). INTERPRETATION Adult patients with scaphoid waist fractures displaced by 2 mm or less should have initial cast immobilisation, and any suspected non-unions should be confirmed and immediately fixed with surgery. This treatment strategy will help to avoid the risks of surgery and mostly limit the use of surgery to fixing fractures that fail to unite. FUNDING National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Joseph J Dias
- Leicester General Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK.
| | - Stephen D Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rouin Amirfeyz
- University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Bhaskar Bhowal
- Leicester General Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK
| | - Neil Blewitt
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Mark Brewster
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Daniel Brown
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Surabhi Choudhary
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Christopher Coapes
- South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, UK
| | - Liz Cook
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Costa
- The Kadoorie Centre, John Radcliffe Hospital, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
| | - Tim Davis
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Livio Di Mascio
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Grey Giddins
- Royal United Hospital Bath NHS Trust, Royal United Hospital, Bath, UK
| | - Helen Hedley
- University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Jonathan Hobby
- Hampshire Hospitals NHS Foundation Trust, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Stephen Hodgson
- Bolton NHS Foundation Trust, Royal Bolton Hospital, Bolton, UK
| | | | - Kanagaratnam Jeyapalan
- Leicester General Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK
| | - Phillip Johnston
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Jonathon Jones
- Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Andrew Logan
- Cardiff and Vale University of Health Board, University Hospital of Wales, Cardiff, UK
| | - Will Mason
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Gloucester, UK
| | - Andrew McAndrew
- Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading, UK
| | - Ian McNab
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Lindsay Muir
- Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - James Nicholl
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, Kent, UK
| | | | - Jared Palmer
- Leicester General Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK
| | - Rob Poulter
- Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - Zulfi Rahimtoola
- Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading, UK
| | - Amar Rangan
- York Trials Unit, Department of Health Sciences, University of York, York, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
| | | | | | - Paul Stuart
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Nicholas Taub
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, UK
| | - Adel Tavakkolizadeh
- King's College Hospital NHS Foundation Trust, King's College Hospital, Brixton, London, UK
| | - Garry Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Warwick
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
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Huang K, Giddins G, Wu LD. Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:2572-2585. [PMID: 31821010 DOI: 10.1177/0363546519888450] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP), as a promising alternative to traditional corticosteroid (CS), is now increasingly used in the treatment of elbow epicondylitis (EE) and plantar fasciitis (PF). To date, however, the synthesis of information on the clinical efficacy of PRP versus CS is limited with divergent conclusions. PURPOSE To compare the clinical efficacy of PRP and CS injections in reducing pain and improving function in EE and PF. STUDY DESIGN Systematic review and meta-analysis. METHODS Online databases were searched from inception to October 2018 for prospective studies evaluating PRP versus CS injections for EE or PF. Independent reviewers undertook searches, screening, and risk-of-bias appraisals. The primary outcomes of interest were pain and function in both the short term (1-3 months) and the long term (≥6 months). RESULTS Twenty trials with 1268 participants were included. For EE, PRP provides a statistically and clinically meaningful long-term improvement in pain, with a very large effect size of -1.3 (95% CI, -1.9 to -0.7) when compared with CS, but the evidence level was low. For EE, there was moderate evidence that CS provides a statistically meaningful improvement in pain in the short term, with a medium effect size of 0.56 (95% CI, 0.08-1.03) as compared with PRP; this improvement might not be clinically significant. For PF, there was low evidence that PRP provides a statistically and clinically meaningful long-term improvement in function (American Orthopedic Foot & Ankle Society score), with a very large effect size of 1.94 (95% CI, 0.61-3.28). There were no significant differences between the groups in improvement in function in EE and pain and short-term function in PF, but the quality of the evidence was low. CONCLUSION The use of PRP yields statistically and clinically better improvement in long-term pain than does CS in the treatment of EE. The use of PRP yields statistically and clinically better long-term functional improvement than that of CS in the treatment of PF.
