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 Dupuytren contracture compared to needle fasciotomy and
The February 2014 Wrist &
Hand Roundup. 360 . looks at: simple debridement and ulnar-sided wrist pain; needle fasciotomy or
Objectives. Recent studies have shown that systemic injection of rapamycin can prevent the development of osteoarthritis (OA)-like changes in human chondrocytes and reduce the severity of experimental OA. However, the systemic injection of rapamycin leads to many side effects. The purpose of this study was to determine the effects of intra-articular injection of Torin 1, which as a specific inhibitor of mTOR which can cause induction of autophagy, is similar to rapamycin, on articular cartilage degeneration in a rabbit osteoarthritis model and to investigate the mechanism of Torin 1’s effects on experimental OA. Methods. Collagenase (type II) was injected twice into both knees of three-month-old rabbits to induce OA, combined with two intra–articular injections of Torin 1 (400 nM). Degeneration of articular cartilage was evaluated by histology using the Mankin scoring system at eight weeks after injection. Chondrocyte degeneration and autophagosomes were observed by transmission electron microscopy. Matrix metallopeptidase-13 (MMP-13) and vascular endothelial growth factor (VEGF) expression were analysed by quantitative RT-PCR (qPCR).Beclin-1 and light chain 3 (LC3) expression were examined by Western blotting. Results. Intra-articular injection of Torin 1 significantly reduced degeneration of the articular cartilage after induction of OA. Autophagosomes andBeclin-1 and LC3 expression were increased in the chondrocytes from Torin 1-treated rabbits. Torin 1 treatment also reduced MMP-13 and VEGF expression at eight weeks after
The February 2024 Foot & Ankle Roundup360 looks at: Survival of revision ankle arthroplasty; Tibiotalocalcaneal nail for the management of open ankle fractures in the elderly patient; Accuracy of a patient-specific total ankle arthroplasty instrumentation; Fusion after failed primary ankle arthroplasty: can it work?; Treatment options for osteochondral lesions of the talus; Managing hair tourniquet syndrome of toe: a rare emergency; Ultrasound-guided collagenase therapy for recurrent plantar fibromatosis: a promising line of therapy?.
To estimate the potential cost-effectiveness of adalimumab compared with standard care alone for the treatment of early-stage Dupuytren’s disease (DD) and the value of further research from an NHS perspective. We used data from the Repurposing anti-TNF for Dupuytren’s disease (RIDD) randomized controlled trial of intranodular adalimumab injections in patients with early-stage progressive DD. RIDD found that intranodular adalimumab injections reduced nodule hardness and size in patients with early-stage DD, indicating the potential to control disease progression. A within-trial cost-utility analysis compared four adalimumab injections with no further treatment against standard care alone, taking a 12-month time horizon and using prospective data on EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and resource use from the RIDD trial. We also developed a patient-level simulation model similar to a Markov model to extrapolate trial outcomes over a lifetime using data from the RIDD trial and a literature review. This also evaluated repeated courses of adalimumab each time the nodule reactivated (every three years) in patients who initially responded.Aims
Methods
In the context of tendon degenerative disorders, the need for innovative conservative treatments that can improve the intrinsic healing potential of tendon tissue is progressively increasing. In this study, the role of pulsed electromagnetic fields (PEMFs) in improving the tendon healing process was evaluated in a rat model of collagenase-induced Achilles tendinopathy. A total of 68 Sprague Dawley rats received a single injection of type I collagenase in Achilles tendons to induce the tendinopathy and then were daily exposed to PEMFs (1.5 mT and 75 Hz) for up to 14 days - starting 1, 7, or 15 days after the injection - to identify the best treatment option with respect to the phase of the disease. Then, 7 and 14 days of PEMF exposure were compared to identify the most effective protocol.Aims
Methods
In the UK, fasciectomy for Dupuytren’s contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients. Prospective data were collected for 30 patients undergoing open fasciectomy on 36 digits (six having two digits affected), over a one-year period and under the care of two surgeons. In total, 10 ml to 20 ml volume of 1% lidocaine with 1:100,000 adrenaline was used. A standard postoperative rehabilitation regime was used. Preoperative health scores, goniometer measurements of metacarpophalangeal (MCP), proximal interphalangeal (PIP) contractures, and Unité Rheumatologique des Affections de la Main (URAM) scores were measured pre- and postoperatively at six and 12 weeks.Aims
Methods
Parathyroid hormone (PTH) (1-34) exhibits potential in preventing degeneration in both cartilage and subchondral bone in osteoarthritis (OA) development. We assessed the effects of PTH (1-34) at different concentrations on bone and cartilage metabolism in a collagenase-induced mouse model of OA and examined whether PTH (1-34) affects the JAK2/STAT3 signalling pathway in this process. Collagenase-induced OA was established in C57Bl/6 mice. Therapy with PTH (1-34) (10 μg/kg/day or 40 μg/kg/day) was initiated immediately after surgery and continued for six weeks. Cartilage pathology was evaluated by gross visual, histology, and immunohistochemical assessments. Cell apoptosis was analyzed by TUNEL staining. Microcomputed tomography (micro-CT) was used to evaluate the bone mass and the microarchitecture in subchondral bone.Aims
Methods
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 June 2015 Wrist &
Hand Roundup360 looks at: Collagenase and Dupuytren’s disease – a genuine alternative to surgery?; iPad PROMise?; Should we learn how to do endoscopic carpal tunnel release?; Two-week radiographs a relic of the past?; Bible? Aspirate or excise?; Patient expectations and trapeziometacarpal osteoarthritis; Splintage in the treatment of sagittal band incompetence and extensor tendon subluxation
Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an Specially prepared medical grade IBS was injected into fresh Dupuytren’s cords excised from patients undergoing surgical fasciectomy. These cords were tested by tension-loading them to failure with the Zwick 1445 (Zwick GmbH & Co. KG, Ulm, Germany) tension testing system.Objectives
Materials and Methods
The October 2013 Wrist &
Hand Roundup360 looks at: Cost effectiveness of Dupuytren’s surgery; A 'new horizon' in distal radius imaging; Undisplaced means undisplaced; The mystery of the distal radial fracture continues; How thick is thick enough?: articular cartilage step off revisited; Is the midcarpal joint more important than we think?; Plates and Kirschner wires; Better early results with an IM nail?
