1
|
Nordenskjöld J, Nilsson J, Kalaf R, Atroshi I. Delayed vascular complication after collagenase injection for Dupuytren disease. BMC Musculoskelet Disord 2023; 24:837. [PMID: 37872560 PMCID: PMC10594859 DOI: 10.1186/s12891-023-06964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Vascular adverse events after collagenase injection for Dupuytren disease are absent in large trials and systematic reviews. The aim of this study is to present a case series of delayed vascular complications after collagenase treatment. METHODS A prospective evaluation of 1181 consecutively treated patients at one orthopedic department identified three patients reporting symptoms of possible vascular complication. Baseline demographics and description of symptoms were collected, with a physical examination documenting extension deficit and neurovascular status. All patients completed the Cold Intolerance Symptom Severity (CISS) scale (range 4-100, lower is better) and underwent Doppler sonography examination of the digital arteries. RESULTS All patients were treated in the small finger and two had an isolated proximal interphalangeal joint contracture. All patients had a delayed presentation of a few months, with episodes of white discoloration of the treated finger relieved within 30 min and associated with variable pain, paresthesia, stiffness and weakness. Two of the patients reported cold exposure as an episode trigger and had a pathological CISS score (40 and 36, respectively). Doppler sonography identified a nonpatent ulnar digital artery in one patient. CONCLUSIONS Delayed vascular complication after collagenase treatment is rare, but surgeons and patients should be aware of the risk, especially when treating the small finger.
Collapse
Affiliation(s)
- Jesper Nordenskjöld
- Department of Orthopedics, Hässleholm- Kristianstad Hospitals, Hässleholm, Sweden.
- Department of Clinical Sciences- Orthopedics, Lund University, Lund, Sweden.
| | - Jonas Nilsson
- Department of Radiology, Kristianstad Hospital, Kristianstad, Sweden
| | - Roua Kalaf
- Department of Radiology, Kristianstad Hospital, Kristianstad, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm- Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences- Orthopedics, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Byström M, Ibsen Sörensen A, Samuelsson K, Fridén JO, Strömberg J. Five-Year Results of a Randomized, Controlled Trial of Collagenase Treatment Compared With Needle Fasciotomy for Dupuytren Contracture. J Hand Surg Am 2022; 47:211-217. [PMID: 35074248 DOI: 10.1016/j.jhsa.2021.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 09/16/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Over the past decade, collagenase treatment and needle fasciotomy (NF) have gained widespread popularity in the treatment of Dupuytren contracture. This prospective study was designed to compare the results of these treatments in terms of clinical and patient-reported outcomes. METHODS A prospective, randomized, controlled trial included patients with a contracture of 20° or more in a single metacarpophalangeal joint. Patients were allocated to treatment with either NF or collagenase Clostridium histolyticum. The primary outcome was a reduction in the metacarpophalangeal joint contracture to less than 5°. Secondary outcomes included recurrence, the presence of Dupuytren cords, and changes in patient-reported outcomes. The participants were examined 5 years after the intervention. RESULTS The study cohort comprised 156 patients divided into 2 equally sized groups. After 5 years, data were collected from 143 (92 %) of the initially enrolled participants. The mean time for the clinical follow-up was 5.1 years. In the remaining cohort without a second procedure, 51% (23 patients) in the collagenase Clostridium histolyticum group and 47% (27 patients) in the NF group still had extension deficits of less than 5°. Among the participants with a successful initial procedure, the recurrence rate was 56% (36 patients) in the collagenase Clostridium histolyticum group and 45% (30 patients) in the NF group. There were no differences between the 2 treatments in regard to passive joint extension, reduction of contracture, range of motion, or patient-reported outcomes. CONCLUSIONS The 5-year outcomes for NF are similar to those for collagenase in terms of sustained correction, recurrence, presence of Dupuytren cords, and patient-reported outcomes for the treatment of metacarpophalangeal joint contractures. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
Collapse
Affiliation(s)
- Martin Byström
- Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Jan O Fridén
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Joakim Strömberg
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery and Orthopaedics, Alingsås Hospital, Alingsås, Sweden
| |
Collapse
|
3
|
Boe C, Blazar P, Iannuzzi N. Dupuytren Contractures: An Update of Recent Literature. J Hand Surg Am 2021; 46:896-906. [PMID: 34452797 DOI: 10.1016/j.jhsa.2021.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
Dupuytren disease is a fibroproliferative disorder that affects the palmar fascia of the hand and results in varying degrees of nodule and cord formation. Over time, patients may develop progressive contractures, impairing their ability to type, to perform with fine instruments, or to participate in social activities such as shaking hands. Treatment options for Dupuytren contractures include needle aponeurotomy (NA), injection of collagenase Clostridium histolyticum (CCH) with manipulation of the digits, and surgical fasciectomy. Over the past decade, the use of CCH has increased. Recent studies have provided additional data regarding the pathophysiology, indications, outcomes, and costs associated with the treatment for Dupuytren contractures, and this review highlights these advances.
Collapse
Affiliation(s)
- Chelsea Boe
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA
| | - Philip Blazar
- Section of Hand and Upper Extremity Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nicholas Iannuzzi
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA.
| |
Collapse
|
4
|
Hirase T, Suresh R, Cotton MO, Han A, Burn MB, Harris JD, Liberman SR. Percutaneous Needle Fasciotomy versus Collagenase Injection for Dupuytren's Contracture: A Systematic Review of Comparative Studies. J Hand Microsurg 2021; 13:150-156. [PMID: 34511831 DOI: 10.1055/s-0040-1721876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction The purpose of this study was to review and compare clinical outcomes between percutaneous needle fasciotomy (PNF) and collagenase Clostridium histolyticum (CCH) injection for the treatment of Dupuytren's contracture. Materials and Methods A systematic review was performed including all level I-III evidence studies investigating the clinical outcomes of PNF and CCH injection in the treatment of Dupuytren's contracture. Results Five studies (278 CCH patients, 225 PNF patients; 285 CCH fingers, 246 PNF fingers, 405 males, and 98 females) were analyzed. Two randomized studies were level I evidence, one randomized study was level II, and two nonrandomized studies were level III. Two studies analyzed a total of 205 patients, each demonstrating statistically superior outcomes in one outcome measure (contracture improvement and Michigan Hand Questionnaire (MHQ) satisfaction subscore) with PNF, while the remaining three studies demonstrated no significant differences in outcomes between the two techniques. Three studies reported a statistically higher rate of minor complications (local pain, edema, ecchymosis, lymphadenopathy, pruritis) with CCH, while the remaining two studies demonstrated no significant difference in complication rates. Conclusion For the treatment of Dupuytren's contracture, there is some evidence that suggests superior clinical outcomes of PNF compared with CCH and a higher minor complication rate with CCH.
Collapse
Affiliation(s)
- Takashi Hirase
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Rishi Suresh
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Michael O Cotton
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Alex Han
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Matthew B Burn
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Shari R Liberman
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| |
Collapse
|
5
|
Abstract
BACKGROUND Return to work is potentially an important factor in assessing the success of treatment. However, little is known about the return to work after treatment for Dupuytren's contracture. Therefore, the primary aim of this study was to assess return to work after limited fasciectomy and percutaneous needle fasciotomy. METHODS Patients who underwent either a limited fasciectomy or percutaneous needle fasciotomy were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Median time to return to work was assessed using inverted Kaplan-Meier curves, and hazard ratios were calculated with Cox regression models. Finally, a cost analysis was carried out using the human capital method to determine indirect costs associated with loss of productivity. RESULTS The authors included 2698 patients in the study, of which 53 percent were employed at intake and included in the follow-up. After 1 year of follow-up, 90 percent of the patients had returned to work. Median time to return to work was 2 weeks after limited fasciectomy and within days after percutaneous needle fasciotomy. Furthermore, physically strenuous work, female sex, and higher age were associated with a longer time to return to work. Lost productivity per patient was estimated at €2614.43. CONCLUSIONS The majority of patients returned to work after treatment for Dupuytren's disease. Return to work is much faster after percutaneous needle fasciotomy compared to limited fasciectomy. These findings can be used for more evidence-based preoperative counseling with patients with Dupuytren's disease.
