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Zimmerman M, Nilsson P, Rydberg M, Dahlin L. Risk of hand and forearm conditions due to vibrating hand-held tools exposure: a retrospective cohort study from Sweden. BMJ Open 2024; 14:e080777. [PMID: 38890140 DOI: 10.1136/bmjopen-2023-080777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES The occurrence of hand and forearm disorders related to vibration exposure, adjusted for relevant background factors, is scarcely reported. We analysed the prevalence of such conditions in a large population cohort, stratified by sex, and associations with exposure to vibrating hand-held tools. DESIGN This is a retrospective cohort study. SETTING Individuals in the Malmö Diet and Cancer Study cohort (MDCS; inclusion 1991-1996; followed until 2018) were asked, 'does your work involve working with vibrating hand-held tools?' (response: 'not at all', 'some' and 'much'). Data were cross-linked with national registers to identify treatment for carpal tunnel syndrome (CTS), ulnar nerve entrapment (UNE), Dupuytren's disease, trigger finger or first carpometacarpal joint (CMC-1) osteoarthritis (OA). Cox regression models, unadjusted and adjusted (age, sex, prevalent diabetes, smoking, hypertension and alcohol consumption), were performed to analyse the effects of reported vibration exposure. PARTICIPANTS Individuals in the MDCS who had answered the questionnaire on vibration exposure (14 342 out of the originally 30 446 individuals in MDCS) were included in the study. RESULTS In total, 12 220/14 342 individuals (76%) reported 'no' exposure, 1392/14 342 (9%) 'some' and 730/14 342 (5%) 'much' exposure to vibrating hand-held tools. In men, 'much' exposure was independently associated with CTS (HR 1.71 (95% CI 1.11 to 2.62)) and UNE (HR 2.42 (95% CI 1.15 to 5.07)). 'Some' exposure was independently associated with UNE in men (HR 2.10 (95% CI 1.12 to 3.95)). 'Much' exposure was independently associated with trigger finger in women (HR 2.73 (95% CI 1.49 to 4.99)). We found no effect of vibration exposure on Dupuytren's disease or CMC-1 OA. 'Much' vibration exposure predicted any hand and forearm diagnosis in men (HR 1.44 (95% CI 1.08 to 1.80)), but not in women. CONCLUSIONS Vibration exposure by hand-held tools increases the risk of developing CTS and UNE and any common hand and forearm conditions in men, whereas women only risk trigger finger and CMC-1 OA. Adjustment for relevant confounders in vibration exposure is crucial.
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Affiliation(s)
- Malin Zimmerman
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden
- Department of Orthopedics, Helsingborgs lasarett, Helsingborg, Sweden
| | | | - Mattias Rydberg
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
| | - Lars Dahlin
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skånes universitetssjukhus Malmö, Malmo, Sweden
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Kang Y, Stewart M, Patel M, Furniss D, Wiberg A. Modifiable Risk Factors for Prevention in Dupuytren Disease: A UK Biobank Case-Control Study. Plast Reconstr Surg 2024; 153:363e-372e. [PMID: 37257135 DOI: 10.1097/prs.0000000000010774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Dupuytren disease is associated with significant comorbidity and mortality, and it has no existing prevention strategies. It is unclear which modifiable risk factors are most amenable for prevention. This study aimed to determine the strength of modifiable risk factors for Dupuytren disease, and to investigate associations with other diseases. METHODS Using UK Biobank data, this case-control study analyzed the association between phenotypic variables and Dupuytren disease through multivariable logistic regression. Exposures assessed were age, sex, body mass index, waist-to-hip ratio, Townsend deprivation index, smoking status, alcohol intake, diabetes mellitus, hypertension, cancer, liver disease, respiratory disease, rheumatoid arthritis, epilepsy, psoriasis, and gout. RESULTS There were 4148 cases and 397,425 controls. Male sex (OR, 3.23; 95% CI, 2.90 to 3.60; P = 1.07 × 10 -100 ), increasing age (OR, 1.08; 95% CI, 1.07 to 1.08; P = 6.78 × 10 -167 ), material deprivation (OR, 1.01; 95% CI, 1.00 to 1.02; P = 0.0305), high-density lipoprotein cholesterol (OR, 1.76; 95% CI, 1.58 to 1.96; P = 3.35 × 10 -24 ), smoking exposure, and alcohol intake were all associated with increased odds of Dupuytren disease. With increasing obesity class, there was approximately 25% decreased odds (OR, 0.774; 95% CI, 0.734 to 0.816; P = 4.71 × 10 -21 ). Diabetes with microvascular or end-organ complications was associated with more than 2.5 times increased odds of Dupuytren disease (OR, 2.59; 95% CI, 1.92 to 3.44; P = 1.92 × 10 -10 ). Within this group, increasing hemoglobin A1c values by 10 mmol/mol, or 0.9%, increased the odds by 31% (OR, 1.31; 95% CI, 1.13 to 1.51; P = 2.19 × 10 -4 ). CONCLUSION Diabetes and poor glycemic control are major risk factors for Dupuytren disease, which present an opportunity for prevention. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Youngjoo Kang
