Proximal Interphalangeal Joint Release in Dupuytren’s Disease of the Little Finger

We present a prospective study, with 3-year follow-up, of the role and outcome of fasciectomy plus sequential surgical release of structures of the proximal interphalangeal joint in Dupuytren’s contracture of the little finger.

Our treatment programme involves fasciectomy for all patients followed by sequential release of the accessory collateral ligament and volar plate as necessary.

Of the 19 fingers in the study, eight achieved a full correction by fasciectomy alone, and in these cases there was a fixed flexion deformity of 6° at 3 months and 8° at 3 years. The remaining 11 fingers (initial mean deformity 70° flexion) were left with a fixed flexion deformity of 42° after fasciectomy which reduced to 7° with capsuloligamentous release. This increased to 26° at 3 months but then remained relatively stable, increasing only to 29° at 3 years.

In our experience sequential proximal interphalangeal joint release has led to consistently good results with few complications in the correction of severe Dupuytren’s disease of the little finger.

A comparison of trapeziectomy via anterior and posterior approaches

Forty-three hands in 41 adults with osteoarthrosis of the trapeziometacarpal joint were allocated randomly to undergo a trapeziectomy through either an anterior approach or the posterior (dorsoradial) approach. Forty hands were available for review at a median of 33 months postoperatively. The demographic characteristics, severity of disease and pre-operative measurements of the two groups were indistinguishable. Trapeziectomy resulted in significantly improved objective and subjective function in both groups, but the anterior approach group had better outcomes for power, scar tenderness and satisfaction. Scar-related complications were three times more common in the posterior group. Trapeziectomy is a good method of treating osteoarthritis of the thumb base, but outcomes for the anterior approach are equally good or better than with the posterior.

A parallel approach: the impact of schuss radiography of the degenerate knee on clinical management

Schuss radiographs are PA weight bearing views of the knee taken in 30 degrees of flexion. Several studies have shown them to be more sensitive detectors of osteoarthritic changes in the knee than standard extension AP views. We compared the plans of management proposed by eight consultant orthopaedic surgeons to two case presentations of each of a series of 50 patients with tibiofemoral osteoarthritis. The clinical and radiological information provided on each patient was identical in the two presentations except that on one occasion the surgeons were shown the extension AP radiograph while on the other it was replaced by the schuss view. The panel altered their management plan in over 40% of cases. This represented a reduction of almost 50% in arthroscopies in the schuss group with a move towards definitive surgery. The total number of procedures proposed was also reduced. The radiograph was useful determining the management of patients with predominantly lateral, as well as medial or generalised symptoms. We conclude that the schuss radiograph is a valuable tool in the assessment of knee osteoarthritis the use of which can alter clinical management. By reducing non-therapeutic arthroscopies it may significantly reduce total number of operations to be performed in this patient group.