RESUMEN
OBJECTIVES: Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren's cords. MATERIALS AND METHODS: Specially prepared medical grade IBS was injected into fresh Dupuytren's cords excised from patients undergoing surgical fasciectomy. These cords were tested by tension-loading them to failure with the Zwick 1445 (Zwick GmbH & Co. KG, Ulm, Germany) tension testing system. RESULTS: We completed a pilot concept-validation study that proved the efficacy of IBS to induce enzymatic fasciotomy in ten cords compared with control in ten cords. We then completed a dosing study with an additional 71 cords injected with IBS in descending doses from 150 mg/cc to 0.8 mg/cc. The dosing study demonstrated that the minimal effective dose of 0.5 cc of 6.25 mg/cc to 5 mg/cc could achieve cord rupture in more than 80% of cases. CONCLUSIONS: These preliminary results indicate that IBS may be effective in enzymatic fasciotomy in Dupuytren's contracture.Cite this article: Dr G. Rubin. A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release. Bone Joint Res 2016;5:175-177. DOI: 10.1302/2046-3758.55.BJR-2016-0072.
RESUMEN
Complete traumatic separation of the distal humeral epiphysis is a rare finding in children, and is usually seen in the battered child. An 11-month-old girl with a complete traumatic separation is described. The family pathology was diagnosed and proper social and legal steps were taken after the only clue, the fracture, was properly interpreted.
Asunto(s)
Maltrato a los Niños , Fracturas del Húmero/etiología , Epífisis , Familia , Femenino , Humanos , Fracturas del Húmero/diagnóstico por imagen , Lactante , RadiografíaRESUMEN
We present a method for the reducing a displaced radial head in children, by rotating the forearm while pressing over the displaced fragment. This has been successful in a series of 10 cases.