ABSTRACT
BACKGROUND: Dupuytren is a fibroproliferative pathology leading to contracture of the palmar fascia. Several approaches have been described for the surgical treatment with partial fasciectomy with few comparisons in literature. Our purpose is to compare the functional outcomes between the partial fasciectomy performed by Bruner type incision and zetaplasty incision. METHODS: The method used was a randomized clinical trial including adult patients of both sexes with surgical indication for Dupuytren disease presented to a reference center. Patients were randomly and consecutively allocated in the groups 1:1. We recorded the Disabilities of the Arm, Shoulder, and Hand (DASH) score; range of motion for active and passive extension of the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints; visual analog scale for pain; and complications. RESULTS: In all, 62 patients were included, with 48 patients reaching the minimum follow-up of 6 months with 63 operated fingers. In the Bruner approach group, we obtained a correction of the active and passive extension of the MP of 28° and of the PIP of 23°. In the zetaplasty group, correction of MP was 30° for active and passive, and 18° for active extension and 16° for passive extension of the PIP. The reduction in the DASH score was 10 points in the Bruner group and 22 points in the zetaplasty group. There was no statistically significant effect of the type of treatment on preoperative and postoperative differences in any of the parameters evaluated. CONCLUSIONS: There were no statistically significant differences between the 2 techniques for self-reported functional outcomes or objective measures of physical examination.
ABSTRACT
OBJECTIVES: To compare the radiographic and functional outcomes of 2 surgical techniques for treating scaphoid nonunion. DESIGN: Randomized prospective study. PATIENTS/PARTICIPANTS: Researchers assessed the outcomes every 2 weeks until bone healing and at discharge. INTERVENTIONS: (1) Vascularized bone grafting (VBG) using the 1, 2 intercompartmental suprareticular artery and (2) a distal radius nonvascularized bone graft. MAIN OUTCOMES/INTERVENTIONS: Time to union (primary), union rate, and functional outcomes. RESULTS: Seventy-five patients were followed for 29 months; 2 were lost to final follow-up. Both groups had similar baseline characteristics. The VBG group reached bone union earlier by 12 days (P = 0.002), but union rates were similar (P = 0.312). There was also less ulnar deviation in the VBG group (P = 0.03). There were no other differences between either intervention groups. CONCLUSIONS: Although the VBG group attained earlier union, this may not be clinically meaningful, nor justify the greater technical difficulty and use of resources associated with this intervention. LEVEL OF EVIDENCE: Therapeutic Level II. See instructions for authors for a complete description of levels of evidence.
