Quite a Pickle: A 10-Year Increase in Pickleball-Related Hand Injuries.

BACKGROUND: Pickleball popularity has significantly increased in the United States. Wrist, hand, and finger injuries are commonly seen among pickleball players and are on the rise. METHODS: The National Electronic Injury Surveillance System database was queried from 2013 to 2022 tennis- and pickleball-related injuries in the United States. Data were filtered to include wrist, hand, and finger injuries only. RESULTS: There were a total of 12 021 estimated pickleball injuries between 2013 and 2022, most commonly in white women greater than 55 years old. The most common mechanism of injury (90.5%) was a fall. The number of injuries increased by 765.6% between 2013 and 2022. The growth in the number of pickleball-related injuries was found to be statistically significant (P < .05), whereas the growth for tennis-related injuries was found to be not statistically different from 0. There was a statistical difference between the growth of the number of pickleball injuries per year and the number of tennis injuries. The wrist was the most common location of injury (70.0%) compared with the hand (10.5%) and fingers (19.5%). The most common injury diagnosis was fracture (60.3%). Overall, the most common injury was wrist fracture (50.0%). CONCLUSIONS: Hand surgeons should be aware of the increasing prevalence of pickleball-related injuries as an alternative mechanism of injury, particularly among the elderly.

Análise epidemiológica das fraturas de mão em um hospital terciário / Epidemiological analysis of hand fractures in a tertiary hospital

Introdução: O trauma de mão constitui uma epidemia, ocorrendo por diversos fatores, como acidentes de trabalho e violência urbana. Isso gera um impacto significativo por ser uma unidade anatômica vulnerável e importante na realização de atividades cotidianas e para o trabalho. Desse modo, faz-se necessária uma avaliação epidemiológica mais aprofundada no que tange, sobretudo, às fraturas de mãos, entendendo sua elevada morbidade. Método: Estudo descritivo e retrospectivo, feito por análise de prontuários de pacientes conduzidos em um hospital terciário no período de janeiro de 2018 a dezembro de 2020. Resultados: Participaram do estudo 290 pacientes, sendo 85,7% do sexo masculino e 14,3% do sexo feminino. 138 indivíduos tinham entre 20 e 39 anos, representando um total de 47,6%. 51,6% eram do interior do estado do Ceará e 48,4% eram da capital. O principal mecanismo de trauma associado às fraturas foram os acidentes de trânsito (36,4%), seguidos por acidentes de trabalho (26,9%) e ferimentos por arma de fogo (14%). Em relação aos ossos fraturados, houve uma acentuada prevalência do acometimento das falangeanas, em todas as faixas etárias, representando 210 pacientes (72,4%). Conclusão: O presente estudo corrobora com os dados presentes na literatura. Desse modo, é evidenciada a repetição de prevalência de faixa etária, principais mecanismos de trauma envolvidos, bem como ossos acometidos nas fraturas de mão.

Introduction: Hand trauma is an epidemic occurring due to several factors, such as work accidents and urban violence. This significantly impacts it as it is a vulnerable and important anatomical unit for daily activities and work. Therefore, a more in-depth epidemiological assessment is necessary regarding hand fractures and understanding their high morbidity. Method: A descriptive and retrospective study was conducted by analyzing the medical records of patients treated in a tertiary hospital from January 2018 to December 2020. Results: 290 patients participated in the study, 85.7% male and 14.3 % female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. 51.6% were from the interior of the state of Ceará, and 48.4% were from the capital. The main trauma mechanism associated with fractures was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14%). Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). Conclusion: The present study corroborates the data present in the literature. In this way, the repetition of the prevalence of age group, main trauma mechanisms involved, as well as bones affected by hand fractures is evidenced.

Hand Reconstruction Using Anterolateral Thigh Free Flap by Terminal Perforator-to-Digital Artery Anastomosis: Retrospective Analysis.

