X-ref For other Roundups in this issue that cross-reference with Wrist & Hand see: Trauma Roundup 8.
While not exactly a pandemic shift or sea change, there is a steady creep of evolution in the treatment of Dupuytren’s disease with more and more surgeons and patients alike utilising less invasive approaches to early Dupuytren’s such as needle fasciotomy and collagenase treatments. Collagenases such as Xiapex (CCH) is an enzymatic treatment which is becoming widely used, and although we already know that it is very effective and patient satisfaction levels are high, there remain question marks over its longer-term effectiveness. We have previously reported in 360 the high recurrence rates observed in some studies and therefore, as time passes, we will all be faced with patients with recurrent disease following Xiapex treatment. Surgeons from Boston (USA) have addressed the question as to what exactly happens when patients require revision surgery following Xiapex treatment.1 Although a very small series of just 19 joints in 11 patients, this paper is important as it is the first to describe revision fasciotomy following CCH treatment. The revision surgery was undertaken on average just 12 months following the initial injection, and although the surgery is described as challenging with a loss of soft-tissue plains and extensive scarring, the clinical results were good with release of MCP joints from 42° to 0° and PIP joints from 60° to 21°. These clinical results are comparable with what should be expected from a primary fasciectomy, so surgeons should be aware of the difficulties associated with CCH revision and make sure that it is only performed by someone particularly adept at complex secondary surgery.
Rehabilitation following extensor tendon injury
Extensor tendon injuries are common. Surgical repair and post-operative management of said injury is generally less challenging than for the bête noire of hand …