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Cureus May 2023Orthopedic surgery literature utilizes numerous eponyms, and they have become commonplace among orthopedic surgeons and the general public alike. These eponyms can have... (Review)
Review
Orthopedic surgery literature utilizes numerous eponyms, and they have become commonplace among orthopedic surgeons and the general public alike. These eponyms can have important historical implications and their history is often overlooked by the physicians using such terms. This paper seeks to specifically explore the origins of eponyms in orthopedic soft tissue diseases involving the upper extremity. Shedding light onto the origin of these eponyms can provide greater respect and understanding of their use in orthopedic surgery today.
PubMed: 37362533
DOI: 10.7759/cureus.39449 -
Journal of Plastic, Reconstructive &... Feb 2024
Topics: Humans; Dupuytren Contracture; Finger Joint; Fasciotomy
PubMed: 38159474
DOI: 10.1016/j.bjps.2023.12.016 -
The Journal of Hand Surgery May 2023Injectable collagenase Clostridium histolyticum has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture of the...
PURPOSE
Injectable collagenase Clostridium histolyticum has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture of the hand. The purpose of this study was to determine the efficacy of collagenase injection and adverse event rate in patients who had undergone previous collagenase treatment.
METHODS
A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009 to 2019. Fifty-nine joints in 45 patients underwent repeat collagenase therapy for recurrent contracture in the same digit. Pretreatment and posttreatment total metacarpophalangeal and proximal interphalangeal joint flexion contractures were recorded, with complete correction defined as <5° residual digital flexion contracture. Postmanipulation skin tears and adverse events were recorded. A comparison was made between average contracture improvement after initial collagenase injection and that after repeat injection.
RESULTS
Forty-five patients with an average duration of 30 months (range, 6-73 months) between initial and repeat collagenase therapies were identified. The mean improvement after first collagenase injection was 45° ± 24° (39° for metacarpophalangeal joint and 50° for proximal interphalangeal joint) compared with a mean improvement of 43° ± 23° (41° for metacarpophalangeal joint and 44° for proximal interphalangeal joint) after second injection. Although similar complete correction rates and skin tear rates (32.2 % for initial and 30.5% for repeat) were observed between initial (80%) and repeat injections (73%), the occurrence of adverse events was 3 times higher (3.4% for initial and 10.2% for repeat) in the latter group.
CONCLUSIONS
Collagenase treatment of Dupuytren contracture yields effective total flexion contracture correction. Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
PubMed: 37256248
DOI: 10.1016/j.jhsa.2023.03.026 -
The Journal of Hand Surgery, European... Feb 2023Multiple treatment options are available to patients with Dupuytren contracture, making shared decision-making complex. Our rigorous qualitative analysis sought to...
Multiple treatment options are available to patients with Dupuytren contracture, making shared decision-making complex. Our rigorous qualitative analysis sought to understand patient perceptions of shared decision-making in Dupuytren contracture treatment and create a conceptual framework to optimize patient-physician communication. We interviewed 30 patients with Dupuytren contracture to learn about their experience with treatment selection. The following themes were integral to shared decision-making for Dupuytren contracture treatment: discussing disease progression and treatment initiation, presenting all available treatment options, assessing patients' pre-existing biases towards treatment, patient values and preferences for treatment trade-offs, treatment risks and benefits, physician recommendation and active patient participation. This model can optimize communication about treatment options and expectations for relevant outcomes including, recovery time, contracture recurrence, complications, and treatment-related expenses. V.
Topics: Humans; Dupuytren Contracture; Decision Making, Shared; Physician-Patient Relations; Patient Participation; Communication; Decision Making
PubMed: 36329565
DOI: 10.1177/17531934221133992 -
Trends in Molecular Medicine Mar 2023We review the biology of Dupuytren's disease (DD), a common localised fibrotic disorder of the hand. The disease develops through a complex interplay of genetic and... (Review)
Review
We review the biology of Dupuytren's disease (DD), a common localised fibrotic disorder of the hand. The disease develops through a complex interplay of genetic and environmental factors, and epigenetic signalling. The early-stage disease nodules comprise a complex milieu of stromal and immune cells which interact to promote disease development. Recently, inhibition of tumour necrosis factor (TNF) locally resulted in softening and a decrease in nodule size, potentially controlling disease progression. Unlike fibrotic disorders of the visceral organs, the easy access to tissue in DD patients enables dissection of the cellular landscape and molecular signalling pathways. In addition, the study of DD may have wider benefits in enhancing our understanding of less-accessible fibrotic tissues.
