Dupuytren’s Contracture: An Audit of the Outcomes of Surgery

2006 ◽  
Vol 31 (5) ◽  
pp. 514-521 ◽  
Author(s):  
J. J. DIAS ◽  
J. BRAYBROOKE
Keyword(s):  
Audit Committee ◽  
Hand Function ◽  
Postal Questionnaire ◽  
High Rate ◽  
Dupuytren’S Contracture ◽  
Subjective Data ◽  
Dupuytren's Contracture ◽  
Patient Reported ◽  
Full Correction

This multi-centre postal questionnaire study was conducted by the Audit Committee of the BSSH to assess the outcomes of surgery for Dupuytren’s Contracture using subjective data provided by 1177 patients at a mean follow-up of 27 (SD 8) months after surgery. Surgery for Dupuytren’s contracture achieved a high rate of full, or almost full, correction in 826 patients (75%) but had a high incidence of post-operative patient-reported complications of 46%. A higher complication rate was seen in those patients with worse initial deformities. The rate of contracture recurrence or persistence was 158 of 1037 (15%). The severity of contracture correlated with the final hand function measured using the PEM score. Recurrence was more common in patients with greater initial deformity. Recurrence was less common if good correction was achieved at surgery. The relevance and limitations of this data are discussed.

scholarly journals Safety and Effectiveness of Percutaneous Needle Fasciotomy for Dupuytren's Disease in the Palm

2017 ◽  
Vol 09 (03) ◽  
pp. 115-119 ◽  
Author(s):  
Darren Flynn ◽  
John Stothard ◽  
Muhammad Mansha
Keyword(s):  
Hand Function ◽  
Postal Questionnaire ◽  
British Society ◽  
Dupuytren’S Contracture ◽  
Complication Rates ◽  
Patient Evaluation ◽  
Dupuytren's Contracture ◽  
Evaluation Measure ◽  
The Mean

Purpose Percutaneous needle fasciotomy is performed in the authors' department to treat Dupuytren's contracture at metacarpophalangeal joints. This study aimed to establish its safety and efficacy, compared with standard fasciectomy. Materials and Methods All patients who had this procedure performed over the study period were sent the validated British Society for Surgery of the Hand (BSSH) postal questionnaire assessing surgical outcome. Hand function and disability were assessed using the Patient Evaluation Measure (PEM). Results Statistically significant improvement was achieved in Dupuytren's contracture at the mean follow-up of 15 months (SD +/− 10). Approximately 97% of the fingers fully corrected at surgery remain straight. Recurrence rate was 2.2% among fully corrected fingers. However, 2 (40%) out of 5 partially corrected fingers had recurrence. No complication of any kind was noted and no antibiotics used. Hand function was measured using PEM score correlated well with the residual contracture. Conclusion Percutaneous needle fasciotomy is safe, effective, has very low complication rates, and yields comparable results to standard fasciectomy.

scholarly journals Surgical management of Dupuytren contracture of the ring finger: a case report

2020 ◽  
Vol 8 (4) ◽  
pp. 1570
Author(s):  
Gede Ketut Alit Satria Nugraha ◽  
Made Bramantya Karna ◽  
Gde Dedy Andika ◽  
Made Sunaria
Keyword(s):  
Gold Standard ◽  
Ring Finger ◽  
High Rate ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Disease Etiology ◽  
Dupuytren's Contracture ◽  
Scar Assessment

