Tuesday, June 21, 2011

Dupuytren's Disease updates Needle Aponeurotomy and Xiaflex are on Facebook

Dupuytren's Disease updates Needle Aponeurotomy and Xiaflex are on Facebook


Dupuytren's Disease New Treatment Updates: Xiaflex and Needle Aponeurotomy

Needle Aponeurotomy and Xiaflex update from the Hand Center of Western MA
Posted by at No comments:

HAND SURGERY PODCASTS

selected podcasts by Dr. Jeffrey C. Wint of the Hand Center of Western Massachusetts
 Dr. Wint recently began a series of Hand Surgery Podcaststo better explain the role of surgery to his patients.  His most popular podcast deals with Endoscopic Carpal Tunnel Release Surgery.  These Hand Surgery Podcasts are also available in ITUNES 
Posted by at No comments:

Needle Aponeurotomy Articles

Needle Aponeurotomy Articles
 
These review articles discuss early results of 
Needle Aponeurotomy for Duypuytren’s Disease
Percutaneous needle aponeurotomy: complications and results G. Foucher, J. Medina and R. Navarro From SOS main Strasbourg, clinique du Parc, 4, boulevard du Président Edwards, 67000 Strasbourg, France Available online 27 August 2003. Abstract Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was 6 years. Division of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely in the finger in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during a second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). The reoperation rate was 24%. In the group assessed at 3.2 years follow up, the recurrence rate was 58% and disease ‘‘activity” 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and predominant MP contracture. Chirurgie de la main 2001;20:206–211 © 2001 Editions scientifiques et medicales Elsevier SAS. Copyrights S1297-3202(01)0035-X/FLA. Corresponding Author Contact InformationCorresponding author. Dr G. Foucher, SOS main Strasbourg, clinique du Parc, 4, boulevard du Président Edwards, 67000 Strasbourg, France. Tel.: +33-3-88-35-4500; Fax: +33-3-88-24-0707; E-mail: ifssh@aol.com *1 Translated from Chirurgie de la main 2001:20:206–11 © 2001 Editions scientifiques et médicales Elsevier SAS. Copyright S1297-3202(01)00035-X/FLA. Copyright © 2006 American Society for Surgery of the Hand Published by Elsevier Inc. Dupuytren’s disease A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren’s Disease: A 6-Week Follow-Up Study Annet L. van Rijssen MD, Feike S.J. Gerbrandy MD, Hein Ter Linden MD, Helen Klip PhD and Paul M.N. Werker MD, PhDCorresponding Author Contact Information, E-mail The Corresponding Author Department of Plastic, Reconstructive, and Hand Surgery, Isala Clinics, Zwolle, the Netherlands Received 19 August 2005; accepted 15 February 2006. Available online 19 May 2006. Purpose The demand for percutaneous needle fasciotomy (PNF) as treatment for Dupuytren’s disease is increasing because of its limited invasiveness, good outcome, limited number of complications, quick recovery, and overall patient satisfaction. This randomized controlled trial was designed to test whether these short-term expectations are sound by comparing this treatment with limited fasciectomy (LF) with regard to these aspects. Methods We treated 166 rays: 88 by PNF and 78 by LF. Total passive extension deficit (TPED) improvement at 1 week and at 6 weeks were the primary outcome parameters; patient satisfaction, hand-function recovery, and complication rate were secondary outcome parameters. We used the Disabilities of the Arm, Shoulder, and Hand questionnaire to measure disabilities of the upper extremity before and after treatment and all adverse effects and complications were recorded. Results Overall TPED improvement was best at 6 weeks. In the PNF group TPED improved by 63% versus 79% in the LF group; this difference was statistically significant. Results at the proximal interphalangeal joint were worse than those at the metacarpophalangeal and distal interphalangeal joints for both the PNF and LF groups. The rays classified before surgery as Tubiana stages I and II showed no difference between these treatments, but for rays higher than stage II LF clearly was superior to PNF as a treatment modality. The rate of major complications in the LF group was 5% versus 0% in the PNF group. Patient satisfaction was almost equal but direct hand function after treatment was considered better in the PNF group, as was the degree of discomfort that patients experienced. This was underscored by the Disabilities of the Arm, Shoulder, and Hand scores in the PNF group, which were significantly lower than those in the LF group at all time points measured. Conclusions In the short term and in cases with a TPED of 90° or less PNF is a good treatment alternative to LF for treatment of Dupuytren’s disease. Type of study/level of evidence Therapeutic, Level I. Key words: Complications; Dupuytren; needle fasciotomy; limited fasciectomy; outcomeshapeimage_2_link_0
Dupuytrens  disesase information from the Hand Center of WMA
Needle Aponeurotomy web hand out information for patientsshapeimage_3_link_0shapeimage_3_link_1shapeimage_3_link_2
 
Posted by at No comments:

Dupuytrens Disease Bibliography

Dupuytren’s Disease Selected Bibliography
 
1.       Results of Surgical Treatment of Dupuytren’s Disease in Women: A Review of 109 Consecutive Patients
M.U. Anwar, S.K. Al Ghazal, R.S. Boome
Journal of Hand Surgery
November 2007 (Vol. 32, Issue 9, Pages 1423-1428)
 
