Management of severe Dupuytren’s contracture of the proximal interphalangeal joint with use of a central slip facilitation device

2012 ◽  
Vol 37 (8) ◽  
pp. 728-732 ◽  
Author(s):  
J. W. White ◽  
S.-N. Kang ◽  
T. Nancoo ◽  
D. Floyd ◽  
S. B. S. Kambhampati ◽  
...  
Keyword(s):  
External Fixator ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Joint Movement ◽  
Hand Therapy ◽  
Elastic Band ◽  
Second Stage ◽  
Dupuytren's Contracture ◽  
Patient Reported

Thirty-eight fingers in 27 patients with Dupuytren’s contracture of the proximal interphalangeal joint (PIPJ) in excess of 70° were treated using a staged technique. The first stage involved applying a mini external fixator across the PIPJ for continuous extension over 6 weeks with intensive hand therapy to maintain mobility of the joint and help correct the deformity. Twice weekly during hand therapy sessions the tension of the elastic band across the mini ex-fix was increased, allowing that full active flexion of the PIPJ against the elastic band could still be achieved. The second stage, 4 weeks after the external fixator was applied, involved an open palm technique of fasciectomy for the contracted cords restricting metacarpophalangeal joint movement and dermofasciectomy with full-thickness skin grafting over the proximal phalanx for bands restricting PIPJ movement. The external fixator was used to maintain active extension force until the graft healed. It was generally removed in the outpatient clinic under ring block 2 weeks after the second stage procedure. The patients were followed for a mean of 20.6 (6–48) months. The mean preoperative PIPJ deformity improved from 75° to 37° postoperatively. Overall, 69% of results were rated as good to excellent. Only one patient reported any on-going functional problems. There were eight cases of pin site infections and one case each of loose pins, osteoarthritics at the PIPJ, reflex sympathetic dystrophy, and disease recurrence needing PIPJ fusion. We conclude that our simple staged procedure is a valid alternative in the management of severe Dupuytren’s PIPJ contracture.

The quantitative role of flexor sheath incision in correcting Dupuytren proximal interphalangeal joint contractures

2015 ◽  
Vol 41 (6) ◽  
pp. 609-613 ◽  
Author(s):  
P. E. Blazar ◽  
E. W. Floyd ◽  
B. E. Earp
Keyword(s):  
Case Series ◽  
Tendon Sheath ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Joint Contractures ◽  
Dupuytren's Contracture

Controversy exists regarding intra-operative treatment of residual proximal interphalangeal joint contractures after Dupuytren’s fasciectomy. We test the hypothesis that a simple release of the digital flexor sheath can correct residual fixed flexion contracture after subtotal fasciectomy. We prospectively enrolled 19 patients (22 digits) with Dupuytren’s contracture of the proximal interphalangeal joint. The average pre-operative extension deficit of the proximal interphalangeal joints was 58° (range 30–90). The flexion contracture of the joint was corrected to an average of 28° after fasciectomy. In most digits (20 of 21), subsequent incision of the flexor sheath further corrected the contracture by an average of 23°, resulting in correction to an average flexion contracture of 4.7° (range 0–40). Our results support that contracture of the tendon sheath is a contributor to Dupuytren’s contracture of the joint and that sheath release is a simple, low morbidity addition to correct Dupuytren’s contractures of the proximal interphalangeal joint. Additional release of the proximal interphalangeal joint after fasciectomy, after release of the flexor sheath, is not necessary in many patients. Level of Evidence: IV (Case Series, Therapeutic)

Conservative Surgery for Dupuytren’s Contracture

1992 ◽  
Vol 17 (6) ◽  
pp. 702-702 ◽  
Author(s):  
A. J. Thurston
Keyword(s):  
Radical Surgery ◽  
Conservative Surgery ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Skin Closure ◽  
Joint Contractures ◽  
Dupuytren's Contracture ◽  
The One

The trend towards conservativism in the management of Dupuytren’s contracture has resulted in less radical surgery than was previously advocated to release disabling contractures of the fingers. 38 cases of Dupuytren’s contracture in the palm have been treated by Z-plasty of skin and underlying contracted band without fasciectomy. Proximal interphalangeal joint contractures were treated by fasciectomy and skin closure with Z-plasties as required. Only one of 16 patients reviewed after two years had evidence of recurrence. Skin compliance has been measured and a return to near-normal levels was found in all but the one patient with a recurrence.

Conservative Surgery for Dupuytren’s Contracture

1987 ◽  
Vol 12 (3) ◽  
pp. 329-334
Author(s):  
A. J. THURSTON
Keyword(s):  
Radical Surgery ◽  
Conservative Surgery ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Skin Closure ◽  
Joint Contractures ◽  
Dupuytren's Contracture ◽  
The One

The trend towards conservativism in the management of Dupuytren’s contracture has resulted in less radical surgery than was previously advocated to release disabling contractures of the fingers. 38 cases of Dupuytren’s contracture in the palm have been treated by Z-plasty of skin and underlying contracted band without fasciectomy. Proximal interphalangeal joint contractures were treated by fasciectomy and skin closure with Z-plasties as required. Only one of 16 patients reviewed after two years had evidence of recurrence. Skin compliance has been measured and a return to near-normal levels was found in all but the one patient with a recurrence.

New insights into the immediate outcome of collagenase injections for Dupuytren’s contracture

2015 ◽  
Vol 41 (6) ◽  
pp. 583-588 ◽  
Author(s):  
D. J. Warwick ◽  
D. Graham ◽  
P. Worsley
Keyword(s):  
Spontaneous Rupture ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Consecutive Series ◽  
High Complication Rate ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
The Mean

Collagenase clostridium histolyticum is now established as an effective and safe option to treat patients with a single joint affected with Dupuytren’s contracture. We have extended its use to natatory and combined cords. In a prospective consecutive series of 298 cords in 237 patients, the mean total extension loss improved in cords crossing the metacarpophalangeal joint from 46° to 1°, in cords crossing the proximal interphalangeal joint from 56° to 7°, in natatory cords from 130° to 25° and in combined cords from 102° to 16°. The immediate correction of combined cords and natatory cords was less reliable than that obtained in cords crossing the metacarpophalangeal joint or proximal interphalangeal joint. Less severe pre-intervention contractures tended to correct better. We found a high complication rate, which may cause alarm. A total of 21% developed skin splits, with the risk of skin splits generally increasing with more severe pre-injection deformity. Blood blisters were only encountered after manipulation of the more severe contractures. A total of 23 patients (8%) had a spontaneous rupture and 57 patients (19%) had a partial spontaneous rupture. Only 4.9% needed a second injection. We noticed a learning curve, with seven of the first 20 cords (35%) needing a second injection to achieve a satisfactory correction and then only seven (2.5%) in the rest. Level of evidence: IV

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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