Collagenase Clostridium Histolyticum for Dupuytren's Contracture: Comparing Single and Concurrent Injections.

BACKGROUND: The U.S. Food and Drug Administration approved collagenase clostridium histolyticum for treatment of Dupuytren's contracture in 2010, and for the concurrent treatment of up to two cords in 2014. Although outcomes and adverse events have been well described for single injections, comparative data on concurrent injections are lacking. METHODS: The authors reviewed 121 concurrent collagenase clostridium histolyticum injections and compared these with 177 single injections over 8 years. All injections were performed by a single surgeon, our senior author (D.F.). A retrospective cohort model was used to compare clinical outcomes and adverse events (i.e., skin tears, spontaneous cord rupture, tendon rupture, lymphadenopathy, blood blisters, and ecchymosis) between groups. RESULTS: There were no statistical differences between groups in clinical success rate or change in contracture per joint. The rate of skin tears per joint in concurrent injections (22.3 percent) was not statistically different from that of single injections (18.6 percent; p = 0.46), and was consistent with previously reported rates. The rate of skin tears did not change significantly over time in either group. Concurrent injection did not influence the incidence of skin tears in a dose-dependent manner (relative risk, 1.20). Patients receiving concurrent injections experienced a higher rate of lymphadenopathy compared with those receiving single injections (p = 0.001). CONCLUSIONS: Concurrent collagenase clostridium histolyticum injections for Dupuytren's contracture have a similar safety profile and treatment efficacy when compared to single injections. The authors did not find a dose-dependent relationship between skin tears and collagenase clostridium histolyticum injected. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

An Extradigital Glomus Tumor of the Median Antebrachial Vein.

Glomus tumors are benign vascular neoplasms that arise from specialized dermal arteriovenous anastomoses called glomus bodies. These tumors are most often found in the digital pulp and subungual region of the fingertips; however, a review of the literature suggests that extradigital glomus tumors may occur more often than is generally recognized. Although most extradigital glomus tumors arise within subcutaneous tissues, glomus tumors have occasionally been found within bones, nerves, and blood vessels. An intravascular glomus tumor of the forearm is a very rare occurrence and only a few cases have been reported in the literature. Here we describe a 55-year-old right-handed man with a 10-year history of exquisite tenderness and dysesthesia of his right proximal forearm. Surgical exploration revealed the presence of a mass arising from the median antebrachial vein, which was confirmed histologically to be a glomus tumor.