Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren's disease.

We report long-term outcomes of proximal interphalangeal joint arthrodesis for treatment of severe recurrent joint contractures secondary to Dupuytren's disease. The patients had at least two previous procedures for Dupuytren's contracture that involved the same joint, before undergoing joint fusion. Patient demographics, satisfaction, functional outcome, complications, revision and re-operation rates are reported. Eleven patients were included with a mean age of 64 years (range 53-73). The mean proximal interphalangeal joint contracture at presentation was 102° (range 80°-120°). None required revision surgery at a mean of 8 years and 9 months (range 9-199 months). All patients were able to perform their activities of daily living and would recommend this operation to family and friends. This series shows that proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren's disease.Level of evidence: IV.

Olecranon bursitis: a systematic overview.

BACKGROUND: Olecranon bursitis is a common condition where the bursal cavity, superficial to the olecranon, becomes inflamed. This can occur either with or without infection and has been given pseudonyms relating to the repeated minor trauma from external pressure that often predisposes. As a result of the multiple aetiologies, olecranon bursitis can present to any medical specialty with reasonable frequency and, although many therapies are described, a single, evidence-based and standardized treatment pathway is not well described. METHODS: We summarize the key points within the literature and subsequently propose an evidence-based treatment pathway. RESULTS: Relevant evidence is presented from appropriate publications to add rational to existing decision-making processes, together with personal experience and suggested operative bursectomy techniques from an established upper limb surgeon. The common and significant aetiologies are summarized and, in particular, red flag symptoms are highlighted by way of warning to the unsuspecting investigator. CONCLUSIONS: The conclusion is provided in diagrammatic form, providing a suggested treatment pathway from history and examination through to operative intervention.