Long-term recurrence of Dupuytren's disease treated with clostridium histolitycum collagenase. Surgical treatment and anatomopathological study.

OBJECTIVE: To present the functional results obtained and the possible surgical difficulties after the surgical treatment of Dupuytren's disease (DD) recurrence in patients previously treated with Clostridium histolyticum (CCH) collagenase. MATERIALS AND METHODS: In this prospective study, 178 patients with DD were treated with CCH from 2011 to 2018; During long-term postoperative follow-up, 34 patients (19.1%) had recurrence of DD. In all patients injected in the IFP the disease recurred; In patients injected in the MCP, recurrence was highest in grade III and IV of the Tubiana classification, with involvement of the 5th finger and the two-finger Y-chord. Fourteen patients (7,8%) required surgery by partial selective fasciectomy due to recurrence of cord DD infiltration. The clinical and functional results of the patients, the difficulty of the surgical technique and the anatomopathological analysis of the infiltrated cords were evaluated in comparison with those of cords and patients who had had no previous CCH treatment. RESULTS: In all patients, cord rupture was achieved after injection, reducing joint contracture. In 14 patients, we observed during the follow-up the existence of DD recurrence that required surgical treatment by selective partial fasciectomy. There were no major difficulties in surgery and good clinical and functional results at 6 months of follow-up. The anatomopathological study of the resected tissue did not present histological alterations with respect to the samples obtained from patients initially treated by selective partial fasciectomy. CONCLUSIONS: Selective fasciectomy after CCH injection does not lead to important operative difficulties, as long as the CCH injection is performed according to the recommendations. There were no histological changes in the tissue after CCH injection. LEVEL OF EVIDENCE: III.

Functional survival of cementless trapeziometacarpal total joint arthroplasty after upper extremity trauma.

INTRODUCTION: Our purpose with this publication is to document the survival of uncemented and unconstrained total trapeziometacarpal arthroplasty after energy trauma to the upper extremity. MATERIAL AND METHODS: From 1999 to the present, ten patients carrying total TMC arthroplasty suffered major traumatic injuries on the hand. Eight patients had fractures of the distal radius, one patient had scapho-lunate dissociation and one patient had a dorsal pullout of the triquetrum. A clinical and radiological examination of the patients after the trauma was carried out and compared with the pre-traumatic prosthesis status. RESULTS: Three patients required surgical intervention for the associated traumatic injury. The postraumatic clinical and functional follow-up of the patients was good, and no differences were documented with respect to mobility, strength and pain at the level of the thumb with respect to the prior to the trauma. No signs of loosening, instability or alteration in the alignment of the components of the protheses were observed in the radiological examinations following the trauma. CONCLUSIONS: There is a high survival rate of uncemented total trapeziometacarpal arthroplasty in the long term, even in the face of energy trauma. It is then a safe implant. Despite of being non-constrained, a good alignment of the prosthetic components is the key to avoid dislocation of the prosthesis.

Tratamiento de la enfermedad de Dupuytren mediante la colagenasa del Clostridium histolyticum / Treatment of Dupuytren's disease using collagenase from Clostridium histolyticum

Objetivo. La colagenasa del Clostridium histolyticum es una nueva opción terapéutica y el primer tratamiento farmacológico en el tratamiento de la enfermedad de Dupuytren. Material y métodos. Estudio prospectivo de 35 pacientes afectos de la enfermedad de Dupuytren. Se evaluó los resultados clínicos, funcionales, la satisfacción del paciente y la seguridad del fármaco. Resultados. Los resultados funcionales y clínicos tras su administración son buenos sobre todo en la articulación metacarpofalángica, con una recuperación rápida. El índice de contractura del dedo MCF previo a la punción fue de 64° y tras la punción de 4°; en las IFP previo a la punción fue de 83,3 grados y tras la punción de 15°; en MCF/IFP previo a la punción fue de 140° y tras la punción de 25°. Conclusiones. Es una alternativa de tratamiento de la enfermedad de Dupuytren, fundamentalmente en los ancianos. La investigación es necesaria para clarificar el índice de recurrencia de la enfermedad, las posibles reacciones adversas y comparar la eficacia y durabilidad con otras alternativas de tratamiento (AU)

Objective: The collagenase from Clostridium histolyticum is a new therapeutic option, and the first pharmacological one, in the treatment of Dupuytren’s disease. Material and methods: A prospective study was conducted on 35 patients with Dupuytren’s disease. The clinical and functional variables, as well as patient satisfaction and drug safety were evaluated. Results: The functional and clinical results after its administration were good, with a rapid recovery, especially at the metacarpophalangeal (MCP) joint. The index finger contracture prior to MCP puncture was 64 degrees and after puncture it was 4 degrees. In the proximal interphalangeal (PIP) prior to puncture it was 83.3 degrees and after puncture it was 15 degrees; In the MCP/PIP prior to puncture it was 140 degrees, and after puncture it 25 degrees. Conclusions: Collagenase from Clostridium histolyticum an alternative of treatment of Dupuytren’s disease, mainly in the elderly. More research is required in order to clarify the rate of recurrence of the disease, the possible adverse reactions, and to compare the efficiency and permanence with other treatment options (AU)

[Treatment of Dupuytren's disease using collagenase from Clostridium histolyticum]. / Tratamiento de la enfermedad de Dupuytren mediante la colagenasa del Clostridium histolyticum.

