Buried Versus Exposed Kirschner Wires Following Fixation of Hand Fractures: l Clinician and Patient Surveys

Background: Fractures of the metacarpals and phalanges are common. Placement of Kirschner wires (K-wires) is the most common form of surgical fixation. After placement, a key decision is whether to bury the end of a K-wire or leave it protruding from the skin (exposed). A recent systematic review found no evidence to support either approach. The aim of study was to investigate current clinical practice, understand the key factors influencing clinician decision-making, and explore patient preferences to inform the design of a randomized clinical trial. Methods: The steering group developed surveys for hand surgeons, hand therapists, and patients. Following piloting, they were distributed across the United Kingdom hand surgery units using the Reconstructive Surgery Trials Network. Results: A total of 423 hand surgeons, 187 hand therapists, and 187 patients completed the surveys. Plastic surgeons and junior surgical trainees preferred to leave K-wires not buried. Ease of removal correlated with a decision to leave wires exposed, whereas perceived risk of infection correlated with burying wires. Cost did not affect the decision. Hand therapists were primarily concerned about infection and patient-related outcomes. Patients were most concerned about wire-related problems and pain. Conclusion: This national survey provides a new understanding of the use of K-wires to manage hand fractures in the United Kingdom. A number of nonevidence-based factors seem to influence the decision to bury or leave K-wires exposed. The choice has important clinical and health economic implications that justify a randomized controlled trial

Perceived Out-Group (Dis)Continuity and Attribution of Responsibility for the Lebanese Civil War Mediate Effects of National and Religious Subgroup Identification on Intergroup Attitudes

Successful reconciliation between groups following a violent conflict requires psychological change. We test a model predicting intergroup attitudes towards Muslims in Lebanon among Maronite (Christian) Lebanese youths. Identification with both their religious subgroup and with the superordinate national group predicted attitudes towards Muslims, in opposite directions. These effects of levels of identification on intergroup attitudes were mediated by attributions of responsibility for the war (Muslim responsibility) and perception that the current generation of out-group members is different from the war generation (perceived out-group discontinuity). Identification with Lebanon fosters positive attitudes towards Muslims by lowering Muslim responsibility for the war, and by increasing perceptions of foreign responsibility and perceived out-group discontinuity. In contrast, increased identification with their own religious subgroup undermines attitude change by increasing Muslim responsibility for the war and lessening perception of out-group discontinuity. Representations of the past have implications for attitudes towards former enemies and reconciliation in the present.SCOPUS: ar.jinfo:eu-repo/semantics/publishe