Educating Future Generations of Surgeons across Borders: Novel Global Linked Hybrid Live Cadaveric Peripheral Nerve Surgical Training Course.

Background: This study aimed to evaluate a novel, multi-site, technology-facilitated education and training course in peripheral nerve surgery. The program was developed to address the training gaps in this specialized field by integrating a structured curriculum, high-fidelity cadaveric dissection, and surgical simulation with real-time expert guidance. Methods: A collaboration between the Global Nerve Foundation and Esser Masterclass facilitated the program, which was conducted across three international sites. The curriculum was developed by a panel of experienced peripheral nerve surgeons and included both text-based and multimedia resources. Participants' knowledge and skills were assessed using pre- and postcourse questionnaires. Results: A total of 73 participants from 26 countries enrolled and consented for data usage for research purposes. The professional background was diverse, including hand surgeons, plastic surgeons, orthopedic surgeons, and neurosurgeons. Participants reported significant improvements in knowledge and skills across all covered topics (p < 0.001). The course received a 100% recommendation rate, and 88% confirmed that it met their educational objectives. Conclusions: This study underscores the potential of technology-enabled, collaborative expert-led training programs in overcoming geographical and logistical barriers, setting a new standard for globally accessible, high-quality surgical training. It highlights the practical and logistical challenges of multi-site training, such as time zone differences and participant fatigue. It also provides practical insights for future medical educational endeavors, particularly those that aim to be comprehensive, international, and technologically facilitated.

The epidemiology and distribution of hand fractures in Singapore.

Introduction: The aim of this study was to elucidate the epidemiology and distribution of hand fractures in Singapore. Methods: A total of 701 hand fractures in 596 patients aged 21 years and above from a single centre were reviewed from 2010 to 2011. Details regarding the patient demographics, occupation, mechanism of injury, associated injuries and treatment were obtained. Results: Hand fractures were particularly significant in patients between the ages of 21 and 40 years 58.9% of the total cases. The relative risk of hand fractures in males was 5.5 times greater than that in females. The majority of hand fractures occurred at the workplace (47.7%), with crush injury being the main mechanism of injury (33.6%). The most common locations of hand fracture were the little finger ray (31.2%) and distal phalanges (37.7%). There were 170 cases that underwent surgical fixation, which accounted for 24.3% of all fractures. Fixation rate was similar for both closed and open fractures but was significantly higher in the proximal and middle phalanges compared to the distal phalanx and metacarpal (P < 0.001). With regards to surgical fixation methods, wires were commonly used in either tuft fractures (100.0%) or intra-articular fractures (69.9%), whereas plates and screws were commonly used in shaft fractures (65.5%). Conclusion: The most significant population that sustained hand fractures in Singapore are young to middle-aged males who are skilled manual workers. The most commonly involved ray and location of hand fractures are the little finger ray and the distal phalanges, respectively, as they are in a relatively more exposed location.

Limb salvage versus primary amputation in Gustilo-Anderson IIIB and IIIC tibial fractures: a systematic review and meta-analysis.

INTRODUCTION: The last systematic review on this topic was published in 2008. With advances in surgical techniques, patients with mangled extremities may now be potentially salvageable with comparable outcomes. This review aims to evaluate the outcomes of limb salvage compared to primary amputation in patients with severe open tibial fractures. MATERIALS AND METHODS: A comprehensive search on PubMed, MEDLINE, Embase, Web of Science, Scopus, CENTRAL and CINAHL was performed from inception to 19 January 2022. The primary outcome was to evaluate clinical and functional outcomes. Secondary outcomes were to evaluate pain, patient preference, quality of life, and patient preferences. Methodological quality was evaluated using the MINORS criteria. Pooled estimates of relative risk (RR) and mean difference (MD) with 95% confidence interval (CI) were used as a summary statistic for dichotomous variables and continuous variables, respectively. RESULTS: Sixteen studies with 645 patients met inclusion criteria. The methodological quality was moderate based on the MINORS score. The majority were male. Mean age was 36.3 years. There was no significant differences in the length of hospitalization (n = 8), return to work rates (n = 9), return to sport rates (n = 4) and quality of life scores (n = 4). Patients with primary amputation had a significantly lower risk of total complications (RR 0.21, 95% CI 0.08-0.53, p = 0.001) (n = 10), infections (RR 0.46, 95% CI 0.25-0.85, p = 0.01) (n = 9), and number of surgeries (MD - 4.17, 95% CI - 6.49 to - 1.85, p = 0.0004) (n = 6). Patients with primary amputation were able to ambulate significantly earlier (MD - 4.06, 95% CI - 7.65 to - 0.46, p = 0.03) (n = 3). Three studies found a significantly higher cost of hospitalization in limb salvage patients. Functional outcomes were similar in both groups. CONCLUSION: While patients with primary amputation had better clinical outcomes in the short-term, functional outcomes were not significantly different in both groups. Despite the heterogenicity of the results in this review, surgeons need to contextualize the decision making for their patients and incorporate these findings. LEVEL OF EVIDENCE: III. TRIAL REGISTRATION: PROSPERO CRD42022303357.