Dupuytren’s disease, also called Dupuytren’s contracture or palmar fibromatosis, is a condition in which the connective tissue under the skin of the palm contracts and toughens over time. The gold standard treatment for Dupuytren’s contracture is surgery. We present a case of Dupuytren’s contracture treated with Bruner incision which resulted in good functional outcome. A 79 year old male presented to our Orthopaedic Clinic RSUP Sanglah Denpasar with the complaints of pain and stiffness on his left ring finger since 5 years ago. Patient had same history with his right hand and had operation 20 years ago. The patient underwent release of contracture using Bruner incision and had no complaint in 6 month follow-up. Extension deficit was <5°, reduction of contracture was >50%, the Patient and Observer Scar Assessment Scale (POSAS) gave overall opinion of the scar being minimal. The Dupuytren's disease etiology remains uncertain, with genetics perceived as most probable factor. Despite short-term success, there is a high rate of recurrent contracture with additional comorbidities such as wound-healing complications and neurovascular injury. In this case, the patient was treated using fasciotomy with Bruner incision and had satisfying outcome. Fasciotomy is known to have less complication in terms of recurrence. Dupuytren disease is characterized by abnormal thickening of the palmar fascia beneath the skin and the gold standard of treatment is surgery. This case presented surgical treatment using Bruner incision which had satisfying outcome in 6 month follow-up.

Dupuytren’s Contracture: The Long-Term Results after Day Surgery

1991 ◽  
Vol 16 (3) ◽  
pp. 272-274 ◽  
Author(s):  
E. A. MÄKELÄ ◽  
H. JAROMA ◽  
A. HARJU ◽  
S. ANTTILA ◽  
J. VAINIO
Keyword(s):  
Surgical Treatment ◽  
Day Surgery ◽  
High Rate ◽  
Long Term Results ◽  
Dupuytren’S Contracture ◽  
Central Hospital ◽  
Dupuytren's Contracture ◽  
The Mean

220 operations in 211 hands in 160 consecutive patients suffering from Dupuytren’s contracture were performed from 1976 through 1984 at the Kuopio University Central Hospital in Finland. 179 operations were carried out as day cases. The mean follow-up was 3.2 years. Sub-total fasciectomy resulted in good immediate and long-term improvement in 86% of patients. The recurrence rate was 27%. Surgical treatment of Dupuytren’s contracture was well-suited to day surgery. A properly planned follow-up programme is suggested because of the relatively high rate of recurrence, which usually appeared within two years after operation.

scholarly journals Collagenase clostridium histolyticum in patients with Dupuytren’s contracture: results from POINT X, an open-label study of clinical and patient-reported outcomes

2014 ◽  
Vol 40 (2) ◽  
pp. 124-132 ◽  
Author(s):  
D. Warwick ◽  
M. Arner ◽  
G. Pajardi ◽  
B. Reichert ◽  
Z. Szabo ◽  
...  
Keyword(s):  
Hand Function ◽  
Large Population ◽  
Metacarpophalangeal Joint ◽  
Patient Treatment ◽  
Dupuytren’S Contracture ◽  
Open Label ◽  
Extension Deficit ◽  
Dupuytren's Contracture ◽  
Patient Reported ◽  
The Mean

In POINT X, a study designed to reflect clinical practice and patient treatment choices, 254 European patients received open-label collagenase for Dupuytren’s contracture. The most severely affected joint was treated first in 74% of patients. In total, 52%, 41%, 7%, and 1% of patients selected the little, ring, middle, and index finger, respectively; 79% had one or two joints treated. Only 9% of patients ( n = 24) received 4 or 5 injections. The mean improvement in total passive extension deficit (TPED) was 34° on day 1, improving further by day 7 to 42°. This secondary improvement was maintained by day 90 and month 6. The mean number of injections/joint was 1.2 for the metacarpophalangeal joint and 1.25 for the proximal interphalangeal joint. Median time to recovery was 4 days; the mean improvement in hand function was clinically relevant as measured by the Unité Rhumatologique des Affections de la Main (URAM) score. In total, 87% and 86% of patients and physicians, respectively, were very satisfied or satisfied with treatment at month 6, although correlation between TPED and patient satisfaction was weak (Spearman −0.18, 95% CI −0.32 to −0.06). Collagenase was well tolerated, with 10 (3.9%) patients experiencing severe adverse events. As a real-world study, the POINT X findings can be generalized to the at-large population.

scholarly journals Hand function and cost effectiveness after collagenase injection versus aponeurectomy for Dupuytren’s contracture: results of the CeCORD-J study

