The Proximal Interphalangeal Joint in Dupuytren’s Disease

1985 ◽  
Vol 10 (3) ◽  
pp. 358-364
Author(s):  
M. A. TONKIN ◽  
F. D. BURKE ◽  
J. P. W. VARIAN
Keyword(s):  
Surgical Approach ◽  
Proximal Phalanx ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Average Percentage ◽  
Percentage Improvement

In one hundred patients with Dupuytren’s disease, one hundred and fifty-four operations were performed. The average pre-operative proximal interphalangeal joint contracture was 42° and the average percentage improvement in proximal interphalangeal joint extension at post­operative review was 41%. Fourteen amputations were performed (9.1%). The primary deformity is caused by disease involvement of the palmar fascial structures. Secondary changes may prevent correction of the deformity despite excision of the contracted fascia. The anatomy of the joint is reviewed together with the primary and secondary mechanisms of joint contracture in Dupuytren's disease. Arthrodesis, osteotomy of the proximal phalanx and joint replacement are considered as alternatives to amputation when a systematic surgical approach fails to correct the flexion contracture.

Severe Contracture of the Proximal Interphalangeal Joint in Dupuytren’s Disease: Does Capsuloligamentous Release Improve Outcome?

2004 ◽  
Vol 29 (3) ◽  
pp. 238-241 ◽  
Author(s):  
K. BEYERMANN ◽  
K. J. PROMMERSBERGER ◽  
C. JACOBS ◽  
U. B. LANZ
Keyword(s):  
Prospective Study ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Postoperative Rehabilitation ◽  
Dupuytren's Disease ◽  
Improve Outcome ◽  
Capsuloligamentous Release

This prospective study assessed whether patients with severe proximal interphalangeal joint contracture (≥60°) due to Dupuytren’s disease which persisted after fasciectomy alone benefited from an additional capsuloligamentous release. Forty-three patients with 43 severely contracted proximal interphalangeal joints underwent operative correction followed by a standardized postoperative rehabilitation programme. All were followed for 6 months. In 11 patients correction of the proximal interphalangeal joint to 20° could not be achieved by fasciectomy alone, and an additional capsuloligamentous release was performed which effectively corrected all their residual flexion contractures. There were no statistically significant differences between the capsulotomy and the non-capsulotomy group with respect to the residual proximal interphalangeal joint contracture at the end of surgery, or at their last follow-up examination.

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.

Nonoperative treatment of PIPJ flexion contractures associated with Dupuytren’s disease

2011 ◽  
Vol 37 (8) ◽  
pp. 722-727 ◽  
Author(s):  
J. Larocerie-Salgado ◽  
J. Davidson
Keyword(s):  
Soft Tissue ◽  
Nonoperative Treatment ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Patient Dissatisfaction ◽  
Flexion Contractures ◽  
Alternative Treatment Option ◽  
Soft Tissue Mobilization

Post-surgical outcomes in patients with Dupuytren’s disease causing flexion contractures of the proximal interphalangeal joint can be inconsistent and are often associated with protracted rehabilitation, reduced flexion, recurrence of the contracture, and patient dissatisfaction. An alternative treatment option, comprised of splinting and soft tissue mobilization techniques, was introduced to stabilize early contractures of the proximal interphalangeal joint in the hopes of delaying or obviating surgery. Over the course of approximately 12.6 months (±7.8), thirteen patients were followed at the hand clinic at Hotel Dieu Hospital in Kingston. One patient was unable to complete the course of therapy. Of the remaining patients, analysis showed significant improvement in active proximal interphalangeal joint extension of approximately 14.6° (SD: ±5.1°; range: 5–25°) over the course of the treatment ( p < .05). Nighttime static extension splinting and soft tissue mobilization techniques appear to delay and possibly prevent the need for surgery in individuals with flexion contractures of the proximal interphalangeal joint due to Dupuytren’s disease.

Predicting the Outcome of Surgery for the Proximal Interphalangeal Joint in Dupuytren’s Disease

2007 ◽  
Vol 32 (2) ◽  
pp. 240-245 ◽  
Author(s):  
Alok Misra ◽  
Abhilash Jain ◽  
Reza Ghazanfar ◽  
Terrencia Johnston ◽  
Jagdeep Nanchahal
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Outcome Of Surgery

Capsular Tissues of the Proximal Interphalangeal Joint: Normal Composition and Effects of Dupuytren’s Disease and Rheumatoid Arthritis

1993 ◽  
Vol 18 (3) ◽  
pp. 371-376 ◽  
Author(s):  
M. BENJAMIN ◽  
J. R. RALPHS ◽  
M. SHIBU ◽  
M. IRWIN
Keyword(s):  
Rheumatoid Arthritis ◽  
Type Ii Collagen ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Volar Plate ◽  
Dupuytren's Disease ◽  
Extracellular Matrix Components ◽  
Central Slip ◽  
Normal Composition

Three fibrocartilages associated with the proximal interphalangeal joint are described—at the attachment of the central slip to bone, within the slip where it passes over the joint, and the volar plate. Material was obtained at surgery following trauma, Dupuytren’s disease and rheumatoid arthritis. The fibrocartilages were structurally distinct and immunolabelled differently with monoclonal antibodies to extracellular matrix components. All fibrocartilages from normal and Dupuytren’s fingers contained chondroitin and keratan sulphate. Type II collagen was present in all attachment zones, although there was little in rheumatoid fingers. It was also present in the dorsal hood of some normal fingers, but not in pathological specimens or the volar plate. The results show that the fibrocartilages are dynamic tissues whose composition varies according to function and use, and changes in disease.

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

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.

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