Local flaps of the hand.

Hand injuries are common, and due to the complex functions of the hand, soft tissue defects present a surgical challenge in reconstruction. Hand defects exposing deeper structures warrant reconstruction with local flaps, but in Denmark, reconstruction surgery of the hand is routinely managed within the orthopaedic specialty alone with no plastic surgical involvement. This review aims at describing the most common local flaps of the hand and forearm and encourage to stronger collaboration between hand- and plastic surgeons in Denmark.

Change in orthopaedic surgeon behaviour by implementing evidence-based practice.

INTRODUCTION: Orthopaedic practice is not always aligned with new evidence which may result in an evidence-practice gap. Our aim was to present and report the use of a new model for implementation of evidence-based practice using treatment of distal radius fractures (DRF) as an example. METHODS: A new implementation model from the Centre for Evidence-Based Orthopaedics (CEBO) was applied. It comprises four phases: 1) baseline practice is held up against best available evidence, and barriers to change are assessed. 2) A symposium involving all stakeholders discussing best evidence is held, and agreement on a new local guideline is obtained. 3) The new guideline based on the decisions at the symposium is prepared and implemented into daily clinical practice. 4) Changes in clinical practice are recorded. We applied the model on the clinical question of whether to use open reduction and internal fixation with a locked volar plate (VLP) or closed reduction and percutaneous pinning (CRPP) in adults with DRF. RESULTS: Prior to application of the CEBO model, only VLP was used in the department. Based on best evidence, the symposium found that a change in practice was justified. A local guideline stating CRPP as first surgical choice was implemented. If acceptable reduction could not be obtained, the procedure was converted to VLP. A year after implementation of the guideline, the rate of VLP had declined from 100% to 44%. CONCLUSION: It is feasible to change surgeons' practice according to best evidence using the CEBO model. FUNDING: None. TRIAL REGISTRATION: Not relevant.

Factors Associated with Increased Risk of Recurrence following Treatment of Trigger Finger with Corticosteroid Injection.

Introduction The aim of the study was to estimate recurrence rates, time to recurrence, and predisposing factors for recurrence of trigger finger when treated with corticosteroid (CS) injection as primary treatment. Materials and Methods In a retrospective chart review, we identified primary trigger fingers treated with CS injection as primary treatment. Affected hand and finger, recurrence, time to recurrence, duration of symptoms, secondary treatment type, and comorbidities were recorded. A total of 539 patients were included with a mean follow-up of 47.6 months Results In total, 330/539 (61%) recurrences were registered. Mean time to recurrence was 312 days. Increased risk of recurrence was seen after treatment of the third finger (relative risk [RR]: 1.22; 95% confidence interval [CI]: 1.06-1.39). Several comorbidities were associated with increased risk of recurrence: carpal tunnel syndrome (RR: 1.27; 95% CI: 1.07-1.52), thyroid disease (RR: 1.45; 95% CI: 1.15-1.83), or shoulder diseases (RR: 1.58; 95% CI: 1.36-1.83). Conclusion We found a recurrence rate after primary treatment of CS injection for trigger finger of 61%. Most recurrences happened within 2 years and we found treatment of third finger, carpal tunnel syndrome, shoulder, or thyroid disease to be associated with an increased risk of recurrence of symptoms.