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

1996 ◽  
Vol 21 (2) ◽  
pp. 246-251 ◽  
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.

Cleland’s ligaments and Dupuytren’s disease

2013 ◽  
Vol 39 (5) ◽  
pp. 477-481 ◽  
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.

THE McCASH TECHNIQUE FOR DUPUYTREN'S DISEASE: OUR EXPERIENCE

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 61-67 ◽  
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.

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

1994 ◽  
Vol 19 (4) ◽  
pp. 534-537 ◽  
Author(s):  
P. D. HODGKINSON
Keyword(s):  
Recurrent Disease ◽  
Flexion Angle ◽  
Simple Device ◽  
Dupuytren’S Disease ◽  
Skeletal Traction ◽  
Dupuytren's Disease ◽  
Pip Joint

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.

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

SICOT-J ◽  
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.

Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease

2020 ◽  
pp. 175319342096030
Author(s):  
Alexander M. Bolt ◽  
Henk Giele ◽  
Ian S. H. McNab ◽  
Michelle Spiteri
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Salvage Procedure ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Dupuytren's Disease ◽  
Joint Contractures ◽  
Patient Demographics

We report long-term outcomes of proximal interphalangeal joint arthrodesis for treatment of severe recurrent joint contractures secondary to Dupuytren’s disease. The patients had at least two previous procedures for Dupuytren’s contracture that involved the same joint, before undergoing joint fusion. Patient demographics, satisfaction, functional outcome, complications, revision and re-operation rates are reported. Eleven patients were included with a mean age of 64 years (range 53–73). The mean proximal interphalangeal joint contracture at presentation was 102° (range 80°–120°). None required revision surgery at a mean of 8 years and 9 months (range 9–199 months). All patients were able to perform their activities of daily living and would recommend this operation to family and friends. This series shows that proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren’s disease. Level of evidence: IV

The Microanatomy of Dupuytren's Contracture

HAND ◽  
1982 ◽  
Vol os-14 (3) ◽  
pp. 215-236 ◽  
Author(s):  
D. A. Mcgrouther
Keyword(s):  
Fibrous Tissue ◽  
Three Dimensional ◽  
Dupuytren’S Disease ◽  
Dimensional System ◽  
Stress Concentrations ◽  
Palmar Fascia ◽  
Dupuytren's Disease ◽  
Joint Contractures ◽  
Normal Hand ◽  
Three Dimensional System

The palmar fascial ligaments have been examined by microdissection using an operating microscope in fresh and preserved cadaveric hands. The palmar fascia is seen to be a precise three dimensional system of skin ligaments having discreet transverse, longitudinal and vertical fibre systems. In the normal hand there is relative motion between the ligament systems on movement. The longitudinal fibres provide a system of skin anchorage which operates irrespective of the position of the underlying joints and acts particularly to resist shearing forces in gripping. The distribution of the lesions of Dupuytren's Disease has been recorded in a series of clinical cases; nodules, skin pits, distortion of the palmar creases, cords and joint contractures, and the pathogenesis of the disease is related to the anatomy of the palmar ligaments. The disease is described as a process of contracture along anatomical pathways. A hypothesis for the development of Dupuytren's Disease is presented whereby the loss of normal motion between palmar fascial ligaments gives rise on use of the hand to stress concentrations which stimulate fibrous tissue deposition and contracture.

Contracture of the Proximal Interphalangeal Joint in Dupuytren’s Disease

1991 ◽  
Vol 16 (4) ◽  
pp. 446-448 ◽  
Author(s):  
J. G. ANDREW
Keyword(s):  
Anatomical Study ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Corrective Surgery ◽  
Collateral Ligaments ◽  
Flexion Deformity ◽  
Dupuytren's Disease ◽  
Secondary Damage ◽  
Fixed Flexion Deformity

The correction of fixed flexion deformity at the P.I.P. joint in Dupuytren’s disease is often difficult. This paper reports an anatomical study of this joint in fingers amputated because of this condition. All the joints would extend fully after release of the accessory collateral ligaments and volar plate. Lateral and dorsal structures showed severe secondary damage and it is suggested that these changes may explain the poor results of corrective surgery to this joint in Dupuytren’s disease.

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

2017 ◽  
Vol 74 (1) ◽  
pp. 19-23 ◽  
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.

Functional Benefit of Dupuytren’s Surgery

2002 ◽  
Vol 27 (4) ◽  
pp. 378-381 ◽  
Author(s):  
R. SINHA ◽  
T. R. CRESSWELL ◽  
R. MASON ◽  
I. CHAKRABARTI
Keyword(s):  
Hand Function ◽  
Dupuytren’S Disease ◽  
Flexion Deformity ◽  
Dupuytren's Disease ◽  
Functional Benefit ◽  
Operative Result ◽  
The Mean ◽  
Results Of Surgery

The results of surgery for Dupuytren’s disease were prospectively assessed to see if there is a correlation between hand function, the degree of deformity and the post-operative result. A total of 42 patients were followed-up for 6 months. The mean flexion deformity was 81° pre-operatively and 32° post-operatively. The mean Sollerman score improved from 71 (out of 80) pre-operatively to 77 post-operatively. There was a significant correlation between the degree of deformity and the Sollerman score, and also between the improvement in deformity after surgery, and the Sollerman score. We conclude that hand function is worsened by increasing deformity in Dupuytren’s disease and improved by correction of the deformity.

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