The Use of Skeletal Traction to Correct the Flexed PIP Joint in Dupuytren’s Disease

The flexed PIP joint presents a particular problem in the treatment of advanced Dupuytren’s disease. Following reports of the use of skeletal traction in the treatment of this condition, a simple device, the “Pipster” was developed to extend the PIP joint by skeletal traction before surgery. In seven fingers in five patients with severe contractures, there was a pre-operative improvement of at least 45° in the flexion angle (measured as maximum achievable passive extension). The technique was effective in primary and recurrent disease. Subsequent surgery was facilitated and amputation avoided in five tigers. The optimum distraction technique was identified. The study continues with more patients.

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Simultaneous Regional Fasciectomy, Skin Grafting, and Distraction Arthrolysis of the Proximal Interphalangeal Joint for Dupuytren’s Contracture of the Little Finger

Hand Surgery ◽

10.1142/s0218810415720077 ◽

2015 ◽

Vol 20 (02) ◽

pp. 298-301

Author(s):

Motohisa Kawakatsu ◽

Susumu Saito

Keyword(s):

Skin Grafting ◽

Proximal Interphalangeal Joint ◽

Dupuytren’S Disease ◽

Dupuytren’S Contracture ◽

Skeletal Traction ◽

Dupuytren's Disease ◽

Dupuytren's Contracture ◽

Pip Joint ◽

History Of ◽

Little Finger

We present a 58-year-old right-handed man, who consulted us with an 11-year history of Dupuytren’s disease. To correct contracture of the little finger, we performed regional fasciectomy, skin grafting, and distraction arthrolysis of the proximal interphalangeal (PIP) joint using an external fixator. Preoperative or postoperative skeletal traction has been advocated to treat potential or residual stiffness of the PIP joint in Dupuytren’s contracture, but its intraoperative use has not been reported before. Our method has the advantage of treating each problem caused by Dupuytren’s disease. A good range of painless PIP joint motion is achieved by our intraoperative distraction technique without interfering with the skin graft and without reducing extensor tone, while the healing period is shortened by performing all procedures simultaneously.

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Cleland’s ligaments and Dupuytren’s disease

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413510440 ◽

2013 ◽

Vol 39 (5) ◽

pp. 477-481 ◽

Cited By ~ 6

Author(s):

D. J. Shewring ◽

U. Rethnam

Keyword(s):

Histological Analysis ◽

Residual Disease ◽

Flexion Contracture ◽

Joint Contracture ◽

Dupuytren’S Disease ◽

Histological Findings ◽

Dupuytren's Disease ◽

Pip Joint ◽

Joint Flexion ◽

Neurovascular Bundles

The aim of this study was to investigate whether Cleland’s ligaments are affected by Dupuytren’s disease and assess their contribution to the flexion contracture of the proximal interphalangeal (PIP) joint. Twenty patients with Dupuytren’s disease undergoing fasciectomy for a PIP joint contracture > 40° (mean 61°, range 45°–100°) were included. After excision of all other identifiable digital disease, Cleland’s ligaments were assessed. If they appeared to be macroscopically affected by Dupuytren’s disease they were excised, sent for histological analysis, and any further improvement of PIP joint contracture was recorded. There were 14 males and six females with a mean age of 62 (range 40–79) years. Excision of Cleland’s ligaments resulted in a mean further correction of 7° (range 0°–15°). Histological analysis indicated that Cleland’s ligament was clearly involved with Dupuytren’s disease in 12 patients, indicating that Cleland’s ligaments can be affected by Dupuytren’s disease. In the remaining specimens the histological findings were equivocal. As these structures are situated dorsal to the neurovascular bundles, a specific dissection has to be undertaken to identify them. Excision of Cleland’s ligaments at digital fasciectomy further avoids leaving residual disease and may yield a worthwhile further correction of PIP joint flexion contracture.

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THE McCASH TECHNIQUE FOR DUPUYTREN'S DISEASE: OUR EXPERIENCE

Hand Surgery ◽

10.1142/s0218810414500117 ◽

2014 ◽

Vol 19 (01) ◽

pp. 61-67 ◽

Cited By ~ 5

Author(s):

Aristides B. Zoubos ◽

Nikolaos A. Stavropoulos ◽

George C. Babis ◽

Andreas F. Mavrogenis ◽

Zinon T. Kokkalis ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Technique ◽

Sensory Evaluation ◽

Rehabilitation Program ◽

Dupuytren’S Disease ◽

Dupuytren's Disease ◽

Bilateral Involvement ◽

Pip Joint ◽

The Mean ◽

Acceptable Outcome

This study presents the clinical outcomes of 35 hands with Dupuytren's Disease treated with the McCash technique between 1990 and 2009. Of the 31 patients (28 males and three females, mean age 53 yrs), four patients had bilateral involvement (12.9%). Thirty hands had no previous medical or surgical treatment for the disease, while the remaining five hands had been operated on at least once. The mean contracture of metacarpophalangeal (MCP) joint improved from 42.14° to 1.83°, while that of the proximal interphalangeal (PIP) joint improved from 62.60° to 7.09°. All wounds healed within a mean 9.8 weeks. Sensory evaluation revealed no permanent numbness. With realistic expectations, clear documentation, meticulous surgical technique and implementation of a demanding post-operative rehabilitation program, an acceptable outcome may be achieved with the McCash technique for Dupuytren's disease.