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Max Stewart
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Manal Patel
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Dominic Furniss
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital
| | - Akira Wiberg
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital
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Liechti R, Merky DN, Sutter D, Ipaktchi R, Vögelin E. Collagenase clostridium histolyticum injection versus limited fasciectomy for the treatment of Dupuytren's disease: a systematic review and meta-analysis of comparative studies. Arch Orthop Trauma Surg 2024; 144:527-536. [PMID: 37665353 DOI: 10.1007/s00402-023-05004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION The aim of the present study is to systematically review the literature on well-selected comparative studies for meta-analysis on outcome differences between collagenase clostridium histolyticum (CCH) injection and limited fasciectomy (LF) for Dupuytren's disease. MATERIALS AND METHODS PubMed/Medline, Embase, and the Cochrane Library were searched for comparative studies assessing differences in outcomes of CCH and LF. Effect estimates were pooled across studies using random effects models and presented as weighted mean difference (MD) and odds ratio (OR) with corresponding 95% confidence interval (CI). RESULTS A total of 11 studies encompassing 1'051 patients was included (619 patients in the CCH and 432 in the LF group). The residual contracture at a minimal average follow-up of three months was higher in the CCH group than in the LF group (27.8 vs. 16.2°, MD 11.6°, 95% CI [8.7, 14.5°], p < 0.001). The recurrence rate was significantly higher in the CCH group (25.8 vs. 9.3%, OR 5.2, 95% CI [1.5, 18.8], p = 0.01) while the rate of severe complications was significantly higher in the LF group (0.3 vs. 7.3%, OR 0.12, 95% CI [0.03, 0.42], p = 0.001). CONCLUSIONS Evidence of the present study confirms that CCH injection has a higher rate of disease recurrence whereas LF carries a higher risk for severe complications. It's imperative that the trade-off between these aspects is considered, keeping in mind that CCH injections may be repeated in case of disease recurrence without increasing procedure related risks, especially in complex cases.
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Affiliation(s)
- Rémy Liechti
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - Dominique Nellie Merky
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Damian Sutter
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Ramin Ipaktchi
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
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Lauritzson A, Eckerdal D, Atroshi I. Responsiveness of the patient-specific Canadian occupational performance measure and a fixed-items activity limitations measure in patients with dupuytren disease. J Patient Rep Outcomes 2023; 7:38. [PMID: 37052819 PMCID: PMC10102265 DOI: 10.1186/s41687-023-00579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Patients with Dupuytren disease experience various activity limitations. Treatment aims to reduce finger joint contractures to improve hand function and activity performance. For assessing improvement different patient-centered measures have been used. The Canadian Occupational Performance Measure (COPM) was developed as an interview-based outcome measure to detect changes over time in patients' perception of their performance and satisfaction in self-identified activity issues. The 11-item disabilities of the arm, shoulder and hand (QuickDASH) scale consists of fixed items that ask patients to rate the difficulty in performing specific daily activities. Few studies have compared the responsiveness of these two types of patient-reported measures in Dupuytren disease. PATIENTS AND METHODS We included 30 patients with Dupuytren disease enrolled in a prospective cohort study of collagenase injection. We used the COPM (score range 1-10), the QuickDASH (score range 0-100) and measurement of finger joint contracture before and 5 weeks after treatment. RESULTS Using the COPM the patients identified 107 activity problems (55 in self-care, 19 in productivity and 33 in leisure). The two most common activity problems were to wash self (21 patients) and to don gloves (19 patients). A clinically important improvement with 3 points or greater from baseline to 5 weeks was seen for performance in 77 activities (72%). The median COPM performance score improved from 4.4 at baseline to 9.0 at 5 weeks and the median QuickDASH score improved from 13.6 to 2.5. Responsiveness (Cohen's d) for the COPM performance was 2.6 (95% CI 1.9-3.3) and for the QuickDASH 0.6 (95% CI 0.1-1.1). CONCLUSION The COPM had about 6-fold larger responsiveness than the QuickDASH, which supports use of an individualized measure when assessing treatment effects in Dupuytren disease.
