Journal of Hand Surgery - June 2022 - S212

S212
Journal of Hand Surgery (Eur) 47(Supplement 1)
Clinical and functional outcomes were assessed with
visual analoge scale (VAS) and Quick Dash score, a
week postoperative and a month, two, six and twelve
months postoperative. A radiological study was carried
out in each consult.
Results: The average age was 38.3 years, (range of
19-56 years); 4 patients were female (26.6%) and 11
male (73.3%). According to the Rettig classification,
we found 7 dislocations (47%) type I, and 8 (53%) type
II. In the first group, we found associated injuries of
the triangular fibro cartilage complex (TFCC) in all
the patients; while in type II we found 3 patients
(38%) without injuries and 5 (62%) with injuries of
the TFCC. In type I, we also found 3 patients with
associated scapholunate ligament injuries.
Conclusion: According to the results obtained in our
series, a 100% of type I and 62% of type II Galeazzi
fracture-dislocation had associated injuries of the
TFCC. For this reason, we believe it is important to
perform an arthroscopic assistance in the same procedure
for a correct diagnosis and treatment.
A-1188 Learning Curves in Total Wrist Arthroplasty
- An Argument for Minimum Unit Volumes
James Redfern1,2, Nisarg Mehta1, Thomas Thorvaldson3,
Ashley Newton1 and Daniel Brown1,2
1Liverpool University Foundation Trust, Liverpool, UK
2University of Liverpool, Liverpool, UK
3Maitland Hospital, Newcastle, Australia
Objective: Modern Total wrist arthroplasty (TWA)
shows promising results although is still associated
with relatively high rates of complications and device
failure. The Motec TWA has been operational since
2006 and has some of the more promising outcomes
of the TWAs currently in use. Like all complex surgery
it is thought that there is a steep operatordependent
learning curve which would suggest, like
other joint replacement surgery, that specific training
and minimum unit volumes for surgeons performing
the procedure would be advisable. This
study aims to quantify this learning curve and highlight
the importance of high-volume surgeons in
reducing risk of complication or failure.
Methods: Retrospective data was collected from
24/01/2011 to 19/12/2019 from five surgeons in high
volume centres in Linkoping (Sweden), Cape Town
(SA), Newcastle (NSW), Southend & Liverpool (UK)
on all their primary Motec TWAs. Data collected
included operation dates in order of sequence,
implants used, complications/revisions and causes
thereof. Exclusion criteria included revision surgery,
non-MOTEC TWA or incomplete data sets.
Complications were classified from 1 to 4, representing
an increasing complexity of surgery to address
the complication, similar to other publications on
revision surgery. We compared individual surgeon's
complication levels against their experience based
on how many procedures they had previously performed,
assessing if the number and severity of complications
did reduce with experience.
Results: Of the 117 TWAs performed on 111 patients,
there were 22 complications, 8 of which required
revision surgery. There were 8 x level 1, 6 x level 2,
3 x level 3, and 5 x level 4 complications. Five surgeons
contributed data, performing 18, 19, 20, 30 and
30 Motec TWAs. Graphical tabulation displays the
level of complication in series for each surgeon,
highlights their learning curves. In total, 15 (68%)
of all complications occurred in the first half of our
surgeons' series, in the second half this dropped to 7
(32%) - showing a distinct reduction in complication
rate. Similarly, for all surgeons, 20 (91%) of complications
occurred within their first 15 patients.
Overall, in patients operated on after the 15th in
each series, the complication rates dropped to
2/22 (5%).
Conclusions: The results of our analysis show a
higher complication rate in the first 15 patients operated
on (91%) by each surgeon. There is a clear association
with increased rate of complications and
lower procedural experience, as has been previously
demonstrated with hip and knee arthroplasty. The
decrease in complication rate from 68% in the first
half of each surgeon's series, to 32% in the second
half, also highlights the steep change in complication
rate associated with experience. Getting it right first
time (Briggs et al 2012), advocates for the correct
operation, to be performed by the correct surgeon,
at the correct centre. This acknowledges the
decrease in complication and failure rates in surgery
performed at specialist centres with adequate case
volumes. This study has demonstrated that this guidance
should definitely apply to surgeons performing
the Motec TWA.
A-1190 Direct repair of acute pulley rupture in high
level rock climbers
Andre Gay, Aurelie Iniesta, Caroline Curvale,
Jean-Luc Pellat, Benoit Poeuf and Philippe Samson
Institut de la Main et du Membre Superieur, Marseille
Closed traumatic rupture of the finger flexor tendon
pulleys is almost specific of rock climbers. There is
no evidence-based published guidelines for the
Journal of Hand Surgery - June 2022

Table of Contents for the Digital Edition of Journal of Hand Surgery - June 2022
