Publications by authors named "Wormald J"

Background: Partial extensor tendon lacerations of the hand and forearm are common. There is a lack of evidence to guide their management and it is also unclear at what threshold surgeons would consider repair necessary. This study aimed to identify national surgical management of partial extensor tendon lacerations of the hand and forearm (zones 2-8) and assess surgeons' willingness to randomise in a future trial.

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Raynaud's conditions of the hand, referred to commonly as Raynaud's phenomenon, both primary and secondary, represents a spectrum of disorders affecting the digits, characterised by recurrent episodes of vasospasm that result in a triad of symptoms: pain, pallor, and cyanosis. Various therapies, ranging from conservative hand therapy techniques to surgical sympathectomy, have been explored with inconsistent results. Recently, the local administration of botulinum toxin type-A (BTX-A) has re-emerged as a treatment option for this condition.

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Article Synopsis
  • Peripheral nerve injuries (PNIs) present complex challenges for reconstruction, with vascularised (VNGs) and non-vascularised nerve grafts (NVNGs) being common treatment options; this review aims to compare their clinical and laboratory outcomes.
  • A systematic literature search identified seven clinical and 34 laboratory studies, showing that VNGs generally favored recovery in sensory and motor functions, and showed better lab results like reduced muscular atrophy and enhanced nerve regeneration.
  • Despite the indications that VNGs may be superior, the evidence quality was low and varied, meaning more robust clinical trials are needed to strengthen these findings.
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Aims: The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality.

Methods: A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017.

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Aims: Pyogenic flexor tenosynovitis (PFT) comprises 2.5-9.4% of all primary hand infections.

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  • Soft tissue facial injuries (STFI) are common in craniofacial trauma, but there's limited data on surgical site infection (SSI) rates and patient-reported outcomes (PROs) after surgery for these injuries.
  • A thorough review of studies from 1990 to 2023 identified 38 relevant studies, revealing a pooled SSI rate of 3.30%, with no significant difference between surgical and non-surgical treatments.
  • The research shows insufficient evidence regarding the benefits of surgical treatment on cosmetic results, quality of life, and psychological effects, highlighting the need for more comprehensive research in this area.
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Background: Raynaud disease of the hands is a complex disorder resulting in inappropriate constriction and/or insufficient dilation in microcirculation. There is an emerging role for botulinum toxin type A (BTX-A) in the treatment armamentarium for refractory Raynaud disease. The aim of this systematic review was to critically evaluate the management of primary and secondary Raynaud disease treated with BTX-A intervention.

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Background: The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery.

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Aims: Hand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore result in significant costs to both healthcare systems and society.

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  • A case study describes a patient who sustained a hand injury while surfing, initially misdiagnosed for a nailbed injury but later found to have a distal phalanx fracture that required surgery and rehabilitation.
  • To reduce injury risk in the future, it’s important to consider fractures in surfing injuries and promote education along with improvements in surfboard leash design.
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Background: People with diabetic foot ulcers (DFUs) are at risk of major amputation, which is associated with a high mortality rate (exceeding 50% at 5 years) and reduced quality of life. The authors hypothesized that flap reconstruction of DFUs improves patient outcomes in comparison with standard treatment modalities, including major amputation.

Methods: MEDLINE, Embase, the Cochrane Library, and gray literature were searched on February 9, 2022.

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Purpose: Fractures of the femoral diaphysis are associated with a risk of morbidity in children. Various fixation methods have been developed, but with only limited evidence to support their use. This systematic review assesses the evidence regarding clinical outcomes of closed femoral diaphyseal fractures in children treated with plate fixation or flexible intramedullary nails.

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Background: Hand trauma, comprising injuries to both the hand and wrist, affects over five million people per year in the NHS, resulting in 250 000 operations each year. Surgical site infection (SSI) following hand trauma surgery leads to significant morbidity. Triclosan-coated sutures may reduce SSI in major abdominal surgery but have never been tested in hand trauma.

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Background: Remote patient-reported outcome measure (PROM) data capture can provide useful insights into research and clinical practice and deeper insights can be gained by administering assessments more frequently, for example, in ecological momentary assessment. However, frequent data collection can be limited by the burden of multiple, lengthy questionnaires. This burden can be reduced with computerized adaptive testing (CAT) algorithms that select only the most relevant items from a PROM for an individual respondent.

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Article Synopsis
  • * A systematic review and meta-analysis assessed the risk of SSI in hand trauma surgeries, analyzing 201 studies involving over 315,000 patients, with findings indicating a 10% infection risk in randomized trials and a 5% overall risk across all studies.
  • * These findings can inform clinical practices, such as aiding in informed consent discussions, fostering shared decision-making, and guiding future trials for antimicrobial treatments in hand trauma cases.
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Injuries to the extensor mechanism of the hand and forearm are common and cause significant functional disability. Complete tendon lacerations are managed with surgical repair, whereas selected partial tendon injuries may be managed without repair but with splinting and physiotherapy alone. There is limited evidence to support the management of partial lacerations, in particular the decision of whether to repair or not.

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The COVID-19 pandemic rapidly impacted the delivery of hand surgery services throughout the UK and Europe; from triage to treatment. Our aim was to assess the impact on management of common hand trauma injuries to inform future service delivery and research. The Reconstructive Surgery Trials Network led a service evaluation during the first wave of COVID-19 in 2020.

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Optimal management of pedunculated ulnar polydactyly is not defined. This systematic review summarises objective and patient-reported outcomes following primary treatment. Two authors screened articles for inclusion according to a PROSPERO published protocol.

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Aims: Hand trauma accounts for one in five of emergency department attendances, with a UK incidence of over five million injuries/year and 250,000 operations/year. Surgical site infection (SSI) in hand trauma surgery leads to further interventions, poor outcomes, and prolonged recovery, but has been poorly researched. Antimicrobial sutures have been recognized by both the World Health Organization and the National Institute for Clinical Excellence as potentially effective for reducing SSI.

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Background: The mainstay of treatment for venous ulceration is conservative wound management and lifelong compression therapy. For patients with recalcitrant ulcers, free flap reconstruction has been proposed as a treatment option to reconstruct the diseased soft tissues as well as the underlying insufficient venous system. This review systematically evaluates the outcomes of free flap reconstruction for chronic venous ulcers in the lower limb.

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Article Synopsis
  • Researchers developed a computerized adaptive testing (CAT) version of the Patient Evaluation Measure (PEM) for patients with trapeziometacarpal osteoarthritis, improving how scores are generated using item response theory.
  • The CAT significantly decreased the number of questions needed for accurate scoring from 11 to a median of 2 while maintaining high measurement precision (median standard error of 0.26).
  • Comparison between CAT scores and traditional PEM scores showed a minimal mean score difference of 0.2, indicating that the CAT method effectively reduced survey burden without sacrificing scoring accuracy.
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Background: Defining the optimal, evidence-based management of flexor tendon injury remains challenging. Lack of consensus on which measures to use to assess the outcome of interventions is a key issue, especially with regard to patient-reported outcome measures (PROMs). This systematic review defines the landscape of outcome measurement in studies on interventions for flexor tendon injuries to guide future research.

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