Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren's contracture in non-Caucasian Japanese patients (CORD-J Study): the first clinical trial in a non-Caucasian population.

To assess the efficacy, safety and pharmacokinetics of 0.58 mg collagenase Clostridium histolyticum injections for the treatment of Dupuytren's contracture in Japanese patients, we conducted a phase III, multicentre, uncontrolled, open-label clinical study in patients with Dupuytren's contracture. Of the 77 patients, 66 achieved clinical success in the primary treated joint (86%; 95% confidence interval: 76% to 93%), confirming the efficacy of collagenase Clostridium histolyticum injections. More improvement was seen in the metacarpophalangeal joints than in the proximal interphalangeal joints (94% versus 73%). The main adverse reaction was a local reaction in the injected hand. No tendon rupture or anaphylactic reactions were seen. The concentrations of collagenase Clostridium histolyticum were below the lower limit of quantification in plasma samples at all time points. As seen in global studies in Caucasian patients, a corrective effect on Dupuytren's contracture and good tolerance were observed in most non-Caucasian (Asian) Japanese patients. LEVEL OF EVIDENCE: Level 3.

Factors associated with ambulatory status 6 months after total hip arthroplasty.

OBJECTIVE: To identify an assessment tool and its cut-off point for indicating ambulatory status 6 months after total hip arthroplasty (THA). DESIGN: Cross-sectional study. SETTING: Kyoto University Hospital. PARTICIPANTS: Eighty-eight patients who underwent unilateral THA. MAIN OUTCOME MEASURE: Lower-extremity muscle strength, hip range of motion and hip pain were measured 6 months after THA. The patients were divided into two groups according to their ability to walk 6 months after THA: an independent ambulation group and a cane-assisted ambulation group. RESULTS: A stepwise multiple logistic regression analysis indicated that age and lower-extremity maximal load were significant variables affecting mid-term ambulatory status following THA. Receiver operating characteristic curve analyses revealed that ambulatory status following THA was indicated more accurately by leg extension strength (cut-off point=8.24N/kg, sensitivity=92%, specificity=82%, area under the curve=0.93) than age. CONCLUSION: Lower-limb load force with a cut-off point of 8.24N/kg is a reliable assessment tool for indicating ambulatory status 6 months after primary THA.

Transverse and longitudinal osteotomy for the treatment of macrodactyly simplex congenita - a case report.

We report on a three-year-old girl with a severely enlarged right ring finger, which was diagnosed as macrodactyly simplex congenita. This was treated by epiphysial resection and osteosynthesis of the distal interphalangeal joint, longitudinal and transverse osteotomy of the phalanges, and soft tissue coverage using palmar proximal and dorsal distal flaps taken from the original oversised finger.

The outcome of peri-operative humeral condylar fractures after total elbow replacement in patients with rheumatoid arthritis.

We compared the outcome of peri-operative humeral condylar fractures in patients undergoing a Coonrad-Morrey semiconstrained total elbow replacement with that of patients with rheumatoid arthritis undergoing the same procedure without fractures. In a consecutive series of 40 elbows in 33 patients, 13 elbows had a fracture in either condyle peri-operatively, and 27 elbows were intact. The fractured condyle was either fixed internally or excised. We found no statistical difference in the patients' background, such as age, length of follow-up, immobilisation period, Larsen's radiological grade, or Steinbrocker's stage and functional class. There was also no statistical difference between the groups in relation to the Mayo Elbow Performance Score, muscle strength, range of movement, or radiolucency around the implants at a mean of 4.8 years (1.1 to 8.0) follow-up. We conclude that fractured condyles can be successfully treated with either internal fixation or excision, and cause no harmful effect.

Lunate plasty for Kienböck's disease: use of a pedicled vascularised radial bone graft combined with shortening of the capitate and radius.

