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Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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School of Medicine, Faculty of Medicine and Health Sciences, Taylor's University, Selangor, Malaysia
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Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Dupuytren’s contracture (DC) is a fibroproliferative disorder of the palmar fascia characterised by the digits’ flexion contractures and is associated with abnormal build-up of type III collagen. The prevalence of the disease is reported to be highest among Northern European descendants. However, the disease is widespread globally with varying prevalence.
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DC is a multifactorial disease, having both genetic and environmental factors contributing to the causality of the disease.
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Over the years, various studies have been conducted to understand the molecular mechanism and genetic aspects of DC but there is a lack of reports on the variants found in the exonic regions. Most reports are backdated making it necessary to re-evaluate the variants to further understand the genetic aetiology of DC.
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In this review, we first highlight the genetic aspects and previous genetic studies on DC. The report is followed by a discussion on the molecular pathways suggested to be associated with DC and a summary of the genetic variants in the exonic regions found in DC and their connections with the molecular pathways.
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A total of nine variants were reported originating from six genes comprising three pathways. Most variants reported are involved in the Wnt signalling pathway. Moreover, all variants identified are in European/Caucasian subjects and the variants found in the exonic regions are missense variants.
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A comparison of these findings with variants from populations of other regions can be conducted to identify the variants with the most occurrence to act as biomarkers or therapeutic targets for DC.
Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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Purpose
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Controversy exists regarding the comparative efficacy of collagenase injection and percutaneous needle fasciotomy in the treatment of Dupuytren contracture. The randomized controlled trials (RCTs) that have compared the two treatment methods have reported results mostly implying similar treatment efficacy, durability, and complications. We aimed to review these RCTs regarding methodical quality and risk of bias.
Methods
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We searched PubMed and Cochrane Library databases up to May 2023. All RCTs comparing collagenase injection with needle fasciotomy were included. Eligible articles were reviewed by two researchers, of whom one was blinded to each article’s title, authors, year of publication, journal, and source of the studies. To assess methodical quality, we used the modified Jadad scale yielding a score of 0 (lowest quality) to 5 (highest quality). We assessed risk of bias with the Cochrane risk-of-bias tool (RoB 2).
Results
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Five studies were eligible, comprising 204 patients treated with collagenase injection and 209 patients treated with needle fasciotomy. The modified Jadad score ranged from 1 to 2 points in the five studies, and the overall risk of bias was high in all studies. Pretrial protocols could be retrieved for only two studies, revealing important discrepancies with the published articles.
Conclusion
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The published RCTs that have compared collagenase injection with needle fasciotomy in the treatment of Dupuytren contracture demonstrate a high risk of bias.
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Wide-awake local anesthesia no tourniquet is named the WALANT technique.
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WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years.
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Safe and efficient application of the technique is based on two principles.
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The first principle is the tumescent injection of a large volume low concentration 0.25–1% lidocaine, with 1:100 000–1:400 000 epinephrine.
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The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle.
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This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.
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Superficial acral fibromyxoma, also known as digital fibromyxoma, is a slow-growing, benign, solitary soft tissue tumor. First described in 2001 by Fetsch et al., it is a condition that often occurs in middle-aged individuals. However, it has also been reported across a wide range of ages, ranging from 4 to 86 years, with males more commonly reported. The condition often presents as solitary soft tissue swelling over the periungual or subungual.
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We present the management experience of the rare presentation of this rare tumor and a detailed review of the past literature on this condition. Detailed management of the condition has been described, along with the outcome after 2 years of follow-up and treatment experience.
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Our detailed analysis shows that 2 years is the shortest duration of follow-up to rule out recurrence. Hence, most of the cases reported earlier had given the false sense of the recurrence rate of the tumor, which could lead to undertreatment of the condition.
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The purpose of this article is to allow the readers to understand better the tumor’s characteristics with bone involvement and the tumor's diagnostic strategies and treatment options.
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In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren’s contracture.
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The risk for complications is significant, certainly in recurrent disease and in the presence of abundant scar tissue.
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Meticulous surgical technique is mandatory.
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Microsurgery increases magnification from four times (with surgical loupes) up to 40 times.
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Using the microscope in Dupuytren’s surgery, a technique named microfasciectomy is likely to increase both safety and efficiency by preventing instead of treating surgical complications.
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Increased experience with microsurgery will benefit Dupuytren’s treatment and hand surgery in general.
Hand Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Purpose
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Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or combined PIN plus (+) anterior interosseous nerve (AIN) neurectomy procedures.
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The purpose of the current systematic review is to investigate any differences in clinical outcomes and failures in patients undergoing AIN + PIN vs isolated PIN neurectomy.
Methods
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A review of the English Literature was performed on Medline, WOS and Scopus according to PRISMA protocol combining ‘wrist denervation’, ‘PIN neurectomy’, ‘AIN neurectomy’, anterior interosseous nerve neurectomy’ and ‘posterior interosseous nerve neurectomy’. Studies were assessed with a modified Coleman Methodology Score (CMS). The primary outcome for meta-analysis was ‘Failures’, including all patients who have required a second surgery or those who are left with pain (defined as ‘bad’).
