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Arthrolysis of the elbow with the use of a standardized technique: Review of 15 year experience
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level of physical activity, work capacity and if the injury had been classified as work related. Those patients who had undergone surgery for tendon problems were asked to describe functional difficulties rather than pain at the same three timepoints.
Results Complete recovery of function was achieved in patients who had undergone the wrap around flap to the extensor tendons with full range of extension. Of the remaining patients who suffered from post-traumatic neuralgia, none considered themselves cured but all claimed an improvement in symptoms.
Conclusions The radial forearm fascial flap is useful in dealing with nerve or tendon injuries that have been complicated by serious adhesions. This is shown by the complete restoration of extensor tendon function and the relative symptomatic improvement in the patients with neural problems. We believe that functionally the antebrachial fascia has the properties of a gliding tissue which is able to restore functions of the gliding apparatus, i.e. gliding and vascular nutrition of nerves and tendons.
Cytogenetic studies in Dupuytren's disease (3. Pilato, A. M. Viotto, R. Casalone, D. Mazzola, E. Meroni, M. Modesti
Pavia, Varese, Italy Dupuytren's disease is a fibromatosis of the midpalmar aponeurosis that often presents as a familial disease. The mode of transmission is an autosomal dominant one, and its penetrance appears to be directly related to the age of the patient. In past years cytogenetic studies were performed in order to detect chromosomal anomalies that could play a role in the abnormal fibroblastic proliferation. We could gather in the literature 43 cases of Dupuytren's disease in which a cytogenetic analysis had been performed on tissue cultures from the diseased fascia: in 24 patients clonal and/or sporadic chromosomal abnormalities had been found, and in 16 of these cases (66%) a trisomy of chromosome 8 had been observed. In order to evaluate the incidence of these abnormalities, and particularly of trisomy 8, we performed cytogenetic studies on the nodules or fibrous cords excised at operation from the hands of 26 patients who underwent aponeurectomy for Dupuytren's disease. The analysis included also 13 specimens of unaffected tissues (skin and/or transverse fibres of palmar fascia) from some of these patients. The study has been carried out on short term cell cultures, analysed in situ by standard methods of processing and banding. In the first 12 patients, FISH analysis using alpha satellite probe for chromosome 8 (D8Z2) was performed. It is the first time, to our knowledge, that in situ hybridization has been used for cytogenetic studies on Dupuytren's disease. This technique has the advantage of allowing the study of a much higher number of cells compared with traditional cytogenetic techniques. Trisomy of chromosome 8 has been considered significant only if three spots could be observed in more than 7.5% of nuclei. Our results show the presence of marked chromosomal instability related to fibroblastic proliferation; chromosomal abnormalities have been found in eighteen specimens of fibromatous tissue (69%). The absence of chromosome Y, found in five cases, has been the most common abnormality; all remain-
T H E J O U R N A L O F H A N D SURGERY VOL. 22B SUPPLEMENT 1
ing clonal anomalies (either numerical or structural) have been observed in single patients. As the absence of chromosome Y is frequently observed in non-neoplastic tissues with high turnover, its relationship with cell proliferation looks unclear. We did not observe, either with cytogenetic analysis or with in situ hybridization, the high frequency of trisomy 8 reported in the literature; this may be due to the short period of our tissue cultures compared to previous studies, thus preventing in vitro artifacts, or to a different sampling procedure. These observations suggest that chromosomal abnormalities seem to be an effect of the disease rather than its cause; they may play a role in the progression of fibromatosis, but they cannot explain the pathogenesis of Dupuytren's disease.
Arthrolysis of the elbow with the use of a standardized technique: Review of 15 year experience K. Fekete, S. Freny6, A. Renner
Budapest, Hungary We reviewed the results of 200 elbow arthrolyses, of which one of the authors performed 157 personally, at a major trauma centre. The objective of the operation is a radical removal of all scar tissue, ligament and periarticular ectopic bone which results in a significant restoration of mobility of the elbow by the end of the procedure. Functional treatment was begun immediately after the operation, including CPM and active exercises, and it was continued until the same elbow function was achieved as it was seen by the end of the operation. Rehabilitation of these cases took a long time, sometimes a few months, but our goal was to maintain maximum restoration of the elbow movements even during the patient's everyday work.
Results In 60% of our cases the patients were able to return to their original work.
Conclusion Arthrolysis of the post-traumatic stiff elbow is the correct procedure even nowadays, and provides better results than prosthetic replacement. Our experience in a large series has proved, that even in seemingly hopeless cases, good functional outcome can be achieved with the correct use of this technique.
Results of post-traumatic use of Swanson's prosthesis to correct digital joint stiffness R.B. Karim, J J. Hage, J. M. E de G r o o t
Amsterdam, The Netherlands Knowledge of the benefits and limitations of Silicone implant arthroplasty for post-traumatic disabilities of finger joints will permit both patient and surgeon to approach this procedure with realistic expectations. Our long-term results of 21 Swanson implant arthroplasties following severe destruction of joints and surrounding tendo-capsular apparatus were evaluated. The data on subjective and objective assessment were obtained in all patients. Statistical correlations were evaluated applying Pearson's correlation co-efficient. Most patients were satisfied with the results as they were free of pain. Although significant levels of rotational defor-
level of physical activity, work capacity and if the injury had been classified as work related. Those patients who had undergone surgery for tendon problems were asked to describe functional difficulties rather than pain at the same three timepoints.
