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

Occurrence and Human-Health Impacts of Mycotoxins in Somalia

Mycotoxins are secondary metabolites produced by various molds that contaminate many staple foods and cause a broad range of detrimental health effects in animals and humans through chronic exposure or acute toxicity. As such, the worldwide contamination of food and feed with mycotoxins is a significant problem, especially in sub-Saharan Africa. In this study, mycotoxin occurrence in staple foods consumed in Somalia was determined. A total of 140 samples (42 maize, 40 sorghum, and 58 wheat) were collected from a number of markets in Mogadishu, Somalia, and analyzed by a UPLC-MS/MS multimycotoxin method that could detect 77 toxins. All of the maize samples tested contained eight or more mycotoxins, with aflatoxin B₁ (AFB₁) and fumonisin B₁ (FB₁) levels reaching up to 908 and 17 322 μg/kg, respectively, greatly exceeding the European Union limits and guidance values. The average probable daily intake of fumonisins (FB₁ and FB₂) was 16.70 μg per kilogram of body weight (kg bw) per day, representing 835% of the recommended provisional maximum tolerable daily intake value of 2 μg/(kg bw)/day. A risk characterization revealed a mean national margin of exposure of 0.62 for AFB₁ with an associated risk of developing primary liver cancer estimated at 75 cancers per year per 100 000 people for white-maize consumption alone. The results clearly indicate that aflatoxin and fumonisin exposure is a major public-health concern and that risk-management actions require prioritization in Somalia

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