Necrotising soft-tissue infections (NSTIs) of
the upper limb are uncommon, but potentially life-threatening. We
used a national database to investigate the risk factors for amputation
of the limb and death. We extracted data from the Japanese Diagnosis Procedure Combination
database on 116 patients (79 men and 37 women) who had a NSTI of
the upper extremity between 2007 and 2010. The overall in-hospital mortality was 15.5%. Univariate analysis
of in-hospital mortality showed that the significant variables were
age (p = 0.015), liver dysfunction (p = 0.005), renal dysfunction
(P <
0.001), altered consciousness (p = 0.049), and sepsis (p
= 0.021). Logistic regression analysis showed that the factors associated with
death in hospital were age over 70 years (Odds Ratio (OR) 6.6; 95%
confidence interval (CI) 1.5 to 28.2; p = 0.011) and renal dysfunction
(OR 15.4; 95% CI 3.8 to 62.8; p <
0.001). Univariate analysis of limb amputation showed that the significant
variables were diabetes (p = 0.017) mellitus and sepsis (p = 0.001).
Multivariable logistic regression analysis showed that the factors
related to limb amputation were sepsis (OR 1.8; 95% CI 1.5 to 24.0;
p = 0.013) and diabetes mellitus (OR 1.6; 95% CI 1.1 to 21.1; p
= 0.038). For NSTIs of the upper extremity, advanced age and renal dysfunction
are both associated with a higher rate of in-hospital mortality.
Sepsis and diabetes mellitus are both associated with a higher rate
of amputation. Cite this article:
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.
We report the outcome at a mean of 93 months (73 to 110) of 71 patients with an acute fracture of the scaphoid who were randomised to Herbert screw fixation (35) or below-elbow plaster cast immobilisation (36). These 71 patients represent the majority of a randomised series of 88 patients whose short-term outcome has previously been reported. Those patients available for later review were similar in age, gender and hand dominance. There was no statistical difference in symptoms and disability as assessed by the mean Patient Evaluation Measure (p = 0.4), or mean Patient-Rated Wrist Evaluation (p = 0.9), the mean range of movement of the wrist (p = 0.4), mean grip strength (p = 0.8), or mean pinch strength (p = 0.4). Radiographs were available from the final review for 59 patients. Osteoarthritic changes were seen in the scaphotrapezial and radioscaphoid joints in eight (13.5%) and six patients (10.2%), respectively. Three patients had asymptomatic lucency surrounding the screw. One non-operatively treated patient developed nonunion with avascular necrosis. In five patients who were treated non-operatively (16%) there was an abnormal scapholunate angle ( >
60°), but in four of these patients this finding was asymptomatic. No medium-term difference in function or radiological outcome was identified between the two treatment groups.
We identified ten patients who underwent arthroscopic revision of anterior shoulder stabilisation between 1999 and 2005. Their results were compared with 15 patients, matched for age and gender, who had a primary arthroscopic stabilisation during the same period. At a mean follow-up of 37 and 36 months, respectively, the scores for pain and shoulder function improved significantly between the pre-operative and follow-up visits in both groups (p = 0.002), with no significant difference between them (p = 0.4). The UCLA and Rowe shoulder scores improved significantly (p = 0.004 and p = 0.002, respectively), with no statistically significant differences between groups (p = 0.6). Kaplan-Meier analysis for time to recurrent instability showed no differences between the groups (p = 0.2). These results suggest that arthroscopic revision anterior shoulder stabilisation is as reliable as primary arthroscopic stabilisation for patients who have had previous open surgery for recurrent anterior instability.