Collapse
|
6
|
Affiliation(s)
- Marta Karbowiak
- Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK
| | | | | | - Arvind Mohan
- Croydon Health Services NHS Trust, Croydon CR7 7YE, UK
| |
Collapse
|
7
|
Vega-Villanueva KI, Espinoza LR. Bilateral Dupuytren's Contracture and the "Prayer's Sign". J Clin Rheumatol 2021; 27:e38. [PMID: 31895108 DOI: 10.1097/rhu.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Luis R Espinoza
- Rheumatology Section, LSU Health Sciences Center, New Orleans, LA
| |
Collapse
|
8
|
Patel MIA, Patel IA. Versatility of percutaneous needle fasciotomy for Dupuytren's disease across a spectrum of disease severity: A single-surgeon experience of 118 rays. JPRAS Open 2020; 27:80-89. [PMID: 33364291 PMCID: PMC7753080 DOI: 10.1016/j.jpra.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023] Open
Abstract
Background Percutaneous needle fasciotomy (PNF) represents the only minimally invasive approach for treatment of Dupuytren's disease in Europe since withdrawal of collagenase from European markets. Though well-established, surgeon preference and uncertainty regarding safety and efficacy, results in limited provision in favour of open fasciectomy. Methods A retrospective review of 74 patients who self-opted to receive PNF between 2017 and 2020 was conducted. Demographic data, complications and degree of release achieved were compared across three cohorts based on contracture severity as per Tubiana staging (TS): Stage 1, 0-45°; Stage 2, 46-90°; Stage 3, 91-130° with χ2 analysis. Results One hundred and eighteen rays were treated amongst 74 patients (mean age, 68 years (R, 32-86), males: 74%) with mean follow-up 51 weeks (IQR 28-76 weeks) with no significant difference in baseline characteristics across cohorts. No cases of permanent sensory disturbance, flexor tendon rupture, arterial transection nor infection were observed. Neuropraxia was seen in six patients, resolving with mean recovery of 6 weeks. 86% (n = 166) of joints had satisfactory release (residual passive extension deficit (PED) ≤10°) with full release in 67%. Full release was most likely in metacarpophalangeal joint (MCPJ; 93%) than distal interphalangeal joint (DIPJ; 67%) or proximal interphalangeal joint (PIPJ; 45%; p<0.0001). Mean release was 54° in MCPJ and 56° in PIPJ. All TS1 patients achieved release with ≤10° residual PED versus 75% of TS2 patients and 22% of TS3 patients (p<0.05), the latter of whom had a mean residual PED of 12° Ninety-two percent of patients stated they would undergo PNF again if necessary, in preference to open fasciectomy. Conclusion We find PNF to facilitate a safe, effective yet minimally invasive approach amongst patients of varying disease severity, across different age groups, with recurrent disease, associated comorbidities or concurrent anticoagulation therapy. Patients reported high satisfaction in preference to open procedures. We, therefore, intend to recommend PNF first-line to all patients regardless of disease severity.
Collapse
Affiliation(s)
- Manal I A Patel
- University of Cambridge, School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Irshad A Patel
- Department of Plastic & Reconstructive Surgery, Royal Devon & Exeter Hospital NHS Foundation Trust, Devon, EX2 5DW, UK
| |
Collapse
|
9
|
Husbands S, Elliott D, Davis TRC, Blazeby JM, Harrison EF, Montgomery AA, Sprange K, Duley L, Karantana A, Hollingworth W, Mills N. Optimising recruitment to the HAND-1 RCT feasibility study: integration of the QuinteT Recruitment Intervention (QRI). Pilot Feasibility Stud 2020; 6:173. [PMID: 33292646 PMCID: PMC7650179 DOI: 10.1186/s40814-020-00710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background Recruitment to randomised controlled trials (RCTs) can be challenging, with most trials not reaching recruitment targets. Randomised feasibility studies can be set up prior to a main trial to identify and overcome recruitment obstacles. This paper reports on an intervention—the QuinteT Recruitment Intervention (QRI)—to optimise recruitment within a randomised feasibility study of surgical treatments for patients with Dupuytren’s contracture (the HAND-1 study). Methods The QRI was introduced in 2-phases: phase 1 sought to understand the recruitment challenges by interviewing trial staff, scrutinising screening logs and analysing audio-recorded patient consultations; in phase 2 a tailored plan of action consisting of recruiter feedback and training was delivered to address the identified challenges. Results Two key recruitment obstacles emerged: (1) issues with the recruitment pathway, in particular methods to identify potentially eligible patients and (2) equipoise of recruiters and patients. These were addressed by liaising with centres to share good practice and refine their pathway and by providing bespoke feedback and training on consent discussions to individual recruiters and centres whilst recruitment was ongoing. The HAND-1 study subsequently achieved its recruitment target. Conclusions Transferable lessons learnt from the QRI in the feasibility study will be implemented in the definitive RCT, enabling a “head start” in the tackling of wider issues around screening methods and consent discussions in the set up/early recruitment study phases, with ongoing QRI addressing specific issues with new centres and recruiters. Findings from this study are likely to be relevant to other surgical and similar trials that are anticipated to encounter issues around patient and recruiter equipoise of treatments and variation in recruitment pathways across centres. The study also highlights the value of feasibility studies in fine-tuning design and conduct issues for definitive RCTs. Embedding a QRI in an RCT, at feasibility or main stage, offers an opportunity for a detailed and nuanced understanding of key recruitment challenges and the chance to address them in “real-time” as recruitment proceeds.
Collapse
Affiliation(s)
- Samantha Husbands
- Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Daisy Elliott
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Tim R C Davis
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Jane M Blazeby
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Eleanor F Harrison
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Alexia Karantana
- Department of Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - William Hollingworth
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Nicola Mills
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| |
Collapse
|
10
|
Sambuy MTC, Nakamoto HA, Bolliger Neto R, Mattar Jr. R, Rezende MR, Wei TH. RANDOMIZED CONTROLLED TRIAL OF LIMITED FASCIOTOMY WITH INJECTION OF ADIPOSE GRAFT FOR DUPUYTREN'S DISEASE. ACTA ORTOPEDICA BRASILEIRA 2020; 28:159-164. [PMID: 32788855 PMCID: PMC7405848 DOI: 10.1590/1413-785220202804233522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective Dupuytren's disease is a genetic disorder related to the proliferation of myofibroblasts. The pluripotent property of stem cells present in adipose tissue inhibits myofibroblast proliferation. Our study sought to evaluate the effect of stem cell-rich fat grafts in patients that underwent limited fasciotomy. Methods We studied 45 patients, in a single-blind, prospective, randomized clinical trial. All patients underwent limited fasciotomy. In one group, fat graft was injected. Results The total passive extension deficit results did not exhibit a significant difference. Fat group exhibited worse functional score at 6 months and 1 year postoperatively, such as higher complication rates (43%), when compared with control group (8%), and more pain at 6 weeks follow-up. Conclusion Fat grafting associated with limited fasciotomy promotes worse functional results compared to conventional limited fasciotomy in the short term. However, long-term results and recurrence rates should be further assessed. Level of Evidence II, Prospective comparative study.
Collapse
|
11
|
Ferreira RM, Fidalgo I, Pimenta S, Costa L. [Non-surgical treatment of Dupuytren's disease by using percutaneous needle aponeurotomy: A 10-year experience]. Rehabilitacion (Madr) 2020; 54:249-253. [PMID: 32441257 DOI: 10.1016/j.rh.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Dupuytren's disease is a fibroproliferative disorder of the palmar aponeurosis that leads to digital flexion contractures. This disabling condition can be treated with a minimally invasive procedure, called percutaneous needle aponeurotomy (PNA). OBJECTIVE To report the results of 10 years of experience treating Dupuytren's contracture by PNA in the rheumatology hand unit of our department. METHODS We conducted a retrospective study with a description of method to perform PNA and analysis of post-procedure results. RESULTS There were 197 patients with Dupuytren's disease. Ninety-eight patients (49.7%) underwent PNA, corresponding to 117 treated fingers. Good immediate results were achieved in 84% of the patients, with results being better in those with less advanced stages. Recurrences occurred in 12% of the patients. The complication rate was 1.7%. CONCLUSION Our results confirm the value of this technique especially in the early stages of Dupuytren's disease, with immediate satisfactory results and a low rate of complications.
Collapse
Affiliation(s)
- R M Ferreira
- Servicio de Reumatología, Centro Hospitalar São João, Porto, Portugal.
| | - I Fidalgo
- Servicio de Reumatología, Centro Hospitalar São João, Porto, Portugal
| | - S Pimenta
- Servicio de Reumatología, Centro Hospitalar São João, Porto, Portugal
| | - L Costa
- Servicio de Reumatología, Centro Hospitalar São João, Porto, Portugal
| |
Collapse
|
12
|
Goubau Y, Vanmierlo B, Goorens CK, Goubau JF. Treatment of Dupuytren's disease using one full dose of Clostridiumhistolyticum collagenase at a lower concentration: Retrospective analysis of clinical outcomes. HAND SURGERY & REHABILITATION 2020; 39:316-319. [PMID: 32259595 DOI: 10.1016/j.hansur.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/15/2020] [Accepted: 02/21/2020] [Indexed: 11/27/2022]
Abstract
Clostridiumhistolyticum collagenase (CHC) is rapidly becoming a mainstream treatment option for Dupuytren's disease for hand surgeons. We performed a retrospective study of the efficacy of this substance at a lower concentration, but a higher total dose than recommended by the manufacturer. Thirty-nine patients with 43 affected hands were treated and analyzed at a mean follow-up of 27 months. Subgroup analysis was done for patients who received treatment in one or two joints (group A), and for patients who received treatment in more than two joints (group B). We found that our CHC solution is safe and effective when simultaneously treating as many as four joints affected by Dupuytren's disease. Patients in group B had a lower (but non-significant) treatment failure rate compared to patients in group A. Also, higher satisfaction rates were observed in group B, again non-significant. No major complications were observed in any group. CHC use is associated with only minor complications. The results are consistent even when up to four joints are treated with one dose. LEVEL OF EVIDENCE: III.