Comparison of Prevalence of Osteoarthritis in the Hand: A Multicenter Retrospective Cohort Study.

Introduction Several studies have previously been undertaken to investigate the prevalence of radiologic hand osteoarthritis (OA) in Caucasian, Japanese, Chinese, and Arabic populations. To date, there has been no direct international comparison study on the prevalence of radiologic hand OA between a Western and a Southeast Asian population. We hypothesize that there is difference in the pattern of joint involvement among individuals of both populations. Materials and Methods Consecutive hand radiographs from individuals aged 60 years and above were reviewed. Radiographic evidence of osteoarthritis in the various joints in the hands was graded using Kellgren-Lawrence (K-L) score. Chi-square test, Fisher's exact test, or Student's t -test was used as appropriate. Multiple logistic regression analysis was performed to evaluate the associations and relationships of radiographic hand OA between joints. Results A total of 194 patients exhibited radiographic OA. Singaporean patients were more likely to have radiographic OA of the thumb interphalangeal joint (IPJ) (65.1%) compared with the thumb carpometacarpal joint (CMCJ; 40.2%); British patients were more likely to have CMCJ (43.3%) OA than thumb IPJ (21.0%). The difference was statistically significant ( p = 0.00026). In the Singapore population, it was more likely that a patient had concurrent OA of both thumb and finger joints, whereas in the British population, this was apparent in only the above-80-year-old group. The most commonly affected joint was the left thumb IPJ (joint specific prevalence of 35%) in the Singapore population, and the right index finger distal interphalangeal joint (DIPJ; joint specific prevalence of 41.5%) in the British population. Conclusion Our study, the first study to compare between Singaporean and British populations, showed statistically significant difference in the prevalence of OA in the hands. These findings suggest ethnic and cultural factors play a part in such a distribution trend.

High Median Nerve Paralysis: Is the Hand of Benediction or Preacher's Hand A Correct Sign?

High median nerve injuries are commonly presented in textbooks as adopting the typical posture of hand of benediction or preacher's hand. This study aimed to show that the hand of benediction or preacher's hand is incorrectly associated with a high median nerve paralysis. Methods: A retrospective review of four cases with a high median nerve injury is presented. Diagnosis of a high median nerve injury was performed by means of intraoperative findings, electrodiagnostic studies, or ultrasound imaging. None of the patients presented in this study had a hand of benediction on physical examination despite the presence of a high median nerve lesion. Results: All four patients with high median nerve injuries showed a similar hand posture when attempting to make a fist. Firstly, the index finger still flexed at the metacarpophalangeal joint because of the ulnar innervated interossei muscles. Secondly the thumb is completely abducted at the carpometocarpal joint and extended at the interphalangeal joint. Lastly, middle finger flexion is possible due to dual innervation of its flexor digitorum profundus by the ulnar nerve as well as due to the quadriga phenomenon. Conclusions: The clinical appearance of a high median nerve palsy is different from the classical hand of benediction or preacher's hand posture pointing finger. We have shown that this incorrect association can result in delayed referral of patients with high median nerve injuries.

Experiences of living with leprosy: A systematic review and qualitative evidence synthesis.