This study aimed to analyze cases of anterolateral thigh (ALT) free flap used for hand reconstruction with terminal perforator-to-digital artery anastomosis. Patients who underwent ALT free flap placement with terminal perforator-to-digital artery anastomosis for hand reconstruction between January 2011 and August 2021 were included. The number, length, and diameter of the perforators and veins, flap size, and operative time were investigated through a retrospective review of charts and photographs. The occurrences of arterial thrombosis, venous thrombosis, arterial spasm, and flap necrosis were analyzed. In total, 50 patients were included in this study. The mean diameter and length of the perforators were 0.68 mm and 3.25 cm, respectively, and the mean number of veins anastomosed was 1.88, with a mean diameter of 0.54 mm. Complications included four cases of arterial thrombosis, one case of venous thrombosis, seven cases of partial necrosis, and one case of total flap failure. Regression analysis showed that a longer perforator was associated with arterial thrombosis whereas larger flap size and number of anastomosed veins were associated with partial necrosis ( p < 0.05). The terminal perforator-to-digital artery anastomosis offers advantages in using compact free flaps with short pedicle lengths to cover small hand defects.

[Psychosocial repercussions of hand injuries and support for patients]. / Répercussions psychosociales des accidents de la main et accompagnement des patients.

PSYCHOSOCIAL REPERCUSSIONS OF HAND INJURIES AND SUPUPORT FOR PATIENTS. There are many nonmedical factors influencing a patient's return to work. To optimize care, the practitioner must be aware of the need to go beyond the scope of their own specialty. In particular, they must be able to identify patients with psychological comorbidity and/or chronic pain, in order to direct them as early as possible towards appropriate care. They must also pay particular attention to administrative requests whether these come from the patient themselves or from their insurers. Last but not least, the decompartmentalization of professional practices and the improvement of communication between the stakeholders are essential, although very complex to implement. In the Île-de-France and Centre regions of France, two associations offer support that meets all these best practices.

RÉPERCUSSIONS PSYCHOSOCIALES DES ACCIDENTS DE LA MAIN ET ACCOMPAGNEMENT DES PATIENTS. Il existe de nombreux facteurs autres que médicaux influençant le retour à l'emploi des patients. Afin d'optimiser la prise en charge, le soignant doit avoir en tête qu'il est nécessaire de sortir du champ de sa spécialité. Il doit notamment être capable d'identifier les patients présentant une comorbidité psychique et/ou des douleurs chroniques afin de les orienter au plus tôt vers une prise en charge adaptée. Il doit également porter une attention toute particulière aux demandes administratives, qu'elles émanent du patient lui-même ou de ses assurances. Enfin, il est primordial, bien que très complexe à mettre en oeuvre, de décloisonner les pratiques professionnelles et d'améliorer la communication entre les acteurs. En Île-de-France et en région Centre, deux associations proposent un accompagnement répondant à l'ensemble de ces bonnes pratiques.

[Surgical indications for hand wounds]. / Indications chirurgicales des plaies de la main.

SURGICAL INDICATIONS FOR HAND WOUNDS. Hand injuries are common, with potentially severe consequences. When a patient is seen in the emergency department, a lesion assessment must be carried out to distinguish between extreme emergencies such as amputation or devascularization, which require immediate treatment in a specialized centre. If there is no immediate indication of seriousness, a clinical examination, possibly combined with meticulous exploration, helps to identify the lesions. The presence of tendon, nerve or vascular damage requires surgical management in the operating theatre. Any wound that cannot be reliably explored should be managed in the operating room by a hand surgeon.

INDICATIONS CHIRURGICALES DES PLAIES DE LA MAIN. Les plaies de la main sont fréquentes, avec potentiellement des conséquences graves. Lors de la prise en charge aux urgences, le bilan lésionnel permet de distinguer les situations d'urgence extrême comme une amputation ou une dévascularisation, nécessitant une prise en charge immédiate dans un centre spécialisé. En l'absence d'éléments de gravité immédiats, l'examen clinique, éventuellement associé à une exploration méticuleuse, précise les lésions. La présence d'une atteinte tendineuse, nerveuse ou vasculaire nécessite une prise en charge chirurgicale au bloc opératoire. Toute plaie sans possibilité d'exploration fiable doit être prise en charge au bloc opératoire par un chirurgien de la main.