Collapse
Affiliation(s)
- Y Goubau
- Department of Orthopedic Surgery and Traumatology, ASZ, Merestraat 80, 9300 Aalst, Belgium
| | - B Vanmierlo
- Department of Orthopedics and Traumatology, Delta Ziekenhuis, Rode Kruisstraat 20, 8800 Roeselare, Belgium
| | - C-K Goorens
- Department of Orthopedics and Traumatology, Regionaal Ziekenhuis Heilig Hart Tienen, Kliniekstraat 45, 3300 Tienen, Belgium
| | - J F Goubau
- Department of Orthopedics and Traumatology, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000 Gent, Belgium; Department of Orthopedics and Traumatology, University Hospital Brussels, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
| |
Collapse
|
13
|
|
14
|
Leafblad ND, Wagner E, Wanderman NR, Anderson GR, Visscher SL, Maradit Kremers H, Larson DR, Rizzo M. Outcomes and Direct Costs of Needle Aponeurotomy, Collagenase Injection, and Fasciectomy in the Treatment of Dupuytren Contracture. J Hand Surg Am 2019; 44:919-927. [PMID: 31537401 DOI: 10.1016/j.jhsa.2019.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 05/31/2019] [Accepted: 07/31/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of our study were to evaluate the rates and predictors of reinterventions and direct costs of 3 common treatments of Dupuytren contractures-needle aponeurotomy, collagenase injection, and surgical fasciectomy. METHODS A retrospective review identified 848 interventions for Dupuytren contracture in 350 patients treated by a single surgeon from 2005 to 2016. The treatments included needle aponeurotomy (NA) (n = 444), collagenase injection (n = 272), and open fasciectomy (n = 132). We collected information on demographics, contracture details, and comorbidities. Outcomes included reintervention rates, time to reintervention, and direct cost of treatments. Standardized costs were calculated by applying 2017 Medicare reimbursement to professional services and cost-to-charge ratios to hospital charges. RESULTS Demographics were similar among the 3 treatment groups. The fifth finger was the most commonly affected digit including 43% of the NA, 60% of the collagenase, and 45% of the fasciectomy groups. The 2-year rates of reintervention following NA, collagenase, and fasciectomy were 24%, 41%, and 4%, respectively, and the 5-year rates were 61%, 55%, and 4%, respectively. Younger age and severity of preintervention proximal interphalangeal (PIP) joint contracture were predictive of reintervention in the NA and collagenase groups. The standardized direct costs for NA, collagenase, and fasciectomy were $624, $4,189, and $5,291, respectively. Including all reinterventions, the cumulative costs per digit following NA, collagenase, and surgery at 5 years were $1,540, $5,952, and $5,507, respectively. CONCLUSIONS Treatment with collagenase resulted in the highest rate of reintervention at 2 years, comparable reintervention rates to NA at 5 years, and the highest cumulative costs. The NA was the least expensive and resulted in longer duration before reintervention compared with collagenase. More severe PIP joint contractures and younger age at time of initial intervention were predictive of reintervention after collagenase and NA. Fasciectomy has a high initial cost but the lowest reintervention rate. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
| | - Eric Wagner
- Department of Orthopedic Surgery, Rochester, MN
| | | | | | - Sue L Visscher
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | | | - Dirk R Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Marco Rizzo
- Department of Orthopedic Surgery, Rochester, MN.
| |
Collapse
|
15
|
Moog P, Buchner L, Cerny MK, Schmauss D, Megerle K, Erne H. Analysis of recurrence and complications after percutaneous needle fasciotomy in Dupuytren's disease. Arch Orthop Trauma Surg 2019; 139:1471-1477. [PMID: 31367843 DOI: 10.1007/s00402-019-03247-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The partial aponeurectomy for treatment of Dupuytren's contracture represents the gold standard for treatment of Dupuytren's contracture. In selected cases, the alternative is the percutaneous needle fasciotomy (PNF). MATERIALS AND METHODS Between 2008 and 2018, 80 rays in 64 patients were treated using PNF. 53 patients (68 rays) were reviewed with a mean follow-up of 31 months. RESULTS The recurrence rate was 18.9%. 49 patients with 62 rays had a totally free extension intra-operatively (92.4%). There were no complications. Only one patient reported a transient dysesthesia (1.8%) in the zone of operation. 86% of all patients would undergo the treatment again, if necessary. Patients were able to return to their job in an average of 5.5 days. CONCLUSIONS PNF is reliable and relatively simple to perform compared to partial aponeurectomy. Therefore, the PNF could be seen as a serious alternative for selected cases.
Collapse
Affiliation(s)
- P Moog
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - L Buchner
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - M K Cerny
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - D Schmauss
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.,Department for Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale Di Lugano, Lugano, Switzerland
| | - K Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - H Erne
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| |
Collapse
|
16
|
Molenkamp S, van Straalen RJM, Werker PMN, Broekstra DC. Imaging for Dupuytren disease: a systematic review of the literature. BMC Musculoskelet Disord 2019; 20:224. [PMID: 31101038 PMCID: PMC6525391 DOI: 10.1186/s12891-019-2606-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/30/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As treatment of Dupuytren disease (DD) is expected to shift towards prevention of progression, the use of imaging in patients with DD becomes more important. In this systematic review an overview is given of the different methods for and applications of imaging for DD that have been described. METHODS The MEDLINE and EMBASE databases were searched for articles reporting the use of imaging in patients with DD, published before May 17, 2018. Studies were systematically examined in two rounds by two observers according to the PRISMA systematic. All studies containing original data on imaging for DD were considered for inclusion. RESULTS Three hundred and seven unique studies were identified, of which 23 were included in the study. Only studies on the use of ultrasound (US) and magnetic resonance imaging (MRI) were identified. Broadly, articles could be divided into 5 categories. Seven studies were found on diagnosis, two on measurement of disease extent, four on measurement of disease activity, seven on guidance of minimally invasive procedures and five studies on evaluation of treatment. According to the Oxford CEBM, the levels of evidence were low, ranging from level 3 to 5. CONCLUSIONS A variety of applications for US and MRI for patients with DD has been described. Based on the results of this review, the largest value for imaging lies in the measurement of disease activity and the follow-up of treatment of patients with early stage disease. Unfortunately, the overall level of evidence of the available literature was low. Future research is necessary to define the exact value of US and MRI in the management of patients with DD.
Collapse
Affiliation(s)
- Sanne Molenkamp
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Roel J M van Straalen
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Paul M N Werker
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Dieuwke C Broekstra
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| |
Collapse
|
17
|
Needle Aponeurotomy Versus Collagenase Injections for Dupuytren Disease: A Review of the Literature and Survey of Patient-Reported Satisfaction, Recurrence, and Complications After Needle Aponeurotomy. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
18
|
Nordenskjöld J, Lauritzson A, Waldén M, Kopylov P, Atroshi I. Surgical fasciectomy versus collagenase injection in treating recurrent Dupuytren disease: study protocol of a randomised controlled trial. BMJ Open 2019; 9:e024424. [PMID: 30808670 PMCID: PMC6398619 DOI: 10.1136/bmjopen-2018-024424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION There is no definitive cure for Dupuytren disease (DD), and recurrence of finger contractures after treatment is common. Surgical fasciectomy is considered the standard treatment method for recurrence, although associated with a high incidence of complications. Collagenase injection, a non-surgical treatment option, has been shown to be a safe and effective method; however, most studies regarding collagenase have involved first-time treatment. Collagenase efficacy in patients with recurrent DD beyond the immediate effect has not yet been determined. The aim of our study is to compare surgical fasciectomy and collagenase injection in treating recurrent DD. METHODS AND ANALYSIS The study is a single-centre randomised controlled trial. Inclusion criteria are recurrence of DD in one or more fingers after previous treatment with fasciectomy or collagenase injection, a passive extension deficit ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint, and a palpable cord causing the recurrent contracture. A total of 56 patients will be randomised to either surgical fasciectomy or collagenase injection. A hand therapist blinded to patients' group allocation will measure range of motion at baseline, 3 months, 12 months, 24 months and 60 months. The primary outcomes are the total active extension deficit (MCP plus PIP) at 3 months and the proportion of patients with contracture worsening ≥20° in the treated finger joint at 2 years compared with 3 months. The secondary outcomes include changes in total active motion, active and passive extension deficit from baseline up to 5 years, scores on patient-reported outcome measures, adverse events and costs of treatment. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Regional Ethical Review Board, Lund University, Sweden(2017/623). The trial will be conducted according to the Helsinki Declaration of 1975, revised in 2000. The results of the trial will be disseminated as published articles in peer-reviewed journals. TRIAL REGISTRATION NCT03406338; Pre-results.