OBJECTIVE: The objective of the review was to identify, appraise, and synthesise qualitative studies on the lived experience of individuals diagnosed with leprosy, the impact of the disease, and how they coped with the disease burden. INTRODUCTION: Leprosy is a chronic disease with long-term biopsychosocial impact and is a leading cause of preventable disabilities. It traps the individuals with leprosy in a vicious circle of disease, stigma, and poverty. The efforts to reduce stigma and discrimination and improve their quality of life have not kept pace with the success of the multidrug treatment. INCLUSION CRITERIA: This review considered published literature on the lived experience of individuals diagnosed with leprosy. There were no limitations on gender, background, or country. All qualitative or mixed-methods studies were accepted. METHODS: The review followed the JBI meta-aggregation approach for qualitative systematic reviews. A structured literature search was undertaken using multiple electronic databases: PubMed, Embase, Web of Science, and CINAHL. RESULTS: The search identified 723 publications, and there were 446 articles after deduplication. Forty-nine studies met the inclusion criteria. The final 173 findings were synthesised into ten categories and aggregated into four synthesised findings: biophysical impact, social impact, economic impact, and mental and emotional impact. These synthesised findings were consistent across the included studies from a patient's perspective. The way people coped with leprosy depended on their interpretation of the disease and its treatment. It affected their help-seeking behaviour and their adherence to treatment and self-care. The review has identified a multi-domain effect on the affected individuals, which goes beyond the biological and physical effects, looking at the social issues, specific difficulties, emotions, and economic hardships. CONCLUSIONS: The researchers, health professionals, and policymakers could use the synthesised findings to address the concerns and needs of the leprosy-affected individuals and offer appropriate support to manage their lives. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO Registration number: CRD42021243223.

Surgical Treatment of Peripheral Nerve Neuromas: A Systematic Review and Meta-Analysis.

BACKGROUND: Despite many treatment options available, no consensus on the optimal surgical management of symptomatic peripheral nerve neuroma has been reached. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of different surgical techniques for treating painful neuromas and to help guide surgeons in electing optimal treatment. METHODS: Four databases (Embase, MEDLINE, Web of Science, and Cochrane Central) were searched. Studies that reported either numerical (visual analogue scale/numeric rating scale) or nonnumeric postoperative pain scores after surgical treatment of peripheral neuroma were identified. RESULTS: Thirty-two articles met the eligibility criteria and were analyzed for qualitative review. Thirty studies were included in qualitative analysis, for a total of 1150 neuromas. Surgical treatment of peripheral neuroma achieved good postoperative results in 70 percent of treated neuromas (95 percent CI, 64 to 77 percent). Proportions between techniques ranged between 60 and 92 percent. In a post hoc analysis, targeted muscle reinnervation (82 percent; 95 percent CI, 73 to 92 percent) performed significantly better than neurectomy ( p = 0.024). CONCLUSIONS: The choice of surgical management in treating symptomatic peripheral neuroma is challenging, yet surgical intervention achieves significant pain relief in the majority of cases. Targeted muscle reinnervation is promising for the management of painful neuromas.

Surgical Treatment Outcome of de Quervain's Disease: A Systematic Review and Meta-analysis.

Background: Surgical release of the extensor retinaculum is performed as a treatment for de Quervain's (DQ) disease when conservative treatment fails. In the literature, there is no consensus about the effectiveness of a surgical release in patients with DQ, the complication rate, or which type of incision is superior. Therefore, a systematic review and meta-analysis were conducted. Methods: A systematic search was performed in Embase, Medline Ovid, Web of Science Core Collection, Cochrane, and Google Scholar. Articles regarding surgical treatment of DQ disease that reported outcome and complications were included. We extracted exact values of visual analog scale scores and percentages of patients who experienced pain at follow-up. Complications assessed were (sub) luxation, superficial radial nerve injuries, wound infections, and scar problems. Results: Twenty-one studies with a total of 939 patients were included. Five percent of these patients (95% CI 1%-18%) did not show complete remission of pain at follow-up. When pooled, the mean reduction in visual analog scale scores was 5.7 (95% CI 5.3-6.1) on a 0-10 scale. No difference in outcome between different types of surgery or incisions was seen. Based on the meta-analysis, the pooled complication rate was 11% (95% CI 5%-22%). Conclusions: Five percent of patients still have residual pain after surgical release of the first extensor compartment. Surgery type, as well as the type of incision, did not affect outcome or complication. Thus, surgical release of the extensor retinaculum for DQ disease is an effective treatment, regardless of the type of surgery.

Online training module for micro suturing incorporating motor imagery and mental practice: a design and development research study.

INTRODUCTION: There have been reduced opportunities for surgical skill acquisition due to the COVID-19 pandemic and the regulated training hours. Despite these challenges, self-regulated learning allows trainees to learn continuously, and one form of this is through mental practice and motor imagery. The study aimed to design and develop an online basic micro suturing training module for skill acquisition for self-regulated learning using a low-fidelity rubber glove model. METHODS: This study utilized a design and developmental research framework and Mayer's multimedia theory guidelines. The primary author created an online instructional module on micro suturing based on the ADDIE instructional design model. This module was then evaluated in a pilot study comparing the new training model to traditional methods of learning using an experimental design. RESULTS: This study describes the use of Design and Development Research to create a new model for surgical skill training and a tool for producing instructional materials and learning products for online learning. The product was evaluated using an experimental design and showed a significant effect on the quality of motor skill outcome and the richness of motor imagery using the resource developed in the research. CONCLUSION: This study describes the methodological approach of a design and developmental framework to create an online training module for micro suturing which has significant utility in hand surgery.

Perilunate Injury Timing and Treatment Options: A Systematic Review.

Introduction Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment. Methods A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7-45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD. Results Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD. Conclusions Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.

Collaborative hand surgery clinical research without sharing individual patient data; proof of principle study.

High-quality research in hand surgery is increasingly important. A vital component is national and international multicenter collaborative research because of better generalizability and larger sample sizes. However, sharing patient data between centers can be hampered by regulations and privacy issues or reluctance to share patient data. Therefore, in this paper, we illustrate an approach for collaborative clinical research without sharing patient data while obtaining similar outcomes. To illustrate that this collaborative clinical research approach without sharing patient data leads to similar outcomes compared to aggregating all individual patient data in one database, we simulate an approach of performing meta-analyses on summary statistics of individual-center data. In the simulation, we compare the results to conventional analyses in an existing multicenter database of patients treated for Dupuytren's disease at three different centers with either limited fasciectomy (LF) or needle aponeurotomy (PNF). We share example data and all analysis code in a public GitHub Library. We found similar results for the meta-analysis approach without sharing individual patient data as in the conventional approach for 1) the proportion of patients treated for recurrences, 2) the Total MHQ score after both treatments, 3) the comparison of Total MHQ score after both treatments, and 4) the comparison of both treatments when correcting for confounders with regression analysis. CLINICAL SIGNIFICANCE: We illustrate how collaborative studies can be performed without sharing individual patient data while obtaining similar results as with conventional analyses. This approach can help speed up collaborative research without losing precision in outcome analysis.

Patient and Surgeon Reported Experiences of Locoregional Anesthesia in Hand Surgery.

Introduction Locoregional anesthesia techniques have been increasingly adopted for use in hand surgery in recent years. However, locoregional anesthesia techniques may place patients under significant psychological stress, and there has been limited evaluation of acceptance and satisfaction rates of these techniques. Materials and Methods An observational study was conducted in a single tertiary institution. Data were collected from patients undergoing upper limb surgery procedures with locoregional anesthesia. After completion of surgery, a questionnaire adapted from Evaluation du Vecu de l'Anesthesie LocoRegionale (EVAN-LR), with scores from 1 to 5 on the Likert scale, was conducted on the same day to evaluate patient satisfaction. Responses were also obtained from the operating surgeon to assess satisfaction. Results A total of 101 patients were evaluated as part of the study. All EVAN-LR domains received a mean score >4.5. Responses from surgeons also showed good acceptance of locoregional anesthesia techniques with almost all giving scores ≥4 on the Likert scale. Conclusion The results of this study showed good satisfaction and acceptance of locoregional anesthesia among patients for upper limb procedures. This provides reassurance regarding the quality of care with locoregional anesthesia techniques. It remains important to be aware of potential sources of discomfort such as tourniquet pain to minimize discomfort and maximize patient satisfaction.

Can the Boston Carpal Tunnel Syndrome Questionnaire Be Used as a Screening Tool Among a Potentially High-Risk Population in Singapore?

