Pain, stiffness, instability and degenerative arthritis are common sequelae of complex fracture-dislocations of the
Dupuytren’s contracture is a benign, myoproliferative condition
affecting the palmar fascia that results in progressive contractures
of the fingers. Despite increased knowledge of the cellular and
connective tissue changes involved, neither a cure nor an optimum
form of treatment exists. The aim of this systematic review was
to summarize the best available evidence on the management of this
condition. A comprehensive database search for randomized controlled trials
(RCTs) was performed until August 2017. We studied RCTs comparing
open fasciectomy with percutaneous needle aponeurotomy (PNA), collagenase
clostridium histolyticum (CCH) with placebo, and CCH with PNA, in
addition to adjuvant treatments aiming to improve the outcome of
open fasciectomy. A total of 20 studies, involving 1584 patients,
were included.Aims
Materials and Methods
The aim of this meta-analysis was to assess the safety and efficacy
of collagenase clostridium histolyticum compared with fasciectomy
and percutaneous needle fasciotomy (PNF) for Dupuytren’s disease. We systematically searched PubMed, EMBASE, LILACS, Web of Science,
Cochrane, Teseo and the ClinicalTrials.gov registry for clinical
trials and cohort or case-control studies which compared the clinical
outcomes and adverse effects of collagenase with those of fasciectomy
or PNF. Of 1345 articles retrieved, ten were selected. They described
the outcomes of 425 patients treated with collagenase and 418 treated
by fasciectomy or PNF. Complications were assessed using inverse-variance
weighted odds ratios (ORs). Clinical efficacy was assessed by differences
between the means for movement of the joint before and after treatment.
Dose adjustment was applied in all cases.Aims
Materials and Methods
We describe a case of rotational dislocation of the proximal interphalangeal joint of the ring finger. This injury was not initially appreciated and therefore closed reduction failed. The clinical findings included puckering of the skin on the dorsum of the joint and rotational incongruity on radiographs. At open reduction there was interposition of the lateral band. Identification of the pathology allows early successful treatment.
In this case report a four-year-old girl with ulnar dimelia is described. She had six digits without mirror symmetry in her right hand. The first pre-axial digit was excised and true pollicisation performed for the second pre-axial digit. The arterial anatomy was abnormal but there was not symmetrical development of the arterial tree.
We randomised 79 patients (84 hands, 90 fingers) with Dupuytren’s contracture of the proximal interphalangeal joint to have either a ‘firebreak’ skin graft (39 patients, 41 hands, 44 fingers) or a fasciectomy (40 patients, 43 hands, 46 fingers) if, after full correction, the skin over the proximal phalanx could be easily closed by a Z-plasty. Patients were reviewed after three, six, 12, 24 and 36 months to note any complications, the range of movement and recurrence. Both groups were similar in regard to age, gender and factors considered to influence the outcome such as bilateral disease, family history, the presence of diabetes, smoking and alcohol intake. The degree of contracture of the metacarpophalangeal and interphalangeal joints of the operated fingers was similar in the two groups and both were comparable in terms of grip strength, range of movement and disability at each follow-up. The recurrence rate was 12.2%. We did not identify any improvement in correction or recurrence of contracture after firebreak dermofasciectomy up to three years after surgery.
