Dupuytren's disease is often disabling and traditionally has been managed with various surgical methods, with recurrence rates up to 50 %. Recently clostridial collagenase injection has been licensed for use in the NHS. We prospectively analysed the results of clostridial collagenase injection in 62 patients with varying degrees of Metacarpo phalangeal (MCP) and Proximal interphalangeal (PIP) joint contractures. There were 48 males and 14 females with an average age of 66 years. The average MCPJ and PIPJ deformities were 33 and 17 degrees respectively. Following the infiltration and subsequent manipulation under local anaesthetic and night splinting for 3 months, patients were followed up at 4 weeks and 6 months. Deformities persisted in 5 patients and later required surgical correction. MCPJ deformities were more amenable for correction than PIPJ and in those with recurrence. The average residual deformity was 7 degrees. Common complications include bruising, swelling, pain not responding to routine analgesia, lymphangitis and skin break in some but none required any additional interventions. 14 patients had completed 6 month follow up and there was no recurrence. Subjective assessment through questionnaires revealed high patient satisfaction rate with early return to work within 1 week in most patients. Patients with previous operations preferred injections over operative correction. Collagenase injections are effective in deformity correction with higher satisfaction rate and low morbidity. Early results are encouraging but long term follow up is required to assess recurrence rates.
Introduction: Haemophilus influenzae type B has been the pathogen responsible for a significant proportion of cases of septic arthritis in children in the past. Vaccination was introduced in the United Kingdom in October, 1992 in order to combat meningitis and epiglottitis. This study looks at the effects of vaccination on childhood septic arthritis in Wales. Methods: Data was collected prospectively from 1988 by the Public Health Laboratory Service in Wales. Data was analysed with a two-sample t-test. Results: There were 17 cases in children in which 16 were attributed to type B. 14 cases occurred in the 5 years before mass immunisation. Only 2 cases occurred in the 8 years following immunisation. The incidence of Haemophilus influenzae septic arthritis in children has fallen significantly since the introduction of immunization (P=0.009). Discussion: Vaccination has resulted in a significant fall in the incidence of Haemophilus influenzae type B septic arthritis in children in Wales. This may have consequences on guidelines for the empirical treatment of septic arthritis. If a child if found to have Haemophilus influenzae septic arthritis, this is suspicious of immunocompromise, or an alternate type infection. The novel way in which infection has been controlled may be one which can be used in future to control multi-resistant bacterial infection in orthopaedic surgery.
Immobilisation of the thumb is widely believed to be important in the management of fractures of the carpal scaphoid. To assess the need for this, we randomly allocated 392 fresh fractures for treatment by either a forearm gauntlet (Colles') cast, leaving the thumb free, or by a conventional 'scaphoid' plaster incorporating the thumb as far as its interphalangeal joint. In the 292 fractures which were followed for six months, the incidence of nonunion was independent of the type of cast used.
A review is presented of the results of treatment in 126 patients over 50 years of age who had suffered a displaced fracture of the ankle. Operative fixation achieved better fracture positions than conservative management, but was associated with a very high complication rate in women. Examination of 86 of the patients more than two years after injury showed little difference in function after conservative or operative treatment.
