Outcomes of Management of Recurrent Dupuytren Contracture: A Systematic Review and Meta-analysis

Background: With numerous treatment modalities available, it is unclear whether the treatment of recurrent Dupuytren disease is as effective as its initial treatment. We aimed to investigate the outcomes of management of recurrent Dupuytren contracture. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, MEDLINE, Embase, PubMed, CINAHL, and Cochrane Central Register of Controlled Trials were searched from their inception to April 2020. Studies of patients aged above 18 years undergoing treatment for recurrent Dupuytren contractures were included. The Risk Of Bias In Non-randomized Studies-of Interventions tool was used for quality assessment. The study was registered with Open Science Foundation. Results: A systematic review identified 12 studies: 311 patients with 224 affected digits—index (n = 5; 2.2%), long (n = 17; 7.6%), ring (n = 57; 25.4%), small (n = 112; 50%), and unspecified (n = 33; 14.7%); of these, there were 76 metacarpophalangeal joints (MCPJ; 45.5%), 90 proximal phalangeal joints (PIPJ; 53.9%), and 1 distal interphalangeal joint (0.6%). Previous treatment included the following: percutaneous needle aponeurotomy (n = 103 of 311 patients; 33.1%), collagenase clostridium histolyticum-injection (CCH; n = 75 of 311; 24.1%), limited fasciectomy (LF) ± skin graft (n = 83 of 311; 26.7%), fasciotomy (n = 1 of 311; 0.3%), and unspecified (n = 64 of 311; 20.6%). Recurrence was treated by percutaneous needle aponeurotomy (n = 68 of 311 patients; 21.9%); CCH injection (n = 53 of 311; 17.0%); aponeurotomy or dermofasciectomy or LF (n = 176 of 311; 56.6%); ray/digit amputation (n = 8 of 311; 2.6%); and PIPJ arthrodesis (n = 6 of 293; 2.0%). Range of motion was improved by 23.31° (95% confidence interval [CI] = 13.13°-33.50°; I2 = 67%; P = .05) and 15.49° (95% CI = 2.67°-28.31°; I2 = 76%; P = .01) for MCPJ and PIPJ, respectively. Conclusions: There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture.

Limited fasciotomy in dupuytren contracture: a case report

Dupuytren's disease is a benign fibroproliferative disorder usually isolated affects the palmar fascia. The condition usually has a progressive course, from the appearance of a nodule, to the formation of a fibrous cord which pulls the finger in a flexion posture. Management from dupuytren's disease has developed, from conservatifly, surgery, and minimal invasive. One of the conventional treatments that can be done is fasciotomy. A man, 72 years old, an Australian patient with Dupuytren's disease that affects his 4th MCP joint. From the history it was found that the complaint had been felt since 8 years ago. Patients were do limited fasciotomy and get recovered his hand function with good result. Dupuytren's disease is a disorder of the palmar and digital fascia that can decrease the function of patient hands. Many therapies have been developed for the treatment of this disease. From conventional treatments such as fasciotomy, to minimal invasive such as the injection of clostridium histolyticum collagenase. All of these therapies give different results and side effects. We would like to say that conventional management, especially limited fasciotomy, is still a good choice in view of the return of hand function and the minimum side effects. Limited fasciotomy gives good results, fast recovery of hand function, with minimal side effects.