[Hand accident prevention]. / Prévention des accidents de la main.

HAND ACCIDENT PREVENTION. Advances in surgical techniques and a better organization with SOS mains structures have improved the management of hand injuries. However, there are still too many accidents, which can lead to functional and aesthetic after-effects, as well as their socio-professional consequences. The prevention of hand injuries is therefore mandatory. It is organized with three levels: primary prevention, that aims to prevent the occurrence of the accident itself; secondary prevention, to guide and provide the best emergency care for the patient; and tertiary prevention, to avoid deprofessionalization and provide support for any physical and psychological after-effects.

PREVENTION DES ACCIDENTS DE LA MAIN. Les progrès des techniques chirurgicales et l'organisation en services SOS mains ont contribué à améliorer la prise en charge des accidents de la main. Ceux-ci restent cependant nombreux et peuvent entraîner des séquelles fonctionnelles, esthétiques et avoir des conséquences socioprofessionnelles. La prévention des accidents de la main est donc fondamentale. Elle s'organise en trois volets : la prévention primaire pour éviter la survenue de l'accident, la prévention secondaire pour orienter et prendre en charge au mieux le patient, et la prévention tertiaire afin d'éviter une déprofessionnalisation et accompagner les séquelles physiques et psychologiques éventuelles.

[Hand infections]. / Infections de la main.

HAND INFECTIONS. Hand and finger infections are very common. They result from the inoculation of a germ through the skin barrier. They can range from simple paronychia to extremely serious necrotizing fasciitis. Certain infections, such as those resulting from bites, have their own specific characteristics, which will determine how they are managed. While management can be medical in the early stages, it is important not to ignore the need for surgical treatment, otherwise serious complications may arise, leading to functional and aesthetic sequelae. Delays in treatment cannot be made up. Any infectious lesion can be potentially serious and must be treated in an appropriate department if there is the slightest doubt.

INFECTIONS DE LA MAIN. Les infections de la main et des doigts sont très fréquentes. Elles résultent de l'inoculation d'un germe à travers la barrière cutanée. Elles vont du simple panaris à la gravissime fasciite nécrosante. Certaines infections, comme celles faisant suite aux morsures, ont des caractéristiques propres dont dépend la prise en charge. Si elle peut être médicale au stade initial, il est important de ne pas méconnaître le moment du traitement chirurgical sous peine de voir survenir des complications graves responsables de séquelles fonctionnelles et esthétiques. Le retard à la prise en charge ne peut être rattrapé. Toute lésion infectieuse peut être potentiellement grave et, au moindre doute, doit être prise en charge dans un service adapté.

[Severe and complex traumatic hand]. / Main traumatique grave et complexe.

SEVERE AND COMPLEX TRAUMATIC HAND . Serious and complex traumatic injuries of the hand are multiple tissue injuries (skin, vascular, bone and nerves), requiring urgent surgical management. They are responsible for significant functional and aesthetic sequelae. Their incidence is clearly decreasing thanks to information, prevention and security measures. The absolute emergencies are injections under pressure, amputations-devascularizations, and serious mutilations. The objective of the management is to make a functional and aesthetic hand: restoration of the opposition of the thumb with a key-pinch, a sufficient length thumb, and restoration of the sensitivity of the reconstructed hand. This calls for numerous surgical and microsurgical techniques and must be undertaken by trained teams in specialized centers.

