Ultrasonographic examination of the ruptured cord after collagenase treatment or needle fasciotomy for Dupuytren’s contracture

2017 ◽  
Vol 42 (7) ◽  
pp. 683-688 ◽  
Author(s):  
J. Strömberg ◽  
P. Vanek ◽  
J. Fridén ◽  
Y. Aurell
Keyword(s):  
Local Treatment ◽  
Metacarpophalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Joint Movement ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
Collagenase Treatment ◽  
Before And After ◽  
The Difference ◽  
Ultrasonographic Appearance

Local treatment of Dupuytren’s contracture, either by collagenase or needle fasciotomy, allows disruption of the pathological cord during forced extension. The purpose of this study was to investigate the cord before and after both treatments by ultrasound. A total of 39 patients with a minimum of 20° contracture in the metacarpophalangeal joint were included and randomized to treatment with either collagenase (20 patients) or needle fasciotomy (19 patients). The distance between the distal and the proximal parts of the ruptured cord was measured by ultrasound and the difference in passive joint movement before and after treatment was measured with a goniomenter. There were no significant differences between the collagenase and needle fasciotomy groups in the size of the rupture or gain of mobility. Most cords treated with collagenase and subsequent forced extension had the same ultrasonographic appearance as cords disrupted mechanically by needle fasciotomy. Level of evidence: III

One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren’s contracture: A two-centre prospective randomized clinical trial

2015 ◽  
Vol 41 (6) ◽  
pp. 577-582 ◽  
Author(s):  
P. Scherman ◽  
P. Jenmalm ◽  
L.B. Dahlin
Keyword(s):  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Joint Involvement ◽  
Dupuytren’S Contracture ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
Collagenase Injection ◽  
Before And After ◽  
One Year

The objective of this study was to compare early and 1 year outcome of needle fasciotomy and collagenase injection for Dupuytren′s disease. Inclusion criteria were primary Dupuytren’s contracture excluding the thumb with a palpable cord and a total extension deficit, i.e. a fixed flexion from 30° to 135° with less than 60° in the proximal interphalangeal joint. The most affected ray was randomized to either treatment at two centres. Passive extension deficits for each joint before and after treatment, and at 3 and 12 months, were recorded together with complications. A total of 96 rays in 93 patients were included. The average total extension deficits before treatment were 60° or more in both groups, and were largely made up of contractures at the metacarpophalangeal joints. The deficits were reduced by 75% in both groups at 3 months and by 70% in both groups at 12 months. Four patients in the needle fasciotomy group and eight patients in the collagenase group had skin ruptures. At 3 months and 1 year, the outcomes of needle fasciotomy and collagenase injection are the same in Dupuytren’s disease with predominantly metacarpophalangeal joint involvement. Level of evidence: 2.

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

Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren’s contracture in non-Caucasian Japanese patients (CORD-J Study): the first clinical trial in a non-Caucasian population

2016 ◽  
Vol 42 (1) ◽  
pp. 30-38 ◽  
Author(s):  
H. Hirata ◽  
K. Tanaka ◽  
A. Sakai ◽  
R. Kakinoki ◽  
H. Ikegami ◽  
...  
Keyword(s):  
Clinical Success ◽  
Japanese Patients ◽  
Phase Iii ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Open Label ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum ◽  
Corrective Effect

To assess the efficacy, safety and pharmacokinetics of 0.58 mg collagenase Clostridium histolyticum injections for the treatment of Dupuytren’s contracture in Japanese patients, we conducted a phase III, multicentre, uncontrolled, open-label clinical study in patients with Dupuytren’s contracture. Of the 77 patients, 66 achieved clinical success in the primary treated joint (86%; 95% confidence interval: 76% to 93%), confirming the efficacy of collagenase Clostridium histolyticum injections. More improvement was seen in the metacarpophalangeal joints than in the proximal interphalangeal joints (94% versus 73%). The main adverse reaction was a local reaction in the injected hand. No tendon rupture or anaphylactic reactions were seen. The concentrations of collagenase Clostridium histolyticum were below the lower limit of quantification in plasma samples at all time points. As seen in global studies in Caucasian patients, a corrective effect on Dupuytren’s contracture and good tolerance were observed in most non-Caucasian (Asian) Japanese patients. Level of Evidence: Level 3

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.

