Study of Hamate Fractures in a Single Tertiary Hands Unit: A Retrospective Cohort Study and Literature Review.

Purpose: The primary purpose of our study was to investigate hamate fractures at a single tertiary hand surgery unit in Western Australia, particularly comparing operative and nonsurgical outcomes. Methods: Patients with hamate and/or hamate plus fifth carpometacarpal injury at our hand unit between 2019 and 2022 were identified. All patients had Quick Disability of the Arm, Shoulder and Hand (QuickDASH) patient-reported outcome measures recorded post treatment. Patients managed operatively and nonsurgically had a period of splinting with plaster of Paris and/or thermoplastic splint for a minimum of 2 weeks. All patients underwent hand therapy. Results: Forty-eight patients with hamate and/or hamate plus fifth carpometacarpal injury were included in this study. Thirteen patients had Milch type 1 fractures, and 35 had Milch type 2 fractures. Six Milch type 1 fractures were managed operatively, and seven were managed nonsurgically. The average QuickDASH score for the operative group was 0.38. The average QuickDASH score for the nonsurgical group was 0.65. Sixteen Milch type 2 fractures were managed operatively, and 19 were managed nonsurgically. The average QuickDASH score for the operative group was 1.3. The average QuickDASH score for the nonsurgical group was 3.5. Conclusions: For Milch type 2 fractures, patient-reported outcome measures were better for the operative group compared with the nonsurgical group. Type of study/level of evidence: Therapeutic IV.

Knowledge retention and usefulness of simulation exercises for disaster medicine - what do specialty trainees know and think?

INTRODUCTION: Disaster medicine education is an important but often neglected part of Emergency Medicine (EM) specialty trainees' curriculum. It is especially neglected in limited resource environments (1), which, owing to poor infrastructure generally, are more likely to be affected by disasters than better resourced environments. Disaster medicine cannot be taught solely in a classroom and various methods are required to teach practical concepts. This study aims to look at Emergency specialty trainees' perception of high-fidelity simulation and their needs with regards to Disaster Medicine Education. METHODS: This was a prospective cross-sectional cohort study involving 27 EM specialty trainees from the University of the Witwatersrand, who, participated in a high-fidelity simulation and were given a questionnaire before and after the exercise. The questionnaire consisted of theory questions relating to disaster medicine as well as Emergency Specialty trainee's perception and needs towards disaster medicine education. RESULTS: High fidelity simulation does not increase theoretical knowledge of Disaster Medicine but it does increase perceived confidence. EM specialty trainees seek yearly training, beginning in their first year and choose high fidelity simulation as their preferred method of training. CONCLUSION: High fidelity simulation is crucial to increasing the confidence of EM specialty trainees during their training. More research is needed to develop core competencies and methods of evaluating training.