Dynamic Manugraphy as a Promising Tool to Assess the Outcome of Limited Aponeurectomy in Patients With 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.

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Treatment of Dupuytren’s Contracture With Collagenase: A Systematic Review

Hand ◽

10.1177/1558944720974119 ◽

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.

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Long term follow-up of dermofasciectomy for Dupuytren's contracture

British Journal of Plastic Surgery ◽

10.1016/0007-1226(94)90075-2 ◽

1994 ◽

Vol 47 (6) ◽

pp. 440-443 ◽

Cited By ~ 40

Author(s):

T.M. Brotherston ◽

C. Balakrishnan ◽

R.H. Milner ◽

H.G. Brown

Keyword(s):

Dupuytren’S Contracture ◽

Dupuytren's Contracture ◽

Long Term Follow Up

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Validation of a Handprint for Clinical Evaluation of Dupuytren’s Contracture

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1735347 ◽

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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A single injection of collagenase clostridium histolyticum for the treatment of moderate Dupuytren’s contracture: a 2 year follow-up of 47 patients

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415597421 ◽

2015 ◽

Vol 41 (6) ◽

pp. 664-665 ◽

Cited By ~ 6

Author(s):

J. McFarlane ◽

A. M. Syed ◽

T.F. Sibly

Keyword(s):

Single Injection ◽

Dupuytren’S Contracture ◽

Collagenase Clostridium Histolyticum ◽

Dupuytren's Contracture ◽

Clostridium Histolyticum

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499020921747 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902092174 ◽

Cited By ~ 1

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.

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Functional outcome after surgery for dupuytren’s contracture: a prospective study

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2004.05.005 ◽

2004 ◽

Vol 29 (5) ◽

pp. 804-808 ◽

Cited By ~ 35

Author(s):

Kingsley Paul Draviaraj ◽

Indranil Chakrabarti

Keyword(s):

Prospective Study ◽

Functional Outcome ◽

Dupuytren’S Contracture ◽

Dupuytren's Contracture ◽

A Prospective Study

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Needle aponeurotomy for dupuytren’s contracture.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.3873 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1300-1305

Author(s):

Muhammad Arif ◽

Saeed Ahmed Shaikh ◽

Badaruddin Sahito ◽

Nadeem Ahmed ◽

Muhamamd Qasim ◽

...

Keyword(s):

Flexion Contracture ◽

Proximal Interphalangeal Joint ◽

Dupuytren’S Contracture ◽

Prospective Longitudinal Study ◽

Dupuytren's Contracture ◽

Number Of Patients ◽

Acute Correction ◽

Stage 1 ◽

Prospective Longitudinal ◽

Needle Aponeurotomy

Needle Aponeurotomy is a negligibly obtrusive method where the cords are debilitated through the manipulation & insertion of a small needle. To determine the frequency of recurrence of flexion contracture after correction by percutaneous needle Aponeurotomy. Study Design: Prospective longitudinal study. Setting: Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi. Period: March 2017 to February 2018. Materials and Methods: 65 patients were collected for this study with dupuytren’s contracture from stage I-III belonging to either sex of age 18-50 years presented in outpatient department. Results: Total 65 patients were included in the study. Mean flexion contracture was 35.840 with the standard deviation of 13.070. Most of the patients 44(67.7%) had flexion contracture of >300 while 21(32.3%) patients had flexion contracture of ≤300. Majority of the patients had stage 1 of Dupuytren’s contracture, i.e. 26(40%), 25(38.5%) patients were of stage 2 contracture. Least number of patients i.e. 14 (21.5%) had stage 3 Dupuytren’s contracture. Recurrence of contracture was observed in 46(70.8%) of patients, while 19(29.2%) patients had no recurrence of contracture. Conclusion: The frequency of recurrence of flexion contracture found significant after correction with percutaneous needle aponeurotomy, so should be carried in selective patients with counseling’s that it will recur. But acute correction can be made at metacarpophalangeal and proximal interphalangeal joint with needle aponeurectomy.

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

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1709097 ◽

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.

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