FESSH abstracts

Abstract

The National Health Service faces the challenges of rising costs and increasing demands whilst continually improving the quality of patient care. The time from referral to surgery was 9 months in our trust (3 months for a new patient clinic appointment and 6 months for surgery). We established a clinic where patients had a consultation and surgery the same day. Summary of the Purpose: The study aim was to evaluate the 'see and treat' hand surgery clinic service to assess whether it reduced waiting times whilst maintaining good clinical outcomes and patient satisfaction. Method: Patients were selected on the basis of standard referral letters, contacted by telephone and (fol-lowing screening questionnaires) invited to the see and treat hand surgery clinic. A single consultant hand surgeon assessed the patient, performed nerve conduction studies and, if indicated, offered surgery the same day. Disabilities of Arm, Shoulder and Hand (DASH) and patient evaluation measure questionnaires were evaluated. Results: Twenty-four patients (17 females and 7 males; mean age 55.73 years; mean DASH score 47) attended 19 weeks after referral. Twenty-one open carpal tunnel decompressions and three trigger finger releases were performed under local anaesthesia. Mean follow-up time was 9.72 weeks in 16 patients (8 were then discharged, 4 listed for a con-tralateral operation and 4 followed up). There were no complications. Patient satisfaction was high. Significance: The period from referral to surgery was reduced from 9 months to 19 weeks. The see and treat hand surgery clinic is a safe, efficient and cost-effective prudent healthcare service which fulfils patient needs and avoids wasteful care. Objective: We report the outcomes of surgical reconstruction for a forearm deformity caused by multiple osteocartilaginous exostoses. Methods: The subjects comprised 30 cases and 33 arms. Removal of exostoses and distraction osteo-genesis of the ulna using external fixation were performed in all cases. The cases included 22 boys and 8 girls with an average age at surgery of 8.3 years. The average follow-up duration was 45 months. The outcomes were assessed using percentage of radial bowing (%RB), the radial articular angle (RAA), and carpal slip (CS) using plain X-ray at preoperation and final follow-up. Assessments are used for (1) all cases and (2) cases followed for more than 6 years (7 cases and 8 arms) postoperatively. Results: In all cases, %RB improved from 14.5 to 11.8, RAA improved from 38.5 to 34.1, and CS improved from 55.4 to 44.1. In cases followed for more than 6 years, %RB improved from 8.9 to 6.5, RAA improved from 36.8 to 35.2, and CS improved from 67.4 to 48.2. Significant improvements were obtained in %RB, RAA, and CS for all cases and in %RB and CS for cases followed for more than 6 years. Conclusions: The present findings indicate that this surgical technique is effective for improving the deformities not only of the ulna but also of the radius.