The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK.
J Hand Surg Asian Pac Vol. 2022 Apr;27(2):261-266. doi: 10.1142/S2424835522500394. Epub 2022 Mar 31.
Management of hand trauma has evolved to incorporate assessment, treatment and rehabilitation of patients in a 'one-stop' clinic on initial presentation. Our aim was to evaluate the effect of coronavirus disease 2019 (COVID-19) on the choice of treatment for hand fractures using inter-rater agreement between surgeons. All patients with hand fractures during the COVID-19 lockdown from March to May 2020 were included in the study. Two experienced hand surgeons blinded to management and outcomes independently reviewed radiographic images and relevant clinical history to provide their opinion on optimal treatment. Weighted kappa analysis was performed to determine concordance and inter-rater agreement between the two surgeons and actual management. The study included 82 patients (62 men and 20 women) with a mean age of 40.3 (SD 19.7). The injuries occurred most often at home following an accident (34%) or a fall (28%). Fractures involved the metacarpals in 29 patients and the distal phalanx in 22 patients. Thirty-five patients underwent surgery, whereas 47 were managed conservatively. Overall agreement between actual management and consultant A and consultant B was moderate ( = 0.55, < 0.0001 and = 0.63, < 0.0001, respectively). Subgroup analysis showed a weak agreement between actual management of metacarpal fractures and consultant A and consultant B ( = 0.22, = 0.29 and = 0.47, = 0.02, respectively). Inter-rater agreement was substantial for management of metacarpal fractures ( = 0.73, < 0.0001), but weak for distal phalanx fractures ( = 0.29, = 0.03). Our study has shown that overall management of hand fractures remained optimised throughout the pandemic. However, a lack of concordance was observed in the management of metacarpals. Level IV (Therapeutic).
手部创伤的管理已经发展到在初次就诊时通过“一站式”诊所对患者进行评估、治疗和康复。我们的目的是通过外科医生之间的评分者间一致性评估 2019 年冠状病毒病（COVID-19）对手部骨折治疗选择的影响。 研究纳入了 2020 年 3 月至 5 月 COVID-19 封锁期间所有手部骨折患者。两名经验丰富的手部外科医生对管理和结果不知情，他们独立审查影像学图像和相关临床病史，提供他们对最佳治疗的意见。采用加权 Kappa 分析确定两位外科医生之间以及实际管理与评分者间的一致性和一致性。 该研究纳入了 82 名患者（62 名男性和 20 名女性），平均年龄为 40.3（标准差 19.7）岁。受伤最常发生在家中，原因是事故（34%）或跌倒（28%）。29 例患者为掌骨骨折，22 例为远节指骨骨折。35 例患者接受了手术治疗，47 例患者接受了保守治疗。实际管理与顾问 A 和顾问 B 的总体一致性为中度（ = 0.55， ＜0.0001 和 = 0.63， ＜0.0001）。亚组分析显示，实际管理掌骨骨折与顾问 A 和顾问 B 之间的一致性较弱（ = 0.22， = 0.29 和 = 0.47， = 0.02）。掌骨骨折的治疗评分者间一致性较大（ = 0.73， ＜0.0001），但远节指骨骨折的评分者间一致性较弱（ = 0.29， = 0.03）。 我们的研究表明，手部骨折的整体治疗在整个大流行期间仍然得到了优化。然而，在掌骨的治疗中观察到缺乏一致性。 四级（治疗）。