Collapse
Affiliation(s)
- Jesper Nordenskjöld
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
| | - Anna Lauritzson
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
| | - Markus Waldén
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
| | - Philippe Kopylov
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
| |
Collapse
|
19
|
Abstract
Dupuytren’s disease is a fibroproliferative disease that involves collagen deposition, leading to hand contractures that ultimately affect hand mobility and grip strength. It is a benign disorder but can cause high morbidity by limiting daily activities. Many factors have been proposed for its aetiology: namely genetics, smoking, alcohol intake and diabetes. However, there is still controversy as to the main aetiological cause of the disease. Treatment is not yet uniform around the world and still varies with the surgeon’s experience and preference. In this review, the authors review the pathogenesis and treatment options for Dupuytren’s disease in an attempt to summarize the current state of the art.
Cite this article: EFORT Open Rev 2019;4:63-69. DOI: 10.1302/2058-5241.4.180021.
Collapse
Affiliation(s)
- Rita Grazina
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Sérgio Teixeira
- Serviço de Cirurgia Plástica, Reconstrutiva e Estética e Unidade de Queimados, Centro Hospitalar de São João, Portugal
| | - Renato Ramos
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Henrique Sousa
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Andreia Ferreira
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Rui Lemos
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| |
Collapse
|
20
|
Abstract
Background Percutaneous needle fasciotomy (PNF) is a minimally invasive treatment option for mild to moderate Dupuytren contractures in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, and the procedure requires limited resources. Multiple contractures can be treated during the same session, and the treatment is considerably easier for the patient and requires a minimum of rehabilitation compared with limited fasciectomy1. Description PNF can be performed in a regular outpatient clinic in most cases. With the patient in a reclined position, the cord of the contracted joint is tensioned by passive extension and is divided percutaneously with a 25-gauge needle under local anesthesia. The immediate treatment effect in terms of reduction of the contracture is readily assessed, and PNF can be performed at additional levels if needed. Alternatives Collagenase Clostridium histolyticum (CCH; Xiaflex).Total or partial fasciectomy.Dermofasciectomy.Amputation (in severe cases after multiple other procedures). Rationale Local treatment with injection of CCH (Xiaflex) in the Dupuytren cord enables rupture of the cord similar to that after PNF2. Both CCH and PNF are minimally invasive treatments with obvious advantages compared with open surgery3, and they seem to have the same intermediate-term outcome4-6. However, CCH treatment is considerably more expensive than PNF and requires 2 visits by the patient to the outpatient clinic instead of 17. CCH has also been reported to have more complications than PNF2,8. Furthermore, multiple (>4) joint contractures9 can be treated by PNF at the same time. In the author's experience, even bilateral contractures can be treated at the same session if requested by the patient. As the number of patients treated with CCH and PNF has increased, there has been a corresponding decrease in more invasive procedures10; however, open surgery will probably always remain an option in more severe cases or as a secondary procedure after recurrence.
Collapse
Affiliation(s)
- Joakim Strömberg
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|
21
|
Leung R, Capstick R, Lei A, Nour D, Rozen WM, Hunter-Smith DJ. Morbidity of interventions in previously untreated Dupuytren disease: A systematic review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1490-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Sözen T, Başaran NÇ, Tınazlı M, Özışık L. Musculoskeletal problems in diabetes mellitus. Eur J Rheumatol 2018; 5:258-265. [PMID: 30388074 PMCID: PMC6267753 DOI: 10.5152/eurjrheum.2018.18044] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/27/2018] [Indexed: 12/13/2022] Open
Abstract
Diabetic patients may suffer from a wide range of musculoskeletal disorders that can cause pain and some dysfunctions in the patient and affect the treatment negatively or reduce the quality of life by causing problems in the implementation of exercise programs, which are very important in the treatment of patients with Diabetes Mellitus. Although most of these problems are also seen in non-diabetics, they are more frequently observed but are not specific to diabetics. Their physiopathology is not fully understood; there is some evidence suggesting that macro- and microvascular complications of diabetes are responsible. A diagnosis of musculoskeletal dysfunctions in diabetic patients is made by clinical findings, and there is currently no specific treatment. If the treatment of problems requires corticosteroid use, diabetes can be hard to manage. In this review, we summarized the general features, diagnosis, and treatment modalities of frequent and important musculoskeletal disorders in diabetic patients.
Collapse
Affiliation(s)
- Tümay Sözen
- Private Ankara Endomer Endocrinology Center, Ankara, Turkey
| | - Nursel Çalık Başaran
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehtap Tınazlı
- Department of Internal Medicine, Near East University School of Medicine, Nicosia, Turkish Republic of Northern Cyprus
| | - Lale Özışık
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
23
|
Corkum JP, Gillis JA, Tang DT. Visual Estimation of Dupuytren's Flexion Contractures-A Prospective Comparative Trial. Plast Surg (Oakv) 2018; 26:165-168. [PMID: 30148128 DOI: 10.1177/2292550317750138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Surgeons and resident physicians in a clinic setting often visually estimate Dupuytren flexion contractures of the hand to follow disease progression and decide on management. No previous study has compared visual estimates with a standardized instrument to ensure measurement reliability. Methods Consecutive patients consulted for Dupuytren flexion contractures of the hand had individual joint contractures estimated in degrees (°) by both a resident physician and staff surgeon. Estimates were compared with goniometer measurements to generate intraclass correlation coefficients (ICCs), and residents and surgeons were compared based on their accuracy. Results Twenty-eight patients enrolled in this study, which provided a total of 80 hand joints for analysis. Resident physicians achieved an ICC of 0.42, which indicates poor reliability. The hand surgeon achieved an ICC of 0.86, which indicates high reliability. The surgeon also had better accuracy than the residents. Conclusion Hand surgeons should be mindful of the limitations of visual estimates of Dupuytren flexion contractures, particularly when conducted by trainees. Joint angle measurements taken for the purposes of research should be done with a goniometer at minimum.
Collapse
Affiliation(s)
- Joseph P Corkum
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joshua A Gillis
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David T Tang
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
24
|
Abstract
Needle aponeurotomy is an effective, minimally invasive treatment for metacarpophalangeal and interphalangeal joint contractures caused by Dupuytren disease. Multiple joints and digits can be safely treated in 1 session. Needle aponeurotomy is more cost-effective and has a significantly lower complication rate compared with open fasciectomy and collagenase injections. Recurrence rates are higher compared with open fasciectomy and collagenase injections. Patient satisfaction rates are high following needle aponeurotomy; the single clinic visit required and the minimal downtime after treatment are advantages unique to this procedure compared with other treatment modalities, including open fasciectomy, dermatofasciectomy, collagenase injections, and lipofilling.
Collapse
Affiliation(s)
- Kate E Elzinga
- Section of Plastic Surgery, University of Calgary, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Michael J Morhart
- Division of Plastic Surgery, University of Alberta, 14310 111 Avenue Northwest, Edmonton, Alberta T5M 3Z7, Canada.
| |
Collapse
|
25
|
Zhou C, Ceyisakar IE, Hovius SER, Feitz R, Slijper HP, Lingsma HF, Selles RW. Surgeon Volume and the Outcomes of Dupuytren’s Surgery. Plast Reconstr Surg 2018; 142:125-134. [DOI: 10.1097/prs.0000000000004512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
26
|
Nseir I, Delaunay F, Latrobe C, Bonmarchand A, Coquerel-Beghin D, Auquit-Auckbur I. Use of adipose tissue and stromal vascular fraction in hand surgery. Orthop Traumatol Surg Res 2017. [PMID: 28645702 DOI: 10.1016/j.otsr.2017.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Adipose tissue is an abundant source of various cell types including not only adipocytes, but also progenitor and endothelial cells from thestroma. Interest in adipose tissue has surged since the identification in 2001 of adipose-derived stem cells (ADSCs) and of the stromal vascular fraction (SVF) obtained from adipose tissue by enzymatic digestion and centrifugation. SVF has been proven effective in ensuring tissue regeneration, thus improving tissue trophicityand vascularisation. These effects have generated strong interest among both physicians and surgeons, particularly in the field of hand surgery. Several applications have been developed and used, for instance to treat Dupuytren's contracture, systemic sclerosis-related hand lesions, and skin ageing at the hand. Other uses are being evaluated in clinical or animal studies. The objective of this article is to review the capabilities of adipose tissue and their current and potential applications in hand surgery.
