Yi-Chao Huang

Outcomes and complications after percutaneous release for trigger digits in diabetic and non-diabetic patients.

We compared the short-term (3 months) and long-term (2 years) outcomes and complications of percutaneous release of 187 trigger digits of 154 patients treated between 2009 and 2012, all treated by a single surgeon. The 154 patients included 48 patients with diabetes mellitus and 106 non-diabetic patients. The only short-term complication was pain, occurring in three digits (5%) in the diabetic patients and six digits (5%) in the non-diabetic patients. The long-term complications were pain in 15 digits (25%) in the diabetic patients and 18 digits (14%) in the non-diabetic patients. This was not significant (p = 0.058). Recurrent triggering occurred in nine digits (15%) in the diabetic patients, which was significantly greater than the six digits (5%) in the non-diabetic patients (p = 0.013). The non-diabetic patients were significantly more satisfied. Level of Evidence: level III

Fibromatosis stem cells rather than bone-marrow mesenchymal stem cells recapitulate a murine model of fibromatosis.

Palmar fibromatosis is a benign fibroproliferative tumor of unknown etiology, with a high rate of recurrence after excision. The offending cells of palmar fibromatosis are myofibroblasts and the cellular origin of other myofibroblasts has previously been reported to be the bone marrow. However, further clarification of the relationship between bone marrow precursors and palmar fibromatosis is required. Stem cells (SCs) are known to exist in various tissues, but whether SCs can be isolated from fibromatosis tissue is still unclear. The purpose of this study was to isolate and identify stem cells from human palmar fibromatosis, and to evaluate the differences in the differentiation and fibrogenic capacities of bone marrow stem cells (BMSCs) and fibromatosis-derived stem cells (FSCs). We found that FSCs had better fibrogenic differentiation potential than BMSCs, whereas BMSCs had better adipogenic and chondrogenic differentiation capacities. Treatment with transforming growth factor-β1 increased the expression of α-smooth muscle actin, and types III and I collagen significantly more in FSCs than in BMSCs. An in vivo study further confirmed the results of fibrogenesis and suggested that FSCs can recapitulate the fibromatosis nodule. In summary, their myofibroblastic differentiation both in vivo and in vitro makes FSCs a potential cell source for future applications in murine models of fibromatosis or fibrogenesis.

Long-term follow-up of Dupuytren disease after injection of triamcinolone acetonide in Chinese patients in Taiwan

Injection of triamcinolone acetonide is a non-operative treatment for early-stage Dupuytren disease in Caucasians, but its effectiveness in non-Caucasians is unclear. We report averaged 5-year follow-up results of 37 patients (49 affected hands) with early-stage Dupuytren disease for patients in Taiwan (non-Caucasian) who received a single dose of 5 mg triamcinolone acetonide injection into nodules monthly for 3 months. Using ultrasound, we recorded no progression of sizes of the modules following injection after 6 months. After an average 5-year follow-up, two patients with three hands (6%) experienced reactivation of the treated nodules. None required surgical intervention. Ultrasound examination showed that sizes of the treated Dupuytren nodules decreased significantly by 40% 6 months after injection and 56% at the final follow-up. We conclude that in these Chinese patients in Taiwan with early Dupuytren nodules, triamcinolone acetonide injection was effective in reducing the size of the Dupuytren nodules and maintaining long-term durable control of the nodular growth. Level of evidence: III

Lunocapitate fusion with scaphoid excision for the treatment of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrist

Background Four‐corner fusion is an effective procedure to treat advanced degenerative osteoarthritis of scaphoid nonunion advanced collapse or scapho‐lunate advanced collapse wrists. However, lunocapitate fusion, an alternative procedure, shows benefits including less dissection of the soft tissue and also a shorter operation time. We reviewed 10 cases to reveal the complication rates and clinical outcomes of this procedure. Methods We retrospectively reviewed 10 patients with symptomatic scaphoid nonunion advanced collapse or scapho‐lunate advanced collapse wrists who had received lunocapitate fusion with scaphoid excision. The average follow‐up period was 44.5 months (range, 22–68 months). Clinical evaluations were conducted and determined by radiographs, range of motion (flexion–extension), visual analog scale, and Mayo wrist scores. Complications including nonunion and implant migration were recorded. Results Among these patients, eight developed solid radiographic union while the remaining two patients showed bone resorption and implant migration and needed revision surgeries. The visual analog scale was decreased from 5.0 to 1.1, and the flexion–extension arc was increased from 61° to 72.5°. The average Mayo Wrist Score was 70 points. The results showed outcomes similar to those of previous studies. Conclusion Through our investigation and findings, we conclude that lunocapitate fusion can restore a functional and almost pain‐free wrist. Moreover, these results were maintained at follow‐up sessions, with complication rates being similar to those of previous studies. These results conclude a satisfactory therapeutic alternative to four‐corner fusion for advanced degenerative osteoarthritis of wrists.

