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

A systematic review of Patient-Reported Outcome Measures (PROM) use in studies of elective hand conditions

The use of patient-reported outcome measures (PROMs) in hand surgery has grown in recent years, and support patient-centred care and research. Their use has been reviewed in Dupuytrens disease and in trauma. The aim of this systematic review was to appraise the usage of hand relevant PROMs in elective hand conditions

AZD1775 induces toxicity through double-stranded DNA breaks independent of 5-FU activity in P53 mutated colorectal cancer cells

Background Novel methods of varicose vein treatment have been introduced in the past few years with the expectation that they might be more advantageous than conventional procedures. A systematic review and network meta-analysis was conducted comparing the effectiveness of current treatment (conservative care, surgery, ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA)) to emerging technologies (mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE)). Methods A systematic review of the literature was undertaken with evidence from randomised controlled trials (RCTs) collected for current technologies. However, because of a paucity of randomised studies, evidence for the newer endovenous ablation procedures was obtained from non-randomised studies in a secondary analysis. Outcomes measured were re-intervention on the truncal vein and re-treatment for residual varicosities. Results Thirty-three RCTs and a further ten non-randomised studies evaluating MOCA or CAE were analysed. Thirteen RCTs and three non-randomised studies reported on re-interventions and re-treatments. The rate of re-interventions was found to be similar between EVLA, RFA and surgery. The rate of re-intervention after MOCA appears lower than UGFS (incidence rate ratio MOCA v UGFS 0.395) and greater than surgery (incidence rate ratio MOCA v surgery 1.378). Conclusion This is the first systematic review that has conducted a meta-analysis of re-intervention and retreatment. The high attrition rate is the main risk of bias identified in the RCTs. Further, high quality studies comparing MOCA and CAE to other modalities are needed to establish truncal re-intervention rates and rate of re-treatment of residual varicosities

Buried versus exposed Kirschner wires following fixation of metacarpal and phalangeal fractures: a national clinician and patient survey

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 Kwires to manage hand fractures in the United Kingdom. A number of nonevidencebased 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.</p