Collapse
Affiliation(s)
- I Nseir
- Service de chirurgie plastique et chirurgie de la main, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - F Delaunay
- Service de chirurgie plastique et chirurgie de la main, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - C Latrobe
- Service de chirurgie orthopédique et traumatologique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - A Bonmarchand
- Service de chirurgie plastique et chirurgie de la main, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - D Coquerel-Beghin
- Service de chirurgie plastique et chirurgie de la main, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - I Auquit-Auckbur
- Service de chirurgie plastique et chirurgie de la main, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| |
Collapse
|
27
|
Mansha M, Flynn D, Stothard J. Safety and Effectiveness of Percutaneous Needle Fasciotomy for Dupuytren's Disease in the Palm. J Hand Microsurg 2017; 9:115-119. [PMID: 29302134 DOI: 10.1055/s-0037-1605387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Muhammad Mansha
- Department of Orthopaedics, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Darren Flynn
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - John Stothard
- Department of Orthopaedics, University of Teesside, Middlesbrough, United Kingdom
| |
Collapse
|
28
|
Outcome of Dupuytren Contractures After Collagenase Clostridium Histolyticum Injection: A Single-institution Experience. Ann Plast Surg 2017; 79:145-148. [PMID: 28604542 DOI: 10.1097/sap.0000000000001068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Collagenase clostridium histolyticum (CCH) injection is an alternative to surgery for patients with Dupuytren disease (DD) of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The success of surgical and nonsurgical treatment modalities for DD is reported to vary widely between 25% and 80% (J Bone Joint Surg Am. 1985;67:1439-1443; Plast Reconstr Surg. 2007;120:44e-54e; J Bone Joint Surg Am. 2007;89:189-198; J Hand Surg Am. 2011:36:936-942; J Hand Surg Am. 1990;15:755-761; J Hand Surg Br. 1996;21:797-800; J Bone Joint Surg Br. 2000;82:90-94; Plast Reconstr Surg. 2005;115:802-810; Ann Plast Surg. 2006;57:13-17). This study presents the outcomes of patients with DD contractures treated with CCH injections at a single institution. METHODS An institutional review board-approved retrospective study was conducted of patients with DD of the hand treated with CCH injections in a single institution from February 2010 to April 2015. All patients received the recommended dose of 0.58 mg of CCH and returned for joint manipulation the following day. Data for follow-up at 7 and 30 days postoperatively and up to 5 years for patients who returned seeking further therapy for recurrent symptoms were reviewed. RESULTS One hundred thirteen patients with a total of 146 affected joints (72 MCP; 74 PIP) were treated with CCH injections (95 males; 18 females; age, 40-92 y). Successful CCH therapy occurred in 75% of injected joints (109/146 joints; 59 MCP; 50 PIP), as defined by less than 5 degrees of contracture after treatment. Twenty-three percent of treated joints had partial correction (34/146 joints; 13 MCP; 21 PIP), as defined by between 5 and 30 degrees of residual contracture after treatment. Three patients (2%) had a failure of treatment, as defined by unchanged or worsened contracture from pretreatment baseline measurements. Fifteen patients (13%) returned to the clinic seeking additional therapy for recurrent joint contracture symptoms in 17 joints over a span of 1.5 months to 4 years after initial successful or partially successful treatment (17/143, 12%; 5 MCP; 12 PIP). Recurrence was defined as patients who sought treatment for a return of symptoms or greater than 20 degrees contracture in the setting of a palpable cord after initial full or partial contracture correction. DISCUSSIONS Our 5-year outcome of CCH injections for DD contractures revealed full correction in 75% and partial correction in 23% of treated joints, with failure of treatment seen in only 2% of patients. Thirteen percent of the patients returned for additional treatment because of symptoms resulting from contracture recurrence in 12% of initially corrected or partially corrected joints. These positive outcomes are comparable with current surgical treatment modalities (J Hand Surg Am. 1990;15:755-761; J Bone Joint Surg Am. 1962;44B:602-613; J Clin Epidemiol. 2000;53:291-296). The use of CCH injections is an important nonsurgical treatment alternative for DD contractures of the MCP and PIP joints.
Collapse
|
29
|
Early Postoperative Results of Percutaneous Needle Fasciotomy in 451 Patients with Dupuytren Disease. Plast Reconstr Surg 2017; 139:1415-1421. [DOI: 10.1097/prs.0000000000003357] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Skov ST, Bisgaard T, Søndergaard P, Lange J. Injectable Collagenase Versus Percutaneous Needle Fasciotomy for Dupuytren Contracture in Proximal Interphalangeal Joints: A Randomized Controlled Trial. J Hand Surg Am 2017; 42:321-328.e3. [PMID: 28473158 DOI: 10.1016/j.jhsa.2017.03.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Collagenase Clostridium histolyticum (CCH) injection was introduced commercially as a treatment for Dupuytren contracture following initial phase-3 investigations in 2009 with promising results. However, the efficacy of CCH has not been prospectively investigated in a direct comparison to other active treatments of Dupuytren contracture with more than 1-year follow-up, despite a wide and increasing clinical use. METHOD In this prospective, independent, open-label, randomized controlled trial, (Clinicaltrials.gov; NCT 01538017), percutaneous needle fasciotomy (PNF) was directly compared with CCH. Fifty patients with primary isolated proximal interphalangeal joint Dupuytren contractures were enrolled and followed for 2 years. The primary outcome was clinical improvement defined as a reduction in contracture by 50% or more relative to baseline. Secondary outcomes included change in contracture, recurrence, adverse events, complications, and Disabilities of the Arm, Shoulder, and Hand questionnaire score. RESULTS Clinical improvement at 2 years was maintained in 7% of CCH patients (2 of 29) and 29% of PNF patients (6 of 21). Collagenase Clostridium histolyticum led to more, mainly transient, complications, in 93% of patients versus 24% of the patients treated with PNF. No other differences were observed. CONCLUSIONS This study provides evidence that CCH is not superior to PNF in the treatment of isolated proximal interphalangeal joint Dupuytren contracture regarding clinical outcome, and it led to more complications than PNF. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
Collapse
Affiliation(s)
- Simon Toftgaard Skov
- Interdisciplinary Research Unit, Center for Planned Surgery, Silkeborg, Denmark; Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - Therkel Bisgaard
- Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Per Søndergaard
- Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Jeppe Lange
- Interdisciplinary Research Unit, Center for Planned Surgery, Silkeborg, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
31
|
Lancerotto L, Davidson DM. Percutaneous needle fasciotomy for Dupuytren's disease: Minimizing morbidity. J Plast Reconstr Aesthet Surg 2017; 70:984-985. [PMID: 28283386 DOI: 10.1016/j.bjps.2017.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Luca Lancerotto
- Edinburgh Department of Plastic Surgery, St. John's Hospital at Howden, West Lothian, UK.
| | - Dominique M Davidson
- Edinburgh Department of Plastic Surgery, St. John's Hospital at Howden, West Lothian, UK
| |
Collapse
|
32
|
Oppermann J, Unglaub F, Müller LP, Löw S, Hahn P, Spies CK. [Percutaneous needle aponeurotomy for Dupuytren's contracture]. DER ORTHOPADE 2017; 46:315-320. [PMID: 28175956 DOI: 10.1007/s00132-017-3388-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dupuytren disease is a benign fibroproliferative disease of the palmar aponeurosis, which can cause considerable functional deficiencies for the person concerned. Partial aponeurectomy is the gold standard in primary surgery. Because it is minimally invasive and has short recovery and low complication rates, the importance of needle aponeurotomy under specific indications has been increasing in the last years. Needle aponeurotomy is a cost-effective treatment with low complication rates. The revision rate compared to partial aponeurectomy is higher. Under consideration of specified indications, needle aponeurotomy is an alternative treatment option.
Collapse
Affiliation(s)
- J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland
- Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland
| | - S Löw
- Sektion Handchirurgie Klinik für Orthopädie und Unfallchirurgie, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Deutschland
| | - P Hahn
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland
| | - C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland.
| |
Collapse
|
33
|
Otayek S, Pierrart J, Masmejean EH. Dupuytren's disease and needle aponeurotomy: rupture of a deep common flexor tendon: A case report and literature review. J Orthop Case Rep 2017; 6:88-90. [PMID: 28116281 PMCID: PMC5245952 DOI: 10.13107/jocr.2250-0685.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical treatment for Dupuytren’s disease with a low rate of complications. Initially described for purely palmar forms, the indications extended to digital adhesions. Numerous surgeons remain hesitant about performing the PNA for digital treatment because of the risk of lesions in the noble structures. In literature, one complication is still rare, even non-existent, i.e. the tendon rupture. Case Presentation: We are reporting here the case of a rupture of the deep common flexor tendon, secondary to a needle aponeurotomy, for a recurring digital form in a 72-year-old woman. We performed surgical treatment by tenodesis of the distal stump and resection of the proximal stump. The result was satisfactory. Conclusion: The purpose of describing this case is to report this rare complication leading to surgical revision. Within our team, we do not recommend performing PNAs for digital cases, and even less so for recurrences. For those who wish to perform the PNA, they need to know some technical artifices that enable these complications to be reduced, albeit not eliminated.
Collapse
Affiliation(s)
- Salma Otayek
- Department of Hand, Upper Limb and Peripheral Nerve Surgery. European Georges, Pompidou Hospital (HEGP) AP-HP, Paris, France
| | - Jérôme Pierrart
- Department of Hand, Upper Limb and Peripheral Nerve Surgery. European Georges, Pompidou Hospital (HEGP) AP-HP, Paris, France; Faculty of Medicine, René Descartes. Paris, France
| | - Emmanuel H Masmejean
- Department of Hand, Upper Limb and Peripheral Nerve Surgery. European Georges, Pompidou Hospital (HEGP) AP-HP, Paris, France; Faculty of Medicine, René Descartes. Paris, France
| |
Collapse
|
34
|
Lipman MD, Carstensen SE, Deal DN. Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014. Hand (N Y) 2017; 12:13-20. [PMID: 28082837 PMCID: PMC5207289 DOI: 10.1177/1558944716647101] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.