Effect of Oral Prednisolone after Collagenase Injection for Dupuytren’s Contracture: A Randomized, Controlled Trial with a 1-Year Follow-Up

2020 ◽  
Author(s):  
Yoshihiro Abe
Keyword(s):  
Controlled Trial ◽  
Oral Prednisolone ◽  
Metacarpophalangeal Joint ◽  
Control Group ◽  
Dupuytren’S Contracture ◽  
Active Motion ◽  
Dupuytren's Contracture ◽  
Significant Difference ◽  
Total Active Motion

Abstract Introduction This study verified the effectiveness of oral prednisolone after collagenase clostridium histolyticum (CCH) (10 mg/day for 2 weeks) for Dupuytren’s contracture with a 1-year follow-up. Materials and Methods This study included 31 patients with a contracture of the metacarpophalangeal joint of ≥ 30 degrees. A total of 16 patients were allocated randomly to treatment with prednisolone and 15 patients were treated without prednisolone (control group). Results At day 7, mean total active motion (TAM) was 235 degrees in the prednisolone group and 228 degrees in the control group. Mean Visual Analog Scale was 3.3 in the prednisolone group and 4.6 in the control group. There was significant difference between two groups. At day 30, mean TAM was 241 degrees in the prednisolone group and 233 degrees in the control group. There were significant difference between two groups The mean QuickDASH score was significantly higher in the control group (5.8 vs. 3.4). Recurrence was observed in 2/16 patients (13%) in the prednisolone group and 5/15 patients (33%) in the control group; there was no significant difference. Conclusion The administration of prednisolone decreased the likelihood of adverse effects, and also improved finger flexion range of motion and reduced pain after CCH.

A Review of Attitudes to Splintage in Dupuytren’s Contracture

1987 ◽  
Vol 12 (3) ◽  
pp. 326-328
Author(s):  
KATE ABBOTT ◽  
JOANNA DENNEY ◽  
F. D. BURKE ◽  
D. A. McGROUTHER
Keyword(s):  
Dupuytren’S Contracture ◽  
Dupuytren's Contracture ◽  
Before And After

A questionnaire on the use of splintage before and after operations for Dupuytren’s contracture has been completed by 45 hand surgeons and ten hand therapists. None considered that preoperative splintage was beneficial, but nearly all used some form of splintage after operation. The types of splint and programmes for using them varied widely, and these are discussed.

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)

Dupuytren’s Contracture: A Bibliometric Study of the Most Cited Papers

Hand Surgery ◽  
2015 ◽  
Vol 20 (03) ◽  
pp. 402-409 ◽  
Author(s):  
Cormac Weekes Joyce ◽  
Kenneth Mary Joyce ◽  
George Rahmani ◽  
Sean Michael Carroll ◽  
Jack Laurence Kelly ◽  
...  
Keyword(s):  
Web Of Science ◽  
Hand Surgery ◽  
Dupuytren’S Contracture ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
Article Type ◽  
Surgery Journals ◽  
The Web ◽  
Medical Plastic

The literature on Dupuytren’s contracture is vast yet little information is known as to which papers have been the most influential. The purpose of this study was to identify the 50 most cited papers on Dupuytren’s contracture and perform a citation analysis. Utilizing the Web of Science™, 23 surgical, medical, plastic and hand surgery journals were searched for papers on Dupuytren’s contracture. Resulting articles were ranked in order of times cited and each paper was analyzed for article-type, year of publication, country of origin, institution and level of evidence. The 50 most cited articles represent many important landmarks in Dupuytren’s treatment and contain several seminal works by experts in the field. Whilst the top 50 list highlights the important papers on the condition, they certainly do not provide information about the quality of the evidence of the research, as most papers presented level 4 or 5 evidence.

Dupuytren’s contracture in Ethiopia

2016 ◽  
Vol 42 (1) ◽  
pp. 26-28 ◽  
Author(s):  
A. Gebereegziabher ◽  
A. Baraki ◽  
Y. Kebede ◽  
I. Mohammed ◽  
V. Finsen
Keyword(s):  
Risk Factors ◽  
Demographic Data ◽  
Control Group ◽  
Dupuytren’S Contracture ◽  
Level Of Evidence ◽  
Female Ratio ◽  
Left Hand ◽  
Dupuytren's Contracture ◽  
Hand Involvement ◽  
Soles Of The Feet

Dupuytren’s contracture is believed to be rare in Africa. We have observed the disease in many patients coming to our hospital. This study aimed to provide information concerning the occurrence of the disease and risk factors in these patients. All 75 patients who were referred to the hospital during a 2-year period because of a hand problem that was diagnosed as Dupuytren’s contracture were included. The demographic data of the patients and possible risk factors were recorded and compared with a control group. The male to female ratio was 18:1. The little and ring fingers were most commonly affected. A total of 43 had bilateral hand involvement. The condition affected only the left hand in one patient. Six men also had fibromatosis of the soles of the feet and three of the penis. There was a statistically significant association with hypertension and alcohol consumption, but not with diabetes mellitus. We conclude that there are more cases of Dupuytren’s contracture in Ethiopia than previously thought. Level of evidence: III

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