We treated eight patients with Kienböck's disease (two patients each with stage 1, 2, 3a and 3b disease by Lichtman's classification) by removing a pedicled, vascularised bone segment from the dorsal aspect of the distal radius and engrafting it into the lunate. Additional shortening of the radius was performed in patients with the ulna-minus or null variant. Shortening of the capitate and capito-hamate fusion were also performed in patients with stage 3 disease. All patients were relieved of their wrist pain at rest and during movement, and the mean grip strength increased from 37% of that in the contralateral hand before surgery to 80% after surgery. The mean post-operative range of motion in the affected wrist was 92% of that in the opposite wrist in patients with stage 1 and 2 disease, and 53% in patients with stage 3 disease. Post-operative assessment revealed that four patients had excellent results, three had good results, and one had a fair result.

Nerve regeneration over a 20-mm gap through a nerve conduit containing blood vessels in rats: the influence of interstump distance on nerve regeneration.

BACKGROUND: The present study was conducted in rats to investigate whether a tube with additional intrachamber vascularization could permit axons to extend over a distance greater than 10 mm, which appears to be the maximum axon regeneration distance for rat sciatic nerve axons through a normal empty tube. METHODS: A sural vessel-containing tube (VCT) was designed and interposed between transected sciatic nerve stumps in the thigh, leaving a 20-mm interneural gap. RESULTS: Twelve weeks after tubulation, six out of nine rats showed successful nerve regeneration and re-innervation of the soleus muscle using the VCT. At 24 weeks, intrachamber nerve regeneration and re-innervation of the soleus and pedal adductor muscles were electrophysiologically and histologically confirmed in all rats. However, no neural tissue was observed within any ligated sural vessel-containing tube (LVCT) or empty unmodified tube (ET) with a 20-mm interneural gap. When nerves regenerated in the VCT with a 20-mm gap were compared with those regenerated in a VCT with a 10-mm gap 12 and 24 weeks after surgery, the results produced by the VCT with a 20-mm gap were inferior to those after use of the VCT with a 10-mm gap, except for motor nerve conduction velocity at 24 weeks. CONCLUSIONS: The value recovered to almost identical levels (about 50-60% normal) in both groups.

Nerve regeneration over a 25 mm gap in rat sciatic nerves using tubes containing blood vessels: the possibility of clinical application.

This study was undertaken to investigate the effect of including vessels in a tube used to promote nerve regeneration across a gap. A tube containing sural vessels was designed in a rat model and interposed between the proximal and distal stumps of a divided sciatic nerve, leaving a 25 mm gap. At 12 weeks, a few myelinated axons were seen at the most distal parts of regenerated nerves in 6 out of 10 rats, none of which evoked action potentials in the tibialis anterior muscle, but by 24 weeks all the rats had developed neural tissue in the tubes, which evoked action potentials in the muscle. The vessels within the tube enhanced nerve regeneration and its distance up 25 mm. This type of vessel-containing tube would be useful for the repair of divided human peripheral nerves with long gaps, almost equivalent to or slightly longer than the maximum length over which nerve fibres can regenerate through a unvascularised unmodified tube.

Relationship between axonal regeneration and vascularity in tubulation--an experimental study in rats.

This study investigated the effect of vascularity in a nerve conduit on peripheral nerve regeneration. The effect of three different types of tube (empty, blood vessel-containing and ligated vessel-containing) was compared using a rat sciatic nerve preparation with a 10-mm gap. Nerve regeneration through the vessel-containing tube was more efficient than in the other tubes 6 and 12 weeks after tubulation surgery, but there were no statistically significant differences among the three types of tube after 24 weeks. Electrophysiological, histological and microangiographic studies showed that vessels which were preinserted in the nerve conduit accelerated axonal regeneration through rapid capillary formation in the tube.

Wrap-around neurorrhaphy: an improved method of repair for disparate nerve stumps.

We report a new method of nerve Reconstruction, wrap-around neurorrhaphy, in which the funicular suture site is wrapped with the epineurium of the larger stump. The specific applications of this procedure in brachial plexus reconstruction are described and the clinical results presented. The method was applied in intercostal nerve transfer to the musculocutaneous nerve in 21 patients and in 12 patients with axillary nerve injury who underwent reconstruction with autografts using wrap-around neurorrhaphy. Rigid fixation of the neurorrhaphy site could be obtained using this method, and the clinical results were satisfactory.