2.       The Complications of Dupuytren’s Contracture Surgery
Neil W. Bulstrode, Barbara Jemec, Paul J. Smith
Journal of Hand Surgery
September 2005 (Vol. 30, Issue 5, Pages 1021-1025)

3.       Enzyme injection as nonsurgical treatment of Dupuytren's disease
Marie A. Badalamente, Lawrence C. Hurst
Journal of Hand Surgery
July 2000 (Vol. 25, Issue 4, Pages 629-636)

4.       Predicting the Outcome of Surgery for the Proximal Interphalangeal Joint in Dupuytren’s Disease
Alok Misra, Abhilash Jain, Reza Ghazanfar, Terrencia Johnston, Jagdeep Nanchahal
Journal of Hand Surgery
February 2007 (Vol. 32, Issue 2, Pages 240-245)

5.       Abductor digiti minimi involvement in dupuytren’s contracture of the small finger1
Kimberley E Meathrel, Achilleas Thoma
Journal of Hand Surgery
May 2004 (Vol. 29, Issue 3, Pages 510-513)

6.       The injection of nodules of Dupuytren's disease with triamcinolone acetonide
Lynn D. Ketchum, Terrence K. Donahue
Journal of Hand Surgery
November 2000 (Vol. 25, Issue 6, Pages 1157-1162)

7.       A congenital hand deformity: Dupuytren's disease
G. Foucher, C. Lequeux, J. Medina, R.Navarro Garcia, D. Nagel
Journal of Hand Surgery
May 2001 (Vol. 26, Issue 3, Pages 515-517)

8.       A Retrospective Review of the Management of Dupuytren’s Nodules
Rachel M. Reilly, Peter J. Stern, Charles A. Goldfarb
Journal of Hand Surgery
September 2005 (Vol. 30, Issue 5, Pages 1014-1018)

9.       Emergency microsurgical revascularization for critical ischemia during surgery for Dupuytren's contracture: A case report
Neil F. Jones, Jerry I. Huang
Journal of Hand Surgery
November 2001 (Vol. 26, Issue 6, Pages 1125-1128)

10.   Efficacy and Safety of Injectable Mixed Collagenase Subtypes in the Treatment of Dupuytren’s Contracture
Marie A. Badalamente, Lawrence C. Hurst
Journal of Hand Surgery
July 2007 (Vol. 32, Issue 6, Pages 767-774)

11.   Functional outcome after surgery for dupuytren’s contracture: a prospective study
Kingsley Paul Draviaraj, Indranil Chakrabarti
Journal of Hand Surgery
September 2004 (Vol. 29, Issue 5, Pages 804-808)

  1. 12.  Collagen as a clinical target: Nonoperative treatment of Dupuytren's disease
    Marie A. Badalamente, Lawrence C. Hurst, Vincent R. Hentz
    Journal of Hand Surgery
    September 2002 (Vol. 27, Issue 5, Pages 788-798)

  2. 13.  A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren’s Disease: A 6-Week Follow-Up Study
    Annet L. van Rijssen, Feike S.J. Gerbrandy, Hein Ter Linden, Helen Klip, Paul M.N. Werker
    Journal of Hand Surgery
    May 2006 (Vol. 31, Issue 5, Pages 717-725)

  3. 14.Metalloproteinase Gene Expression Correlates With Clinical Outcome in Dupuytren's Disease
    Phillip Johnston, Debbie Larson, Ian M. Clark, Adrian J. Chojnowski
    Journal of Hand Surgery - September 2008 (Vol. 33, Issue 7, Pages 1160-1167, DOI: 10.1016/j.jhsa.2008.04.002)

  4. 15.A Complete Expression Profile of Matrix-Degrading Metalloproteinases in Dupuytren’s Disease
    Phillip Johnston, Adrian J. Chojnowski, Rose K. Davidson, Graham P. Riley, Simon T. Donell, Ian M. Clark
    Journal of Hand Surgery - March 2007 (Vol. 32, Issue 3, Pages 343-351, DOI: 10.1016/j.jhsa.2006.12.010)

  5. 16.Molecular Phenotypic Descriptors of Dupuytren’s Disease Defined Using Informatics Analysis of the Transcriptome
    Samrina Rehman, Fiona Salway, John K. Stanley, William E.R. Ollier, Philip Day, Ardeshir Bayat
    Journal of Hand Surgery - March 2008 (Vol. 33, Issue 3, Pages 359-372, DOI: 10.1016/j.jhsa.2007.11.010)

  6. 17.Evidence for a polyclonal etiology of palmar fibromatosis
    Howard A. Chansky, Thomas E. Trumble, Ernest U. Conrad, John F. Wolff, Lorne W. Murray, Wendy H. Raskind
    Journal of Hand Surgery - March 1999 (Vol. 24, Issue 2, Pages 339-344, DOI: 10.1053/jhsu.1999.0339)