MAIN TRAUMATIQUE GRAVE ET COMPLEXE. Les lésions traumatiques graves et complexes de la main sont des lésions tissulaires multiples (cutanées, vasculaires, osseuses et nerveuses), nécessitant une prise en charge chirurgicale urgente. Elles sont responsables de séquelles fonctionnelles et esthétiques importantes. Leur incidence est en nette diminution grâce aux mesures d'information, de prévention et de sécurité. Les principales urgences absolues sont les injections sous pression, les amputations-dévascularisations et les mutilations graves. L'objectif de la prise en charge de ces traumatismes est de rendre une main fonctionnelle et esthétique : restauration d'opposition du pouce, d'un pouce de longueur suffisante, d'une pince pollici-digitale termino-latérale, rétablissement de la sensibilité de la main reconstruite. Ceci fait appel à de nombreuses techniques chirurgicales et microchirurgicales et doit être entrepris par des équipes entraînées en centres spécialisés.

Acute Hand Injury in Surfing: A Case Report.

Hand injuries from surfing tend to be severe and require medical attention. Follow-up of a surfing injury is difficult because many patients are visiting and go home after treatment. We report a case of a surfing hand injury sustained abroad, which was treated upon the patient's return, allowing for follow-up. The mechanism of injury was traction and torsion from the surfboard leash while surfing. The patient was initially treated for nailbed injury but presented later back home after persistent pain, for which an unstable distal phalanx fracture in their right ring finger was found by x-ray. This was surgically reduced with K-wire insertion and nailbed repair. Postoperatively, the injured finger was kept in a splint, and the patient had physiotherapy. Pain was significantly reduced, and the patient regained sufficient function. Considering a fracture as a differential for finger injury caused by the surfboard leash may prevent management delays. Injury may be prevented through education and redesign of the surfboard leash.

Burnt hand outcomes tool: Translation, adaptation and validation into Brazilian Portuguese.

INTRODUCTION: In burn trauma, hands are often injured due to defensive action or proximity to the causative agent, leading to significant morbidity during a patients work and social rehabilitation process. In this context, the use of patient-reported outcome measures is a first step in measuring and improving these outcomes. The Burned Hand Outcome Tool (BHOT) is a specific questionnaire for adults with burned hands aimed at quantifying outcomes related to this trauma. OBJECTIVE: To translate, culturally adapt, and validate the BHOT into Brazilian Portuguese. METHODS: Following established standards in the literature, the original English questionnaire was translated, back translated, and analyzed by a panel of experts in the field. Cultural adaptation of the translation was carried out with a sample of target patients. The questionnaire was validated concurrently with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire translated into Portuguese, at three time points (0 h, 2 h, 48 h), with two different evaluators. RESULTS: The cultural adaptation was conducted on a sample of 30 adult patients with hand burns without the need for reassessment of the translated items. The questionnaire validation was carried out on a sample of 100 adult patients with hand burns. The Cronbach's Alpha found at the first time point was 0.936. The correlations between the questionnaires varied from 0.656 to 0.915. CONCLUSION: The Burned Hand Outcome Tool has been translated, culturally adapted, and validated for a target population in Brazilian Portuguese.

Investigation of the barriers to and functional outcomes of telerehabilitation in patients with hand injury.

