Title : Evolution of hand surgery over four decades: Experience from the pulvertaft hand centre
Abstract:
Introduction: Prevalence of common hand conditions is increasing. Hand injuries account for ~20% of attendances to the UK emergency department. We aimed to analyse temporal trends in hand surgery over a 40-year period at the Pulvertaft Hand Centre.
Methods: We conducted a retrospective review of prospectively recorded procedure documentation at a specialist tertiary hand centre. Data were collected for trauma and elective hand procedures for two weeks per year from 1985–2024. We analysed trends in patient demographics, acuity, date of surgery and procedure type. Subgroup analyses of Dupuytren’s and thumb carpometacarpal joint (CMCJ) procedures were performed.
Results: 3851 procedures were recorded. Most procedures were elective (n=2767; 72%) compared with trauma (n=1084; 28%). Mean patient age increased by ~11 years. Hand surgery activity grew across all five-year intervals with the exception of 2020–2024. There was a ~13-fold increase in trauma procedures (n=8 [1985–1989]; n=103 [2020–2024]). Highest procedure volume (n=305) was reported in 2015–2019. Nerve, vessel, and tendon repairs (n=339) was the most common trauma procedure. There was a 1.3-fold increase in elective procedures (n=121 [1985–1989]; n=158 [2020–2024]). Highest procedure volume (n=578) was reported in 2010–2014. Nerve procedures (n=891) was the most common elective procedure. Number of Dupuytren’s (n=351) and thumb CMCJ (n=149) procedures increased.
Conclusion: Volume and complexity of hand surgery has risen greatly. Increasing service demand coincides with an older patient population and a shift toward more complex and reconstructive procedures. Our findings should prompt discussion on how best to meet the evolving challenges of hand surgery.
