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.

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.

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

Hand Surgery ◽  
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.

Amputations in the Treatment of Dupuytren’s Disease

1993 ◽  
Vol 18 (6) ◽  
pp. 781-782 ◽  
Author(s):  
C. M. JENSEN ◽  
M. HAUGEGAARD ◽  
S. W. RASMUSSEN
Keyword(s):  
Phantom Limb Pain ◽  
Dupuytren’S Disease ◽  
Phantom Limb ◽  
Limb Pain ◽  
Dupuytren's Disease ◽  
Finger Amputation ◽  
Difficult Cases ◽  
Little Finger

23 finger amputations in 19 patients operated on for Dupuytren’s disease were reviewed 6 months to 8.5 years after operation (mean 4 years). The distribution of amputations were 17 little fingers and six ring fingers. We found a recurrent lack of extension in nine out of 16 finger amputations distal to the MP joint and painful neuroma or phantom limb pain in five out of seven little finger amputations through or proximal to the MP joint. When amputation in the little finger is necessary, disarticulation of the MP joint may be preferable to amputation at a more distal level. Alternatives to finger amputation should be sought in difficult cases of Dupuytren’s disease.

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.

Anterior Tenoarthrolysis for Severe Flexion Contracture of the Fingers (The “Tata” Operation): A Review of 50 Cases

2007 ◽  
Vol 32 (2) ◽  
pp. 224-229 ◽  
Author(s):  
P. LOREA ◽  
J. MEDINA HENRIQUEZ ◽  
R. NAVARRO ◽  
P. LEGAILLARD ◽  
G. FOUCHER
Keyword(s):  
Flexion Contracture ◽  
Salvage Procedure ◽  
Extension Deficit ◽  
Salvage Operation ◽  
Active Range Of Motion ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Joint Flexion ◽  
The Mean

The “hook finger”, with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (Téno-Arthrolyse Totale Antérieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had had at least one previous operation, most on the flexor apparatus. The mean PIP and DIP extension deficit pre-operatively was 133° with a mean PIP lag of extension of 83°. With a mean follow-up of 7.8 years, 45 fingers were improved, five were not and none was worsened. The mean PIP and DIP extension deficit postoperatively was 47°, with a mean PIP lack of extension of 31°. The overall gain in extension deficit of both joints was 86° and of the PIP was 52°. One PIP joint developed septic arthritis immediately after surgery. The benefit of this salvage operation is mainly in the change of the active range of motion to a more functional arc.

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.

The “Jacobsen Flap” for the Treatment of Stages III–IV Dupuytren’s Disease: A Review of 98 Cases

2008 ◽  
Vol 33 (6) ◽  
pp. 779-782 ◽  
Author(s):  
M. TRIPOLI ◽  
M. MERLE
Keyword(s):  
Postoperative Complications ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Flap Procedure ◽  
Significant Correction ◽  
Low Rate ◽  
Little Finger

The treatment of severe Dupuytren’s disease of the little finger is controversial: several techniques have been described with variable reported results and postoperative complications. This paper reviews 98 cases that underwent surgery between 2001 and 2006 using the Jacobsen flap procedure, a modification of the McCash technique. We found this technique relatively simple and it allowed significant correction of the contracture, with a low rate of complication. We believe this is an excellent alternative to dermofasciectomy or amputation.

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