Variables associated with recurrent Dupuytren's disease, or a 'diathesis', have been investigated, but those associated with functional outcome and complications are less well studied. Outcomes 1 or 5 years after an aponeurotomy, fasciectomy or dermofasciectomy were assessed by patient interview and examination at five UK centres. A total of 432 procedures were studied. The reoperation rate did not differ at 1 year (p = 0.396, Chisquare test with Monte Carlo simulation), but was higher after aponeurotomy in the 5-year group (30%, versus 6% after fasciectomy and 0% after dermofasciectomy, p = 0.003, Chi square test with Monte Carlo simulation). Loss of function (DASH>15) did not differ between procedures at 5 years, even when reoperation and other variables were controlled. Diabetes, female gender and previous ipsilateral surgery were associated with poorer function in logistic regression analysis. The variables associated with poor function after treatments differ from diathesis variables. Aponeurotomy had lower complication rates than fasciectomy and dermofasciectomy. This may counterbalance the former's higher recurrence rate and explain why aponeurotomy demonstrated similar long-term functional outcome compared with excisional surgery in this study. Level of evidence: III

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.

Introduction A core outcome set is a baseline set of agreed upon outcomes to be used in all future clinical research on a given health topic. We aimed to develop a core outcome set for hand fractures and joint injuries in adults. Methods We synthesised the outputs of our prior systematic review of treatment outcomes and qualitative work exploring the patient perspective to develop a longlist of outcome domains. This longlist entered a consensus prioritisation process. An international three-round Delphi survey involving patients, hand therapists and surgeons prioritised domains which were then considered in a subsequent virtual international consensus meeting involving key stakeholder groups. Using a process of discussion and prioritisation steps with pre-determined consensus criteria, the panel agreed upon a final core outcome set. Results In the Delphi survey 41 outcome domains were rated. 144/152 participants (>94%) completed all three rounds (54 patients, 55 surgeons, 35 hand therapists). 20 domains reached consensus as very important. The final consensus meeting had 27 participants (12 patients, seven surgeons, six hand therapists, a health economist and a trial manager). After iterative prioritisation steps, a final vote selected seven outcome domains for inclusion in the core outcome set. Conclusion Through consensus prioritisation steps we developed a final set of seven core outcome domains. These cover areas such as functional tasks, patient comfort, abstract/physiological function and patient satisfaction. They are recommended as the baseline domains to be measured in all future clinical research on hand fractures and joint injuries in adults. Take-home message A core outcome domain set has been developed for hand fractures and joint injuries in adults, based on agreement by the key stakeholder groups. All future clinical research on these injuries should measure these domains as a baseline to improve consistency and comparability of the field of research.