The August 2024 Wrist & Hand Roundup. 360. looks at: Methotrexate shows potential in reducing pain for hand osteoarthritis with synovitis; Circumferential casting versus plaster splinting in adult distal radius fractures: the CAST study findings; Surgery shows superior long-term success for
The December 2022 Wrist & Hand Roundup360 looks at: Anti-tumour necrosis factor therapy for early-stage Dupuytren’s disease; Patient experiences of scaphoid waist fractures and their treatment; Postoperative complications following open a1 pulley release for a trigger finger or thumb; How certain are findings in distal radius fractures: a systematic review of randomized controlled trials; Partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function; Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures; How is reduction lost in distal radius fractures in females aged 50 years and older; The HAND-Q: psychometrics of a new patient-reported outcome measure for clinical and research applications.
With novel promising therapies potentially limiting progression of Dupuytren’s disease (DD), better patient stratification is needed. We aimed to quantify DD development and progression after seven years in a population-based cohort, and to identify factors predictive of disease development or progression. All surviving participants from our previous prevalence study were invited to participate in the current prospective cohort study. Participants were examined for presence of DD and Iselin’s classification was applied. They were asked to complete comprehensive questionnaires. Disease progression was defined as advancement to a further Iselin stage or surgery. Potential predictive factors were assessed using multivariable regression analyses. Of 763 participants in our original study, 398 were available for further investigation seven years later.Aims
Methods
Dupuytrens disease is a fibrosing condition of the palmar aponeurosis and its extensions within the digits. Normal fascial fibres running longitudinally in the subcutaneous tissues of the palm become thickened and form the characteristic nodules and cords pathognomonic of Dupuytrens disease. A wide variety of surgical interventions exist, of these the partial fasciectomy remains the most conventional and widely used technique. Minimally invasive surgical treatments such as needle fasciotomy are, however, becoming increasingly popular. Dupuytrens disease remains a challenging condition to treat as recurrence is universally found with all surgical interventions. Although recurrence may be related to the severity of the disease, there are currently no research tools other than clinical examination to examine changes in the diseased tissue postoperatively and predict likelihood of long-term success. Magnetic Resonance Imaging (MRI) may be of value for the study of
Aim. To determine effectiveness of Collagenase Clostridium Histolyticum (CCH) in deformity correction and hand function for patients with Dupuytren's disease. Materials & Methods. Patients with MCPJ contractures with no previous surgery to the same finger were included. Treatment consisted of one Xiapex injection to a prominent pretendinous band as an outpatient procedure. Follow up was arranged at 48 hours, 3 weeks and final follow up > 6 months. Results. 17 patients were included. Of the 21 fingers that were studied 14 were right and 7 were left sided. Average age was 69 years (56–82) and mean deformity was 37.6° (10–70). Mean follow up was 11.6 months (SD – 3.13, range 7–17). Post manipulation under correction of deformity was present in 3 fingers which improved by final follow up (mean 6.7°). Three patients had re-appearance of deformity (mean 6.7°). The remaining patients had complete correction of deformity. All deformities were significantly corrected, average correction 35.7° (p<0.05). Michigan hand questionnaire (MHQ) score improved significantly following correction of deformity (p<0.005). The subsets of MHQ – hand function, activities of daily living, aesthetics and satisfaction scores improved significantly (p<0.005). Conclusion. CCH an effective, minimally invasive option for the treatment of
Introduction: Common pathologies seen in hand clinics include Dupuytren’s contracture, ganglia and trigger digits. Some patients can be treated in the out patient department by percutaneous fasciotomy, aspiration, or percutaneous A1 pulley release. The effectiveness and safety of these procedures has been documented in the literature. There are no studies investigating the cost effectiveness these of treatments. Aim: Our aim was to compare the cost of treatment of Dupuytren’s contracture, ganglia and trigger digits in the out-patient department with the operating theatre. Methods: All patients seen in a new patient hand clinic with a diagnosis of Dupuytren’s contracture, trigger digit or ganglion of the wrist or hand were prospectively identified over a 6 month period.. The number undergoing a procedure in the out-patient clinic or theatre was recorded. Costings of theatre time and out-patient time were obtained from the hospital management. Results: 80, 26, and 52 patients were treated with regard to Dupuytrens contracture, ganglia, and trigger digits respectively over the 6-month period. Of these, 37, 23, and 44 were treated by an out patient procedure, and 43, 3 and 8 underwent a formal operation. Based on a cost of £216 per out-patient clinic session, the cost of the out-patient procedures was calculated at £1872 over 6 months, or £3744 per annum. Based on a theatre cost of £1785 per session, to perform all the clinic procedures as formal operations would have cost £60,690 over 6 months, or £121380 per annum. The cost savings were therefore £117636 per annum. Discussion: We conclude that outpatient interventions for
Dupuytren’s contracture is characterized by increased fibrosis of the palmar aponeurosis, with eventual replacement of the surrounding fatty tissue with palmar fascial fibromatosis. We hypothesized that adipocytokines produced by adipose tissue in contact with the palmar aponeurosis might promote fibrosis of the palmar aponeurosis. We compared the expression of the adipocytokines adiponectin and leptin in the adipose tissue surrounding the palmar aponeurosis of male patients with Dupuytren’s contracture, and of male patients with carpal tunnel syndrome (CTS) as the control group. We also examined the effects of adiponectin on fibrosis-related genes and proteins expressed by fibroblasts in the palmar aponeurosis of patients with Dupuytren’s contracture.Aims
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