Open versus percutaneous release for trigger digits: Reversal between short-term and long-term outcomes.

Background There have been excellent outcomes reported with both open and percutaneous release of trigger finger. However, a comparison of short‐ and long‐term outcomes between these two techniques has not been performed. The purpose of this study is to compare the short‐term (3 months) and long‐term (2 years) outcomes between open surgical release and percutaneous needle release of trigger finger. Methods Between 2009 and 2012, a total of 198 patients with trigger finger treated with either open (n = 72) or percutaneous (n = 126) release of the A1 pulley were enrolled in the study. Both short‐term and long‐term outcomes were evaluated, using the criteria established through Gilberts et als questionnaire. Results The short‐term satisfaction of patients with their results was significantly better in the percutaneous release group, whereas the long‐term satisfaction rates were better in the open‐release group, although not at a statistically significant level. Conclusion The percutaneous release method to release trigger finger does not have a better long‐term satisfaction rate than the open release approach, although percutaneous release has a significantly better short‐term satisfaction rate.

Recapitulation of Fibromatosis Nodule by Multipotential Stem Cells in Immunodeficient Mice

Musculoskeletal fibromatosis remains a disease of unknown etiology. Surgical excision is the standard of care, but the recurrence rate remains high. Superficial fibromatosis typically presents as subcutaneous nodules caused by rapid myofibroblast proliferation followed by slow involution to dense acellular fibrosis. In this study, we demonstrate that fibromatosis stem cells (FSCs) can be isolated from palmar nodules but not from cord or normal palm tissues. We found that FSCs express surface markers such as CD29, CD44, CD73, CD90, CD105, and CD166 but do not express CD34, CD45, or CD133. We also found that FSCs are capable of expanding up to 20 passages, that these cells include myofibroblasts, osteoblasts, adipocytes, chondrocytes, hepatocytes, and neural cells, and that these cells possess multipotentiality to develop into the three germ layer cells. When implanted beneath the dorsal skin of nude mice, FSCs recapitulated human fibromatosis nodules. Two weeks after implantation, the cells expressed immunodiagnostic markers for myofibroblasts such as α-smooth muscle actin and type III collagen. Two months after implantation, there were fewer myofibroblasts and type I collagen became evident. Treatment with the antifibrogenic compound Trichostatin A (TSA) inhibited the proliferation and differentiation of FSCs in vitro. Treatment with TSA before or after implantation blocked formation of fibromatosis nodules. These results suggest that FSCs are the cellular origin of fibromatosis and that these cells may provide a promising model for developing new therapeutic interventions.

Recurrence rate of the Paine retinaculotome carpal tunnel release in diabetic and non-diabetic patients at long-term follow-up

Background Carpal tunnel release (CTR) is considered effective in treating carpal tunnel syndrome (CTS), and diabetes is considered to complicate the outcome and recovery. However, the difference in recurrence rate between diabetic and non‐diabetic patients after mini‐open CTR in the long‐term has not yet determined. Methods This study enrolled 1251 wrists (1091 patients), with 841 (67%) females and 480 (33%) males at a mean age of 58.5 years at operation. Patients were followed for a mean duration of 10.5 years. We retrospectively compared the recurrence rates of the Paine retinaculotome for mini‐open CTR at wrist in diabetic and non‐diabetic patients. Results In our study, a total of 161 wrists (13%) were in the diabetic patients and 1090 wrists (87%) were in the non‐diabetic patients. Two wrists (1.24%) in the diabetic group and seven (0.6%) in the non‐diabetic group exhibited recurrence (p = 0.325). Conclusion The mini‐open CTR with the Paine retinaculotome in diabetic patients didn’t show significantly higher recurrence rate than that in non‐diabetic patients in the long term.