DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 86
Follow-up after four minor hand surgery operations –
general practitioner or hand clinic?
A randomized prospective study
N. Søe, N. Vendel-Jensen, J. Dahl, B. Cumberland,
L. Munch, S. Jørring
Hand Section in Gentofte, Department of Orthopaedic, Herlev Hospital;
Department of Anesthesiology, Intensive Care and Operations,
Gentofte Hospital; General Practioner, Region Hovedstaden;
Planned Surgery Ward Z, Gentofte Hospital; Hand Section,
Department of Orthopaedic, Hillerød Hospital
Background: This study was designed to access the safety and effectiveness of
transferring the 3-4 day and 2 weeks postoperative assessment to the general
practioner ( GP) after operation for carpal tunnel syndrome, ganglion cyst, Quervain´s
disease and trigger finger.
Purpose: An increasing number of patients are visiting hand clinics. Postoperative
follow-up after minor hand operations are increasing and can be expensive in
terms of time consuming for patients and transport. If the patients could be transfer
safety and with effectiveness to the general practioner, time could be used otherwise.
Methods: Fifty two patients undergoing one of four hand-operations ( CTR 35 ;
ganglion cyst 8 ; pulley release 9) were randomized on a block basis for the 3-4
day and 2-week postoperative wound inspection and removal of stitches to either
their GP or the hospital outpatient clinic. All patients were reviewed at hospital 6
weeks postoperative when a simple questionnaire was completed. The questionnaire
asked whether a wound infection had been diagnosed and if so, whether any
antibiotics were prescribed . Wrist-TAM, finger-TAM, grip-strength, time consuming
and VAS-pain before and 6 week after operation ,were assessed.
Findings: Two of 29 patients followed up at a GP were considered to be infected
and one patient were prescribed antibiotics. None of the 23 wounds assessed in
the hospital clinic were considered to be infected or having antibiotics . Both
groups had a mean treatment time of 9 minutes ( 3-30 ). VAS pain was reduced
in GP group with 65 % and in clinic group 72 % ( not significant). Preoperative
grip strength were reduced 20 % in both groups. At the 6-week assessment all 52
wounds had healed satisfactorily and none showed any evidence of infection. 6
patients were referred for hand therapy in the GP group and none in the hospital
group. Finger-TAM was reduced 0.8 % in the GP group and increased 0.8 % in
the clinic group.
Conclusion: Patients were assessed safely in the GP group but wound infections
were probably over- diagnosed. Six out of 29 patients were referred to hand therapy
in the GP group and none in the hospital group. VAS pain and grip strength
were the same in both groups.
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