The Surgical Release of Dupuytren's Contracture Using Multiple Transverse Incisions

What are we measuring? A critique of range of motion methods currently in use for Dupuytren's disease and recommendations for practice

BACKGROUND

Range of motion is the most frequently reported measure used in practice to evaluate outcomes. A goniometer is the most reliable tool to assess range of motion yet, the lack of consistency in reporting prevents comparison between studies. The aim of this study is to identify how range of motion is currently assessed and reported in Dupuytren's disease literature. Following analysis recommendations for practice will be made to enable consistency in future studies for comparability. This paper highlights the variation in range of motion reporting in Dupuytren's disease.

METHODS

A Participants, Intervention, Comparison, Outcomes and Study design format was used for the search strategy and search terms. Surgery, needle fasciotomy or collagenase injection for primary or recurrent Dupuytren's disease in adults were included if outcomes were monitored using range of motion to record change. A literature search was performed in May 2013 using subject heading and free-text terms to also capture electronic publications ahead of print. In total 638 publications were identified and following screening 90 articles met the inclusion criteria. Data was extracted and entered onto a spreadsheet for analysis. A thematic analysis was carried out to establish any duplication, resulting in the final range of motion measures identified.

RESULTS

Range of motion measurement lacked clarity, with goniometry reportedly used in only 43 of the 90 studies, 16 stated the use of a range of motion protocol. A total of 24 different descriptors were identified describing range of motion in the 90 studies. While some studies reported active range of motion, others reported passive or were unclear. Eight of the 24 categories were identified through thematic analysis as possibly describing the same measure, 'lack of joint extension' and accounted for the most frequently used.

CONCLUSIONS

Published studies lacked clarity in reporting range of motion, preventing data comparison and meta-analysis. Percentage change lacks context and without access to raw data, does not allow direct comparison of baseline characteristics. A clear description of what is being measured within each study was required. It is recommended that range of motion measuring and reporting for Dupuytren's disease requires consistency to address issues that fall into 3 main categories: Definition of terms, Protocol statement, Outcome reporting.

Pulmonary artery re-thrombosis following interruption of anti-thrombotic therapy for bilateral carpal tunnel release surgery: an update of current protocols

In the perioperative period, patients who are under anti-thrombotic therapy should be managed with care, although there is no clear consensus on this matter. For hand surgery, several authors have advocated no interruption of the anti-thrombotic therapy, but the choice differs between institutes according to protocols and surgeons' preference. We report a case of massive pulmonary embolism after stopping warfarin for carpal tunnel release in a patient with a previous history of pulmonary embolism. Although the patient recovered after thrombolytic therapy and intensive care unit (ICU) care, this case has struck the authors as a valuable lesson. In managing anti-thrombotic therapy, we should weigh the risks and benefits of the patients carefully before making a decision.