Three-Year Recurrence of Dupuytren Contracture after Needle Fasciotomy or Collagenase Injection: A Randomized Controlled Trial.

BACKGROUND: In this randomized controlled trial, the authors compared the recurrence of Dupuytren disease at 3 years following needle fasciotomy or collagenase injection treatment for isolated metacarpophalangeal joint contractures. METHODS: The study was conducted between 2013 and 2015. The study design was a single-center, randomized controlled clinical trial with an independent blinded observer. Patients were randomized between collagenase clostridium histolyticum injections (Xiapex) and percutaneous needle fasciotomy (collagenase clostridium histolyticum versus percutaneous needle fasciotomy). A total of 36 patients were followed in the percutaneous needle fasciotomy group and 32 in the collagenase clostridium histolyticum group. RESULTS: Patients who were treated with collagenase clostridium histolyticum had a significantly lower recurrence rate than patients treated with percutaneous needle fasciotomy during the 3-year period ( P = 0.007). Of the 36 patients who were followed in the percutaneous needle fasciotomy group, 17 (47%) had recurrence of extension deficit or progression of the disease leading to further treatment. Of the 32 patients who were followed in the collagenase clostridium histolyticum group, six (19%) had recurrence or progression. No serious adverse event was reported in any of the patients. CONCLUSIONS: In this randomized controlled trial, we found less recurrence and progression of Dupuytren disease using collagenase injection as compared to percutaneous needle fasciotomy 3 years following treatment for isolated metacarpophalangeal joint contractures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Base fractures of the fifth proximal phalanx can be treated conservatively with buddy taping and immediate mobilisation.

INTRODUCTION: Treatment of base fractures in the proximal phalanx depends on the fracture type, the degree of displacement and whether fracture reduction is stable or not. Internal fixation often leads to decreased mobility of the injured finger despite exact reduction of the fracture. Our treatment is focused upon function and to a lesser extent on exact reposition of the fractured fifth digit. Buddy taping was used after initial, closed reduction of the fracture allowing for immediate mobilisation. MATERIAL AND METHODS: This was a prospective follow-up study of 53 consecutive conservatively managed base fractures in 53 patients with a mean age of 39 years. All fractures were treated with buddy taping to the fourth digit and immediate mobilisation. RESULTS: The subjective outcome showed high overall satisfaction, and only four patients reported mild pain at rest or work. Malrotation was noted in three cases, none of which needed corrective surgery. All but one patient regained full flexion of the affected finger. Satisfactory extension was seen as only two patients had a lack of extension in both the metacarpo-phalangeal and the proximal interphalangeal joint. No nonunion or delayed unions occurred. CONCLUSION: In the literature there is no consensus on the treatment of fractures in the base of the proximal phalanx in the fifth digit. We propose conservative management with buddy taping which enables immediate mobilisation of this particular fracture. FUNDING: Not relevant. TRIAL REGISTRATION: No trial registration of this quality study was performed.

Missed isolated volar dislocation of the scaphoid.

A patient presented with volar dislocation of the scaphoid, the diagnosis of which had been missed for two weeks. He was treated with open reduction through a combined volar and dorsal approach with decompression of the median nerve, internal fixation, and a cast for eight weeks. One year postoperatively the functional result was good. A radiograph showed no sign of avascular necrosis.