Triamcinolone acetonide (TA) is widely used for the treatment of rotator cuff injury because of its anti-inflammatory properties. However, TA can also produce deleterious effects such as tendon degeneration or rupture. These harmful effects could be prevented by the addition of platelet-rich plasma (PRP), however, the anti-inflammatory and anti-degenerative effects of the combined use of TA and PRP have not yet been made clear. The objective of this study was to determine how the combination of TA and PRP might influence the inflammation and degeneration of the rotator cuff by examining rotator cuff-derived cells induced by interleukin (IL)-1ß. Rotator cuff-derived cells were seeded under inflammatory stimulation conditions (with serum-free medium with 1 ng/ml IL-1ß for three hours), and then cultured in different media: serum-free (control group), serum-free + TA (0.1mg/ml) (TA group), serum-free + 10% PRP (PRP group), and serum-free + TA (0.1mg/ml) + 10% PRP (TA+PRP group). Cell morphology, cell viability, and expression of inflammatory and degenerative mediators were assessed.Objectives
Methods
Injectable collagenase is an alternative to surgical
treatment for Dupuytren’s disease. Previous studies have reported
on the effectiveness of collagenase in finger contractures. This
prospective study reports on the short-term safety and efficacy
of collagenase treatment in five thumb and first web space Dupuytren’s
contractures. The thumb and first web space contractures were treated
with injectable collagenase in four consecutive patients (five hands) with
experience of previous surgical digital fasciectomy. The thumb contracture
was measured by angle and span in two planes of thumb extension
and abduction before injection and after manipulation. Collagenase
treatment resulted in release of the contracture with a mean increase
in thumb to index angle from 23° (10° to 35°) to 56° (45° to 60°)
in extension and from 30° (10° to 50°) to 58° (50° to 65°) in abduction
and a mean increase in span from 1.9 cm (1 to 3.5) to 3.9 cm (3
to 5) in extension and from 2.4 cm (1.5 to 3.5) to 3.9 cm (3 to
4.5) in abduction. All patients reported an increased range of movement
and function and described collagenase therapy as preferable to
surgery. In the short-term collagenase is an effective, well-tolerated
and safe alternative to surgery for Dupuytren’s disease of the thumb.
In Canada, Dupuytren's contracture is managed
with partial fasciectomy or percutaneous needle aponeurotomy (PNA).
Injectable collagenase will soon be available. The optimal management
of Dupuytren’s contracture is controversial and trade-offs exist
between the different methods. Using a cost-utility analysis approach,
our aim was to identify the most cost-effective form of treatment
for managing Dupuytren’s contracture it and the threshold at which
collagenase is cost-effective. We developed an expected-value decision
analysis model for Dupuytren’s contracture affecting a single finger,
comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase
from a societal perspective. Cost-effectiveness, one-way sensitivity
and variability analyses were performed using standard thresholds
for cost effective treatment ($50 000 to $100 000/QALY gained).
Percutaneous needle aponeurotomy was the preferred strategy for
managing contractures affecting a single finger. The cost-effectiveness
of primary aponeurotomy improved when repeated to treat recurrence.
Fasciectomy was not cost-effective. Collagenase was cost-effective
relative to and preferred over aponeurotomy at $875 and $470 per
course of treatment, respectively. In summary, our model supports the trend towards non-surgical
interventions for managing Dupuytren’s contracture affecting a single
finger. Injectable collagenase will only be feasible in our publicly
funded healthcare system if it costs significantly less than current
United States pricing. Cite this article:
