Volar plate fixation in intra-articular distal radius fractures with a volar lunate facet fragment.

The aims of the study were to determine whether a volar lunate facet fragment is present in 67 displaced intra-articular distal radius fractures and to investigate which factors are associated with reduction loss after treatment with a volar plate and locking screws. The fractures were analyzed preoperatively with three-dimensional computed tomography. The volar lunate facet fragment was present in 42 fractures. Reduction loss occurred in five wrists and in two of those, the carpus was subluxated. Loss of reduction was associated with a short palmar cortex (9mm or less) of the volar lunate facet fragment. This study has shown that measuring the length of the palmar cortex of a volar lunate facet fracture fragment may be useful for identifying distal radius fractures that have a higher risk of displacement after treatment with a standard volar plate and locking screws.

Effectiveness and safety of collagenase Clostridium histolyticum in Dupuytren's disease : an observational study in Belgium.

Dupuytren's disease is a connective tissue disorder leading to contractures. It can be treated surgically or through injections of collagenase Clostridium histolyticum (CCH). Patients with Dupuytren's contracture (> 20°) and a palpable cord were included in this observational study, aiming to characterise the Belgian patient population and to assess the effectiveness and safety of CCH. Overall, 108 patients (114 joints) received at least one injection of CCH, and 104 patients completed the study. The percentages of joints achieving a degree of contracture of 5° or less, or a relative contracture reduction of at least 50% after the extension procedure were 64.9% and 90.1%, respectively. The mean number of injections per cord was 1.0. The Unité Rhumatologique des Affections de la Main score decreased from 29.4 ±â€ˆ11.0 to 12.9 ±â€ˆ6.3 (mean ±â€ˆSD ; p < 0.0001). CCH was demonstrated to be effective, safe and able to increase quality of life.

Therapeutic innovations in inflammatory bowel diseases.

Inflammatory bowel disease (IBD) is a spectrum of complex multifactorial immune disorders characterized by chronic inflammation of the gut. Significant advances have been made in unraveling the pathogenesis of this disease spectrum, which have spurred the discovery of new therapeutic targets and strategies. In this review, we highlight the emerging new classes of IBD therapeutics under clinical evaluation and their method of action, including JAK inhibitors, anti-SMAD7 oligonucleotides, and cell-based therapies. Moreover, we discuss how an approach based on unique molecular insights in a given patient will, in the future, lead to a truly individualized/tailored disease management, starting at diagnosis, aiding in prognosis, and resulting in a personalized therapeutic approach.

Short communication: Correlation of on-site inspection and laboratory milk testing results for Wisconsin grade A dairy farms in 2007 and 2008.

This study examined whether regulatory on-site dairy farm inspection results correlated with reported laboratory somatic cell count (SCC), standard plate count (SPC), and beta-lactam drug residue (DR) results for individual farms. Results were obtained for Wisconsin grade A dairy farms in 2007 and 2008 (>11,000 farms, >1.4 million data points). The proportion of farms failing an on-site inspection ranged from 12% for farms that had never failed an SCC test (>750,000 cells/mL), an SPC test (>100,000 cfu/mL), or a DR test (drug detected) to 55% for farms that had failed at least 1 of each type of test. Conditional probability analysis showed that the probability of a farm failing an on-site farm inspection was higher if the farm had failed a DR test and increased as the proportion of samples failing SCC or SPC or both increased. However, the statistical correlations were weak (R

Muscle fibres crossing the line of incision used in carpal tunnel decompression.

Muscle fibres that cross the proposed line of incision of the flexor retinaculum at carpal tunnel decompression can be a source of confusion, particularly for the less experienced surgeon. We investigated how frequently muscle fibres crossed the line of incision on the palmar surface of the flexor retinaculum at carpal tunnel decompression in 143 hands, and dissected 103 cadaver hands to study the origin and insertion of these muscle fibres. The line of incision was defined as a longitudinal line between thenar and hypothenar eminences along the third web space, with the wrist in neutral radioulnar deviation and the fingers in extension. Muscle fibres crossing the line of incision were absent in 50% of the operated hands, 2-10 mm wide in 39% and more than 10 mm wide in 11%. In the cadaver hands the proportions were similar at 50%, 35% and 15%, respectively. The fibres were extensions of the thenar and hypothenar muscles and did not appear to represent a separate anomalous muscle.

Proximal row carpectomy versus four-corner arthrodesis as a treatment for SLAC (scapholunate advanced collapse) wrist.

Four-corner arthrodesis and proximal row carpectomy are motion-preserving salvage solutions for the scapholunate advanced collapse wrist. We compared both procedures in a non-randomised, retrospective study of 30 cases with a mean follow-up of 3(1/2) years. Pain relief and functional gain were equal in both treatment groups. However, the complication rate was higher in the four-corner arthrodesis group, partly because of the need for internal fixation. The higher incidence of carpal tunnel syndrome following four-corner arthrodesis is intriguing. We also found significant differences in the duration of hospital stay and of postoperative sick leave in favour of proximal row carpectomy. If the cartilage on the capitate head is well preserved (Stages I-II), we prefer proximal row carpectomy because of the socio-economic benefits, the lower complication rate and the ease of the procedure. Degenerative changes following proximal row carpectomy may be a concern in young manual labourers, but have not been observed.