Collapse
Affiliation(s)
- Marc D. Lipman
- University of Virginia Health System, Charlottesville, VA, USA
| | | | - Dylan Nicole Deal
- University of Virginia Health System, Charlottesville, VA, USA,Dylan Nicole Deal, Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 801016, Charlottesville, VA 22908, USA.
| |
Collapse
|
35
|
Dupuytren’s disease susceptibility gene, EPDR1, is involved in myofibroblast contractility. J Dermatol Sci 2016; 83:131-7. [DOI: 10.1016/j.jdermsci.2016.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/01/2016] [Accepted: 04/28/2016] [Indexed: 01/06/2023]
|
36
|
The efficacy of open partial aponeurectomy for recurrent Dupuytren's contracture. Arch Orthop Trauma Surg 2016; 136:881-9. [PMID: 27038313 DOI: 10.1007/s00402-016-2448-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION To evaluate the efficacy of open partial aponeurectomy for recurrent Dupuytren's contracture. METHODS Eighteen patients with recurrent Dupuytren's contracture of 22 fingers were retrospectively assessed with a mean follow-up time of 94 months (range: 70-114 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and subjective outcome (disabilities of the arm, shoulder and hand (DASH) questionnaire). SURGICAL TECHNIQUE Dissection with special regard to former skin incision and expected wound defect. Modified incisions after Bruner (Mini-Bruner incisions) were facilitated. Dissection started at the palm. Fibrous tissue was resected proximally within the palm including vertical fibrotic septae. Direct preparation of the neurovascular bundles (NVB) was facilitated from proximal to distal. If the anatomy of the neurovascular structures became unclear around the natatory ligament preparation of the NVB at the distal end of the fibrous cord was performed. After complete preparation of a NVB, dissection was continued from medial to lateral until the other bundle was completely released. Transposition flaps and skin transplants were often used for sufficient wound closure. RESULTS Recurrence rate was 36 % applying the definition of van Rijssen et al. Fifteen patients had a grip strength of 90 % or higher in comparison to the contralateral side. Ten patients had a pinch strength of 90 % or higher in comparison to the contralateral side. All patients except for one had pain reduction or none postoperatively. Fifteen patients had a DASH score of 15 or lower (range: 0-47). An unrelated ray amputation was suffered due to wound healing complications. CONCLUSIONS Open partial aponeurectomy performed by a board certified hand surgeon proved to be safe. The postoperative functional outcome seemed to be related to the individual course of the disease.
Collapse
|
37
|
Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture. Plast Reconstr Surg 2016; 137:1800-1812. [DOI: 10.1097/prs.0000000000002224] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Cost comparison of open fasciectomy versus percutaneous needle aponeurotomy for treatment of Dupuytren contracture. Ann Plast Surg 2016; 70:454-6. [PMID: 23486126 DOI: 10.1097/sap.0b013e31827e531d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many surgical options exist for the treatment of Dupuytren contracture. Little has been written regarding their financial implications. The purpose of this study was to compare the immediate direct costs of open fasciectomy to percutaneous needle aponeurotomy (NA) for the surgical treatment of Dupuytren contracture. MATERIALS AND METHODS A retrospective review was performed comparing patients treated with open fasciectomy (group 1) to patients treated with percutaneous NA (group 2) for the treatment of Dupuytren disease from 2008 to 2010. Financial and medical records were reviewed. Direct cost of treatment was calculated from hospital billing records, including surgical, anesthesia, and facility fees. Statistical analysis was performed using unpaired t test. RESULTS Twenty-four patients received open segmental palmar and/or digital fasciectomy (group 1). Average preoperative metacarpophalangeal joint flexion contracture was 30 degrees, and proximal interphalangeal joint flexion contracture was 42 degrees. Group 2 consisted of 24 patients. Average preoperative metacarpophalangeal flexion contracture was 31 degrees, and proximal interphalangeal flexion contracture was 27 degrees. Mean cost for group 1 was $11,240 and mean cost for group 2 was $4657 (P < 0.0001). Immediate postoperative contracture correction was similar between both. Two complications occurred in group 1 (wound dehiscence and nerve injury); no complications in group 2. CONCLUSIONS Percutaneous NA is associated with decreased direct costs in the short-term compared to traditional open fasciectomy with comparable deformity correction.
Collapse
|
39
|
Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to Subtotal Fasciectomy. Case Rep Orthop 2016; 2015:509732. [PMID: 26783478 PMCID: PMC4689905 DOI: 10.1155/2015/509732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/16/2015] [Indexed: 12/01/2022] Open
Abstract
Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.
Collapse
|
40
|
Pratt AL, Ball C. What are we measuring? A critique of range of motion methods currently in use for Dupuytren's disease and recommendations for practice. BMC Musculoskelet Disord 2016; 17:20. [PMID: 26762197 PMCID: PMC4712477 DOI: 10.1186/s12891-016-0884-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Range of motion is the most frequently reported measure used in practice to evaluate outcomes. A goniometer is the most reliable tool to assess range of motion yet, the lack of consistency in reporting prevents comparison between studies. The aim of this study is to identify how range of motion is currently assessed and reported in Dupuytren's disease literature. Following analysis recommendations for practice will be made to enable consistency in future studies for comparability. This paper highlights the variation in range of motion reporting in Dupuytren's disease. METHODS A Participants, Intervention, Comparison, Outcomes and Study design format was used for the search strategy and search terms. Surgery, needle fasciotomy or collagenase injection for primary or recurrent Dupuytren's disease in adults were included if outcomes were monitored using range of motion to record change. A literature search was performed in May 2013 using subject heading and free-text terms to also capture electronic publications ahead of print. In total 638 publications were identified and following screening 90 articles met the inclusion criteria. Data was extracted and entered onto a spreadsheet for analysis. A thematic analysis was carried out to establish any duplication, resulting in the final range of motion measures identified. RESULTS Range of motion measurement lacked clarity, with goniometry reportedly used in only 43 of the 90 studies, 16 stated the use of a range of motion protocol. A total of 24 different descriptors were identified describing range of motion in the 90 studies. While some studies reported active range of motion, others reported passive or were unclear. Eight of the 24 categories were identified through thematic analysis as possibly describing the same measure, 'lack of joint extension' and accounted for the most frequently used. CONCLUSIONS Published studies lacked clarity in reporting range of motion, preventing data comparison and meta-analysis. Percentage change lacks context and without access to raw data, does not allow direct comparison of baseline characteristics. A clear description of what is being measured within each study was required. It is recommended that range of motion measuring and reporting for Dupuytren's disease requires consistency to address issues that fall into 3 main categories: Definition of terms, Protocol statement, Outcome reporting.
Collapse
Affiliation(s)
- Anna L Pratt
- Division of Occupational Therapy and Community Nursing, College of Health and Life Sciences, Brunel University, Kingston Lane, Uxbridge, UB8 3PH, UK.
| | - Catherine Ball
- Kennedy Institute, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, UK.
