RESUMO
INTRODUCTION: There are several operative modes to address hand fractures to gain better anatomical and functional results including external fixator, percutaneous K-wire fixation, lag screw fixation, tension band wiring, intra-medullary nails or wires, and plate-screw fixation. We evaluated the results of plate osteosynthesis in fractures of metacarpals and phalanges in a prospective manner. MATERIAL AND METHODS: A total 50 adults (19-60 years) of either sex having 58 fractures managed by miniature plate osteosynthesis and followed for a minimum six months (6-19), including metacarpal and phalangeal fractures (unstable or serial fractures), intra-articular fractures, fracture-dislocation of proximal interphalangeal and distal interphalangeal joints with joint incongruity or subluxation were enrolled while contaminated compound fractures, pathological fractures and cases of reimplantation were excluded from study. Clinical assessment was done using the American Society for Surgery of the Hand (ASSH), total active flexion (TAF), total active range of motion (TAM) score, and the Disabilities of the Arm, Shoulder, and Hand (quick DASH) score while sequential radiographs were done at each follow-up. RESULT: All the fractures had perfect union clinically as well as radiologically with a mean duration of six weeks while functional outcomes in reference to clinical scores were observed excellent and fair in all cases. None of the cases had any loss of reduction, loosening of the implant, or other major complications. CONCLUSIONS: Miniature plate fixation provides enough stability in metacarpal and phalanges fractures, thereby allowing immediate active movements, which leads to excellent functional outcomes and early return to normal activities.
RESUMO
BACKGROUND: The need for software suppliers to react swiftly to the plethora of application requests and constantly shifting market requirements is one of the major problems facing the health IT business in the context of digital health transformation. This can only be achieved when the necessary staff and resources are available. OBJECTIVES: The objective of this work is to identify challenges health IT companies are confronted with related to personnel capacities and skilled workers. METHODS: Using a questionnaire distributed through newsletters and social media among representatives of software companies and hospitals we collected information on current hurdles of health software providers and their strategies to overcome these in order to address the demands of the digital health transformation. RESULTS: The main findings of the survey are that scarce resources in software development are among the reasons for not achieving strategic goals on time in the health IT sector and for not being able to react flexibly to market changes. A strategy to overcome missing expert knowledge and own resources without free capacity is to hire external resources. CONCLUSIONS: With the ever-changing landscape of digital health, it is essential to have skilled workers with knowledge on the peculiarities of clinical workflows. The existing shortage of skilled workers leads to a reduction of innovative power in the health IT sector, potentially slowing down the digital health transformation.