2021 ◽  
Author(s):  
Michiro Yamamoto ◽  
Hideo Yasunaga ◽  
Ryosuke Kakinoki ◽  
Naoto Tsubokawa ◽  
Akimasa Morita ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Direct Cost ◽  
Hand Function ◽  
Group Extension ◽  
Dupuytren’S Contracture ◽  
Extension Deficit ◽  
Dupuytren's Contracture ◽  
Surgery Group ◽  
Patient Reported ◽  
Pip Joint

Abstract BackgroundThis study compared hand function and the cost effectiveness of treatment between collagenase Clostridium histolyticum (CCH) injection and limited fasciectomy for patients with Dupuytren’s contracture (DC).Materials and MethodsThe CeCORD-J study is a prospective, multicenter, non-randomized controlled, observational study of two parallel groups. Participants were DC patients with multiple affected fingers, including flexion contracture of the proximal interphalangeal (PIP) joint. The primary outcome was the Hand10 score, as a patient-reported outcome measure. We set secondary outcomes of EQ-5D-5L score, degree of extension deficit, and direct cost. Propensity score adjustment was used to balance differences in patient characteristics between groups.ResultsParticipants comprised 52 patients in the Collagenase group and 26 patients in the Surgery group. Hand10 score was significantly better in the Collagenase group at 1 and 2 weeks. EQ-5D-5L score was significantly higher in the Collagenase group at 8 weeks. Mean direct cost was 248,000 yen higher in the Surgery group than in the Collagenase group. Extension deficit angle of the PIP joint was significantly larger in the Collagenase group at 26 weeks.ConclusionsCCH injection provides better short-term hand function and cost effectiveness than surgery.UMIN-CTR (UMIN000029826)

Efficacy and tolerability of Day 2 manipulation and local anaesthesia after collagenase injection in patients with Dupuytren’s contracture

2013 ◽  
Vol 39 (5) ◽  
pp. 466-471 ◽  
Author(s):  
C. J. Manning ◽  
R. Delaney ◽  
M. J. Hayton
Keyword(s):  
Clinical Trials ◽  
Local Anaesthesia ◽  
Hand Function ◽  
Dupuytren’S Contracture ◽  
Patient Evaluation ◽  
Viable Option ◽  
Dupuytren's Contracture ◽  
Collagenase Injection ◽  
Evaluation Measure

In clinical trials, treating Dupuytren’s contracture with collagenase injection involves manipulation the day after injection, without local anaesthesia. We evaluated the efficacy and tolerability of manipulation 2 days after injection with local anaesthesia. Forty-five patients received 50 injections into cords contracting metacarpophalangeal and proximal interphalangeal joints; follow-up visits were at 3 and 14 weeks. For the metacarpophalangeal joints there were >90% reduction in contracture at both visits. The proximal interphalangeal joints that improved spontaneously after metacarpophalangeal injection or received direct injections showed 51–55% reduction in contracture. Changes in scores on the Patient Evaluation Measure suggest that patients perceived improvements in their hand function was good and they were satisfied with the procedure. Collagenase and local anaesthesia injections were well tolerated; adverse events were localized to the injection site and were mild and transient in nature. These findings provide another viable option for practising surgeons and may help with the logistics of patient care.

Treatment of Dupuytren’s Contracture With Collagenase: A Systematic Review

Hand ◽  
2021 ◽  
pp. 155894472097411
Author(s):  
Alexis B. Sandler ◽  
John P. Scanaliato ◽  
Thomas Dennis ◽  
Gilberto A. Gonzalez Trevizo ◽  
Sorana Raiciulescu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hand Function ◽  
Tendon Injury ◽  
Flexion Contracture ◽  
Treatment Modalities ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Review Of The Literature ◽  
Dupuytren's Contracture