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Affiliation(s)
- Kai Huang
- Department of Orthopaedic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Grey Giddins
- Department of Orthopaedic Surgery, Royal United Hospital Bath, Bath, UK
| | - Li-Dong Wu
- Department of Orthopaedic Surgery, The Second Hospital of Medical College, Zhejiang University, Hangzhou, China
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Abstract
HYPOTHESIS When the distal fracture fragment in distal radius fractures displaces, it commonly rotates as well as shortens and angulates. AIM The aim of this study was to assess the frequency and magnitude of malrotation of the distal fracture fragment using computed tomography (CT). METHODS A retrospective radiological assessment of 85 CT scans of the distal radius, 35 following fracture and 50 normal radii, was carried out. We developed and applied a simple method for measuring rotation of the distal radius relative to the diaphysis using routine CT scans of the wrist. A Mann-Whitney analysis was used to identify differences in radial rotation between fractures and controls. Intra- and inter-observer reliability were analyzed using intra-class correlation coefficients (ICCs) and Bland-Altman plots. RESULTS The articular surface of the distal radius is normally rotated in the long axis of the forearm relative to the diaphysis, either into pronation or into supination. The median radial rotation angle of controls was 1° pronation (range -15° to 4°) compared to 3° pronation (range -24° to 31°) in the fracture group. The absolute rotation angle was significantly greater in the fracture group (median 10°, range 0-31° vs. 3°, range 0-15°; p < 0.001) and outside the "normal range" of controls in 26 cases indicating that 75% had rotated appreciably following injury. Intra- and inter-observer reliability of measurements were good with ICCs of 0.99 and 0.98, respectively. CONCLUSIONS Malrotation of the distal radius appears common following distal radius fracture. Malrotation of the distal fracture fragment has been shown to affect distal radio-ulnar joint function. Despite this, rotational deformity is rarely addressed in clinical practice as it is difficult to appreciate on simple radiographs. The simplified method described here is easy to use in routine clinical practice and also appears reliable. Measuring radial rotation may be an important consideration when planning both primary treatment and corrective osteotomy for patients with distal radial malunion.
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Affiliation(s)
- Joshua Filer
- 1 Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Adam Smith
- 2 Department of Trauma & Orthopaedics, Royal United Hospital NHS Trust, Royal United Hospital, Bath, UK
| | - Grey Giddins
- 2 Department of Trauma & Orthopaedics, Royal United Hospital NHS Trust, Royal United Hospital, Bath, UK
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25
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Abstract
There are a number of possible assessments of functional outcomes for thumb carpometacarpal joint arthritis. The most important and easiest to measure is pain, but it is not the only material outcome. Functional scores for measuring the outcome of the treatment of thumb carpometacarpal joint arthritis have been recommended for some time, but are still not widely used even in published studies. It is also unclear which functional scores are the most valuable. Easily used scores, such as the Disabilities of the Arm Shoulder and Hand questionnaire, are freely available, but may not be sensitive enough to assess outcomes especially of thumb carpometacarpal joint arthroplasty. The optimal functional outcome measurement would be weighted for the individual patient. A minimum dataset needs to be defined in order to compare studies and derive meaningful data.
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Abstract
Single-piece silicone implants dominate metacarpophalangeal joint arthroplasty. The NeuFlex® implant was introduced to improve on the clinical performance of other silicone implants by having a pre-flexed hinge. By visually examining a cohort of 30 explanted NeuFlex® metacarpophalangeal joint prostheses we sought to identify the failure modes of these implants. Seven were not fractured, 11 had fractured across the hinge, nine had fractured at the junction of the distal stem and the hinge, and three showed fractures at both the hinge and at the junction of the distal stem and the hinge. These data may prove helpful in identifying how the performance of single-piece silicone implant designs can be improved.
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Affiliation(s)
- Thomas J Joyce
- 1 School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Grey Giddins
- 2 Orthopaedic Department, Royal United Hospital, Bath, UK
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28
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Moorhouse A, Giddins G. National variation between clinical commissioning groups in referral criteria for primary total hip replacement surgery. Ann R Coll Surg Engl 2018; 100:443-445. [PMID: 29962296 DOI: 10.1308/rcsann.2018.0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The referral criteria used by the UK clinical commissioning groups for primary total hip replacement surgery appear inconsistent; the criteria rarely follow National Institute for Health and Care Excellence criteria. With established guidelines available, it is unclear why the clinical commissioning groups have referral criteia with less evidence base, without obviously addressing particular issues in their locality.
