Clinical outcomes following collagenase injections compared to fasciectomy in the treatment of Dupuytren’s contracture

IntroductionThe aim of this study is to compare the efficacy of collagenase injections with that of fasciectomy in the treatment of Dupuytren’s contracture.MethodsThis is a case–control retrospective study. We reviewed the electronic medical records from January 2009 through January 2013, identifying 142 consecutive patients who underwent either fasciectomy or collagenase injection. Exclusion criteria for both groups were age <18 years, pregnant women, and arthroplasty or arthrodesis of the treated joint. Follow-up data beyond 1-year duration was available for 117 of the patients: 44 patients who had undergone fasciectomy, and 73 patients who had received collagenase injection. The primary outcome measure in this study was resolution of joint contracture to 0–5° deficit of full extension. Data was analyzed using two-sample t tests for continuous data and chi-square test for categorical data. A significant P value was set at <0.05.ResultsAt the latest follow-up, significantly more joints treated with fasciectomy met the primary outcome measure. Metacarpophalangeal (MP) joints responded better than the proximal interphalangeal (PIP) joints for both treatments. At the latest follow-up (14.2 months for collagenase, 16.3 months for fasciectomy), 46 % of MP joints treated with collagenase and 68 % of MP joints treated with fasciectomy maintained resolution of joint contracture. Sub-analysis of the affected joints based on the severity of initial contracture demonstrated that MP and PIP joints with contractures <45° responded better than more severely contracted joints (>45°).ConclusionsFasciectomy yields a greater mean magnitude of correction for digital contractures at the latest follow-up when compared to collagenase. Both treatments were more effective for treatment of MP joint contracture compared to PIP joint contracture.

Level of Evidence

Level III, therapeutic.     

Beals-Hecht 综合征1 例报告

目的报道1例FBN2基因新发杂合变异Beals-Hecht综合征病例。方法回顾分析1例Beals-Hecht综合征患儿的临床资料,并检索相关文献,总结其临床特征及基因型。结果患儿男,3个月28天,存在皱耳、多关节屈曲挛缩和下肢肌肉发育不良等表现。基因分析显示患儿FBN2基因有2个新发杂合变异c.2944TG(p.C982G)和c.6518AG(p.N2173S),均为错义变异。结论 Beals-Hecht综合征可累及多系统,基因检测有助于诊断。     

The scourge of burn contractures: Who will bell the cat?

IntroductionMajority of burn injuries occur in developing world. There have been many advances in burn care management. But this advance comes at a price of ever increasing burn sequel of scarring. Burn scar contractures, in spite of being preventable, continue to be a common reality in our world. This paper aims to evaluate the lacunae in burn care leading to formation of contractures, to evaluate common sites of contractures, practice of advising splintage and anti-deformity positioning.ProcedureThis retrospective observational study was conducted over a period of six years (January 2010–December 2015) at a tertiary Burn unit in Mumbai (India). The records of burn contracture patients were scrutinized to obtain the data regarding patient’s socio-demographic profile, details of burn injury, splinting and exercises advised and details of surgeries required. Data was tabulated and analysed.ResultsThere was a significantly lower prevalence of advice regarding splinting, mobilization exercises and pressure garments. The prevalence of early surgery was also found to be low.ConclusionsAttempt has been made to identify the factors affecting the prevalence of burn scar contractures. Authors recommend that efforts be made for improving the knowledge of the treating doctors. Also, efforts should be made to increase awareness of burn prevention and emergent management.     

Total Hip Arthroplasty in Ankylosing Spondylitis With Extension Contracture of Hips

Background

Despite significant pain relief following total hip arthroplasty (THA) in patients with ankylosing spondylitis, a small subset of patients presenting with extra-articular extension contracture of hips remains unsatisfied.

Ankle dorsiflexion after isolated medial versus complete proximal gastrocnemius recession: A cadaveric study

PurposeGastrocnemius recession has been described in the treatment of gastrocnemius contracture. The aims of this study were: (1) to assess the change in ankle dorsiflexion after isolated medial gastrocnemius recession performed according to L.S. Barouk’s technique; (2) to compare ankle dorsiflexion after isolated medial head with complete proximal gastrocnemius recession.MethodsA cadaveric study was performed on 15 lower limb adult specimens. Isolated medial gastrocnemius head recession was initially performed, followed by an additional recession of the lateral gastrocnemius head. Ankle dorsiflexion torque was applied with 2 and 4 kg forces on second metatarsal head. Ankle dorsiflexion was measured with the knee both in extension and at 90° of flexion and values were recorded before surgery (T0), after medial head recession (T1) and after both heads recession (T2). Normality of data was assessed using the Shapiro–Wilk test, then measurements were compared in the three conditions with appropriate statistical tests.ResultsAfter isolated medial gastrocnemius recession (Δ = T1-T0), ankle dorsiflexion assessed with the knee in extension significantly increased by 5° ± 3 (range, −2 to 10) with a 2-kg torque (p = 0.02) and by 4.5° ± 3 (range, −4 to 10) with a 4-kg torque (p = 0.04). No significant difference was observed with the knee flexed at 90° (p > 0.05 for all measurements). After both gastrocnemius heads recession (Δ = T2-T1), although a further increase in dorsiflexion was noticed, statistical significance was not reached neither with the knee in extension nor at 90° of flexion (p > 0.05 for all measurements).ConclusionIn this study, isolated medial gastrocnemius head recession performed according to LS Barouk’s technique was effective in improving ankle dorsiflexion, whereas the additional release of the lateral head did not produce any significant change.Level of evidenceLevel V, cadaveric study.