Introduction Carpal tunnel syndrome (CTS) causes significant morbidity with delayed diagnosis or management. The Boston Carpal Tunnel Questionnaire (BCTQ) is validated for monitoring CTS following diagnosis; however, it has not been trialed in a screening capacity. The study aimed to determine whether it can be utilized when screening a focused population in Singapore. Materials and Methods A single-center survey-based study was undertaken prospectively to identify whether positive symptoms could be identified among nursing and administrative staff. Results A total of 605 staff responded. Positive symptoms were identified in 317 (52.4%) of participants and 23 (3.8%) reported them to be severe. Functional limitations were detected in 157 (26.0%) of participants with 5 (0.8%) reporting these as severe. Positive symptoms (84.9%) and functional limitations (81.5%) were more prevalent among nursing staff. Cronbach's α scores (0.896 for symptoms and 0.84 for functional limitations) suggested good reliability in matching symptoms and functional limitations. Conclusion The BCTQ can potentially be implemented as a screening tool for CTS among those without a prior diagnosis. It has a greater depth of questioning with symptomatic and functional limitations considered, and in situations where a formal diagnosis is subsequently made, the same tool can be subsequently used for progression tracking pre- and post-treatment. Level of Evidence This is a Level II study.

Design, Development, and Validation of a High-Fidelity "Ganglion Cyst" Model for Cadaveric Hand Surgery Training.

Introduction This study presents a design and developmental model with prospective validation. This study was aimed to design, develop, and validate a cadaveric model simulator of a ganglion cyst to train surgeons in its surgical excision. Materials and Methods A novel "ganglion cyst" was designed using a latex powder-free glove and water-based, water-soluble lubricant (K-Y jelly). This "ganglion cyst" was then inserted subcutaneously into a cadaveric hand, positioned over the dorsum of the wrist to simulate a ganglion lesion. This simulation model was prospectively validated using postsimulation surveys conducted on novices and experts in hand surgery. The simulation was conducted during a basic hand surgery cadaveric workshop that included a practical station on ganglion excision. Results Both the novices and experts had a concurrent agreement that the simulator provided relevance, realism, and value as a simulator for the teaching, excision and procedural assessment of ganglions in the hand. Conclusion The role of high-fidelity simulation has been documented in the literature for surgical procedures. This simple and affordable model that we have developed and validated allows for the creation of a high-fidelity ganglion simulator in the cadaveric hand for teaching, excision, and procedural assessment among trainees.

Management of Recurrent Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis.

PURPOSE: Few comparisons have been performed between the outcomes of surgical techniques for recurrent carpal tunnel syndrome. Using a meta-analysis, this study aimed to compare the outcomes of different surgical techniques using the Boston Carpal Tunnel Questionnaire (BCTQ) and visual analog scale (VAS) for pain as outcomes. METHODS: The following categories were used to define the study's inclusion criteria: population, intervention, comparator, outcomes, and study design. Studies were examined by 2 reviewers, and the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed. The studies were assigned to 1 of the following treatment groups: decompression with or without neurolysis, autologous fat transfer, hypothenar fat pad, pedicled or free flap, and "other." For our primary outcome, we compared improvement using the BCTQ and VAS for pain between the treatment groups. For our secondary outcome, postoperative BCTQ and VAS pain values were compared. RESULTS: Fourteen studies were included: 5 case series with postoperative data only and 9 pre-post studies without a control group. With regard to our primary outcome, the studies reported an average improvement of 1.2 points (95% confidence interval [CI][1.5, 0.9]) on a scale of 1-5 on the symptoms severity scale (SSS) of the BCTQ, 1.9 points (95% CI [1.37, 0.79]) on a scale of 1-5 on the function severity scale of the BCTQ, and 3.8 points (95% CI [4.9, 2.6]) on a scale of 1-10 on the VAS for pain. We only found significantly lesser improvement in the "other" treatment group than in the hypothenar fat pad group and autologous fat transfer group using the SSS. The hypothenar fat pad group had the best reported postoperative SSS score of 1.75 (95% CI [1.24, 2.25]), function severity scale score of 1.55 (95% CI [1.20, 1.90]), and VAS pain score of 1.45 (95% CI [0.83, 2.07]). CONCLUSIONS: All the techniques showed clinically important improvements in all the outcomes. We found lesser improvement in the "other" treatment group than in the hypothenar fat pad group and autologous fat transfer group using the SSS. We found that the hypothenar fat pad group had the best reported postoperative values in our secondary analysis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Diagnosing surgical site infections using telemedicine: A Systematic Review.

