Hand therapy referral for hand fractures and dislocations: A multicenter snapshot study

Background: It is unclear which patients with fractures and dislocations of the hand necessitate hand therapy referral, which can lead to practice variation. Purpose: The study aimed to evaluate hand therapy referral patterns following non-operative and operative treatments of hand fractures and dislocations and to identify practice variations. Study Design: This multicenter, observational snapshot study was conducted across 12 hospitals in the Netherlands over a 3-month period in 2020. Methods: Adult patients admitted to the emergency department with metacarpal and phalangeal fractures or dislocations were included. Analyses were stratified by hand therapy referral status for different injury categories following non-operative and operative treatment. Determinants for hand therapy referral, including patient and injury characteristics, hospital setting, and medical specialty, were assessed using multivariable logistic regression. Results: Of 1654 included patients, 22% (306/1405) were referred to hand therapy after non-operative treatment, and 72% (178/249) after operative treatment. Among the 10 most prevalent injuries treated non-operatively, referral rates were highest for dislocations of digits two to five (43% [48/112]), followed by middle phalanx shaft fractures (34% [11/32]), and mallet fractures (33% [23/70]). The referral rates across hospitals significantly differed for metacarpal shaft fractures, dislocations of digits two to five, and proximal interphalangeal joint palmar plate avulsion fractures. Among the five most prevalent injuries treated operatively, middle and proximal phalanx shaft fractures were most frequently referred (90% [9/10] and 87% [33/38]), and referral rates across hospitals varied between 28% (95% confidence interval: 13%-50%) and 89% (95% confidence interval: 51%-100%). In multivariable logistic regression, hospital setting and medical specialty were determinants of hand therapy referral (p < 0.001 and p < 0.001). Conclusions: There is considerable practice variation in hand therapy referral within injury categories, which seems to be largely attributed to hospital setting and medical specialty. This highlights the knowledge gap in this field.