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Finger shortening for Dupuytren’s disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases

SICOT-J ◽

10.1051/sicotj/2021005 ◽

2021 ◽

Vol 7 ◽

pp. 11

Author(s):

Yoko Ito ◽

Kiyohito Naito ◽

Nana Nagura ◽

Yoichi Sugiyama ◽

Hiroyuki Obata ◽

...

Keyword(s):

Daily Living ◽

Treatment Method ◽

Flexion Contracture ◽

Dupuytren’S Disease ◽

High Patient Satisfaction ◽

Dupuytren's Disease ◽

Extended Position ◽

Pip Joint ◽

Joint Flexion ◽

Little Finger

When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren’s disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren’s disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.

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The use of skeletal traction in the treatment of severe primary Dupuytren’s disease

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.80b1.0800126 ◽

1998 ◽

Vol 80-B (1) ◽

pp. 126-129 ◽

Cited By ~ 5

Author(s):

N. Citron ◽

J. C. Messina

Keyword(s):

Dupuytren’S Disease ◽

Skeletal Traction ◽

Dupuytren's Disease

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A Comparison of Methods of Treatment of Pip Joint Contractures in Dupuytren’s Disease

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80107-0 ◽

1996 ◽

Vol 21 (2) ◽

pp. 246-251 ◽

Cited By ~ 14

Author(s):

C. M. BREED ◽

P. J. SMITH

Keyword(s):

Surgical Intervention ◽

Dupuytren’S Disease ◽

Comparison Of Methods ◽

Flexion Deformity ◽

Dupuytren's Disease ◽

Joint Contractures ◽

Joint Level ◽

Pip Joint ◽

Methods Of Treatment

An analysis of the different methods of treating residual flexion deformity at the PIP joint level after digital fasciectomy in 75 PIP joints has shown that gentle passive manipulation alone gives better results with fewer complications than more aggressive surgical intervention.

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The influence of Dupuytren's disease fingers contracture degree on surgical treatment outcome

Vojnosanitetski pregled ◽

10.2298/vsp150331103s ◽

2017 ◽

Vol 74 (1) ◽

pp. 19-23 ◽

Cited By ~ 1

Author(s):

Nenad Stepic ◽

Jovana Koncar ◽

Milica Rajovic

Keyword(s):

Surgical Treatment ◽

Functional Limitations ◽

Joint Contracture ◽

Dupuytren’S Disease ◽

Optimal Time ◽

Dupuytren's Disease ◽

Significant Difference ◽

Pip Joint ◽

Group 3 ◽

Reduction Index

Background/Aim. Dupuytren?s disease is a progressive disease of the palmar and digital fascial structures, with functional limitations. There are no clear recommendations about the optimal time of surgical repair, concerning the hand impairment. The aim of our study was to investigate the relation between finger?s contracture degree and success of surgical treatment of the Dupuytren's disease. Methods. This prospective analysis included 60 patients operated on due to Dupuytren?s contracture. According to preoperative contracture degree of proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint, patients were divided into three groups: the group 1: < 15?, the group 2: 15?30? and the group 3: > 30?. All the patients underwent operation of partial palmar fasciectomy. Postoperative improvement was expressed with contracture reduction INDEX. Results. There were 60 patients with 85 fingers affected. The groups 1, 2 and 3 had 22 (37%), 37 (62%) and 26 (43%) fingers with MCP contracture and 32 (37.4%), 24 (28.2%) and 29 (34.1%) fingers with PIP contracture, respectively. Postoperative contractures of MCP joint in these groups were 0, 0.135? and 5?, and of PIP joint 0, 2.08 ? and 16.89?, respectively. After six months all MCP contractures resolved, while PIP joint contracture in the group 3 remained 13.62?. The reduction INDEX was 98.85%, 97.62% and 75.52% in the groups 1, 2 and 3, respectively. There was a statistically significant difference in the INDEX value between the groups (p = 0.0001). Conclusion. The degree of PIP joint contracture is related to the outcome of surgical treatment of Dupuytren?s disease. Optimal results are achieved when contracture degree is between 15? and 30?. Surgical treatment of MCP joint contracture is successful regardless of the preoperative joint contracture degree.

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