Results Complete recovery of function was achieved in patients who had undergone the wrap around flap to the extensor tendons with full range of extension. Of the remaining patients who suffered from post-traumatic neuralgia, none considered themselves cured but all claimed an improvement in symptoms.
Conclusions The radial forearm fascial flap is useful in dealing with nerve or tendon injuries that have been complicated by serious adhesions. This is shown by the complete restoration of extensor tendon function and the relative symptomatic improvement in the patients with neural problems. We believe that functionally the antebrachial fascia has the properties of a gliding tissue which is able to restore functions of the gliding apparatus, i.e. gliding and vascular nutrition of nerves and tendons.
Cytogenetic studies in Dupuytren's disease (3. Pilato, A. M. Viotto, R. Casalone, D. Mazzola, E. Meroni, M. Modesti
Pavia, Varese, Italy Dupuytren's disease is a fibromatosis of the midpalmar aponeurosis that often presents as a familial disease. The mode of transmission is an autosomal dominant one, and its penetrance appears to be directly related to the age of the patient. In past years cytogenetic studies were performed in order to detect chromosomal anomalies that could play a role in the abnormal fibroblastic proliferation. We could gather in the literature 43 cases of Dupuytren's disease in which a cytogenetic analysis had been performed on tissue cultures from the diseased fascia: in 24 patients clonal and/or sporadic chromosomal abnormalities had been found, and in 16 of these cases (66%) a trisomy of chromosome 8 had been observed. In order to evaluate the incidence of these abnormalities, and particularly of trisomy 8, we performed cytogenetic studies on the nodules or fibrous cords excised at operation from the hands of 26 patients who underwent aponeurectomy for Dupuytren's disease. The analysis included also 13 specimens of unaffected tissues (skin and/or transverse fibres of palmar fascia) from some of these patients. The study has been carried out on short term cell cultures, analysed in situ by standard methods of processing and banding. In the first 12 patients, FISH analysis using alpha satellite probe for chromosome 8 (D8Z2) was performed. It is the first time, to our knowledge, that in situ hybridization has been used for cytogenetic studies on Dupuytren's disease. This technique has the advantage of allowing the study of a much higher number of cells compared with traditional cytogenetic techniques. Trisomy of chromosome 8 has been considered significant only if three spots could be observed in more than 7.5% of nuclei. Our results show the presence of marked chromosomal instability related to fibroblastic proliferation; chromosomal abnormalities have been found in eighteen specimens of fibromatous tissue (69%). The absence of chromosome Y, found in five cases, has been the most common abnormality; all remain-
T H E J O U R N A L O F H A N D SURGERY VOL. 22B SUPPLEMENT 1
ing clonal anomalies (either numerical or structural) have been observed in single patients. As the absence of chromosome Y is frequently observed in non-neoplastic tissues with high turnover, its relationship with cell proliferation looks unclear. We did not observe, either with cytogenetic analysis or with in situ hybridization, the high frequency of trisomy 8 reported in the literature; this may be due to the short period of our tissue cultures compared to previous studies, thus preventing in vitro artifacts, or to a different sampling procedure. These observations suggest that chromosomal abnormalities seem to be an effect of the disease rather than its cause; they may play a role in the progression of fibromatosis, but they cannot explain the pathogenesis of Dupuytren's disease.
Arthrolysis of the elbow with the use of a standardized technique: Review of 15 year experience K. Fekete, S. Freny6, A. Renner
Budapest, Hungary We reviewed the results of 200 elbow arthrolyses, of which one of the authors performed 157 personally, at a major trauma centre. The objective of the operation is a radical removal of all scar tissue, ligament and periarticular ectopic bone which results in a significant restoration of mobility of the elbow by the end of the procedure. Functional treatment was begun immediately after the operation, including CPM and active exercises, and it was continued until the same elbow function was achieved as it was seen by the end of the operation. Rehabilitation of these cases took a long time, sometimes a few months, but our goal was to maintain maximum restoration of the elbow movements even during the patient's everyday work.
Results In 60% of our cases the patients were able to return to their original work.
Conclusion Arthrolysis of the post-traumatic stiff elbow is the correct procedure even nowadays, and provides better results than prosthetic replacement. Our experience in a large series has proved, that even in seemingly hopeless cases, good functional outcome can be achieved with the correct use of this technique.
Results of post-traumatic use of Swanson's prosthesis to correct digital joint stiffness R.B. Karim, J J. Hage, J. M. E de G r o o t
Amsterdam, The Netherlands Knowledge of the benefits and limitations of Silicone implant arthroplasty for post-traumatic disabilities of finger joints will permit both patient and surgeon to approach this procedure with realistic expectations. Our long-term results of 21 Swanson implant arthroplasties following severe destruction of joints and surrounding tendo-capsular apparatus were evaluated. The data on subjective and objective assessment were obtained in all patients. Statistical correlations were evaluated applying Pearson's correlation co-efficient. Most patients were satisfied with the results as they were free of pain. Although significant levels of rotational defor-