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29
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Giddins G, Pickering G. Letter Regarding "Outcomes of Isolated Radial Osteotomy for Volar Distal Radioulnar Joint Instability Following Radial Malunion in Children". J Hand Surg Am 2018; 43:e7. [PMID: 29976391 DOI: 10.1016/j.jhsa.2018.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/04/2018] [Indexed: 02/02/2023]
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30
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Huang K, Giddins G, Zhang JF, Lu JW, Wan JM, Zhang PL, Zhu SY. Asymmetrical traumatic bilateral hip dislocations with hemodynamic instability and an unstable pelvic ring: Case report and review of literature. World J Clin Cases 2018; 6:94-98. [PMID: 29774222 PMCID: PMC5955734 DOI: 10.12998/wjcc.v6.i5.94] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/01/2018] [Accepted: 04/17/2018] [Indexed: 02/05/2023] Open
Abstract
Simultaneous anterior and posterior traumatic dislocations of both hips are very rare. Only 33 cases have been previously reported in the English language literature. Although they were all due to high-energy injuries, they were hemodynamically stable and had a stable pelvic ring. We report a unique case of asymmetrical hip dislocations with an unstable pelvic ring and hemodynamic instability. A 40-year-old man was injured in a high-energy motor vehicle accident. He was hemodynamically unstable when he presented in the emergency department. Radiolographs showed asymmetrical dislocations of both hips with an unstable pelvic ring. Under general anesthesia, he had closed reduction of the dislocations of both hips, followed by temporary stabilization with an external fixator. Transcatheter arterial embolization was performed to stop active pelvic bleeding. Delayed open reduction and internal fixation was performed 12 d later with anterior and posterior plates. The patient recovered well with an uneventful post-operative course. Asymmetrical bilateral hip dislocations with pelvic ring instability caused by trauma, as presented in this case, is very rare and potentially life threatening. Prompt treatment can give a good outcome.
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Affiliation(s)
- Kai Huang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Grey Giddins
- Department of Orthopedics, Royal United Hospital Bath, BA1 3NG, United Kingdom
| | - Jian-Fang Zhang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Jian-Wei Lu
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Jun-Ming Wan
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Peng-Li Zhang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Shao-Yu Zhu
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
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31
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Abstract
Common hand problems are treated differently in different countries. This article attempts to bring together the views of surgeons from different countries on some of the most common hand problems that hand surgeons encounter in daily practice. In practice, the correct treatment of these problems may be the most important and influential to patients.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
| | - Grey Giddins
- The Hand to Elbow Clinic, 29a James Street West, Bath BA1 2BT, UK.
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, Nara, Japan
| | | | - Shian Chao Tay
- Department of Hand Surgery, Singapore General Hospital, Singapore, Singapore
| | - Thomas Giesen
- Plastic Surgery and Hand Surgery Division, University Hospital Zurich, Zurich, Switzerland
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32
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Abstract
Hand fractures (excluding small avulsion fractures and scaphoid fractures) almost always unite with bone. The role of the hand surgeon is not to achieve bone union but to achieve stability in an adequate position, often with some displacement, and maintenance of good soft tissue gliding. This article establishes that many fractures treated operatively do no better and often could not realistically do better than with good nonoperative treatment. Yet many are treated surgically to satisfy surgical egos, the desire to produce excellent radiographs, or just the mistaken belief that current surgical techniques can improve on nonoperative treatment.
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Affiliation(s)
- Grey Giddins
- The Hand to Elbow Clinic, 29a James Street West, Bath BA1 2BT, UK.
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33
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong, Jiangsu, China.
| | - Grey Giddins
- University of Bath, 29a James Street West, Bath BA1 2BT, UK.
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Affiliation(s)
- A Taylor
- Trauma and Orthopaedics Department, Royal United Hospital Bath, Bath, UK
| | - G Giddins
- Trauma and Orthopaedics Department, Royal United Hospital Bath, Bath, UK
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35
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Giddins G, Shewring D. British Society for Surgery of the Hand. J Hand Surg Eur Vol 2017; 42:535-536. [PMID: 28516814 DOI: 10.1177/1753193417701062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Lavalette D, Giddins G. The Outcome of Treatment of Flexor Sheath (seed) Ganglia by a Percutaneous Partial Pulley Release. J Hand Surg Asian Pac Vol 2017; 22:219-221. [PMID: 28506163 DOI: 10.1142/s0218810417500289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aims of this study were to assess the safety and efficacy of a technique of partial percutaneous pulley release. METHODS A retrospective cohort study was undertaken treating adults with seed ganglia with a percutaneous pulley release. The patients were reviewed independently after a mean of 6 (range 6-36) months. RESULTS We treated 24 patients over a 3 year period. There were 14 women and ten men. The mean age was 39 (range 17-65) years. We were able to assess 21 patients with long term follow up. There was complete resolution in 14 (2/3) and partial resolution in four. The remaining three patients had persisting symptoms and requested open surgical excision. Apart from local tenderness and failure of resolution there were no complications of percutaneous pulley release. CONCLUSIONS Bursting or aspiration of flexor sheath ganglia appears to be the best primary treatment. If the ganglion recurs, this study suggests a percutaneous release is safe and will resolve the symptoms in most patients.