Topics: Humans; Dupuytren Contracture; Signal Transduction; Tumor Necrosis Factor-alpha
PubMed: 36566101
DOI: 10.1016/j.molmed.2022.12.001 -
Advanced Biomedical Research 2022We aimed to evaluate the effect of shock wave therapy on the improvement of symptoms and function of patients with Dupuytren's contracture.
INTRODUCTION
We aimed to evaluate the effect of shock wave therapy on the improvement of symptoms and function of patients with Dupuytren's contracture.
MATERIALS AND METHODS
This research is a pre-post intervention study, conducted among patients referred to the physical medicine clinics of Isfahan during 2019-2020. In this study, subjects experienced shock wave therapy for 6 sessions, each in a week, and improvement of symptoms and function were assessed and compared after the period of study and follow-up (before treatment, 6 weeks after treatment, and 14 weeks after treatment). The pain visual analog scale and disabilities of the arm shoulder and hand questionnaire were completed for all patients at the mentioned time, and the finger contraction angle was also measured by a goniometer over these intervals.
RESULTS
Twenty patients, 11 (55%) men and 9 (45%) women participated in the study. The mean and standard deviation of their age was 66.6 ± 7.11 years. The trend of pain severity of patients was continuously and significantly decreasing up to 14 weeks, which implies the effectiveness of the intervention ( < 0.05). Moreover, the patients' functional status improved due to the continuation of the intervention, and its trend was decreasing up to 14 weeks ( < 0.05). As for the contraction angle, there was a continuous and significant decreasing trend until week 14, and the intervention was also effective on the contraction angle ( < 0.05).
CONCLUSION
It can be concluded that shock wave therapy can be effective in improving the symptoms and function of patients with Dupuytren's Contracture.
PubMed: 35284349
DOI: 10.4103/abr.abr_155_21 -
The Journal of Hand Surgery, European... Mar 2022This study aimed to determine the association between the echogenicity of Dupuytren's disease nodules and myofibroblast load, and between echogenicity and nodule...
This study aimed to determine the association between the echogenicity of Dupuytren's disease nodules and myofibroblast load, and between echogenicity and nodule hardness. Thirty-eight nodules were assessed sonographically. The echogenicity of nodules was measured objectively with Image J (grey-value) and subjectively by visual inspection (hypo-, mixed and hyper-echogenicity). These findings were compared with myofibroblast load measured by histopathological analysis. In a different cohort, 97 nodules were assessed for grey-value and nodule hardness using a tonometer. There was a moderate, significant, negative association between grey-value and myofibroblast load and the subjective visual measurements corresponded to this finding. There was also a moderate, significant, negative association between grey-value and nodule hardness. Ultrasound and tonometry may be useful in the selection of patients for possible future preventive treatments.
Topics: Dupuytren Contracture; Hardness; Humans; Myofibroblasts; Ultrasonography
PubMed: 34617826
DOI: 10.1177/17531934211050214 -
Hand (New York, N.Y.) Jun 2023Autologous fat grafting (AFG) has traditionally been used for facial rejuvenation and soft tissue augmentation, but in recent years, its use has expanded to treat... (Review)
Review
Autologous fat grafting (AFG) has traditionally been used for facial rejuvenation and soft tissue augmentation, but in recent years, its use has expanded to treat diseases of the hand. Autologous fat grafting is ideal for use in the hand because it is minimally invasive, can restore volume, and has regenerative capabilities. This review summarizes the emerging evidence regarding the safety and efficacy of AFG to the hand in several conditions, including systemic sclerosis, Dupuytren disease, osteoarthritis, burns, and traumatic fingertip injuries. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature search on the use of AFG in hand pathologies was performed on October 8, 2020, in Ovid MEDLINE, Elsevier Embase, Clarivate Web of Science, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by 2 independent reviewers and a third reviewer adjudicated when required. Reviewers identified 919 unique hits. Screening of the abstracts identified 22 manuscripts which described the use of AFG to treat an identified hand condition. Studies suggest AFG in the hands is a safe, noninvasive option for the management of systemic sclerosis, Dupuytren contracture, osteoarthritis, burns, and traumatic fingertip injuries. While AFG is a promising therapeutic option for autoimmune, inflammatory, and fibrotic disease manifestations in the hand, further studies are warranted to understand its efficacy and to establish more robust clinical guidelines. Studies to date show the regenerative, immunomodulatory, and volume-filling properties of AFG that facilitate wound healing and restoration of hand function with limited complications.