| |
Collapse
|
41
|
Rodrigues JN, Becker GW, Ball C, Zhang W, Giele H, Hobby J, Pratt AL, Davis T. Surgery for Dupuytren's contracture of the fingers. Cochrane Database Syst Rev 2015; 2015:CD010143. [PMID: 26648251 PMCID: PMC6464957 DOI: 10.1002/14651858.cd010143.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dupuytren's disease is a benign fibroproliferative disorder that causes the fingers to be drawn into the palm via formation of new tissue under the glabrous skin of the hand. This disorder causes functional limitations, but it can be treated through a variety of surgical techniques. As a chronic condition, it tends to recur. OBJECTIVES To assess the benefits and harms of different surgical procedures for treatment of Dupuytren's contracture of the index, middle, ring and little fingers. SEARCH METHODS We initially searched the following databases on 17 September 2012, then re-searched them on 10 March 2014 and on 20 May 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, the British Nursing Index and Archive (BNI), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Latin American Caribbean Health Sciences Literature (LILACS), Ovid MEDLINE, Ovid MEDLINE-In-Process and Other Non-Indexed Citations, ProQuest (ABI/INFORM Global and Dissertations & Theses), the Institute for Scientific Information (ISI) Web of Science and clinicaltrials.gov. We reviewed the reference lists of short-listed articles to identify additional suitable studies. SELECTION CRITERIA We included randomised clinical trials and controlled clinical trials in which groups received surgical intervention for Dupuytren's disease of the index, middle, ring or little finger versus control, or versus another intervention (surgical or otherwise). We excluded the thumb, as cords form on the radial aspect of the thumb and thus are not readily accessible in terms of angular deformity. Furthermore, thumb disease is rare. DATA COLLECTION AND ANALYSIS A minimum of two review authors independently reviewed search results to select studies for inclusion by using pre-specified criteria, assessed risk of bias of included studies and extracted data from included studies.We grouped outcomes into the following categories: (1) hand function, (2) other patient-reported outcomes (e.g. satisfaction, pain), (3) early objective outcomes (e.g. correction of angular deformity), (4) late objective outcomes (e.g. recurrence) and (5) adverse effects. MAIN RESULTS We included 14 articles describing 13 studies, comprising 11 single-centre studies and two multi-centre studies. These studies involved 944 hands of 940 participants; of these, 93 participants were reported twice in separate articles describing early and late outcomes of one trial. Three papers reported the outcomes of two trials comparing different procedures. One trial compared needle fasciotomy versus fasciectomy (125 hands, 121 participants), and the other compared interposition firebreak skin grafting versus z-plasty closure of fasciectomy (79 participants). The other 11 studies reported trials of technical refinements of procedures or rehabilitation adjuncts. Of these, three investigated effects of postoperative splinting on surgical outcomes.Ten studies (11 articles) were randomised controlled trials (RCTs) of varying methodological quality; one was a controlled clinical trial. Trial design was unclear in two studies awaiting classification. All trials had high or unclear risk of at least one type of bias. High risks of performance and detection bias were particularly common. We downgraded the quality of evidence (Grades of Recommendation, Assessment, Development and Evaluation - GRADE) of outcomes to low because of concerns about risk of bias and imprecision.Outcomes measured varied between studies. Five articles assessed recurrence; two defined this as reappearance of palpable disease and two as deterioration in angular deformity; one did not explicitly define recurrence.Hand function on the Disabilities of the Arm, Shoulder and Hand (DASH) Scale (scores between 0 and 100, with higher scores indicating greater impairment) was 5 points lower after needle fasciotomy than after fasciectomy at five weeks. Patient satisfaction was better after fasciotomy at six weeks, but the magnitude of effect was not specified. Fasciectomy improved contractures more effectively in severe disease: Mean percentage reduction in total passive extension deficit at six weeks for Tubiana grades I and II was 11% lower after needle fasciotomy than after fasciectomy, whereas for grades III and IV disease, it was 29% and 32% lower.Paraesthesia (defined as subjective tingling sensation without objective evidence of altered sensation) was more common than needle fasciotomy at one week after fasciectomy (228/1000 vs 67/1000), but reporting of complications was variable.By five years, satisfaction (on a scale from 0 to 10, with higher scores showing greater satisfaction) was 2.1/10 points higher in the fasciectomy group than in the fasciotomy group, and recurrence was greater after fasciotomy (849/1000 vs 209/1000). Firebreak skin grafting did not improve outcomes more than fasciectomy alone, although this procedure took longer to perform.One trial investigated four weeks of day and night splinting followed by two months of night splinting after surgery. The other two trials investigated three months of night splinting after surgery, but participants in 'no splint' groups with early deterioration at one week were issued a splint for use. All three studies demonstrated no benefit from splinting. The two trials investigating postoperative night splinting were suitable for meta-analysis, which demonstrated no benefit from splinting: Mean DASH score in the splint groups was 1.15 points lower (95% confidence interval (CI) -2.32 to 4.62) than in the no splint groups. Mean total active extension in the splint groups was 2.21 degrees greater (95% CI -3.59 to 8.01 degrees) than in the no splint groups. Mean total active flexion in the splint groups was 8.42 degrees less (95% CI 1.78 to 15.07 degrees) than in the no splint groups. AUTHORS' CONCLUSIONS Currently, insufficient evidence is available to show the relative superiority of different surgical procedures (needle fasciotomy vs fasciectomy, or interposition firebreak skin grafting vs z-plasty closure of fasciectomy). Low-quality evidence suggests that postoperative splinting may not improve outcomes and may impair outcomes by reducing active flexion. Further trials on this topic are urgently required.
Collapse
Affiliation(s)
- Jeremy N Rodrigues
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
| | - Giles W Becker
- University of Arizona Medical CenterDepartment of Surgery1501 N Campbell AvenueTucsonArizonaUSA85724
| | - Cathy Ball
- University of OxfordKennedy Institute of RheumatologyRoosevelt DriveHeadingtonOxfordUKOX3 7FY
| | - Weiya Zhang
- The University of NottinghamDivision of Academic RheumatologyClinical Sciences BuildingCity HospitalNottinghamEnglandUKNG5 1PB
| | - Henk Giele
- Oxford University HospitalsDepartment of Plastic, Reconstructive and Hand SurgeryOxfordOxfordshireUKOX3 9DU
| | - Jonathan Hobby
- North Hampshire HospitalTrauma and Orthopaedic SurgeryAldermaston RoadBasingstokeHampshireUKRG24 9NA
| | - Anna L Pratt
- Brunel UniversityCollege of Health and Life SciencesKingston LaneUxbridgeMiddlesexUKUB8 3PH
| | - Tim Davis
- Nottingham University HospitalsTrauma and OrthopaedicsQueens Medical CampusNottinghamUKNG7 2UH
| | | |
Collapse
|
42
|
Joyce CW, Joyce KM, Rahmani G, Carroll SM, Kelly JL, Regan PJ. Dupuytren's Contracture: A Bibliometric Study of the Most Cited Papers. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2015; 20:402-9. [PMID: 26388001 DOI: 10.1142/s0218810415500318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Cormac Weekes Joyce
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - Kenneth Mary Joyce
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - George Rahmani
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - Sean Michael Carroll
- † Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Jack Laurence Kelly
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland.,‡ Department of Plastic, Reconstructive and Hand Surgery, National University of Ireland, Galway, Ireland
| | - Padraic James Regan
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland.,‡ Department of Plastic, Reconstructive and Hand Surgery, National University of Ireland, Galway, Ireland
| |
Collapse
|
43
|
Herrera FA, Mitchell S, Elzik M, Roostaeian J, Benhaim P. Modified percutaneous needle aponeurotomy for the treatment of dupuytren's contracture: early results and complications. Hand (N Y) 2015; 10:433-7. [PMID: 26330774 PMCID: PMC4551619 DOI: 10.1007/s11552-015-9740-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of our study was to identify postoperative results and complications using a percutaneous approach to treat Dupuytren's contracture in a consecutive series of patients. METHODS A review of all patients with Dupuytren's contracture treated with percutaneous needle aponeurotomy (NA) from 2008 to 2010 was performed. Patient demographics, digits affected, and disease severity was recorded. Pre-operative total passive extension deficit (TPED) was calculated for each affected digit. TPED in the immediate postoperative period and at the time of most recent follow-up was measured. Treatment-related complications and incidence of disease recurrence were identified. Statistical analysis was performed using paired t-test. (Statistical significance p-value <0.05). RESULTS 525 digits in 193 hands were treated with NA. 140 patients were male, average age was 65 years. The average preoperative TPED was 41° and the average immediate postoperative TPED was 1° (98% correction) (P=0.0001). The average TPED at 4.5 month follow up was 11 o (73% correction). Complications included infection in 3 patients and one case each of triggering, delayed flexor tendon rupture, complex regional pain syndrome and persistent numbness. Recurrence was observed in 62 digits. CONCLUSION Percutaneous needle aponeurotomy is an effective technique in the treatment of Dupuytren's contracture. Near complete correction of contracture was achieved and few complications were observed. Longer follow-up is needed to determine if these short-term results are maintained.
Collapse
Affiliation(s)
- Fernando A. Herrera
- />Division of Plastic and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA 90095 USA
- />Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA 90404 USA
- />Division of Plastic and Reconstructive Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, South Carolina 29425 USA
| | - Scott Mitchell
- />Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA 90404 USA
| | - Mark Elzik
- />Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA 90404 USA
| | - Jason Roostaeian
- />Division of Plastic and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA 90095 USA
| | - Prosper Benhaim
- />Division of Plastic and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA 90095 USA
- />Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA 90404 USA
| |
Collapse
|
44
|
Spies CK, Müller LP, Skouras E, Bassemir D, Hahn P, Unglaub F. [Percutaneous needle aponeurotomy for Dupuytren's disease]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2015; 28:12-9. [PMID: 26303259 DOI: 10.1007/s00064-015-0417-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/19/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Percutaneous transverse aponeurotomy of the cord by using a hypodermic needle as a scalpel blade in order to improve function of the hand. INDICATIONS Symptomatic flexion contracture with positive table top test caused by a single, palpable cord within the palm (primarily Tubiana stages I and II). CONTRAINDICATIONS Multiple, infiltrating or broad-based cords within the palm; irritated skin conditions; exclusive digital cord localization; recurrence after aponeurectomy; previous surgical intervention at the site of interest, digital nerve lesions; lack of patient compliance. SURGICAL TECHNIQUE Pinpoint surface anesthesia is obtained by injecting each portal area subdermally with 0.1 ml of local anesthetic. These applications start from distally to proximally within the palm while the most distal injection site is located proximal to the distal palm crease. Then the needle tip is introduced perpendicular to the cord. Sawing movements through the cord are performed transversely. While passively extending the contracted finger, the cord is held under tension which guarantees safe cutting. Patients are encouraged to report immediate pain sensation or numbness in order to prevent injuries to neurovascular structures and active finger flexion excludes tendon lesions during the procedure. Introducing the needle tip may be performed at several sites along the cord, if necessary, from distal to proximal at least 5 mm apart with prior pinpoint surface anesthesia. Finally, cautious passive stretching may be done after each release. POSTOPERATIVE MANAGEMENT Bandaging allowing immediate motion; application of a hand-based extension splint-glove during the night for 3-6 months. RESULTS Recurrence rate was 53% in 15 retrospectively examined patients after a mean interval of 40 months postoperatively.
