Analysis of efficacy and safety of treatment with collagenase Clostridium histolyticum among subgroups of patients with Dupuytren contracture.

Collagenase Clostridium histolyticum (CCH) injection is a nonoperative treatment of hand contractures from Dupuytren disease. This study assessed the efficacy and safety of CCH in several subgroups of patients with increased surgical risk.Data were pooled from 3 randomized, placebo-controlled, double-blind trials. This analysis included 271 patients with metacarpophalangeal (n = 167) or proximal interphalangeal (n = 104) joint contractures greater than or equal to 20 degrees treated with CCH (0.58 mg collagenase per injection). Subgroups included age, sex, and diabetes status. End points included rate of clinical success (reduction in contracture to 0-5 degrees of normal) and percentage of adverse events.There was no significant difference in clinical success by age, diabetes status, or sex with 63% reaching the end point. There was no difference in adverse events among the subgroups, with peripheral edema, contusion, and injection-site hemorrhage being most common.High-risk subgroups do not demonstrate differences in efficacy or safety with CCH treatment of Dupuytren-related contractures.

Guidelines for ethical and professional use of social media in a hand surgery practice.

In growing numbers, patients are using social media platforms as resources to obtain health information and report their experiences in the health care setting. More physicians are making use of these platforms as a means to reach prospective and existing patients, to share information with each other, and to educate the public. In this ever-expanding online dialogue, questions have arisen regarding appropriate conduct of the physician during these interactions. The purpose of this article is to review the laws that govern online communication as they pertain to physician presence in this forum and to discuss appropriate ethical and professional behavior in this setting.

Extensor mechanism repair failure with use of bidirectional barbed suture in total knee arthroplasty.

Total knee arthroplasty (TKA) continues to advance as innovative devices become available. #2 PDO Quill SRS (Angiotech, Reading, Pa) bidirectional barbed suture was used for 161 primary TKAs at our facility. We report on 3 separate cases of extensor mechanism repair failure after primary TKA in which a barbed suture was used for extensor mechanism closure. Before the implementation of this device, there were no reported failures in 385 primary TKAs. We recommend that surgeons who use this device for extensor mechanism repair of a medial parapatellar arthrotomy in TKA exercise caution when operating on patients with morbid obesity, diabetes, and rheumatoid arthritis. We have discontinued use of the bidirectional barbed suture until more definitive large orthopedic studies establish its efficacy and safety.

Nontraumatic, spontaneous dislocation of polyethylene tibial insert 1 year after TKA.

The authors report a case of nontraumatic, spontaneous dislocation of a polyethylene insert detected 1 year after total knee arthroplasty. The patient demonstrated initial improvement and returned to work 4 months postoperatively. At 6 months postoperatively, the patient developed pain and a clunking sensation with motion; however, he denied any traumatic precipitating events. An arthroscopic procedure revealed arthrofibrotic formations but no signs of locking mechanism failure. At 12 months postoperatively, the patient developed sudden instability, and radiographs demonstrated an anteriorly dislodged insert. Revision surgery was performed, and the insert was removed. The insert showed some signs of fatigue due to the locking mechanism. We postulated that repetitive flexion produced an anterior superior force leading to failure of the locking mechanism.

The extended-short nail system, a novel concept in the management of proximal femur fractures.

In light of recent health care reform and the aging US Medicare population, it is becoming increasingly important for orthopedic surgeons to use effective and efficient strategies for hip fracture surgery. The Extended-Short Nail System (ES nail) is a US Food and Drug Administration-approved titanium nail which is locked at the same location as the locking hole of a short intramedullary (IM) nail. The ES nail takes advantage of an "extended-short" hybrid design combining the mechanical characteristics of a long IM nail with the surgical ease of use offered with a short IM nail.