Collagenase and the Treatment of Dupuytren Contracture: Efficacy of Treatment and Patient Satisfaction.

Background: Collagenase clostridium histolyticum has become a widely used treatment in the management of Dupuytren disease. The aims of this study are to assess the immediate success of treatment of Dupuytren contracture with collagenase injection, to measure long-term patient-rated outcomes, to determine whether the risk factors for the disease impacted outcomes and to report complications of collagenase treatment. Methods: A prospective study was performed in a tertiary referral centre. Measurements were recorded pre-treatment, day 1 and day 90. Patient-rated outcome scores were measured using Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Michigan Hand Questionnaire (MHQ) at minimum 36 months post-injection. Results: The study included 45 patients with 53 hands with a mean age of 65.7 years. The treatment was successful in 62% of patients with the greatest improvement in the metacarpal-phalangeal joint of the little finger. Diabetes, epilepsy, gender, alcohol intake and positive family history had no statistically significant predictive value on successful outcomes. Patient satisfaction at 41 months was high with mean MHQ score of 97.3. Conclusions: Collagenase is effective in the treatment of Dupuytren contracture, with disease involving the little finger showing the greatest benefit. Risk factors for development of Dupuytren disease had no effect on successful outcome and long-term satisfaction rates are high. Level of Evidence: Level III (Therapeutic).

Trends in the management of fractures of the distal radius in Ireland: did the Distal Radius Acute Fracture Fixation Trial (DRAFFT) change practice?

AIMS: The aim of this study was to examine trends in the management of fractures of the distal radius in Ireland over a ten-year period, and to determine if there were any changes in response to the English Distal Radius Acute Fracture Fixation Trial (DRAFFT). PATIENTS AND METHODS: Data was grouped into annual intervals from 2008 to 2017. All adult inpatient episodes that involved emergency surgery for fractures of the distal radius were included. RESULTS: In 2008 Kirschner-wire (K-wire) fixation accounted for 59% of operations for fractures of the distal radius, and plate fixation for 21%. In 2017, the rate of K-wire fixation had fallen to 30%, and the proportion of patients who underwent plate fixation had risen to 62%. CONCLUSION: There is an increasing trend towards open reduction and internal fixation for fractures of the distal radius in Ireland. This has been accompanied by a decrease in popularity for K-wire fixation. DRAFFT did not appear to influence trends in the management of fractures of the distal radius in Ireland. Cite this article: Bone Joint J 2019;101-B:1550-1556.

Telesurveillance: Exploring the Use of Mobile Phone Imaging in the Follow-Up of Orthopedic Patients with Hand Trauma.

Background: Intra-articular phalangeal fractures involving the proximal interphalangeal joint (PIPJ) are notoriously difficult injuries to treat and often require regular follow-up to assess progress, guide treatment, and determine outcomes. Some patients often have to travel long distances for follow-up care. The aim of our study was to assess the clinical outcomes of intra-articular fractures of the PIPJ through use of clinical pictures sent through a mobile phone.Methods: A retrospective study was conducted of a consecutive group of patients treated with a static external fixator (Micro Hoffman-2 Stryker®) between 2006 and 2016 for an intra-articular fracture of the PIPJ. Range of motion (ROM) at the PIPJ was assessed through clinical pictures taken on a mobile phone.Results: Clinical images were received from 15 patients with a mean age of 31.9 years (range 15-51), of which 73.3% of patients were male. Mean length of follow-up was 39 months. Around 73.3% of injuries occurred while playing a sport. Mean PIPJ ROM assessed through the clinical images was 67°.Conclusion: Our study shows that it was possible to assess ROM at the PIPJ through the use of clinical pictures taken by mobile phone. The use of mobile phones to take images provided a simple, easy, and convenient means of assessing outcome in this cohort of patients. We describe a method of follow-up that may have a greater role in the future.

Volar plate versus k-wire fixation of distal radius fractures.

