Clinical decision making in the assessment and treatment of closed hand fractures: A scoping review

Abstract

Introduction Closed hand fractures represent a significant proportion of emergency department attendances, result in substantial health service utilisation and have a detrimental effect on quality of life. Increasingly, hand therapists in the United Kingdom provide first line fracture treatment. However, the knowledge and skills required to work in such an extended scope capacity have not been elucidated or standardised. This literature review synthesises and reports evidence for the knowledge requisite of clinicians to make evidence-based treatment decisions for patients with hand fractures. Methods A systematic search was undertaken, using Embase, MEDLINE, PsychInfo and CINAHL electronic databases. Inclusion criteria were English language, full research reports of studies assessing of the reliability or validity of the decision-making process in hand fracture treatment published between 2013 and 2023. Data were summarised narratively. Results 15 studies met inclusion criteria; most assessed decision making for metacarpal fractures. Studies on imaging ( n = 4) suggested the reliability of plain radiograph interpretation of hand fracture characteristics such as angulation is good and similar across various levels of experience. Agreement between surgeons and therapists in choosing surgical or nonsurgical treatment was generally good, but factors influencing decision making remained unclear. No evidence was identified that explored clinical assessment knowledge (subjective or objective patient factors) or the specific competencies required to treat hand fractures. Conclusions There is limited evidence for the knowledge and skills required of clinicians for the competent assessment and treatment of hand fractures. Stakeholder consensus work is required to develop robust competencies and standardise practice.