Outcomes Following Repeat Collagenase Treatment of Dupuytren Contracture.

PURPOSE: Injectable collagenase Clostridium histolyticum has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture of the hand. The purpose of this study was to determine the efficacy of collagenase injection and adverse event rate in patients who had undergone previous collagenase treatment. METHODS: A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009 to 2019. Fifty-nine joints in 45 patients underwent repeat collagenase therapy for recurrent contracture in the same digit. Pretreatment and posttreatment total metacarpophalangeal and proximal interphalangeal joint flexion contractures were recorded, with complete correction defined as <5° residual digital flexion contracture. Postmanipulation skin tears and adverse events were recorded. A comparison was made between average contracture improvement after initial collagenase injection and that after repeat injection. RESULTS: Forty-five patients with an average duration of 30 months (range, 6-73 months) between initial and repeat collagenase therapies were identified. The mean improvement after first collagenase injection was 45° ± 24° (39° for metacarpophalangeal joint and 50° for proximal interphalangeal joint) compared with a mean improvement of 43° ± 23° (41° for metacarpophalangeal joint and 44° for proximal interphalangeal joint) after second injection. Although similar complete correction rates and skin tear rates (32.2 % for initial and 30.5% for repeat) were observed between initial (80%) and repeat injections (73%), the occurrence of adverse events was 3 times higher (3.4% for initial and 10.2% for repeat) in the latter group. CONCLUSIONS: Collagenase treatment of Dupuytren contracture yields effective total flexion contracture correction. Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Matching into an Orthopedic Residency: Which Application Components Correlate with Final Rank List Order?

OBJECTIVE: To determine if any of the unique elements of the applications of medical students who were granted interviews to an orthopedic residency program correlate to the program's final rank order list of candidate residents. DESIGN: Eight domains of the standard residency application were considered as independent variables for 36 applicants. Personal, identifying information was removed from the application material within each domain, thus blinding the application domains for 5 core faculty members from the program to review and rank independently. These 8 domain rank lists were then compared to the program's final rank list order to determine the correlation of each domain with the final rank list order. SETTING: Academic medical center. PARTICIPANTS: Applicants to a university-based orthopedic surgery residency program who were granted interviews in the 2016 academic year. RESULTS: Two domains of the application correlated with the final rank list order: interview and personal statement. None of the other domains had a significant correlation with the final rank list order. Interobserver variability among the faculty members was high for the rankings of the different domains. CONCLUSIONS: Interview and personal statement were the only domains within the application that had correlation with the final rank list for an orthopedic residency program. A better understanding of how these 2 components affect the rank list may provide opportunity for process improvements.

Shoulder Arthrodesis.

PURPOSE: The purpose of this video is to demonstrate the surgical technique of a shoulder arthrodesis for a patient with multidirectional instability and multiple failed previous surgeries. METHODS: A 25-year-old woman with a long history of left shoulder multidirectional instability in the setting of Ehlers-Danlos syndrome is shown undergoing a shoulder arthrodesis. The video demonstrates intraoperative patient positioning, approach, shoulder osseous and articular preparation, implant placement (narrow 4.5 dynamic compression plate), and wound closure. The video includes a brief case history with preoperative radiographic imaging, indications, and patient outcome with postoperative radiographic imaging. RESULTS: The video is 11 minutes, 34 seconds in time. CONCLUSION: This video demonstrates a left shoulder arthrodesis with successful glenohumeral positioning of 30 degrees/30 degrees/30 degrees flexion, abduction, and internal rotation, respectively, and functional ability to reach the mouth and top of the head.