The optimal management of distal radius fractures remains controversial. The aim of this study was to compare the radiographic and functional outcomes of 318 patients who underwent k-wire fixation or volar plating for fractures of the distal radius. Patients were aged between 20 and 65 years and followed for a mean of 32 months. The mean values for volar tilt, radial inclination, radial length and ulnar variance were all significantly better in the volar plate group. Malunion occurred in 13.2% of patients undergoing k-wiring and 4% of patients treated with a volar plate (p<0.007). Higher values for radial inclination, radial length and volar tilt correlated with better functional outcome as measured by disabilities of the arm shoulder and hand (DASH) and patient rated wrist evaluation (PRWE) scores. Lower values for ulnar variance correlated with better functional outcome. Although volar plate treatment resulted in a superior radiological outcome, there was no evidence that this translated into a superior functional outcome (DASH 13.12 vs. 11.25, p=0.28) (PRWE 17.56 vs. 16.31, p=0.69). The k-wiring procedure remains a suitable inexpensive option for simple fractures. Volar plating should be reserved for complex fractures that cannot be reduced by closed means.

Irreducible Pulled Elbow in an Adolescent. A Case Report.

We present a case of pulled elbow in an adolescent patient that required open reduction.

The effects of freezing on the tensile properties of repaired porcine flexor tendon.

PURPOSE: When conducting complex testing of tendon repairs, it is essential that the samples are adequately preserved to prevent degradation. Freezing of samples is the most convenient method of preservation; however, there is no evidence in the literature to prove that freezing tendon before or after repair is acceptable. We aimed to prove that freezing tendons does not significantly alter the results of linear load-to-failure testing of tendon repairs. METHODS: After a power study, 150 tendons were harvested from porcine forelimbs and randomized into 5 groups of 30 tendons. After division, tendons were repaired using a Pennington modified core technique with a Silfverskiöld peripheral cross-stitch. Tendons in group 1 were divided, repaired, and tested within 3 hours postmortem. Tendons in group 2 were refrigerated at 4 degrees C for 24 hours prior to repair and testing. Tendons in group 3 were frozen at -25 degrees C for 3 months prior to repair and testing. Tendons in group 4 were frozen at -25 degrees C for 6 months prior to repair and testing. Tendons in group 5 were frozen at -25 degrees C for 6 months, repaired, refrozen for 1 month, and then tested. All repairs were linear load tested to ascertain the ultimate strength and force to produce 3-mm gap in the repair. RESULTS: Analysis of variance analysis of the results did not demonstrate any significant differences between groups. CONCLUSIONS: Freezing tendons both before and after suture repair is an acceptable method of preservation when investigating the force to produce 3-mm gap and ultimate strength of tendon repairs.

Static two-dimensional aperture coding for multimodal, multiplex spectroscopy.

We propose a new class of aperture-coded spectrometer that is optimized for the spectral characterization of diffuse sources. The instrument achieves high throughput and high spectral resolution by replacing the slit of conventional dispersive spectrometers with a more complicated spatial filter. We develop a general mathematical framework for deriving the required aperture codes and discuss several appealing code families. Experimental results validate the performance of the instrument.

Role of recording geometry in the performance of spectral diversity filters with spherical beam volume holograms.

We present experimental demonstrations of spectral diversity filters with spherical beam volume holograms for multimodal multiplex spectroscopy. Major properties of filters under diffuse-light illumination are discussed. The comparisons of spectral diversity between the transmission geometry holograms and the reflection geometry holograms are also studied. The results show that there is a trade-off between the degree of the spatial coherence of the source and the spectral diversity of the filter. We also conclude that the reflection geometry holograms have better spectral diversity and less sensitivity to the spatial coherence of the source.

Spherical beam volume holograms for spectroscopic applications: modeling and implementation.

The spherical beam volume hologram, recorded by a plane wave and a spherical beam, is investigated for spectroscopic applications in detail. It is shown that both the diffracted and the transmitted beam can be used for spectroscopy when the hologram is read with a collimated beam. A new method is introduced and used for analysis of the spherical beam volume hologram that can be extended for analysis of arbitrary holograms. Experimental results are consistent with the theoretical study. It is shown that the spherical beam volume hologram can be used in a compact spectroscopic configuration when the transmitted beam is monitored. Also, on the basis of the properties of the spherical beam hologram, the response of a hologram recorded by a plane wave and an arbitrary pattern is predicted. The information can be used to optimize holographic spectrometer design.