D-WHIN: Danderyd Wrist and Hand INitiative – Research group

D-WHIN: Danderyd Wrist and Hand INititative

D-WHIN is a research group at Karolinska Institutet, within the Department of Clinical Sciences at Danderyd Hospital. We conduct clinical, interdisciplinary research in orthopaedics and rehabilitation, with a particular focus on hand and wrist injuries, as well as the environmental impact and resource use of healthcare.

Our research is based on patients’ needs and aims to improve the treatment of common conditions in ways that are relevant to everyday clinical practice. The goal is to generate knowledge that can be translated into practice and benefit patients, while also taking costs and environmental impact into account.

D-WHIN has several ongoing research projects. A selection of these is presented below:

CARBO (MetaCARpal BOne study)

Background: Metacarpal fractures are common following accidents and injuries. Current treatment practices vary, as it remains unclear whether surgery, cast immobilization, or early mobilization provides the best outcomes for patients.

Aim: To investigate whether early mobilization without surgery results in outcomes that are not inferior to those achieved with surgery followed by rehabilitation. 

Design: An international pragmatic multicentre randomized non-inferiority trial comparing immediate mobilization without surgery to surgical treatment for spiral and oblique metacarpal fractures of the index, middle, ring, or little finger.

Primary outcome measure: Grip strength at 12 months, measured using a JAMAR dynamometer.
Secondary outcome measures: Patient-reported outcomes, range of motion, radiographic findings, complications, duration of sick leave, and return to work and sports.

Significance: As the first large randomized trial investigating the treatment of metacarpal fractures, this study is expected to influence future treatment guidelines.

Funding: ALF region Stockholm, Centrum för Idrottsforskning, Svenska Läkarsällskapet.

Read more about the project under 'The CARBO study' tab

CARBO CARBON

Background: Healthcare accounts for approximately 5% of global greenhouse gas emissions, and surgical care is among the most emission-intensive healthcare activities.

Aim: To investigate the difference in climate impact between surgical and non-surgical treatment of metacarpal fractures.

Design: Comparative prospective cohort study.

Primary outcome measure: Difference in climate impact.

Secondary outcome measures: Differences in environmental impact and direct costs between the treatments, as well as identification of emission-intensive activities (“hotspots”).

Significance: Findings from this study may support the development and adaptation of fracture treatment strategies aimed at reducing carbon emissions and promoting more sustainable healthcare.

Funding: Innovationsfonen, Region Stockholm Hållbarhetskontoret, ALF Region Stockholm, Svenska Läkarsällskapet

USE LESS & WHIN

Background: Healthcare accounts for approximately 5% of global greenhouse gas emissions, and surgical procedures are among the most emission-intensive activities within healthcare. At the same time, many procedures are performed in resource-intensive, high-technology operating theatres, despite the fact that simpler alternatives may be feasible in some cases.

Aim: To investigate whether short orthopaedic procedures can be moved from resource-intensive, high-technology operating theatres to a simpler operating room setting.

Design: Prospective cohort study.

Primary outcome measure: Climate impact.

Secondary outcome measures: Complication rates and costs.

Significance: Findings from this study may support the future performance of short orthopaedic procedures with lower climate impact and reduced costs, provided that patient safety is maintained

Funding: Innovationsfonen, Region Stockholm Hållbarhetskontoret, ALF Region Stockholm, Svenska Läkarsällskapet

DUO kval

Background: Rehabilitation and recovery following a forearm fracture can continue for a long time after the injury and are influenced by factors such as the severity of the injury, the intensity of rehabilitation, and the individual’s functional needs and prerequisites for hand function.

Aim: To describe how individuals with fractures of the radius and/or ulna perceive their function and ability to perform daily activities during the first year after injury.

Design: Qualitative study using semi-structured interviews.

Outcomes and significance: The study will provide a deeper understanding of patients’ experiences of function and activity performance during the first year after injury. These insights may contribute to the development of rehabilitation strategies that better support optimal recovery and rehabilitation outcomes for patients.

Funding: Applications for external funding are currently ongoing.

HAND – Health And Nationwide Data in wrist and hand research

Background: Sweden has extensive national quality registers and population-based registries with high coverage and high-quality data, enabling reliable analyses across large populations.

Aim: To map treatment choices, regional differences in incidence and treatment practices, and future needs within hand and wrist surgery.

Design: Registry-based epidemiological research using national databases.

Outcomes: Incidence, prevalence, demographic distribution, and predictive modelling.

Significance: Several studies have been published within this subproject, including an analysis of radiocarpal and intercarpal arthrodesis demonstrating substantial regional variation and a decreasing use of arthrodesis over time. A population-based study of fracture fixation in the hand and wrist showed an increase in plate and screw fixation, particularly among older women, with a continued increase expected in the future. In addition, prosthetic use, thumb base surgery, and corrective hand surgery have also been analysed.

Funding: Applications for external funding are currently ongoing.

Operation or early mobilization in metacarpal fractures

About the study

The CARBO study (metaCARpal Bone Osteosynthesis) is an international multicentre study investigating treatment of displaced metacarpal fractures in adults. These fractures are common and account for approximately 30–50% of all hand fractures. Despite this, sufficiently large randomized studies comparing surgical and non-surgical treatment are still lacking.

The aim of the CARBO study is to investigate whether non-operative treatment with immediate mobilization can provide functional outcomes equivalent to those achieved with surgery with internal fixation. The primary outcome of the study is grip strength in the injured hand one year after injury. The study includes a total of 552 patients and is conducted as a prospective randomized controlled multicentre trial involving hospitals across several Nordic countries.

The results of the study are expected to contribute stronger evidence for treatment decisions in metacarpal fractures and may influence future clinical guidelines.

Study ID at clinicaltrials.gov NCT07357493