BACKGROUND: Telerehabilitation is an approach that is growing in importance and rapidly becoming more prevalent. However, the potential barriers to this approach and its effectiveness relative to face-to-face treatment still need to be determined. PURPOSE: The aim of this study was to investigate the technology and access barriers, implementation and organizational challenges, and communication barriers faced by patients undergoing postoperative telerehabilitation after hand tendon repair surgery. It also aimed to investigate the effect of telerehabilitation on pain, kinesiophobia, and functional outcomes. STUDY DESIGN: Prospective, open-label, nonrandomized comparative clinical study. METHODS: The study was conducted with 44 patients who underwent tendon repair surgery due to tendon injuries of the extrinsic muscles of the hand. Participants were divided into two groups (face-to-face group and telerehabilitation group). All participants received three physiotherapy sessions per week for 8 weeks from their surgery (via video conference using mobile phones to the telerehabilitation group). An early passive motion protocol was applied for flexor tendon and zone 5-7 extensor tendon repairs. Mallet finger rehabilitation was performed for zone 2 extensor tendon repairs, while an early active short arc approach was used for zone 3-4 repairs. The telerehabilitation and face-to-face groups received the same treatment protocols three times a week. In the eighth week of treatment (in the 24th session), the Turkish version of the Arm, Shoulder, and Hand Injury Questionnaire (DASH-T) and Tampa Scale for Kinesiophobia were administered to all patients. The telerehabilitation group also underwent a barrier questionnaire. A pretreatment assessment could not be conducted. The independent-sample t-test was used for DASH-T data, and the Mann-Whitney U-test was used for Tampa Scale for Kinesiophobia to compare groups. RESULTS: In the study, there were 24 participants (age: 31.58 ± 12.02 years) in the face-to-face group and 20 participants (age: 39.25 ± 12.72 years) in the telerehabilitation group. The two groups were similar in terms of DASH-T and pain (p = 0.103, effect size = 0.647, and p = 0.086, effect size = 0.652, respectively) in the 8 weeks. However, the telerehabilitation group had a higher fear of movement (p = 0.017, effect size = 3.265). The most common barriers to telerehabilitation practices were the fear of damaging the tendon repair and the need for help during the treatment. CONCLUSIONS: We determined that face-to-face treatment in acute physiotherapy for patients who have undergone tendon repair may be more effective compared to telerehabilitation, as it appears to be less likely to induce kinesiophobia. However, in situations where face-to-face treatment is not possible (such as lockdown), telerehabilitation can also be preferred after at least one in-person session to teach and perform exercises.

Reconstruction of soft tissue defects of hand: A systematic approach.

Background and Objective: A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. Methods: This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. Results: The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). Conclusion: This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.

Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis.

BACKGROUND: Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking. PURPOSE: This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions. STUDY DESIGN: Systematic review. METHODS: A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren's release for improving total active extension (mean difference [MD] -2.8°, 95% confidence interval [CI]: -9.6° to 4.0°, p = 0.84), total active flexion (MD -5.8°, 95% CI: -12.7° to 1.2°, p = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: -2.7 to 3.6, p = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: -0.49 to 0.09, p = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD -16.7°, 95% CI: -20.1° to -13.3°, p < 0.001). No studies evaluated orthotic intervention to improve PIPJ flexion. CONCLUSION: The addition of an extension orthosis following procedures to manage Dupuytren's contracture is no better than hand therapy alone for improving PIPJ extension. In contrast, the addition of a PIPJ extension orthosis in the presence of traumatic PIPJ fixed flexion deformities is more effective for improving PIPJ extension than hand therapy alone. Future studies are needed to evaluate the role of orthotic intervention for improving PIPJ flexion.

Non-surgical treatment of oblique diaphyseal fractures of the fourth and fifth metacarpals in a professional athlete: A case report.

INTRODUCTION: Metacarpal fractures are common sports-related injuries, often requiring tailored treatment strategies, especially in athletes. The management of oblique diaphyseal fractures poses unique challenges due to their inherent instability. This case report discusses a non-surgical approach in treating such fractures in a professional athlete. CASE PRESENTATION: A 26-year-old professional soccer player sustained oblique diaphyseal fractures of the fourth and fifth metacarpals during training. Given the athlete's professional demands and the fracture's nature, a conservative treatment was implemented. This included the application of a modified ulnar gutter brace, allowing for immobilization of the metacarpophalangeal joints (MP) while permitting active mobilization of the interphalangeal joints(IP). CLINICAL DISCUSSION: The non-surgical treatment focused on achieving skeletal stability and maintaining hand function. Despite the complexity of oblique fractures, the conservative approach was successful, enabling the athlete to resume professional activities with minimal risk of fracture displacement. Regular radiographic follow-ups showed no further displacement, highlighting the effective management of such fractures through personalized conservative treatment plans. CONCLUSIONS: This case underscores the viability of conservative treatment for specific metacarpal fractures in athletes. Tailoring the treatment to accommodate the athlete's professional needs and understanding the biomechanical characteristics of the fracture are crucial for successful outcomes. The case also suggests that non-surgical management can be a viable option for certain complex metacarpal fractures, especially in high-demand patients.

