Michael A Lapner1, Thomas J Goetz2. 1. Department of Orthopedics, Saint Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 2. Department of Orthopedics, Saint Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: thomas_goetz@telus.net.
Abstract
PURPOSE: To evaluate the functional outcome after removal of digital calcinosis cutis in patients with scleroderma using a high-speed burr. METHODS: A retrospective analysis was performed of 9 consecutively enrolled scleroderma patients who underwent surgery by the senior author. A debulking procedure using a high-speed micro-burr to soften and express calcific material in digits was performed. Demographics, complications, recurrence, and postoperative functional outcome measurements including the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Michigan Hand Questionnaire, a study-specific questionnaire, a visual analog scale, and the Short Form-12 were collected. RESULTS: Mean follow-up time was 2 years. Four of 9 patients were very or somewhat satisfied with the procedure. Eight complications were recorded in 6 patients, including weakness, decreased motion, numbness, and superficial wound infection. The mean Disabilities of the Arm, Shoulder, and Hand score in patients who would have surgery again was 27 (4 of 9), versus 54 (5 of 9) for those who would not. Two patients had no recurrence. There were 7 cases of recurrence; 3 patients had late recurrence to a small degree, 3 had early complete recurrence, and 1 had recurrence at an unknown onset. No patient reported complete resolution of calcinosis. Patient satisfaction appeared inversely correlated to the number of digits involved. CONCLUSIONS: Patients with discrete areas of calcinosis cutis, including those with 1 or 2 digits affected, did much better than patients with diffuse disease and multiple affected digits. Patients should be counseled that the benefit might be more limited than previously reported, and recurrence is likely. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
PURPOSE: To evaluate the functional outcome after removal of digital calcinosis cutis in patients with scleroderma using a high-speed burr. METHODS: A retrospective analysis was performed of 9 consecutively enrolled sclerodermapatients who underwent surgery by the senior author. A debulking procedure using a high-speed micro-burr to soften and express calcific material in digits was performed. Demographics, complications, recurrence, and postoperative functional outcome measurements including the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Michigan Hand Questionnaire, a study-specific questionnaire, a visual analog scale, and the Short Form-12 were collected. RESULTS: Mean follow-up time was 2 years. Four of 9 patients were very or somewhat satisfied with the procedure. Eight complications were recorded in 6 patients, including weakness, decreased motion, numbness, and superficial wound infection. The mean Disabilities of the Arm, Shoulder, and Hand score in patients who would have surgery again was 27 (4 of 9), versus 54 (5 of 9) for those who would not. Two patients had no recurrence. There were 7 cases of recurrence; 3 patients had late recurrence to a small degree, 3 had early complete recurrence, and 1 had recurrence at an unknown onset. No patient reported complete resolution of calcinosis. Patient satisfaction appeared inversely correlated to the number of digits involved. CONCLUSIONS:Patients with discrete areas of calcinosis cutis, including those with 1 or 2 digits affected, did much better than patients with diffuse disease and multiple affected digits. Patients should be counseled that the benefit might be more limited than previously reported, and recurrence is likely. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.