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Affiliation(s)
- David Lavalette
- 1 Department of Orthopaedic Surgery, Royal United Hospital, Bath, United Kingdom
| | - Grey Giddins
- 1 Department of Orthopaedic Surgery, Royal United Hospital, Bath, United Kingdom
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41
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Sassi SA, Giddins G. Gender differences in carpal tunnel relative cross-sectional area: a possible causative factor in idiopathic carpal tunnel syndrome. J Hand Surg Eur Vol 2016; 41:638-42. [PMID: 26802792 DOI: 10.1177/1753193415625404] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/08/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Previous research has not established a consistent difference in hand size or carpal tunnel cross-sectional area between patients with and without carpal tunnel syndrome. We tested the hypothesis that there would be no difference in relative carpal tunnel sizes between men and women. We defined relative carpal tunnel size as the cross-sectional areas at the inlet (level of the pisiform) and outlet (level of the hook of the hamate) of the carpal tunnel divided by the length of the capitate (as a measure of hand size). We made the measurements on the magnetic resonance imaging scans of 50 men and 50 women taken for symptoms unrelated to carpal tunnel syndrome. The mean relative cross-sectional area was appreciably smaller in women than men (p < 0.05). This suggests that the carpal tunnel cross-sectional area relative to the size of the hand is constitutionally smaller in women than in men. This could in theory be a significant factor in patients developing carpal tunnel syndrome. LEVEL OF EVIDENCE V.
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Affiliation(s)
- S A Sassi
- Orthopaedic Department, Royal United Hospital, Bath, UK
| | - G Giddins
- Orthopaedic Department, Royal United Hospital, Bath, UK
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42
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43
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44
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46
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Giddins G. Specialist support for hand surgery research. J Hand Surg Eur Vol 2015; 40:899. [PMID: 26494906 DOI: 10.1177/1753193415609508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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47
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Giddins G. Editorial: Editor-in-Chief. J Hand Surg Eur Vol 2015; 40:667-668. [PMID: 28071175 DOI: 10.1177/1753193415597585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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48
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Rodger MP, Theobald P, Giddins G. Vein grafts to augment flexor tendon repairs: a biomechanical study on strength and gap resistance. J Hand Surg Eur Vol 2015; 40:695-9. [PMID: 25541551 DOI: 10.1177/1753193414564902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 11/22/2014] [Indexed: 02/03/2023]
Abstract
The ultimate tensile repair strength and gap formation of the pig extensor tendons repaired with a standard 4-strand Savage with epitendinous suture repair, was compared with a new technique of adding a vein sleeve. Force and displacement data were recorded, and video images during linear cyclic loading up to failure. At 35 N, video-graphic observation detected significantly smaller gap lengths in the standard and vein repair specimens compared with standard repair specimens (p = 0.047). The incidence of 3 mm gaps between the repaired tendon ends in the standard repair group was 20 %, but no 3 mm gaps were seen in the standard and vein specimens. The addition of a vein sleeve increased the ultimate tensile strength of the standard repair from 50.4 N (4.5) to 55.4 N (4.5); this was statistically significant (p = 0.03). This study demonstrated that the addition of a vein graft prevented gap formation and increased ultimate tensile strength of tendon repair.
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Affiliation(s)
- M P Rodger
- School of Engineering, Cardiff University, Cardiff, UK
| | - P Theobald
- School of Engineering, Cardiff University, Cardiff, UK
| | - G Giddins
- Department of Mechanical Engineering, University of Bath, Bath, UK
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49
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50
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Abstract
Thumb carpometacarpal joint total arthroplasty has been undertaken for many years. The proponents believe the short-term outcomes are better than trapeziectomy and its variants, but the longer term complications are often higher. This systematic review of all peer reviewed articles on thumb carpometacarpal joint total arthroplasty for osteoarthritis shows that there are reports of many implants. Some are no longer available. The reported outcomes are very variable: for some there are good long-term outcomes to beyond 10 years ; for others there are unacceptably high early rates of failure. Overall the published evidence does not show that total arthroplasty is better than trapeziectomy and its variants yet there is a higher complication rate and significant extra cost of using an implant. Future research needs to compare total arthroplasty with trapeziectomy to assess short term results where the arthroplasties may be better, long-term outcomes and the healthcare and personal costs so that surgeons and patients can make fully informed choices about the treatment of symptomatic thumb carpometacarpal joint osteoarthritis.
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Affiliation(s)
- K Huang
- Tongde Hospital of Zhejiang Province, Zhejiang, People's Republic of China
| | | | - G Giddins
- Royal United Hospital Bath, Bath, UK
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