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Mr G Shyamalan (Shyam) Hand Surgeon HEFT. So Much Choice!

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Presentation on theme: "Mr G Shyamalan (Shyam) Hand Surgeon HEFT. So Much Choice!"— Presentation transcript:

1 Mr G Shyamalan (Shyam) Hand Surgeon HEFT

2 So Much Choice!

3  Benign proliferative disease  Fascia of digits and palm  Nodules, cords and contractures

4 Need yes to one of the questions to approve  Moderate MCPJ contracture >30 degrees  Any PIPJ contracture  First web contracture

5  Age  Ancestry  Sex  FH  Diabetes  Smoking and Alcohol  Epilepsy

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7  Trauma  Surgery  Diabetes  No FH  Any race  Generally non-progressive

8  Male  <50  Affected siblings/parents  Ectopic Disease ‘Garrod’s pads’  Bilateral Disease

9  1. Do nothing  2. Radiotherapy – early disease  3. Steroid Injection  4. Percutaneous Needle Fasciotomy  5. Collagenase/Xiapex  6. Limited Fasciectomy  7. Dermato-fasciectomy and skin graft  8. Amputation

10  1. Do nothing £0  2. Radiotherapy – early disease £2500 (10 visits)  3. Steroid Injection (£ Steroid vial +OPD)  4. Percutaneous Needle Fasciotomy (£ OPD +needle +/- theatres)  5. Collagenase/Xiapex (£760 per vial/digit)  6. Limited Fasciectomy (£2500 plus therapy)  7. Dermato-fasciectomy and skin graft (>£3000 plus therapy)

11  1. Age/Retirement  2. Occupation  3. Hand Dominance  4. Pain  5. The speed of progression of disease  6. Recurrence Vs Extension  7. Extent of contracture PIP joint  8. Diathesis (bilateral, radial side, male)  9. General Systemic Health  10.Patient expectations

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13  Triamcinalone  50% softening  50% recurrence one year

14  Mostly clinic based  Splint 6 – 12 weeks at night  Low complication rate  Early return to work  5% early failure – akin to a failed injection for CMC joint arthritis!  Long-term 50% recurrence in 5 years but not always requiring surgery

15  Good option for early rehabilitation  Less time off work  Less recurrence than needle release  Recurrence rate akin to surgical fasciectomy  Has side effects as a drug (see next slide)

16 Side Effects  Paraesthesia,Complex regional pain syndrome (CRPS)  Hypoaesthesia  Monoplegia  Burning sensation  Tremor  Lymphadenopathy  Crepitus  Arthralgia  Hyperhidrosis  Myalgia /Muscle weakness and spasm  Wound dehiscence  Joint swelling  Tendon rupture  Injection site reactions  Ligament injury  Ecchymosis

17  Procedure with known results  Good for limited disease  Can be performed under local anaesthesia  Recurrence rates higher than skin grafts

18  Lowest recurrence rate  Best choice for young patient  Increase time to wound healing (diabetics and smokers take longer)  Longer rehabilitation time

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20  Extent of the pre-surgical contracture of the finger  Longer you live, the higher the recurrence!

21  Refer early  Tailor treatment to patient

22  uk uk  Solihull Hand Clinic Heartlands Fracture Clinic Good Hope Hand Clinic Spire Parkway Spire Little Aston


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