  7. 18.Factors in the Pathogenesis of Dupuytren’s Contracture
    Mohammad M. Al-Qattan
    Journal of Hand Surgery - November 2006 (Vol. 31, Issue 9, Pages 1527-1534, DOI: 10.1016/j.jhsa.2006.08.012)

  8. 19.Genetic and epigenetic influences on the pathogenesis of Dupuytren's disease
    Raj H. Ragoowansi, Jonathan A. Britto
    Journal of Hand Surgery - November 2001 (Vol. 26, Issue 6, Pages 1157-1158)

  9. 20.On the origin and spread of Dupuytren's disease
    Robert M. McFarlane
    Journal of Hand Surgery - May 2002 (Vol. 27, Issue 3, Pages 385-390, DOI: 10.1053/jhsu.2002.32334)
Dupuytrens  disesase information from the Hand Center of WMA
 
Needle Aponeurotomy web hand out information for patientsshapeimage_2_link_0shapeimage_2_link_1shapeimage_2_link_2
 

 
 
Posted by at No comments:

MALLET FINGER____BASEBALL FINGER

MALLET FINGER (BASEBALL FINGER)



A mallet finger occurs when the extensor tendon at the tip of a finger ruptures. The rupture of this tendon can involve the tendon alone, be associated with a small bone fragment or fracture or can be associated with a fracture that requires significant care.

The force applied to the finger can come from something as simple as tucking in a bed sheet or can come from a direct blow to the end of a finger. Mallet finger has also been known as baseball finger.

A mallet finger often begins with pain at the distal joint of the finger.  At times there is an immediate loss of motion while at other times the finger seems to stay straight for a while and only later starts to lose its ability to be extended actively at the tip.  At times there is an injuries are typically closed in that the skin and nail is intact but at times there is an injury to the skin or nail bed as well. In severe cases the injury is associated with an open injury to the joint or bone, a so called open or compound fracture.

In adults the injury can involve the joint surface.  In children it can involves the growth plate or physis.

The diagnosis is often made based upon the type of injury and the appearance of the finger.  The fingertip will droop down and there is a loss of active motion.  Often the finger can be passively pushed up to straighten it but the independent active motion to extend the digit at the tip has been lost

Mallet finger.
X-rays are often taken to further delineate the injury and see how much if any bone, joint or growth plate is involved

Treatment depends largely upon the extent the soft tissue and underlying boney injury.

Tendon rupture without bone injury

Most of these mallet finger injuries can be treated with splinting.  The splint can be applied in a variety of ways depending upon the injury.  Typically the split is left in place full time for six to eight weeks with a time for part time splinting after that depending upon what daily activity is done by the patient with a typical part time period of 3 – 4 weeks.  In some situations pinning of the joint is used rather than a splint

Tendon rupture with a small bone fragment

These injuries typically are treated like non-boney injuries
Types of splints used to treat mallet finger. A, Dorsal aluminum splint. B, Commercial splint.
Reproduced with permission from Culver JE Jr: Office management of athletic injuries of the hand and wrist. Instr Course Lect 1989;38:473-482.

Tendon rupture with a large bone fragment involving the joint.



These injuries may respond to splinting and splinting is often used however a small bump may always be present a t the joint.  At times if the doctor feels that that the bone fragment is large enough and the joint may be unstable surgery may be offered.  During surgery pins or small screws may be used and the joint itself may be pinned to prevent motion during the healing process.

Above: X-rays showing fracture at the insertion of the extensor tendon. In the first image on the left the fragment is displaced.  This will heal with a bump but will be able to be treated with a splint.  IN the image on the right the joint has subluxed.  This will  need to have surgical repair.
In adults with severe open injury more immediate surgery may also be offered

Children

In children the doctor needs to differentiate between these injuries that require reduction or realignment of the bone without surgery and those who may have a portion of the nail bed significantly torn or retained within the fracture site or growth plate.  Often children will not have a tendon injury but a fracture through the physis which appears to be a mallet injury.  X-rays often will reveal this.







Mallet deformity from a fracture across the growth plate in a child is different than the adult fracture or tendon avulsion

Late or Delayed Treatment in adults

Delayed treatment of mallet finger deformity may consist of splinting initially and at times surgical methods are offered to correct chronic deformities and other associated joint and tendon problems that may accompany the chronic situation

Results

Most mallet fingers heal well, although often there is a slight loss of full extension. The slight extension loss typically has no effect on hand of finger function, but if left untreated it can cause other issues to occur in the finger due to tendon imbalance. While treatment of a closed mallet finger is not an acute emergency, the improper, partial or untreated injury can lead to further problems such as a swan neck deformity.

 Swan neck deformity from tendon imbalance and laxity at the proximal joint.
 
Athletics
While there may be special circumstances where a professional athletes plays with a splint in place for mallet finger for the child or recreational athlete, or even most professional or collegiate level athletes this is not typically recommended.

Posted by at No comments:

Wednesday, June 1, 2011



THE HAND CENTER OF WESTERN MASSACHUSETTS
3550 MAIN ST STE 204
SPRINGFIELD, MA 01107
(413) 733-2204  map
Posted by at No comments:
Subscribe to: Posts (Atom)