OBJECTIVE: The collagenase from Clostridium histolyticum is a new therapeutic option, and the first pharmacological one, in the treatment of Dupuytren's disease. MATERIAL AND METHODS: A prospective study was conducted on 35 patients with Dupuytren's disease. The clinical and functional variables, as well as patient satisfaction and drug safety were evaluated. RESULTS: The functional and clinical results after its administration were good, with a rapid recovery, especially at the metacarpophalangeal (MCP) joint. The index finger contracture prior to MCP puncture was 64 degrees and after puncture it was 4 degrees. In the proximal interphalangeal (PIP) prior to puncture it was 83.3 degrees and after puncture it was 15 degrees; In the MCP/PIP prior to puncture it was 140 degrees, and after puncture it 25 degrees. CONCLUSIONS: Collagenase from Clostridium histolyticum an alternative of treatment of Dupuytren's disease, mainly in the elderly. More research is required in order to clarify the rate of recurrence of the disease, the possible adverse reactions, and to compare the efficiency and permanence with other treatment options.

Amputaciones y reimplantes / Amputation and reimplantation

Hoy en día, con el progresivo aumento de los viajes, el manejo de maquinaria industrial, los deportes de riesgo, etc, los accidentes en los que se producen amputaciones traumáticas de algún miembro son cada vez más frecuentes. Por tal motivo, se hace necesario conocer el manejo general para la recuperación de miembros amputados o gravemente dañados, ya que fundamentalmente de ello, dependerá la posibilidad de un futuro reimplante. El reimplante de segmentos amputados es una de las indicaciones quirúrgicas consideradas realmente urgentes, donde el factor tiempo tiene una importancia primordial. En este tipo de pacientes, la perfecta coordinación entre todos los participantes en el proceso del reimplante (personal de primera asistencia en el lugar del accidente, personal responsable del traslado al centro sanitario, personal de atención en urgencias, cirujanos, rehabilitadores, etc.) será decisiva en el resultado final. Pretendemos revisar este tipo de lesiones y actualizar los conocimientos existentes (AU)

Amputations due to accidental trauma have become more common in today's world of frequent travel, use of heavy machinery, and the practice of high-risk sports. An understanding of how to handle amputations or severely damagedlimbs has therefore become increasingly important, so that reimplantation remains a viable treatment option. Reimplantation of an amputated segment is considered a true emergency procedure in which timing plays a key role. All personnel involved in such procedures must coordinate their actions perfectly, starting at the moment of providing firstaid at the scene of the accident, and continuing with transfer to a hospital, emergency care on arrival, surgery, rehabilitation, etc. All will contribute to the final outcome in important ways. The aim of this update is to review current knowledge related to this type of injury (AU)

Microosteosíntesis con tornillos a cielo cerrado en las fracturas de la mano / Percutaneous screw fixation in hand fractures

Objetivo: Exponer la experiencia de los autores en la realización de la técnica de microosteo síntesis percutánea con tornillos para el tratamiento de ciertas fracturas de la mano. Material y método: Se realizó un estudio prospectivo en el período comprendido entre noviembre de 2002 y noviembre de 2006 en el que 84 pacientes con fracturas en la mano se trataron mediante osteosíntesis a cielo cerrado con tornillos. La localización de la lesión fue en la base del primer metacarpiano en 12 (14,28%) ocasiones y el resto fueron fracturas de las falanges (85,71%). Todas las fracturas eran cerradas y 40 fracturas eran intraarticulares (47,61%). El tipo de fractura más frecuente fue la oblicua larga en 68 casos (80,95%). Resultado: Los resultados funcionales obtenidos tras la última revisión (6 meses) fueron excelentes en 64 pacientes (76,19%), fueron buenos en 15 pacientes (17, 86%) y fueron malos en 5 pacientes (5,95%). Conclusiones: La osteosíntesis percutánea con tornillos disminuye el tiempo de inmovilización de la fractura al mínimo, favorece una recuperación funcional más temprana y no deja defectos estéticos. Es una técnica muy útil en fracturas y en pacientes especialmente seleccionados (AU)

Purpose: To expound our experience of percutaneous screw fixation in the treatment of certain hand fractures. Materials and methods: We carried out a prospective study between November 2002 and November 2006, in which 84 patients with hand fractures were treated by means of closed screw osteosynthesis. The injury was located at the base of the first metacarpal in 12 cases (14.28%) the remainder being phalangeal fractures (85.71%). All fractures were closed, 40 of them intra-articular (47.61%). The most frequent fracture type was the long oblique fracture, which was present in 68 cases (80.95%). Results: Functional results obtained at the last follow-up visit (6 months) were excellent in 64 patients (76.19%), good in 15 (17.86%) and poor in 5 (5.95%). Conclusions: Percutaneous screw fixation sharply reduces immobilization time permitting earlier functional recovery without causing any cosmetic defects. It is a highly useful technique for carefully selected fractures and patients (AU)