BACKGROUND: Surgical site infections (SSI) are preventable post-operative complications. With the increase in use of telehealth modalities, there is a need to assess if telehealth modalities are safe for assessment of SSI. AIM: This review aims to assess the accuracy of using telemedicine in the diagnosis of SSI in post-surgical adult patients as compared to in-person assessments. METHODS: A comprehensive search on 6 databases (PubMed, MEDLINE, Embase, Web of Science, Scopus and CENTRAL) was performed from inception to 1 December 2020. Data was extracted to determine accuracy, feasibility, acceptability, and usability of using telemedicine to detect SSIs. The primary outcome of this review was to review the diagnostic accuracy of telemedicine to diagnose SSIs as compared to direct, in-person assessment. Methodological quality was evaluated using the MINORS criteria. RESULTS: Six studies met inclusion criteria. Results were summarized qualitatively. The overall methodological quality of the studies was moderate based on the MINORS score. Four studies utilized telephone surveillance, whilst two utilized mobile applications. Telemedicine modalities were able to accurately diagnose 66 SSIs, where an additional 15 were found on direct clinical review. The diagnostic accuracy across the studies ranged from 69.5 to 100%. Between 82.5 and 100% of patients were able to be contacted through these telemedicine modalities. CONCLUSIONS: Telemedicine modalities are a feasible option for post-operative follow-up, especially in the identification of SSIs. As technology becomes more affordable and widely available, future applications of telemedicine are limitless. However, further research is still required to ensure that telemedicine is a safe and effective tool.

Intravascular Papillary Endothelial Hyperplasia: Case Report of a Recurrent Masson's Tumor of the Finger and Review of Literature.

Intravascular papillary endothelial hyperplasia (IPEH), often referred to as Masson's Tumor, is an uncommon yet benign vascular disease of the skin and subcutaneous tissues. It usually arises within a blood vessel, but is considered to be a non-neoplastic reactive endothelial proliferation commonly associated with vascular injury. Although it is rare, knowledge of this disease is important as it may mimic other benign and malignant tumors, especially angiosarcoma, which may lead to unnecessary aggressive management. Typically, IPEHs are asymptomatic and are slow growing soft-tissue masses with extremely low-recurrence rates. In this article, we describe a 19-year-old male with a recurrence of Masson's Tumor over the right little finger within 2 months of a routine excision of the lesion. We also present accompanying multimodality clinical, radiological, and pathological imaging. This case illustrates the innocuous nature of the initial lesion easily mistaken for a hemangioma. Awareness of the possibility of a recurrence of a Masson's Tumor is important for clinicians to rule out the presence of malignant vascular lesions.

Can Open Hand Injuries Wait for Their Surgery in a Tertiary Hospital?

Objective Open hand injuries are routinely admitted and planned for surgery acutely, competing with other surgical emergencies. This retrospective study aims to evaluate if a delay in timing to surgery for open hand injuries led to an increased rate of infection. Materials and Methods All patients who sustained open hand injuries and underwent semi-emergent day surgery from January 1, 2015 to December 31, 2016 were included. Outcome of postoperative infection was analyzed against demographic data, injury details, and delay from trauma to therapy. Results There were 232 cases (91% males) included, with 92.0% performed under local anesthesia. Deep seated postoperative infection was seen in 1.3%, which was not significantly associated with delay to surgery. Conclusion We had comparable infection rates as compared with published literature. Delayed timing of surgical treatment in open hand injuries was not associated with increased rates of deep-seated infection. Managing open hand injuries as semi-emergent surgeries may be acceptable given the low infection rates.

Hand Surgery in Singapore.

Singapore as an island nation is one of three countries in the world that has hand and reconstructive microsurgery (HRM) as an independent specialty. The 52 accredited hand surgeons serving a population of 5.7 million facilitate hassle free access to patients. Hand surgery historically is rooted very much in orthopaedic surgery as in most Asian countries with more than five decades of rapid evolution. Singapore pioneered a structured and systematic training program for HRM and the local surgeons have contributed significantly to the body of knowledge in hand surgery with targeted research and publications with three surgeons being awarded international recognition for their contributions. Singapore continues to contribute significantly to surgical volunteerism regionally through active involvement in the training of regional surgeons through their sustainable volunteer activities and through international fellowships in Singapore hospitals. The future of hand surgery in Singapore will be more competency and multidiscipline based on community-centered approach.