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Boxer's fractures are common hand injuries, but their management varies greatly. Two years ago, a boxer's fracture care pathway was developed for use in the Royal London Hospital emergency department to standardise management. This article describes a clinical service evaluation carried out to test the validity of the pathway. The evaluation examined the functional outcomes of patients with boxer's fractures with 50° or less palmar angulation who were discharged with no follow up. Findings show that most returned to work immediately and had good functional outcomes, which suggests that the pathway is safe for uncomplicated fractures with 50° or less palmar angulation. [ABSTRACT FROM AUTHOR]

Objective:Litigation is a rising financial burden on the National Health Service. This study aims to show if litigation is increasing in rhinology and which procedures lead to the most claims.Methods:Ten years of data were obtained from the National Health Service Litigation Authority. Rhinology claims were examined for cost, injury, diagnosis and operation type.Results:Of the 123 rhinology claims identified, 52 per cent were successful. There was a 56 per cent increase in the average annual number of claims between the first half of the study period and the second (p = 0.0451). The commonest reasons for a claim were poor cosmesis (15.6 per cent) and lack of informed consent (14 per cent).Conclusion:The number of claims in rhinology increased over the study period. Most claims resulted from poor cosmetic outcome, lack of consent or recognised complications. It is suggested that enhanced communication and management of patient expectations could reduce litigation and improve patient satisfaction. [ABSTRACT FROM PUBLISHER]

Focuses on the incidence of congenital hip dislocation among babies in Southampton, England. Development of poor prognosis during first year of life; Development of tests aimed at detecting the defect in the neonatal period; Use of rigid Barlow splints in treating patients diagnosed during the neonatal period.

During the decade 1970-9, 23 002 infants born in the University of Bristol Department of Obstetrics were examined for congenital dislocation of the hip by junior members of the paediatric staff on the first day of life and again on discharge from hospital. Suspected hip abnormality was checked by a senior member of the staff on the same day. A total of 445 (1.9%) infants were found to have a hip abnormality in the neonatal period. Immediate treatment in an abduction splint was undertaken, usually six weeks for dislocatable hips and 12 weeks for dislocated hips. Routine follow up included clinical and radiological examination at six, 12, 24, and 60 months. Altogether 90% completed the 12 month, 85% the 24 month, and 76% the 60 month checks. Five infants (1.1%) required further orthopaedic treatment (adductor tenotomy and abduction splinting) but no major surgery was necessary, nor was avascular necrosis encountered. The radiological results were excellent. Every effort (1970-84) was also made to identify all cases of late congenital dislocation of the hip diagnosed after the neonatal period in infants born to women in Avon during the same decade (n = 103 431). Ninety one cases were detected (0.88 per 1000 births), 10 in the university cohort (0.44 per 1000) and 81 in the non-university group (1.00 per 1000) (P less than 0.01). Seven of 10 in the former group required open surgery and in seven the radiological outcome at follow up was moderate or poor. The early and late diagnosed groups are compared in respect of perinatal factors and management. It is possible to detect most cases of congenital dislocation of the hip at birth and treat them safely and successfully. [ABSTRACT FROM AUTHOR]

Introduction: Objectives were to identify areas for clinical and service development to improve Physiotherapists and Occupational Therapists adherence to the new Practice Guidelines published by the Association of Chartered Physiotherapists in Neurology (ACPIN) and the College of Occupational Therapy (COT) (COT, ACPIN 2015). Methods: The audit was carried out over a 3 month period. All patients discharged from a Level One inpatient tertiary neurological rehabilitation unit in 2013 who received splinting or casting were identified. Data was collected from clinical documentation and compared using the Clinical Audit Tool included within the Practice Guidelines. Results were recorded and analysed using Microsoft Excel™. Results: Of a total cohort of 95, 38 adults received a total of 65 interventions (54 upper limb, 11 lower limb). A total of 39 were custom made, with 26 pre-fabricated splints issued. Exploration of clinical reasoning identified 82% of splints were preventative, and 18% targeted correction. Based on information contained in clinical documentation, guideline statements were assigned for each intervention where possible. Statement number 13 (selective use of upper limb splints and not as routine practice) was the most prevalent. Remedial management of spasticity was considered in 74% of cases. Only 25% of interventions achieved goals set at baseline and in 10% no formal goals could be identified from the clinical documentation. Conclusion: The audit has identified weaknesses in clinical documentation, particularly goal setting and the review of specific outcome measures. The Practice Guideline Statements are useful to guide clinical reasoning and decision making but were difficult to audit retrospectively. New MDT clinical documentation to facilitate the clinical reasoning process through clear goals, outcomes and reviews is currently being trialled. A repeat audit is planned to complete the audit cycle. [ABSTRACT FROM AUTHOR]

Introduction and Background: Up to 80% of stroke survivors have impairments of the upper limb, which considerably affects participation in everyday activities and quality of life (Langhorne et al., 2009). Improving upper limb function to maximise functional potential is an integral part of a stroke survivor's rehabilitation programme (Lum et al., 2009). The use of splinting to improve functional outcomes has been a source of debate in the literature as its application in practice is diverse and warrants further research to guide practice (Basaran et al., 2012). Methods: An in-depth case study approach was used to evaluate eight stroke survivors' sensorimotor and functional outcomes following a splinting regime using either dorsal or volar splints. The ICF framework was used to develop and structure the study. Data collection occurred biweekly for 2 months and then at 6 months to evaluate the impact of splinting. Descriptive and non-parametric data analysis of sensorimotor, functional and quality of life measures was done using SPSS. Results and conclusion: All participants showed some degree of improvement in majority of the study measures following an 8-week splinting programme. For younger participants, improvements of sensorimotor components were significantly associated with an improvement in functional ability and quality of life. Impact: The findings highlight areas of splinting practice that are potentially effective for the rehabilitation of the upper limb of stroke survivors but require research on a larger population using randomised controlled trials to confirm the findings. Implications for practice: A 6 month splinting programme has the potential to effect sensorimotor, functional and quality of life outcomes for individuals in the chronic phase of Stoke rehabilitation. There are many variables that need to be considered and the structure of the ICF model is well suited in guiding OTs when using splints for the rehabilitation of the upper limb for stroke survivors. [ABSTRACT FROM AUTHOR]

The article focuses on a study on how exercise program for arms and hands improve hand function in rheumatoid arthritis (RA) controlled with medication. Topics discussed include improving quality of life, pain control and hand function in RA patients , the exercise program focusing on having face-to-face sessions with a physical or occupational therapist, and importance of joint-protection education and splinting for improving hand function.