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.

scholarly journals The efficacies and limitations of fasciectomy and collagenase clostridium histolyticum in Dupuytren’s contracture management: A meta-analysis

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092174 ◽  
Author(s):  
Tokai B Cooper ◽  
Keshav Poonit ◽  
Chenglun Yao ◽  
Zeyuan Jin ◽  
Jingwei Zheng ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Treatment Algorithm ◽  
Cochrane Library ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum ◽  
Palmar Aponeurosis ◽  
The Mean

Background: We intend to assess the efficacies and limitations of collagenase clostridium histolyticum (CCH) and fasciectomy in treating Dupuytren’s contracture, and the associated complications and rate of recurrences aiming to present a treatment algorithm. Methods: A literature search within the PubMed, Web of Sciences, Cochrane Library, and EMBASE databases was performed using the combined key words ‘Dupuytren, palmar aponeurosis contracture, collagenase clostridium histolyticum and fasciectomy’, including all possible studies with a set of predefined inclusion and exclusion criteria. Results: Thirty studies were assessed for eligibility from 215 identified records. Seventeen publications satisfied the inclusion criteria including 2142 joints in 1784 patients. The mean follow-up time was 18.0 months (3–60). Conclusion: Acceptable contractures release was obtained in both techniques. Severe complications associated with fasciectomy outrank those of CCH, whereas the low rate of recurrence favors the fasciectomy technique.

scholarly journals Dynamic Manugraphy as a Promising Tool to Assess the Outcome of Limited Aponeurectomy in Patients With Dupuytren's Contracture

2021 ◽  
Vol 7 ◽  
Author(s):  
Angelina Garkisch ◽  
Thomas Mittlmeier ◽  
Axel Kalpen ◽  
Marion Mühldorfer-Fodor ◽  
Dagmar-C. Fischer ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Grip Force ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Base Line ◽  
Dash Score ◽  
Force Transmission ◽  
Additional Tool ◽  
Dupuytren's Contracture

Background: Dupuytren's contractures interfere with physiological gripping. While limited aponeurectomy is an accepted treatment modality to restore finger mobility, methods to objectify functional outcome beyond determination of the range of motion are scarce.Methods: Patients with Dupuytren's contracture being scheduled for unilateral limited aponeurectomy were invited to participate. Clinical data were gathered prospectively by chart review and interview. The DASH-score and flexion contracture for fingers were registered prior to surgery, 3 and 6 months afterwards. At the same time, dynamic manugraphy for simultaneous recording of the grip pattern and forces generated by the affected hand and anatomic areas (i.e., thumb, index finger, middle finger, ring finger, little finger and palm) were performed. All findings obtained during the follow-up period were compared to the situation at baseline. Comparison between paired samples was done using Wilcoxon rank test. All p-values are two-sided and p < 0.05 was considered to be significant.Results: Out of 23 consecutively enrolled patients, 19 (15 men, 4 women) completed follow-up examinations. Manugraphy confirmed the impairment of physiological gripping with concomitant pathological load distribution at base line. Limited aponeurectomy significantly reduced flexion contractures. However, the DASH-score remained at an excellent level in one patient, indicated improvement in 11 and worsening in seven patients. Six patients had lower grip force at t6 compared to the preoperative condition, although the preoperative flexion contracture (≥110°) was considerably improved in all of them. In four of those, the DASH-score improved while it turned worse in two of them. The force of surgically treated fingers remained unchanged in three patients while it was improved and worsened in half of the remaining patients, respectively. Manugraphy revealed physiological gripping by enlargement of contact area and higher force transmission by the fingertips in 10 of 12 patients with constant or even improved DASH-score and in three of seven patients with a worsened DASH-score.Conclusions: Assessing the reduction of flexion contracture and grip force alone is not sufficient to comprehensively reflect the functional outcome of aponeurectomy for Dupuytren's disease. Visualizing physiological grip pattern provides an additional tool to objectify the success of surgical treatment.

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.

RESOURCE UTILISATION ASSOCIATED WITH SINGLE DIGIT DUPUYTREN'S CONTRACTURE TREATED WITH EITHER SURGERY OR INJECTION OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM

Hand Surgery ◽  
2014 ◽  
Vol 19 (02) ◽  
pp. 205-209 ◽  
Author(s):  
Bo Povlsen ◽  
Adrian M. Shields ◽  
Gev S. Bhabra
Keyword(s):  
Surgical Treatment ◽  
Daily Living ◽  
Surgical Excision ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Single Digit ◽  
Dupuytren's Contracture ◽  
Skin Healing ◽  
Non Surgical Treatment

The gold standard treatment for Dupuytren's contracture is surgical excision of the cord. A non-surgical treatment with collagenase clostridium histolyticum injection is available but appears costly. Objectives: To provide data on resource consumption related to surgical and non-surgical treatment for Dupuytren's contracture. Design and Participants: Twenty patients with a single digit Dupuytren's contracture, 10 treated with surgical excision, and 10 treated with a single injection of collagenase. Measurements: Minutes spent in theatre, number of follow-up appointments, time to skin healing, and patients return to normal activities of daily living. Results: The injection group was significantly better regarding theatre time (p < 0.0001), follow-up appointments (p = 0.048), skin healing time (p < 0.001), and return to normal activities of daily living (p = 0.02) than the operated group. Conclusions: There are significant personal and health economic differences between the two methods of treatment which may influence local choice.

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 Safety and tolerability of collagenase Clostridium histolyticum and fasciectomy for Dupuytren’s contracture

2014 ◽  
Vol 40 (2) ◽  
pp. 141-149 ◽  
Author(s):  
C. A. Peimer ◽  
S. Wilbrand ◽  
R. A. Gerber ◽  
D. Chapman ◽  
P. P. Szczypa
Keyword(s):  
Adverse Events ◽  
Clinical Decision Making ◽  
Pain Syndrome ◽  
Clinical Decision ◽  
Arterial Injury ◽  
Tendon Injury ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum

Safety was evaluated for collagenase Clostridium histolyticum (CCH) based on 11 clinical trials ( N = 1082) and compared with fasciectomy data in a structured literature review of 48 European studies ( N = 7727) for treatment of Dupuytren’s contracture. Incidence of adverse events was numerically lower with CCH vs. equivalent complications from fasciectomy (median [range] incidence), including nerve injury (0% vs. 3.8% [0%−50+%]), neurapraxia (4.4% vs. 9.4% [0%−51.3%]), complex regional pain syndrome (0.1% vs. 4.5% [1.3%−18.5%]) and arterial injury (0% vs. 5.5% [0.8%−16.5%]). Tendon injury (0.3% vs. 0.1% [0%−0.2%]), skin injury (16.2% vs. 2.8% [0%−25.9%]) and haematoma (77.7% vs. 2.0% [0%−25%]) occurred at a numerically higher incidence with CCH than surgery. Adverse events in CCH trials not reported after fasciectomy included peripheral oedema; extremity pain; injection site pain, haemorrhage and swelling; tenderness; pruritus and lymphadenopathy. CCH-related adverse events were reported as predominantly injection-related and transient. These results may support clinical decision-making for treatment of Dupuytren’s contracture.

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