RESUMO
Background: In patients with a high recurrence risk after treatment for Dupuytren contracture (DC) by Collagenase Clostridium histolyticum (CCH), adjuvant medical therapy may improve the outcome. Non-steroidal anti-inflammatory drugs have been used in the treatment of similar fibroproliferative processes. The aim of this study was to investigate if adjuvant anti-inflammatory medication could improve the outcome of CCH treatment for DC. Methods: In a prospective double blinded randomised trial, the effect of adjuvant peroral celecoxib on the outcome of DC treated with CCH was investigated in 32 patients with a high fibrosis diathesis. Primary outcome was the increase in Total Passive Extension Deficit (TPED)/ray. Secondary outcomes were the TPED of the individual finger joints, Tubiana index, Disability of Arm, Shoulder and Hand score (DASH) and visual analogue scale (VAS) for pain and satisfaction. Results: A significantly greater improvement in the celecoxib group for TPED and metacarpophalangeal contracture was found. For the proximal interphalangeal joint, the effect was much less pronounced. The VAS for pain and satisfaction were better at 6 and 12 weeks in the celecoxib group. The other outcome parameters did not significantly differ between both groups. Conclusions: Adjuvant peroral administration of celecoxib might improve the gain in TPED after treatment with CCH in patients with DC and a high fibrosis diathesis, with a beneficial effect up to 24 months. Level of Evidence: Level II (Therapeutic).
RESUMO
Intraosseous schwannomas represent an extremely rare subgroup of schwannomas, accounting for <1% of all primary bone tumors. They mostly occur in the mandible, the maxilla, the sacrum, and they are also seen in long bones. We herein report a rare presentation of an intraosseous schwannoma in the glenoid of a 49-year-old patient. She complained of shoulder pain and was referred to the orthopaedic oncologist after detection of a suspicious lesion on imaging. Biopsy revealed benign spindle cells and immunohistochemistry was positive for S100. Because of the rarity of these intraosseous schwannomas it is important to recognize their radiological and histological features and make a differential diagnosis with other lytic tumors. Only if these characteristics are recognized, correct treatment can be given with definite curettage and bone grafting and correct follow-up with avoidance of unnecessary adjuvant therapy.
RESUMO
Recurrence after primary resection of a dorsal wrist ganglion may necessitate a reintervention. A technique was introduced in 2004 in which a flap of the extensor retinaculum is used to cover the defect left in the wrist capsule following repeat radical excision. This retrospective study presents the follow-up 4.6 years after this surgery in 20 patients. Recurrence, grip strength and possible flexion deficit are measured in 13 patients who attended clinic, as well as pain and satisfaction scores. Disability scores have been evaluated in 18 patients. One refractory patient was ascertained. A flexion deficit ≤ 10° was observed in 7 patients. Overall, mild pain, very mild disability, a flexion deficit of 14.2° and a loss of grip strength of 3.6 kg was observed. The retinaculum flap for recurrent dorsal wrist ganglion is a reliable procedure with limited risk for flexion deficit after surgery, high satisfaction rate and low recurrence risk.
