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Rethinking hand fracture management in frail patients: the perspectives of hand surgeons and therapists in Ireland.

L. Aljohmani,Nicola McShane,Shane Carr,I. Marinescu,Linda Kelly,Simone Kneafsey,Kylie O’Grady,Emma Carr,Roisin Dolan

Published 2025 in Journal of hand and microsurgery

ABSTRACT

Introduction Frailty is a well-recognized predictor of adverse surgical outcomes. Utilization of frailty indices has become more common across surgical specialties, yet variability persists in how frail patients with hand fractures are assessed and managed by hand surgeons and therapists, and in the extent of their engagement with frailty services. Aim To evaluate the awareness and institutional management of frailty among consultant and fellow hand surgeons (HS) and hand therapists (HT) treating patients over 65 years old with hand fractures. Methods A 16-item web-based questionnaire was distributed to HS and HT affiliated with the Irish Hand Surgery Society between September and December 2024. The survey examined awareness of frailty, use of assessment tools, availability and uptake of frailty pathways, and attitudes toward osteoporosis management. Descriptive and frequency statistics were used to summarize quantitative data, while qualitative responses were thematically summarized. Results Forty-two responses were received (21 HS, 21 HT; response rate 84 %). Most respondents considered frailty a predisposing factor for hand fractures (HS 76.2 %, HT 85.7 %), but fewer routinely assessed it in clinical practice (HS 61.9 %, HT 71.4 %). Awareness of institutional frailty pathways was significantly higher among HT (80.9 %) compared with HS (23.8). Frailty influenced treatment decisions for most respondents (HS 76.2 %, HT 90.5 %), yet formal frailty assessment was rarely performed. A diagnosis of osteoporosis/osteopenia significantly impacted management, particularly among HT compared to HS. Therapists highlighted slower healing, increased fall risk, and the need for individualized splinting and prolonged therapy as key considerations in frail patients. Conclusion This study demonstrates considerable variability in the recognition and management of frailty among clinicians treating hand fractures in Ireland. While frailty intervention teams (FIT) or equivalent pathways are available in some institutions, they remain inconsistently utilized and are often unfamiliar to potential referrers. These findings highlight the need for greater education and standardisation within the Irish setting, as results may not be directly generalisable to other healthcare systems. Encouraging similar surveys in other regions could support collaboration, harmonise practice, and improve outcomes for this vulnerable patient population.

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