Paediatric Burns of the Hand: Our Experience Over Three Years.

Background and aim Contact burn injuries to the hand are common in the paediatric population, with the most common aetiology involving touching hot surfaces in the household. The hand is also often involved in paediatric scald injuries. The aim of this study was to determine the different presentations of hand burn injuries and analyse the outcomes in the paediatric population at Royal Aberdeen Children's Hospital (RACH). Methods Anonymised clinic data for paediatric patients with hand burns presenting to our burn centre from 2017 to 2020 were retrospectively reviewed. A total of 52 patients (65 affected hands) were included in the study. Clinic letters stored on NHS Grampian's electronic patient record system were reviewed for burn surface area, time to healing, management measures including medications prescribed and sequelae of the burn injury. Results The average patient age was three years and four months old. There were 31 male patients and 21 female patients. Paediatric hand burns were most commonly confined to the palm only, followed by the fingers only. Contact with a hob was the most common aetiology, followed by scald burns. The average time to healing was 10 days (range 2-28 days). No correlation was found between length of stay on initial hospital admission and time to complete healing. A total of 86.5% (n=45) of patients were managed with dressings and 13.5% (n=7) of patients underwent surgical management. Of these seven patients, four had surgical debridement of burn tissue, washout, and dressing, and the remaining three had an excision and grafting with thick split-thickness skin grafts. Of these three patients, one patient had to undergo secondary reconstruction with a full-thickness skin graft. Conclusion It has been found that most patients in this study completely healed with primarily conservative measures of dressing care and regular check-ups. Isolated hand burns in the paediatric population present a low rate of sequelae and palms are the most common area of burn injury in this demographic.

Return to sport following surgical management of triangular fibrocartilage tears: a systematic review.

INTRODUCTION: This review aims to provide information on return rates and times to return to sport following surgical management of triangular fibrocartilage (TFC) tears. SOURCES OF DATA: A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Scopus, SPORTDiscus and Web of Science was performed using the keywords 'triangular', 'fibro-cartilage', 'complex', 'tear', 'distal radio-ulnar joint', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. AREAS OF AGREEMENT: In all of the 10 studies included, conservative management for 6 weeks to 6 months was the first-line treatment. If symptoms persisted following this period, surgical management was advised. Arthroscopic debridement was recommended for central tears, and arthroscopic repair was recommended for peripheral tears. AREAS OF CONTROVERSY: The optimal treatment modalities for TFC tears remain to be defined. GROWING POINTS: Traumatic central tears can be treated with arthroscopic debridement alone. Arthroscopic repair with an all-inside repair can improve return rates to sport over an outside-in technique for ulna-sided tears. AREAS TIMELY FOR DEVELOPING RESEARCH: Future prospective studies should aim to establish the optimal treatment modalities for TFC tears.

Return to sport following Lisfranc injuries: A systematic review and meta-analysis.

BACKGROUND: Information regarding return rates (RR) and mean return times (RT) to sport following Lisfranc injuries remains limited. METHODS: A systematic search of nine major databases was performed to identify all studies which recorded RR or RT to sport following lisfranc injuries. RESULTS: Seventeen studies were included (n=366). For undisplaced (Stage 1) injuries managed nonoperatively (n=35), RR was 100% and RT was 4.0 (0-15) wks. For stable minimally-displaced (Stage 2) injuries managed nonoperatively (n=16), RR was 100% and RT was 9.1 (4-14) wks. For the operatively-managed injuries, Percutaneous Reduction Internal Fixation (PRIF) (n=42), showed significantly better RR and RT compared to both: Open Reduction Internal Fixation (ORIF) (n=139) (RR - 98% vs 78%, p<0.019; RT - 11.6 wks vs 19.6 wks, p<0.001); and Primary Partial Arthrodesis (PPA) (n=85) (RR - 98% vs 85%, p<0.047; RT - 11.6 wks vs 22.0 wks, p<0.002). CONCLUSIONS: Stage 1 and stable Stage 2 Lisfranc injuries show good results with nonoperative management. PRIF offers the best RR and RT from the operative methods, though this may not be possible with high-energy injuries. LEVEL OF EVIDENCE: IV. Systematic Review of Level I to Level IV Studies.