{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T07:06:42Z","timestamp":1788851202831,"version":"build-2803163510"},"reference-count":29,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["NIHR127292"],"award-info":[{"award-number":["NIHR127292"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n Proximal phalanx finger shaft fractures are common and can impair hand function. There is controversy, but no high-quality evidence, on how they are best treated. We compared the clinical and cost-effectiveness of surgery versus non-surgical splint treatment.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The primary objective was to compare hand function following surgical fixation with hand function following non-surgical splint treatment using the Hand Health Profile of the Patient Evaluation Measure at 6 months post randomisation.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Pragmatic multicentre, parallel superiority randomised (1\u2005:\u20051) trial.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Twenty-four acute hospitals in the United Kingdom National Health Service.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Patients \u2265\u200516 years with one or more proximal phalanx shaft fracture(s), which can be treated via either surgery or non-surgical splint treatment. Patients with intra-articular, base-metaphyseal, neck, open proximal phalanx fractures, injury \u2265\u00a014 days or unable to adhere to trial procedures\/complete questionnaires were excluded.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Surgery was any mode of surgical fixation that was considered as appropriate by the treating specialist. Non-surgical splint treatment consisted of any technique\/material used in routine care, which may involve manipulation of the fracture with analgesia or local anaesthetic, and subsequent bracing through an externally applied support, usually performed in a clinic or therapy room environment.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n The primary outcome measure was the Hand Health Profile of the Patient Evaluation Measure (possible range 11\u201377, higher scores indicate worst function). Measurements were collected at 6 weeks, 3, 6 and 12 months; 6 months was the primary outcome time point. The primary health outcome for economic evaluation was quality-adjusted life-years in accordance with National Institute for Health and Care Excellence guidelines.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Between 9 November 2020 and 2 February 2023, 113 participants were randomised to surgery (\n n<\/jats:italic>\n \u2005=\u200556) or non-surgical treatment (\n n<\/jats:italic>\n \u2005=\u200555); 2 were excluded. Participants were 60% male, with mean age of 38 years. Treatment arms were balanced. Fifty-three participants in the surgical and 46 in the non-surgical group were included in the primary analysis. At 6 months, the mean Patient Evaluation Measure was 27.1 (standard deviation\u2005=\u200513.6,\n n<\/jats:italic>\n \u2005=\u200548) in the surgical group and 25 (standard deviation 12.4,\n n<\/jats:italic>\n \u2005=\u200541) in the non-surgical group, with no clinically important difference between groups (adjusted difference in means for surgery vs. non-surgical groups 3, 95% confidence interval\u00a0\u22121.6 to 7.7). There were no differences at 6 weeks and 3 months. There were more complications in the surgery group.\n <\/jats:p>\n Surgery was more expensive, resulting in an incremental cost-effectiveness ratio of \u00a339,686 per quality-adjusted life-year, with a 3.2% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of \u00a320,000.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study supports the conclusion that surgery does not restore better hand function than non-surgical treatment. Surgery results in additional complications and is more expensive.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n We were unable to further determine if surgery is worse than splint or if the two treatments are equivalent, because of slow recruitment and the smaller than the planned sample size.<\/jats:p>\n <\/jats:sec>\n \n Future work<\/jats:title>\n Research should be directed towards further comparisons of treatments for common hand fractures.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR127292.<\/jats:p>\n 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