Comparison of the Results of Delayed Repair of Flexor Pollicis Longus (FPL) Tendon with Tendon Transfer or with Tendon Graft.

Background: In Flexor Pollicis Longus (FPL) injuries, primary repair with end-to-end suture is the treatment of choice. In cases where primary repair is not possible, tendon transfer or tendon grafting is used, each of which has its strengths and weaknesses. We aimed to investigate the effectiveness of each of the above two methods in patients. Methods: Patients with FPL injury who referred to Hazrat Fatemeh Hospital, Tehran, Iran late in 2020 to 2021, if primary tendon repair was not possible, were randomly repaired with tendon transfer or tendon graft. After the appropriate time, the splint was opened and physiotherapy was performed for the patients. Then, at least three months after the repair, the range of motion of the IP and MP joints of the patients thumb was measured and compared in two groups. Results: Ten patients in the tendon transfer group and 10 patients in the tendon graft group were studied. In the secondary repair of FPL with tendon grafting, the range of motion of both IP and MP joints of the thumb was not significantly different compared to repair with tendon transfer. Conclusion: The findings of this research confirm controversies in this field. In order to obtain more accurate results, it is suggested to carry out a research with a larger number of patients and with strict control over the surgical technique and post-operative care, as well as taking into account the morbidities caused by donor tendon removal and examining the overall satisfaction of the patients.

The Rural Hand Therapy Project - providing hand therapy services closer to home.

CONTEXT: Hand therapy optimises functional use of the hand and arm after injury and is an expert area of practice for occupational therapists (OTs) and physiotherapists. In rural Australia, patients frequently travel to metropolitan or larger regional centres for initial hand surgery and rehabilitation. However, rural patients' access to follow-up hand therapy after the initial phase of care is impacted by several factors such as transport options, distance, staff shortages and availability of therapists skilled in hand therapy. To ensure service equity, these challenges require consideration of an alternative model of care that can be provided in rural areas. The aim of this project was to develop a shared care model that would better support rural OTs and rural patients in accessing follow-up hand therapy services closer to home. ISSUE: Two part-time accredited hand therapists (herein referred to as clinical leads) were employed in 2019-2020 to investigate a suitable model of care. Consultation with key stakeholders identified the following core issues: barriers, enablers, processes and intervention, and technology and resources. These findings were combined with recommendations from the literature to develop a model of service delivery: the Rural Hand Therapy Project (RHTP). Under the RHTP, eligible rural patients with complex hand conditions were either seen for their initial appointment, or had their referral screened, by a clinical lead at the regional hospital (Toowoomba Hospital, Queensland). During this process, a detailed handover to the rural OT was completed. Weekly case conferences with a clinical lead were available to all rural clusters. Rural patient cases remained open at the regional hospital for at least 3 months to allow patients to be easily seen by a clinical lead, face to face, or via telehealth (with the rural OT) if needed. The clinical leads also served as the primary contact for any clinical questions from rural OTs. Additionally, the clinical leads provided support and professional development to rural OTs based on the mix of patient cases at the time. LESSONS LEARNED: The RHTP clinical leads were involved in both initial assessment and ongoing intervention for 56% of rural hand therapy patients. The provision of videoconference occasions of service increased from 1% to 8%. Although a low response rate impaired therapist evaluation, an unexpected positive outcome of the RHTP was its flexibility to respond temporarily during rural staff crises and provide vital patient care. The RHTP model of care has shown promise in addressing the challenges faced by rural patients in accessing follow-up hand therapy services closer to home. Further research has been initiated to inform care at a local level. By sharing the model of RHTP, it is hoped that the equity of hand therapy service provision can be increased to improve patient outcomes in other rural and remote localities.