Topics: Humans; Adipose Tissue; Transplantation, Autologous; Autografts; Wound Healing; Hand
PubMed: 35130761
DOI: 10.1177/15589447211066347 -
Medical Dosimetry : Official Journal of...Dupuytren's contracture (DC) and Ledderhose disease (LD) are benign conditions of the fascia in the hands and feet respectively, which result in contracture of the...
Dupuytren's contracture (DC) and Ledderhose disease (LD) are benign conditions of the fascia in the hands and feet respectively, which result in contracture of the digits. Radiation therapy has been proven effective in treating early-stage DC and LD; however, the problem is that there is a paucity of literature regarding radiation therapy treatment set-up for Dupuytren's and Ledderhose patients. The purpose of this case study was to demonstrate treatment set-up considerations of 6 and 9 MeV for DC and LD cases in radiotherapy (RT). Two patients were selected from the same cancer center, each diagnosed with DC and LD. Treatment plans were established utilizing a clinical set-up, electron dose tables, bolus, and target volumes delineated by the radiation oncologist. For each patient, the radiation oncologist prescribed 2 treatment courses of 300 cGy in 5 fractions per treatment site. The radiation oncologist determined the desired depth of treatment, through the palpation of the nodules, and used electron depth dose tables to determine the energy, isodose lines, and bolus thickness necessary to treat the lesions to the appropriate depth. Doses delivered were verified with metal oxide semiconductor field effect transistors (MOS-FET) in vivo on the first day of treatment for each course. In this case study, researchers demonstrated clinical set-up for 2 patients treated for both DC and LD. The clinical set-up considerations resulted in successful treatment delivery with minor, but acceptable, variations during treatment.
PubMed: 37059629
DOI: 10.1016/j.meddos.2023.03.001 -
Journal of Plastic Surgery and Hand... Feb 2021Dupuytren disease (DD) has been associated with enlarged Pacinian corpuscles (PCs) and with PCs having a greater number of lamellae. Based on these associations, we...
PURPOSE
Dupuytren disease (DD) has been associated with enlarged Pacinian corpuscles (PCs) and with PCs having a greater number of lamellae. Based on these associations, we hypothesized that subjects with DD would have altered sensitivity to high-frequency vibrations and that the changes would be more prominent at 250 Hz, where healthy subjects demonstrate the highest sensitivity.
METHODS
A novel device was created to deliver vibrations of specific frequencies and amplitudes to the fingers and palm. Using a Psi-marginal adaptive algorithm, vibrotactile perception thresholds (VPTs) were determined in 36 subjects with DD and 74 subjects without DD. Experiments were performed at 250 Hz and 500 Hz at the fingertip and palm. The VPTs were statistically analyzed with respect to disease status, age, gender, location tested, and frequency tested.
RESULTS
We found that VPT increases with age, which agrees with findings by others. Women showed greater sensitivity (i.e. lower VPT) than men. Men exhibited lower sensitivity in DD versus healthy subjects, but the results were not statistically significant. In subjects with DD presenting unilaterally, the unaffected hand was more sensitive than the affected hand, in particular for a 250 Hz stimulus applied to the finger.
CONCLUSIONS
The data on vibration sensitivity obtained from a large group of subjects with and without DD present interesting trends that may serve as a useful reference to future DD researchers. Understanding additional symptoms of DD may facilitate development of novel diagnostic or prognostic protocols.
Topics: Aged; Case-Control Studies; Dupuytren Contracture; Female; Humans; Male; Middle Aged; Sensory Thresholds; Sex Factors; Touch; Vibration
PubMed: 33043747
DOI: 10.1080/2000656X.2020.1828898