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Affiliation(s)
- Anna Lauritzson
- Department of Rehabilitation, Hässleholm Hospital, Hässleholm, Sweden
| | - David Eckerdal
- Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden.
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, 223 62, Sweden.
| | - Isam Atroshi
- Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, 223 62, Sweden
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Dupuytren Disease: Prevalence, Incidence, and Lifetime Risk of Surgical Intervention. A Population-Based Cohort Analysis. Plast Reconstr Surg 2023; 151:581-591. [PMID: 36730480 PMCID: PMC9944385 DOI: 10.1097/prs.0000000000009919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Health care burden attributable to Dupuytren disease (DD) is largely unknown. The authors determined (1) the prevalence and incidence of DD, (2) the incidence of first surgical intervention, and (3) the lifetime risk of surgical intervention in the United Kingdom National Healthcare Service. METHODS In this population-based dynamic cohort analysis, data of the Clinical Practice Research Datalink was linked to Hospital Episode Statistics, to characterize the diagnosis and surgical treatment of DD. Secular trends of incidence of DD diagnosis and first surgical treatment were calculated for 2000 to 2013. A multistate Markov model was designed to estimate the lifetime risk of first surgical intervention. RESULTS A total of 10,553,454 subjects were included in the analyses, 5,502,879 (52%) of whom were women. Of these, 38,707 DD patients were identified. Point prevalence in 2013 was 0.67% (99% CI, 0.66 to 0.68). The incidence of DD almost doubled from 0.30 (99% CI, 0.28 to 0.33) per 1000 person-years in 2000, to 0.59 (99% CI, 0.56 to 0.62) per 1000 person-years in 2013. The incidence of first surgical intervention similarly increased from 0.29 (99% CI, 0.23 to 0.37) to 0.88 (99% CI, 0.77 to 1.00) in the same period. A man or woman newly diagnosed with DD at age 65 has a lifetime risk of surgical intervention of 23% and 13%, respectively, showing only a very subtle decrease when diagnosed later in life. CONCLUSIONS DD is an important health condition in the older population, because prevalence and incidence rates have almost doubled in the past decade. Estimated lifetime risk of surgical treatment is relatively low, but almost twice in men compared with women. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Finger Joint Contractures 5 Years After Treatment for Dupuytren Disease: A Comparative Cohort Study of Collagenase Injection Versus Surgical Fasciectomy. J Hand Surg Am 2022; 47:834-842. [PMID: 35868901 DOI: 10.1016/j.jhsa.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/16/2022] [Accepted: 04/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare collagenase injection with surgical fasciectomy in Dupuytren disease (DD) for the prevalence of contracture in treated fingers 5 years after treatment. METHODS This was a single-center, comparative cohort study comprising 2 cohorts of patients treated for DD in 1 or more of 3 ulnar fingers with collagenase injection (159 patients) or surgical fasciectomy (59 patients). At 5 years after treatment, 13 collagenase-treated and 8 fasciectomy-treated patients had undergone subsequent treatment on the treated fingers and were considered to have current contracture. Of the remaining patients, 112 collagenase-treated patients (128 hands, 180 fingers) and 46 fasciectomy-treated patients (49 hands, 63 fingers) attended follow-up evaluation performed by 2 independent examiners (participation rate 84% and 93%, respectively). We defined current contracture in a treated finger as an active extension deficit of ≥20° in the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint or a total (MCP + PIP) active extension deficit (TAED) of ≥30°. We used linear mixed models to analyze differences between the cohorts over time. RESULTS In the collagenase cohort, current contracture was present in 45 (25%) MCP and 60 (33%) PIP joints, and in the fasciectomy cohort, current contracture was present in 12 MCP (19%) and 30 PIP (48%) joints; a TAED of ≥30° was present in 79 (44%) of the collagenase-treated and 30 (48%) of the fasciectomy-treated fingers. In MCP and PIP joints with ≥20° pretreatment contracture, complete correction was observed in 82 (56%) MCP and 30 (30%) PIP joints in the collagenase cohort and 23 (70%) MCP and 5 (16%) PIP joints in the fasciectomy cohort. There was no statistically significant difference between the 2 cohorts in the TAED change over time. CONCLUSIONS In patients with DD, collagenase injection and surgical fasciectomy improved finger joint contracture over the pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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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.
