The 'Universal Approach' for Dupuytren's disease: A safe and reproducible sequence for planning fasciectomy incisions.

Dupuytren's disease continues to present many challenges for the surgeon. A variety of surgical approaches and their variations have been described in the literature, further complicated by the degree of skin shortage and/or the need for local flap procedures or a full thickness skin graft. In the face of all these decisions - none of which is supported by Level 1 evidence - it can be very difficult to plan the best incision(s). We describe a safe and reproducible technique to plan fasciectomy incisions in primary or recurrent Dupuytren's disease. Our short communication and accompanying artwork demonstrates the anatomical landmarks and a simple decision-making algorithm based on just 3 key stages: (1) Proximal incision planning and execution of the palmar release(s); (2) Extension distally into the digit(s) based on the tissue quality, with either with zigzag (Brunner's) or a midline longitudinal (McIndoe) incision(s); (3) Flap assisted closure or coverage with a full thickness skin graft where required.

Internal Joint Stabilization for Recurrent Nontraumatic Elbow Dislocation in a Skeletally Immature Patient.

CASE: A 14-year-old adolescent boy with SCN1B mutation experienced frequent seizures and recurrent elbow dislocation, occurring up to 30 times per day. Following failed conservative treatment, the decision was made to surgically repair the lateral collateral ligament complex and stabilize the elbow with the internal joint stabilizer (IJS). At more than 3 years postoperatively, the patient has not had a dislocation event and will retain the device for the foreseeable future to maintain predictable elbow stability. CONCLUSION: Although there is scant evidence supporting the use of the IJS in pediatric cases, the current case supports its use in pediatric elbow instability.

Can artificial intelligence make elective hand clinic letters easier for patients to understand?

We investigated whether ChatGPT was able to increase the Flesch reading ease and the Flesch-Kincaid reading level of elective clinic letters written by hand surgeons. ChatGPT could not reliably simplify the hand clinic letters any further.

Early outcomes of patients undergoing total hip arthroplasty for trauma during COVID-19.

AIMS: This study aimed to identify patients receiving total hip arthroplasty (THA) for trauma during the peak of the COVID-19 pandemic in the UK and quantify the risks of contracting SARS-CoV-2 virus, the proportion of patients requiring treatment in an intensive care unit (ICU), and rate of complications including mortality. METHODS: All patients receiving a primary THA for trauma in four regional hospitals were identified for analysis during the period 1 March to 1 June 2020, which covered the current peak of the COVID-19 pandemic in the UK. RESULTS: Overall, one of 48 patients (2%) contracted COVID-19 during their admission. Although they required a protracted stay in hospital, they did not require ICU treatment. Two patients did require ICU support for medical problems but not relating to COVID-19. Complications were no greater than expected given the short follow-up. There were no mortalities. CONCLUSION: There is a paucity of evidence to guide restarting elective joint arthroplasties following the COVID-19 pandemic. Although THAs for trauma are by no means a perfect surrogate, the results of this study show a low incidence of contracting COVID-19 virus during admission and no significant sequalae during this period.Cite this article: Bone Joint Open 2020;1-7:438-442.

Cyclist's nodule: no smooth ride.

A fit and active amateur cyclist was referred by his general practitioner to a surgical oncology outpatient clinic with a slowly-growing perineal mass. Following clinical examination, the patient underwent imaging and biopsy at a tertiary soft tissue tumour centre, which diagnosed perineal nodular induration: a rare, benign tumour caused by repetitive trauma associated with 'saddle sports' such as cycling or horse riding. It is important to consider soft tissue tumours in patients who present with 'lumps and bumps'; they can occur anywhere in the body including the groin or perineum, where it is sometimes referred to as a 'third' or 'accessory' testicle in men. Although unusual, the case emphasises the importance of rapid specialist referral from primary care, and consideration of a patient's occupation and hobbies when formulating diagnoses.

Consumption of omega-3 fatty acids and the risk of skin cancers: a systematic review and meta-analysis.

Skin cancers have a higher incidence than all other cancers combined and are a major cause of morbidity worldwide. Laboratory data suggest certain dietary constituents, notably omega-3 polyunsaturated fatty acids (n-3 PUFAs), could potentially protect against skin malignancy, although no large-scale review has been conducted in humans. The objective of this review and meta-analysis was to determine the relationship between dietary n-3 PUFAs and skin cancer incidence. It considered all published randomized controlled trials and observational studies up to March 2013. Five studies (two case-control and three cohort) were identified pertaining to oral n-3 PUFA consumption and incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma (or a combination) and were included in a random-effects meta-analysis. A further six studies considering nondietary n-3 PUFA exposure (e.g., by tissue analysis) and/or recognized biological markers of skin cancer risk (e.g., p53 expression) were analyzed qualitatively. Dietary n-3 PUFAs were not associated with BCC (pooled OR 1.05, 95% CIs 0.86-1.28). Consumption of high levels of n-3 PUFAs were inversely associated with melanoma, although with only one estimate available (OR 0.52, 95% CI 0.34-0.78), and SCC, although nonsignificantly (pooled OR 0.86, 95% CIs 0.59-1.23). Available evidence is suggestive, but currently inadequate, to support the hypothesis that n-3 PUFAs protect against skin malignancy.