Background: Patient-reported outcome measures (PROMs) are important tools for assessing outcomes following injuries to the hand and wrist. Many commonly used PROMs have no evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. This systematic review examines the PROMs used in the assessment of hand and wrist trauma patients, and the evidence for reliability, validity, and responsiveness of each measure in this population. Methods: a systematic review of Pubmed, Medline, and CInaHL searching for randomized controlled trials of patients with traumatic injuries to the hand and wrist was carried out to identify the PROMs. For each identified PROM, evidence of reliability, validity, and responsiveness was identified using a further systematic review of the Pubmed, Medline, CInaHL, and reverse citation trail audit procedure. Results: The PROM used most often was the disabilities of the arm, Shoulder and Hand (daSH) questionnaire; the PatientRated Wrist Evaluation (PRWE), Gartland and Werley score, Michigan Hand Outcomes score, Mayo Wrist Score, and Short Form 36 were also commonly used. Only the daSH and PRWE have evidence of reliability, validity, and responsiveness in patients with traumatic injuries to the hand and wrist; other measures either have incomplete evidence or evidence gathered in a nontraumatic population. Conclusions: The daSH and PRWE both have evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. Other PROMs used to assess hand and wrist trauma patients do not. This should be considered when selecting a PROM for patients with traumatic hand and wrist pathology.

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Background and purposeRestoration of bone stock at revision hip surgery remains a challenge. Alternative graft materials with suitable mechanical properties for impaction grafting have been sought due to issues with infection, antigenicity, cost, and availability of allograft. We have previously presented good short-term results of the use of BoneSave, a biphasic porous ceramic bone graft substitute, consisting of sintered 80% tricalcium phosphate and 20% hydroxyapatite, in a 50:50 mix with femoral head allograft. We now present the medium-term results.MethodsWe conducted a retrospective review of a cohort of 43 consecutive patients undergoing impaction grafting of contained acetabular defects by multiple surgeons at a single center. 34 patients received uncemented acetabular components and 9 received cemented components. Patients were followed up radiographically and with the self-reported satisfaction scale (SAPS), Oxford hip score (OHS), and the Short-Form 12 (SF12) health survey. Kaplan-Meier survivorship analysis was performed with revision of the acetabular component, revision of any part of the construct, and reoperation as endpoints.Results The fate of all cases was known. Median follow-up of the surviving patients was 80 (69–106) months. 15 patients died during the follow-up period, 14 with their construct in situ. The survivorship of the grafted acetabulum and acetabular component was 94% (95% CI: 99–78) at 7 years. 1 patient had been revised for aseptic loosening of the acetabulum and 1 for deep infection. The mean OHS was 31 (SD 12), the mean SF12 physical-component score (PCS) was 38 (SD 13), the median SAPS was 83 (0–100), and the median SF12 mental-component score (MCS) was 55 (23–65). The graft material became incorporated in all 3 zones of the acetabulum in 23 out of 24 cases that had complete radiographic follow-up.Interpretation These medium-term results show that BoneSave is a reliable material for impaction grafting of the acetabulum when used in conjunction with femoral head allograft.

A recent survey of UK core medical training (CMT) training conducted jointly by the Royal College of Physicians (RCP) and Joint Royal College of Physicians Training Board (JRCPTB) identifi ed that trainees perceived major problems with their training. Service work dominated and compromised training opportunities, and of great concern, almost half the respondents felt that they had not been adequately prepared to take on the role of medical registrar. Importantly, the survey not only gathered CMT trainees' views of their current training, it also asked them for their 'innovative and feasible ways to improve CMT'. This article draws together some of these excellent ideas on how the quality of training and the experience of trainees could be improved. It presents a vision for how CMT trainees, consultant supervisors, training programme directors, clinical directors and managers can work together to implement relevant, feasible and affordable ways to improve training for doctors and deliver the best possible care for patients.