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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
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Degreef I, Van Hoecke E, Van Nuffel M. Spectacular Accidental Distraction Arthroplasty in Dupuytren Contracture with Good Outcome: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00017. [PMID: 35050924 DOI: 10.2106/jbjs.cc.21.00463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An exceptional event occurred during gradual extension with an external fixator for recurrent small finger Dupuytren flexion deformity. A massive proximal interphalangeal joint distraction arose, possibly because of the center of rotation misalignment and a hasty patient-controlled correction. The device was removed, and a plaster splint protected the finger for 5 days to prevent dislocation of the unstable joint. It relocated with an acceptable clinical result. CONCLUSION Gradual extension of Dupuytren contractures with an external fixator may induce severe joint distraction by eccentric placement of the device. On the other hand, the good outcome of this case report may inspire further research on controlled joint distraction in hooked deformity.
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Affiliation(s)
- Ilse Degreef
- Orthopaedic Department-Hand Unit, Leuven University Hospitals, Leuven, Belgium
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Ruettermann M, Hermann RM, Khatib-Chahidi K, Werker PMN. Dupuytren's Disease–Etiology and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:781-788. [PMID: 34702442 DOI: 10.3238/arztebl.m2021.0325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The worldwide prevalence of Dupuytren's disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and Embase. RESULTS Genetic factors account for 80% of the factors involved in causing this disease. Diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools are also associated with it. Limited fasciectomy is the most common treatment and is considered the reference standard. Possible complications include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6 -39.1% for all complications taken together. The recurrence rate at 5 years is 12-73%. Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy. 85% of patients have a recurrence after an average of 2.3 years. Radiotherapy can be given before contractures arise in patients with high familial risk, or postoperatively in selected patients with a very high individual risk of recurrence. CONCLUSION Although DD is not curable, good treatments are available. Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment. When counseling patients about the available treatment options, particularly the modalities and timing of surgery, the physician must take the patient's degree of suffering into account. Nowadays, fast recovery from surgery and less postoperative pain are a priority for many patients. Different surgical methods can be used in combination. It remains difficult to predict the natural course and the time to postoperative recurrence in individual patients; these matters should be addressed in future studies.
