The Journal of Hand Surgery - European Volume - April 2018 - 15

BSSH Spring meeting abstracts
consider flexor sheath aspiration regardless of clinical scenario. For those advising surgery, the majority
felt this should be performed within 24 hours in all
three scenarios. More than 50% would advocate
active mobilisation either immediately or as soon as
possible regardless of severity of the infection.
Almost all of the respondents would use either general or regional anaesthesia for the procedure and a
2 incision technique with catheter irrigation.
Conclusions: Our survey demonstrates huge variation
in the management of pyogenic flexor tenosynovitis.
Advice from the pre-antibiotic era of emergent surgical debridement continues to be followed; a proportion continue to use an open technique. The
importance of immobilisation is stated throughout
the literature but many advocate early active mobilisation. Further study into the management and outcomes of PFT is required to establish best practice for
this potentially devastating condition.

Defining Displacement Thresholds for Surgical
Intervention for Distal Radius Fractures - A Delphi
Study
Mr Nick Johnson, Dr Paul Leighton, Mr Distal Radius
Study Group, Professor Charles Pailthorpe and
Joseph Dias
University Hospitals of Leicester
Time in programme: Friday 4th May 2018 10:01

Aims: This study had three aims; to identify which
radiographic parameters in distal radius fractures
are clinically important; quantify the threshold of displacement at which intervention should occur and
investigate which patient factors influence the
threshold of the decision to intervene.
Methods: A modified three round Delphi study was
carried out and responses were qualitatively
analysed.
The panel was composed of 3 groups of national and
international expert surgeons:
Hand and wrist surgeons.
Trauma surgeons.
International researchers
46 participants initially agreed to take part. 43 completed the first round and all then completed three
rounds.
Participants were asked questions based around case
vignettes in patients of three ages (38, 58, 75 years).
Results: For all age groups ulnar variance was
ranked as the most important extra-articular parameter followed by dorsal tilt, step was ranked as the
most important intra-articular parameter.

S15
Agreed thresholds were the same for all parameters
for patients aged 38 and 58. Surgeons would intervene in patients aged 38 and 58 with þ2 mm ulnar
variance, 10 degrees dorsal tilt, 2 mm step and 3 mm
gap. In patients aged 75 the agreed thresholds were
20 degrees dorsal tilt, 3 mm step and 4 mm gap, consensus was not achieved for ulnar variance.
Conclusions: Our findings provide useful advice
about which parameters should be measured and
radiographic thresholds for intervention. These
thresholds may then be modified depending on
important patient factors. This information can help
guide clinicians with management decisions and
reduce variation.

Scaphoid Fractures - Not Just for the Young and
Reckless
Mr Adam Sykes, Mr Nick Riley, Mr Tamas Szabo,
Mr Ian McNab and Mr Christopher Little
Nuffield Orthopaedic Centre
Time in programme: Friday 4th May 2018 10:05

Aims: While previous studies have found scaphoid
fractures to be injuries of young, male adults, we
have noted an increasing proportion of older patients
presenting with such injuries. We aimed to determine
the age distribution of these patients, and to evaluate
potential causative factors.
Methods: We prospectively collected patients with
scaphoid fractures over a two year period for analysis
of their demographics, mechanism of injury and imaging. The sub-group of patients over the age of 50
was compared to age- and gender-matched controls
who had sustained distal radius fractures to look for
potential differences in the mechanism of injury,
bone density, and extent of carpal degenerative
change.
Results: 198 scaphoid fractures were identified in
153 male and 45 female patients. The age range
was 15-84 years (mean age 35 years); the mean
age in females of 47 years (range 16 to 84 years)
was significantly higher than in males (mean 31
years, range 15 to 76 years, p < 0.00001, Mann
Whitney U test). 41 fractures occurred in patients
over the age of 50 (21%).
There was no difference in the extent or distribution
of pre-existing carpal degeneration, the energy of
injury, or the patients' bone density (measured by
the metacarpal index) when comparing patients
over 50 years old with scaphoid fractures with control
patients who had fractured their distal radius.

Table of Contents for the Digital Edition of The Journal of Hand Surgery - European Volume - April 2018