Clinical outcomes of absorbable plates (hydroxyapatite-poly-l-lactide composites) for phalangeal fractures - case reports.

We report two cases of the basal phalanx fractures of the thumb treated with absorbable mesh plates. In both cases, the mesh plates specifically tailored for each fracture were effective in obtaining bone union and healing. We conclude that absorbable mesh plates could be a practical option for phalangeal fractures, especially where proprietary pre-molded metallic plates do not neatly fit the reduced fracture area.

DIFFUSION OF INJECTED COLLAGENASE CLOSTRIDIUM HISTOLYTICUM FOR DUPUYTREN´S DISEASE: AN IN-VIVO STUDY.

INTRODUCTION: While injecting Clostridium Histolyticum as a non-surgical tratment for Dupuytrens disease on the palmar side of the hand the recommended depth of the needle should be “around 2 to 3 mm in depth”. The diffusion of CCH inside the soft tissues around the cord might explain the occurrence of common adverse events reported in the literature such as oedema, injection site swelling, blood blisters, skin laceration, and pain in extremity. We hypothesized that the injected Collagenase Clostridium Histolyticum does not only concentrate inside the cord but also dissipates both along the cord and into the adjacent tissues. This study investigated our hypothesis by visual intraoperative findings after injecting Povidone iodine into the cord. MATERIAL AND METHODS: Povidone iodine  (PI)was injected into the cord on six patients with Dupuytrens contracture before an open surgical operation (partial fasciectomy). We marked three hypothetical Collagenase Clostridium Histolyticum injection points at 2 mm intervals on the skin above the cord around the metacarpo-phalangeal joint and the depth of the injection (distance from the skin surface to the middle of the cord) was measured by ultrasonography. After dispensing 0.25 ml of Povidone iodine into the three points at the measured depths, we performed careful dissection and investigated the extent of diffusion of Povidone iodine visually. RESULTS: The injection depth averaged 2.6 mm. In all cases, the cord was homogenously stained about 10 mm along its extent centrally to the injected sites and infiltration of Povidone iodine into the subcutaneous structure and fat tissue occurred. Three cases showed diffusion into the neurovascular bundles and two cases showed infiltration underneath the cord structure. CONCLUSIONS: This study simulated the likely diffusion outcomes of injected Collagenase Clostridium Histolyticum around the cord. This implies that even if Collagenase Clostridium Histolyticum is injected into the centre of the cord, it does not concentrate inside the cord only but also dissipates along the cord and infiltrates into the adjacent tissues with potential secondary damages.

OPTIMAL INJECTION DEPTH FOR COLLAGENASE CLOSTRIDIUM HISTOLYTICUM DETERMINED BY ULTRASONOGRAPHY IN THE TREATMENT OF DUPUYTREN´S DISEASE.

INTRODUCTION: A non-surgical procedure for the treatment of Dupuytrens disease is a palmar injection of Collagenase Clostridium Histolyticum to the recommended depth of “around 2-3 mm”. However, there is little supporting evidence from the literature to substantiate this. The aim of this study was to evaluate the “optimal depth” for injection of Collagenase Clostridium Histolyticum by ultrasonography for the treatment of Dupuytrens disease. MATERIAL AND METHODS: A total of 43 patients were enrolled in this study. We marked the collagenase injection point on the skin above the cord before injection. We then measured the distance from the surface of the skin to the middle of the cord by ultrasonography long axis imaging and defined this as the “optimal depth”. RESULTS: The average depth from the skin to the centre of the cord was 2.4 mm. The average distance from the surface of the skin to the proximal surface of the cord was 1.0 mm and the average thickness of the cord was 2.7 mm. CONCLUSION: By precise measurement of individual cases utilising ultrasonography we were able to confirm that the recommendations for injection depth as provided by the supplier of Collagenase Clostridium Histolyticum (2-3 mm) were in agreement with our findings. However no objective guide was supplied as with regards to interindividual variability between patients and we suggest that the use of preliminary ultrasonography will likely provide improved outcomes.

Repair of osteochondral defects with a new porous synthetic polymer scaffold.

We developed a new porous scaffold made from a synthetic polymer, poly(DL-lactide-co-glycolide) (PLG), and evaluated its use in the repair of cartilage. Osteochondral defects made on the femoral trochlear of rabbits were treated by transplantation of the PLG scaffold, examined histologically and compared with an untreated control group. Fibrous tissue was initially organised in an arcade array with poor cellularity at the articular surface of the scaffold. The tissue regenerated to cartilage at the articular surface. In the subchondral area, new bone formed and the scaffold was absorbed. The histological scores were significantly higher in the defects treated by the scaffold than in the control group (p<0.05). Our findings suggest that in an animal model the new porous PLG scaffold is effective for repairing full-thickness osteochondral defects without cultured cells and growth factors.