Treatment of Dupuytren's contracture: a systematic review.

Aims: 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. Materials and Methods: 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. Results: PNA tended to provide higher patient satisfaction with fewer adverse events, but had a higher rate of recurrence compared with limited fasciectomy. Although efficacious, treatment with CCH had notable recurrence rates and a high rate of transient adverse events. Recent comparative studies have shown no difference in clinical outcome between patients treated with PNA and those treated with CCH. Conclusion: Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. Cite this article: Bone Joint J 2018;100-B:1138-45.

Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints.

OBJECTIVES: Sustained intra-articular delivery of pharmacological agents is an attractive modality but requires use of a safe carrier that would not induce cartilage damage or fibrosis. Collagen scaffolds are widely available and could be used intra-articularly, but no investigation has looked at the safety of collagen scaffolds within synovial joints. The aim of this study was to determine the safety of collagen scaffold implantation in a validated in vivo animal model of knee arthrofibrosis. MATERIALS AND METHODS: A total of 96 rabbits were randomly and equally assigned to four different groups: arthrotomy alone; arthrotomy and collagen scaffold placement; contracture surgery; and contracture surgery and collagen scaffold placement. Animals were killed in equal numbers at 72 hours, two weeks, eight weeks, and 24 weeks. Joint contracture was measured, and cartilage and synovial samples underwent histological analysis. RESULTS: Animals that underwent arthrotomy had equivalent joint contractures regardless of scaffold implantation (-13.9° versus -10.9°, equivalence limit 15°). Animals that underwent surgery to induce contracture did not demonstrate equivalent joint contractures with (41.8°) or without (53.9°) collagen scaffold implantation. Chondral damage occurred in similar rates with (11 of 48) and without (nine of 48) scaffold implantation. No significant difference in synovitis was noted between groups. Absorption of the collagen scaffold occurred within eight weeks in all animals CONCLUSION: Our data suggest that intra-articular implantation of a collagen sponge does not induce synovitis or cartilage damage. Implantation in a native joint does not seem to induce contracture. Implantation of the collagen sponge in a rabbit knee model of contracture may decrease the severity of the contracture.Cite this article: J. A. Walker, T. J. Ewald, E. Lewallen, A. Van Wijnen, A. D. Hanssen, B. F. Morrey, M. E. Morrey, M. P. Abdel, J. Sanchez-Sotelo. Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints. Bone Joint Res 2016;6:162-171. DOI: 10.1302/2046-3758.63.BJR-2016-0193.

Flyingfish feeding ecology in the eastern Pacific: prey partitioning within a speciose epipelagic community.

To test the hypothesis that prey partitioning contributes to community stability in flyingfish, the gut contents of 359 flyingfish specimens (representing five genera and eight species within Exocoetidae and Hemiramphidae) were collected at 50 dip-net stations during hour-long night-time fishing in oceanic waters of the eastern tropical Pacific Ocean between August and November 2007. Analyses using multidimensional scaling, and analysis of similarity revealed significant dietary differences among species, and similarity percentages tests helped identify the specific prey taxa responsible for these differences. Six species specialized on copepods (58·3-96·9% by number), but targeted different families. Specifically, the barbel flyingfish Exocoetus monocirrhus (n = 205) focused on euchaetids (51·6%), the banded flyingfish Hirundichthys marginatus (n = 24) fed on pontellids (21·8%), while the tropical two-wing flyingfish Exocoetus volitans (n = 11) and the bigwing halfbeak Oxyporhamphus micropterus (n = 34) ingested calanoids (54·6 and 17·0%). In contrast, the whitetip flyingfish Cheilopogon xenopterus (n = 73) and the mirrorwing flyingfish Hirundichthys speculiger (n = 4) had generalized diets comprising similar proportions of amphipod, copepod, mollusc and larval fish prey. Distinct differences in mean fullness, highly digested material, per cent empty guts and mean numbers of prey per gut were also synthesized, and uncovered a pattern of asynchronous feeding. Altogether, these findings provide valuable descriptive data on the diets of an understudied group of epipelagic teleosts, and, by extension, suggest that prey partitioning (taxa and feeding times) may influence flyingfish feeding ecology by reducing interspecific competition.