Collapse
Affiliation(s)
- C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - E Skouras
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - D Bassemir
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - P Hahn
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| |
Collapse
|
45
|
Peimer CA, Blazar P, Coleman S, Kaplan FTD, Smith T, Lindau T. Dupuytren Contracture Recurrence Following Treatment With Collagenase Clostridium histolyticum (CORDLESS [Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-Year Data. J Hand Surg Am 2015; 40:1597-605. [PMID: 26096221 DOI: 10.1016/j.jhsa.2015.04.036] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study was a 5-year noninterventional follow-up study to determine long-term efficacy and safety of collagenase clostridium histolyticum (CCH) treatment for Dupuytren contracture. METHODS Patients from previous CCH clinical studies were eligible. Enrolled patients were evaluated annually for contracture and safety at 2, 3, 4, and 5 years after their first injection (0.58 mg) of CCH. In successfully treated joints (≤ 5° contracture following CCH treatment), recurrence was defined as 20° or greater worsening (relative to day 30 after the last injection) with a palpable cord or any medical/surgical intervention to correct new/worsening contracture. A post hoc analysis was also conducted using a less stringent threshold (≥ 30° worsening) for comparison with criteria historically used to assess surgical treatment. RESULTS Of 950 eligible patients, 644 enrolled (1,081 treated joints). At year 5, 47% (291 of 623) of successfully treated joints had recurrence (≥ 20° worsening)-39% (178 of 451) of metacarpophalangeal and 66% (113 of 172) of proximal interphalangeal joints. At year 5, 32% (198 of 623) of successfully treated joints had 30° or greater worsening (metacarpophalangeal 26% [119 of 451] and proximal interphalangeal 46% [79 of 172] joints). Of 105 secondary interventions performed in the successfully treated joints, 47% (49 of 105) received fasciectomy, 30% (32 of 105) received additional CCH, and 23% (24 of 105) received other interventions. One mild adverse event was attributed to CCH treatment (skin atrophy [decreased ring finger circumference from thinning of Dupuytren tissue]). Antibodies to clostridial type I and/or II collagenase were found in 93% of patients, but over the 5 years of follow-up, this did not correspond to any reported clinical adverse events. CONCLUSIONS Five years after successful CCH treatment, the overall recurrence rate of 47% was comparable with published recurrence rates after surgical treatments, with one reported long-term treatment-related adverse event. Collagenase clostridium histolyticum injection proved to be an effective and safe treatment for Dupuytren contracture. For those receiving treatment during follow-up, both CCH and fasciectomy were elected options. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
Collapse
Affiliation(s)
- Clayton A Peimer
- College of Human Medicine, Michigan State University, East Lansing, MI; UP Health System-Marquette/Duke-LifePoint, Marquette, MI.
| | - Philip Blazar
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | | | | | - Ted Smith
- Auxilium Pharmaceuticals, Inc., Chesterbrook, PA
| | - Tommy Lindau
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
| |
Collapse
|
46
|
Broekstra DC, Lanting R, Werker PM, van den Heuvel ER. Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent. ACTA ACUST UNITED AC 2015; 20:580-6. [DOI: 10.1016/j.math.2015.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 12/24/2022]
|
47
|
Ji X, Tian F, Tian L. Identification and function analysis of contrary genes in Dupuytren's contracture. Mol Med Rep 2015; 12:482-8. [PMID: 25760233 DOI: 10.3892/mmr.2015.3458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 01/29/2015] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to analyze the expression of genes involved in Dupuytren's contracture (DC), using bioinformatic methods. The profile of GSE21221 was downloaded from the gene expression ominibus, which included six samples, derived from fibroblasts and six healthy control samples, derived from carpal-tunnel fibroblasts. A Distributed Intrusion Detection System was used in order to identify differentially expressed genes. The term contrary genes is proposed. Contrary genes were the genes that exhibited opposite expression patterns in the positive and negative groups, and likely exhibited opposite functions. These were identified using Coexpress software. Gene ontology (GO) function analysis was conducted for the contrary genes. A network of GO terms was constructed using the reduce and visualize gene ontology database. Significantly expressed genes (801) and contrary genes (98) were screened. A significant association was observed between Chitinase-3-like protein 1 and ten genes in the positive gene set. Positive regulation of transcription and the activation of nuclear factor-κB (NF-κB)-inducing kinase activity exhibited the highest degree values in the network of GO terms. In the present study, the expression of genes involved in the development of DC was analyzed, and the concept of contrary genes proposed. The genes identified in the present study are involved in the positive regulation of transcription and activation of NF-κB-inducing kinase activity. The contrary genes and GO terms identified in the present study may potentially be used for DC diagnosis and treatment.
Collapse
Affiliation(s)
- Xianglu Ji
- Department of Hand and Foot Surgery, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110003, P.R. China
| | - Feng Tian
- Department of Hand and Foot Surgery, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110003, P.R. China
| | - Lijie Tian
- Department of Hand and Foot Surgery, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110003, P.R. China
| |
Collapse
|
48
|
Clinical Results of Percutaneous Needle Fasciotomy for Dupuytren's Disease in Japanese Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e384. [PMID: 26090274 PMCID: PMC4457247 DOI: 10.1097/gox.0000000000000338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/19/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Clinical results of percutaneous needle fasciotomy (PNF) in Japanese patients with Dupuytren's disease are reported. METHODS In this prospective study, 51 patients (103 fingers: 1 index, 9 middle, 47 ring, and 46 small) underwent PNF at 99 metacarpophalangeal (MCP) and 68 proximal interphalangeal (PIP) joints. Patients were assessed postoperatively after 1 day, at 1, 2, 4, 6, and 8 weeks, and at 3, 6, 9, and 12 months. Correction of contracture was measured in degrees, and an improvement index (% improvement) was described previously by Tonkin et al. A correction of the contracture to 5° or less at each joint and at each digital ray represented a successful correction. The recurrence rates in MCP and PIP joints were also evaluated. Correlations between the Tubiana classification stage and successful correction, % improvement, and recurrence rate were evaluated. The relationships between recurrence rate and the diathesis score (more/less than 5 points) and between recurrence rate and age at surgery (<50/≥50 years) were also examined. RESULTS In MCP and PIP joints, the improvement maintained at final follow-up was 89% and 57%, respectively, with successful corrections in 89% and 76%, respectively. PNF corrected digital rays at various Tubiana stages: stage 1 = 100%, stage 2 = 82%, stage 3 = 46%, and stage 4 = 0%. Improvements were preserved in stage 1 = 83%; stage 2 = 62%; stage 3 = 58%, and stage 4 = 60%. Recurrence of Dupuytren's disease was significant for the PIP joint, severe Tubiana stage, and younger patients. CONCLUSIONS Clinical results of PNF in Japanese patients with Dupuytren's contractures were similar to those of whites.
Collapse
|
49
|
|
50
|
Verheyden JR. Early outcomes of a sequential series of 144 patients with Dupuytren's contracture treated by collagenase injection using an increased dose, multi-cord technique. J Hand Surg Eur Vol 2015; 40:133-40. [PMID: 24698852 DOI: 10.1177/1753193414530590] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Collagenase clostridium histolyticum is the first and only United States Food and Drug Association approved nonsurgical treatment for patients with a palpable Dupuytren's contracture cord. However, the Food and Drug Association has only approved injection of 0.58 mg of this enzyme into one palpable Dupuytren's contracture cord at a time. This review reports on the early outcome of 144 patients treated with the entire bottle of enzyme, approximately 0.78 mg, along with use of a novel slow intracord multi-cord technique. Use of 0.78 mg of enzyme, with the slow intracord multi-cord technique is safe and allows one to inject multiple Dupuytren's contracture cords at one setting. Correction at metacarpophalangeal and proximal interphalangeal joints, taken individually, are comparable with the Collagenase Option for the Reduction of Dupuytren's studies at 43° and 33°, respectively, however due to the multi-cord injection, we achieved 94° average immediate and 76° average final combined metacarpophalangeal and proximal interphalangeal contracture releases per bottle of enzyme. Implementation of the slow intracord multi-cord technique has the potential to improve current treatment for Dupuytren's contracture with resultant significant healthcare savings.
Collapse
Affiliation(s)
- J R Verheyden
- The Center for Orthopedic and Neurosurgical Care & Research, Bend, OR, USA
| |
Collapse
|