Funded Research Update: From First Data to a £500,000 Trial — How BMRF Funding Helped Shape the Future of Hand Trauma Care

In this funded research update, we report on the progress of Mr Justin Wormald's research into surgical site infection in hand trauma care — a programme that began with BMRF funding and has since grown into a national clinical trial.

Research Fellowship Grant recipient Mr Justin Wormald

Hand injuries are among the most common causes of surgical intervention in the UK. There are around five million hand and wrist injuries every year, with approximately 250,000 operations carried out to treat them. When you consider how often we use our hands — eating, drinking, working, caring for others, pursuing hobbies — the importance of getting these operations right, and recovering well from them, becomes clear.

Because the tendons, nerves, and bones of the hand sit very close to the surface of the skin, even a relatively minor post-operative infection can cause serious harm. Deep infections involving bone are particularly devastating: they require long-term antibiotics, carry the highest risk of prolonged recovery, and in severe cases can result in amputation. For patients who are immunocompromised or living with diabetes — a population that is growing globally — the risks are even greater.

Despite this, until recently there was very limited reliable evidence on how often infections occur following hand trauma surgery, or what can most effectively be done to prevent them. Mr Justin Wormald's research, supported by the Blond McIndoe Research Foundation and the Royal College of Surgeons of England, has begun to change that.

A critical moment for early funding

When Mr Wormald applied to the National Institute for Health Research (NIHR) for doctoral research funding in 2020, he was successful at interview — but was told that the NIHR would only be funding COVID-related research at that time. It was BMRF and the Royal College of Surgeons who stepped in, funding the first year of his research and enabling him to get his programme off the ground. The following year, he secured a full NIHR Doctoral Research Fellowship, converting to a three-year PhD. Without that early charitable investment, the entire programme that followed might never have started.

Establishing the baseline

A key early contribution of this work was to quantify infection risk at scale for the first time. By analysing large datasets and conducting systematic reviews across more than 300,000 patients, Mr Wormald was able to show that the overall risk of surgical site infection following hand trauma surgery is around 5%. But this headline figure masks significant variation. Severe infections requiring hospital treatment occur in approximately 2% of patients, while more superficial infections managed in the community — still painful, disruptive, and requiring antibiotic treatment — affect around 14%, or roughly one in seven patients. This was far higher than previously understood.

These figures matter enormously. They give clinicians more accurate information to share with patients before surgery, support better shared decision-making, and establish a clear evidence base for designing future research aimed at bringing those numbers down.

Proving that trials are possible

Building on this foundation, the research programme moved on to testing whether infection risk could be reduced. A key study examined the use of antimicrobial sutures — surgical threads coated with triclosan, a substance that kills bacteria on contact, preventing them from colonising the wound site. These sutures had been tested in other surgical settings but never in hand trauma. The trial recruited over 100 patients across multiple sites and was published in the British Journal of Surgery, the largest surgical journal in Europe. Its significance lies not only in what it found, but in what it demonstrated: that rigorous, multi-site randomised controlled trials can be successfully conducted in hand trauma surgery — an area where this had previously been considered too difficult.

Understanding global practice

With BMRF funding, the research then expanded beyond individual interventions to map the international landscape. An audit involving 45 hospitals across 12 countries and more than 2,000 patients examined how surgeons around the world approach infection prevention in hand trauma, and how consistently they follow World Health Organization guidelines. The audit identified a wide range of practices in use — including antimicrobial dressings, sutures, antibiotics, and different surgical preparation techniques — and established a large international network of collaborating clinicians. That network is a major asset for future research, enabling large-scale studies that no single centre could deliver alone.

Further work investigated the safety of performing certain hand trauma operations outside the main operating theatre environment. The findings — showing that infection risk was no higher in these settings — have already informed the national Getting It Right First Time (GIRFT) programme guidelines for hand trauma surgery, representing direct, near-term impact on clinical practice across the NHS.

The HAWAII DRIFT trial

This body of work has now culminated in a major, definitive clinical trial funded by the NIHR: the HAWAII DRIFT study. The trial addresses one of the most common but unresolved questions in hand fracture management — whether metal fixation wires used to hold broken bones in place should be left with their ends exposed through the skin, or buried beneath it.

Currently, a patient's chance of receiving either approach is essentially 50-50, determined largely by individual surgeon preference rather than evidence. Because infections involving bone are the most serious and difficult to treat, resolving this question has significant implications for patient outcomes. The trial is currently recruiting across 25 NHS sites, with a target of 470 patients, and its findings are expected to inform NICE guidelines — with potential impact on clinical practice both in the UK and internationally.

The return on charitable investment

The cumulative impact of BMRF's investment in this programme illustrates powerfully what early-stage charitable funding can achieve. A total investment of £79,000 — £69,000 to fund the first year of doctoral research, and £10,000 to support the international audit — has directly leveraged over £820,000 in follow-on funding, including the £500,000 NIHR grant currently supporting the HAWAII DRIFT trial. Each stage of investment enabled the next: the foundational data supported the trial, the trial supported the audit, and together they made the case for the definitive study now underway.

The ultimate goal is to reduce infection rates, preserve hand function, and improve quality of life for patients after trauma — and the evidence base to achieve that is now firmly in place.