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Summary Introduction This study evaluates COVID-19 related patient risk, when undergoing management within one of the largest specialist centres in Europe, which rapidly implemented national COVID-19 safety guidelines. Method A prospective cohort study was undertaken in all patients who underwent surgical (n = 1429) or non-operative (n = 191) management during the UK COVID-19 pandemic peak (April–May 2020); all were evaluated for 30-day COVID-19 related death. A representative sample of elective/trauma/burns patients (surgery group, n = 729) were selected and also sub-analysed within a controlled cohort study design. Comparison was made to a random selection of non-operatively managed (non-operative group, n = 100) or waiting list (control group, n = 250) patients. These groups were prospectively followed-up and telephoned from the end of June (control group) or at 30 days post-first assessment (non-operative group)/post-operatively (surgery group). Results Complex general (9.2%, 136/1483) or regional (5.0%, 74/1483) anaesthesia cases represented 14.2% (210/1483) of operations undertaken. There were no 30-day post-operative (0/1429)/first assessment (0/191) COVID-19 related deaths. Neither the three sub-speciality plastic surgery, or non-operative groups, displayed increases in post-operative/first assessment symptoms in comparison to each other, or to control. The proportion of COVID-19 positive tests were: 7.1% (1/14) (non-operative), 5.9% (2/34) (burns) and 3.0% (3/99) (trauma); there were however no significant differences between these groups, the elective (0%, 0/54) and control (0%, 0/24) groups (p = 0.236). Conclusion We demonstrate that even heterogeneous sub-speciality patient groups, who required operative/non-operative management, did not incur an increased COVID-19 risk compared to each other or to control. These highly encouraging results were achieved with described, rapidly implemented service changes that were tailored to protect each patient group and staff.

Trigger finger is a common cause of hand pain. It is caused by stenosis at the level of the first annular (A1) pulley, which interrupts the smooth gliding of the underlying flexor tendons at the level of the metacarpophalangeal joint. Patients present with locking of the finger in flexion and clicking or snapping. It is important that GPs have an understanding of this condition, in order to help their patients deal with its sequelae. In this article the pathophysiology, clinical assessment and management of patients with suspected trigger finger are discussed.

De Quervain’s tenosynovitis is a common cause of wrist pain in adults. It is characterised by atraumatic pain or tenderness along the radial side of the wrist and is often associated with overuse or repetitive movements of the wrist or thumb. De Quervain’s tenosynovitis affects the first dorsal compartment of the wrist. Better understanding of this disease can help GPs and their patients manage its sequelae. In this article, the clinical assessment of patients with suspected de Quervain’s tenosynovitis and its conservative and surgical treatment options are discussed.

Purpose: We aimed to assess the prospective association of serum albumin with venous thromboembolism (VTE) risk and evaluate if the association is independent of or modified by inflammation, as measured by high sensitivity C-reactive protein (hsCRP). Design: We analysed data of 2176 men aged 42–61 years free from VTE in the Kuopio Ischemic Heart Disease study, with serum albumin concentrations measured at baseline using Coulter’s bromocresol purple colorimetric assays. Hazard ratios (HRs) (95% confidence intervals [CI]) were calculated for VTE. Results: There were 109 validated cases of VTE recorded during a median follow-up of 24.9 years. The risk of VTE increased linearly below a serum albumin concentration of ∼48 g/l. In Cox regression analysis adjusted for established risk factors and other potential confounders, the HR (95% CI) for VTE per 1 standard deviation lower serum albumin was 1.23 (1.02–1.47). The association remained persistent on further adjustment for hsCRP 1.22 (1.01–1.46). Furthermore, the association was not modified by hsCRP and persisted on exclusion of men with elevated hsCRP levels. Conclusions: In middle-aged Caucasian men, low serum albumin is associated with an increased risk of VTE, consistent with a linear dose-response relationship. The association is independent of and not modified by inflammation.Key messages • Serum albumin may be associated with future risk of venous thromboembolism (VTE); however, the shape, nature, magnitude and consistency of the association is uncertain. • In a population-based prospective cohort study, low serum albumin was associated with an increased risk of VTE in a linear dose-response manner and this association was independent of and not modified by inflammation. • Serum albumin concentrations may play a role in the development of VTE. • Serum albumin may be associated with future risk of venous thromboembolism (VTE); however, the shape, nature, magnitude and consistency of the association is uncertain. • In a population-based prospective cohort study, low serum albumin was associated with an increased risk of VTE in a linear dose-response manner and this association was independent of and not modified by inflammation. • Serum albumin concentrations may play a role in the development of VTE.

Hand trauma forms an important part of plastic surgery and orthopedic training curricula. Although numerous practical hand trauma courses exist, there is always difficulty in achieving the right balance between educational content and practical workshops. AOTrauma-Hand Fixation for Surgeons is a 2.5-day course for plastic surgery and orthopedic trainees that aims to instill the principles of hand fracture fixation and soft tissue coverage through self-directed learning, lectures, small group discussion, and dry bone practical workshops. This course with international faculty and delegates is held in Leeds, United Kingdom, at a cost of 860 Swiss francs (880 US dollars). In this review, we provide an evaluation of the course.

Early in their careers, trainees contemplating a career in plastic surgery may have limited specialty experience. Courses can provide valuable insight into specialty training and help develop necessary basic skills. However, this is not without a significant financial burden.Plastic Surgery for Surgical Trainees is a 1-day course that only costs £50 GBP (US $65). Accredited by the Royal College of Surgeons, this course held in Bristol, United Kingdom, offers an inexpensive practical introduction toward plastic surgical techniques for trainees interested in plastic surgery and those in other surgical specialties. In this review, we provide an evaluation of the course.