This systematic review investigates complications and recurrence of Dupuytren’s contracture in metacarpophalangeal joints (MCPJs) and/or proximal interphalangeal joints (PIPJs) of fingers treated with collagenase clostridium histolyticum (CCH). A review of the literature on Dupuytren’s disease was performed using PRISMA guidelines. Included publications described complications and/or recurrences for contractures ≥20° in MCPJs and/or PIPJs treated with CCH. Successful treatments reduced contractures to ≤5° immediately. Treatment-related adverse events (AEs) were classified as minor, major surgical, and major nonsurgical. Contracture recurrence involved return of fixed-flexion contracture ≥20° in a successfully treated finger in patients with ≥12 months of follow-up. Of 2675 patients (3753 joints), 94% experienced ≥1 treatment-related AE, most commonly peripheral edema (64%), pain in extremity (53%), and contusion (51%). Major surgical complications occurred in 9 patients (1.0%). Major nonsurgical complications occurred in 2 patients, specifically nonrupture tendon injury and anaphylaxis. Of 1488 patients (2069 joints), recurrences were reported in 23% of successfully treated joints (n = 466; 20% MCPJs, 28% PIPJs), on average 12 to 24 months after treatment. MCPJs achieved greater success than PIPJs in initial contracture reduction (77% versus 36%). CCH is a safe, effective treatment to improve hand function in Dupuytren’s contracture. Most AEs are minor and self-resolving, although the risk of major AEs still exists. Following treatment, 23% of successfully treated joints experience recurrence, typically within 12 to 24 months but sometimes as early as 6 months. Surgeons are encouraged to discuss these risks with patients for shared decision-making regarding optimal treatment modalities.

Long term follow-up of dermofasciectomy for Dupuytren's contracture

1994 ◽  
Vol 47 (6) ◽  
pp. 440-443 ◽  
Author(s):  
T.M. Brotherston ◽  
C. Balakrishnan ◽  
R.H. Milner ◽  
H.G. Brown
Keyword(s):  
Dupuytren’S Contracture ◽  
Dupuytren's Contracture ◽  
Long Term Follow Up

Validation of a Handprint for Clinical Evaluation of Dupuytren’s Contracture

2021 ◽  
Author(s):  
Takashi Ajiki ◽  
Akira Murayama ◽  
Yukinori Hayashi ◽  
Katsushi Takeshita
Keyword(s):  
Clinical Evaluation ◽  
High Reliability ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Therapeutic Effects ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
Palmar Surface ◽  
Patient Reported ◽  
Quick Dash

Abstract Objective We have developed a handprint-based method for visualizing and quantifying the palmar contact of patients with Dupuytren’s contracture. The purpose of this study was to examine whether the generated handprint was useful for assessing the severity of flexion contracture of the fingers and for evaluating the therapeutic effects of collagenase clostridium histolyticum (CCH) injection for Dupuytren’s contracture. Methods The handprint was created by applying medical-grade ethanol-containing hand sanitizer over the entire palmar surface of the affected hand and then pressing it on thermal paper for word processors. The reliability of the handprint was evaluated through test–retest of 10 healthy volunteers at an interval of 10 days, and the validity of the handprint was assessed using a flexion contracture model in which the little finger was fixed in an Alfence splint. In addition, we obtained handprints of the affected hand in 33 patients with unilateral Dupuytren’s contracture both before CCH injection and at the final observation after injection to investigate the contact area of the hand (CAH) and the length of the hand (LH). The relationships between CAH, LH, total extension deficit angle (TEDA), and patient-reported outcome measures (Japanese Society for Surgery of the Hand Version of the Quick Disability of Arm, Shoulder, and Hand Questionnaire [Quick DASH-JSSH] and Hand20) were examined. Results The test–retest correlation coefficient was 0.9187 (p < 0.001) for CAH and 0.9052 (p < 0.001) for LH, indicating high reliability of the handprint. The ratios of CAH and LH decreased gradually as the contracture angle of the splinted finger increased. The handprint revealed a marked improvement of palmar contact after CCH injection for Dupuytren’s contracture. Furthermore, the ratios of CAH and LH were strongly correlated with TEDA, Quick DASH-JSSH, and Hand20 before treatment. Conclusion Our handprint-based assessment method was extremely useful for clinical evaluation of CCH treatment for Dupuytren’s contracture. Type of Study/Level of Evidence Therapeutic.

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