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Hand fractures are a common injury resulting in significant morbidity if managed incorrectly. The final outcome is determined by the initial injury but is also affected by timely and appropriate intervention. The British Society for Surgery of the Hand (BSSH) national guidelines recommend that when operative fixation is first choice, surgery should occur within 7-days of injury or within 72-hours when conservative management fails. Method We assessed compliance with BSSH closed hand fracture guidelines retrospectively using electronic patient records. Interventions involved department-wide education of national BSSH guidelines alongside suggestion of a dedicated closed hand fracture list. A sporadic WALANT list staffed by hand fellows was provided. The efficacy of the interventions was re-audited five months later. Results The first and second cycles included 100 and 56 cases respectively. Compliance improved between the two cycles from 59% to 75% when operative management was first choice. Average number of days until operative management was carried out, when operative fixation was first choice, improved from 7.47 to 5.44 between the two cycles. 23/156 (15%) cases underwent operative management on the additional list, where overall compliance was 78%. Conclusions Departmental education and the additional operating list improved compliance to BSSH guidelines. Education of staff involved in the management of closed hand fractures should continue regularly, especially considering the frequent rotation of trainee doctors. Patients should be provided with information leaflets to promote early presentation. The key intervention to improve compliance with national guidelines however remains the provision of a weekly closed hand fracture theatre list.

british journal of surgery

263 Improving the Timing of Operative Management of Closed Hand Fractures – A Closed-Loop Audit of Compliance with BSSH Guidelines in One of The Largest Teaching Hospitals in Europe