Results
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Overall, 10 studies totalling 347 wrists were included in this systematic review, with a ‘moderate’ CMS. The isolated PIN neurectomy technique showed a 15.1% pooled failure rate at a median follow-up of 22 months, while the combined AIN+PIN denervation had a pooled failure rate of 23.6% at a follow-up with a median of 29 months. The combined analysis of both procedures did not show significantly better results in favour of either technique, with a general failure rate of 21.6% (P = 0.0501).
Conclusion
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Partial denervation for chronic wrist pain is a salvage procedure that leads to an overall success of 78.4% for pain relief, with no substantial complications. Apparently, performing the neurectomy also of the AIN does not offer greater advantages compared to the isolated PIN neurectomy.
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Surgical Department - Hand Surgery Unit EOC, Locarno's Regional Hospital, Locarno, Switzerland
Locarno Hand Center, Locarno, Switzerland
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Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Introduction
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The aim of this systematic review and meta-analysis was to evaluate whether volar locking plate (VLP) fixation leads to better clinical and radiological outcomes than those of closed reduction and cast immobilization for the treatment of distal radius fractures (DRFs).
Materials and methods
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A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane databases up to January 2022. Inclusion criteria included randomized controlled trial (RCT) studies comparing VLP fixation with cast immobilization for DRFs. Investigated parameters were Patient-Rated Wrist Evaluation questionnaire, Disabilities of the Harm, Shoulder, and Hand score (DASH), range of motion (ROM), grip strength, quality of life (QoL), radiological outcome, and complication and reoperation rate, both at short- and mid-/long-term follow-up. Assessment of risk of bias and quality of evidence was performed with Downs and Black’s ‘Checklist for Measuring Quality’.
Results
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A total of 12 RCTs (1368 patients) were included. No difference was found for ROM, grip strength, QoL, and reoperation, while the DASH at 3 months was statistically better in the VLP group (P < 0.05). No clinical differences were confirmed at longer follow-up. From a radiological perspective, only radial inclination (4°) and ulnar variance (mean difference 1.1 mm) at >3 months reached statistical significance in favor of the VLP group (both P < 0.05). Fewer complications were found in the VLP group (P < 0.05), but they did not result in different reintervention rates.
Conclusions
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This meta-analysis showed that the surgical approach leads to a better clinical outcome in the first months, better fracture alignment, and lower complication rate. However, no differences in the clinical outcomes have been confirmed after 3 months. Overall, these findings suggest operative treatment for people with higher functional demand requiring a faster recovery, while they support the benefit of a more conservative approach in less demanding patients.
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Total joint replacement has certain advantages over other surgical treatment methods for osteoarthritis of the thumb carpometacarpal joint, including restoration of thumb length and alignment, good cosmetical result, fast recovery of hand function and prevention of iatrogenic complications at neighbouring joints.
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Disadvantages include the technical difficulty to perform this surgery and a possible higher complication rate.
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A meticulous surgical technique is mandatory.
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Combined with a cementless and modular ball-in-socket implant with a metal-on-polyethylene friction couple, a 10-year survival rate higher than 90% can be expected.
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Revision surgery is possible with implant exchange or conversion to trapeziectomy.
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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The Swedish National Patient Insurance Company, Stockholm, Sweden
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Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
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Misdiagnosed and maltreated scaphoid fractures filed to the Swedish National Patient Insurance Company (LÖF) 2011–2018 were analyzed in terms of complications and costs for society. All filed claims are database-registered (altogether 200 000 claims since 2000). This database was assessed in June 2019 through injury ICD10-SWE-diagnoses. Demographics, complications, complaints, corrective surgeries and costs were analyzed. The numbers of claims for scaphoid fractures were reviewed and compared with all claims.
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There was a statistically significant trend towards decreasing numbers of notified scaphoid fracture cases during this time. This is not the case compared with the total annually notified injuries to LÖF during the same time, where we instead can see statistically significant increased numbers.
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Median age for the 128 patients was 24 years. Men represented 76%. Seventy-eight of the 128 (61%) claims were judged as avoidable, compared with 42% in terms of all notified injuries. Pseudoarthrosis dominated as complication (n = 71). Total numbers of complications were 117, and 47 of the 78 patients had medical invalidity as a consequence. Up to six secondary corrective surgeries per patient were required. Complications and disabilities were more severe if patients needed more than one surgery. The total costs were calculated to €1 226 193.
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Level of Evidence: LoE III, Therapeutic.
Department of Orthopaedics and Traumatology, Paracelsus Medical University, Nuremberg, Germany
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Institute for Hand- and Plastic Surgery, Oldenburg, Germany
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Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results.
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Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally.
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The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies.
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A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring.
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All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.