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Turesson C, Kvist J, Krevers B. Experiences of men living with Dupuytren's disease-Consequences of the disease for hand function and daily activities. J Hand Ther 2021; 33:386-393. [PMID: 31477329 DOI: 10.1016/j.jht.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/18/2019] [Accepted: 04/28/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Qualitative descriptive. INTRODUCTION Dupuytren's disease (DD) is a chronic hand condition causing impairment in hand function. Research describing persons' experiences of living with DD is limited. Understanding the subjective experience of illness is valuable for planning and implementing health-care services. PURPOSE OF THE STUDY To explore experiences among men living with an impaired hand function due to DD and the consequences of the disease for daily activities. METHODS Interviews were conducted with 21 men before surgery. The model of the patient evaluation process guided data collection. Data were analyzed using problem-driven content analysis. RESULTS Participants described DD as a chronic disease caused by heredity, previous injury, hard work, or aging. DD was, according to the participants, an uncomfortable and sometimes painful condition, causing a feeling of constant stiffness in the affected hand. DD could cause participants to have fear of hurting the hand, feelings of shame or embarrassment, and a sense of being old. Participants handled the deteriorating hand function by avoiding or refraining from activities, adapting their performance, or performing activities with less quality. The ideal hand function was seen as being able to use the hands without effort. DISCUSSION The diverse experiences of DD and if the hand is experienced as something that causes distress can be understood further using body-self dialectic and Gadow's states of embodiment, as well as the process of adapting and learning to live with the functional limitations. CONCLUSIONS A clinical implication for hand therapy is to acknowledge patients' individual experiences and support self-modifications and development of new skills.
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Affiliation(s)
- Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Division of Occupational Therapy, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
| | - Joanna Kvist
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Krevers
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Rydberg M, Zimmerman M, Löfgren JP, Gottsäter A, Nilsson PM, Melander O, Dahlin LB. Metabolic factors and the risk of Dupuytren's disease: data from 30,000 individuals followed for over 20 years. Sci Rep 2021; 11:14669. [PMID: 34282190 PMCID: PMC8289914 DOI: 10.1038/s41598-021-94025-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/30/2021] [Indexed: 01/22/2023] Open
Abstract
Dupuytren’s disease (DD) is a fibroproliferative disorder affecting the palmar fascia of the hand. Risk factors include diabetes mellitus (DM), whereas a high body mass index (BMI) is associated with a lower prevalence of DD. The aim of this study was to further elucidate risk and protective factors for the development of DD using longitudinal population-based data from the Malmö Diet and Cancer Study (MDCS). During 1991–1996, the inhabitants aged 46–73 years in the city of Malmö, Sweden were invited to participate in the population-based MDCS (41% participation rate). Data on incident DD were retrieved from Swedish national registers. Associations between DM, alcohol consumption, BMI, and serum apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) at baseline were analysed in multivariable Cox regression models adjusted for known confounders. Among 30,446 recruited participants, 347 men and 194 women were diagnosed with DD during a median follow-up time of 23 years. DM (men HR 2.23; 95% CI 1.50–3.30, women HR 2.69; 95% CI 1.48–4.90) and alcohol consumption (men HR 2.46; 95% CI 1.85–3.27, women HR 3.56; 95% CI 1.95–6.50) were independently associated with incident DD in the Cox regression models. Furthermore, inverse associations with incident DD were found for obesity among men, and ApoB/ApoA1 ratio among both sexes. DM and excess alcohol consumption constituted major risk factors for the development of DD. Furthermore, an inverse association between obesity among men and DD, and also between ApoB/ApoA1 ratio and DD was found in both sexes.
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Affiliation(s)
- Mattias Rydberg
- Department of Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, 205 02, Malmö, Sweden. .,Department of Translational Medicine-Hand Surgery, Lund University, Lund, Sweden.
| | - Malin Zimmerman
- Department of Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Translational Medicine-Hand Surgery, Lund University, Lund, Sweden
| | - Jin Persson Löfgren
- Department of Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Translational Medicine-Hand Surgery, Lund University, Lund, Sweden
| | - Anders Gottsäter
- Department of Vascular Diseases, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Lars B Dahlin
- Department of Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Translational Medicine-Hand Surgery, Lund University, Lund, Sweden
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12
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Salari N, Heydari M, Hassanabadi M, Kazeminia M, Farshchian N, Niaparast M, Solaymaninasab Y, Mohammadi M, Shohaimi S, Daneshkhah A. The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis. J Orthop Surg Res 2020; 15:495. [PMID: 33115483 PMCID: PMC7594412 DOI: 10.1186/s13018-020-01999-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Dupuytren disease is a benign fibroproliferative disorder that leads to the formation of the collagen knots and fibres in the palmar fascia. The previous studies reveal different levels of Dupuytren’s prevalence worldwide; hence, this study uses meta-analysis to approximate the prevalence of Dupuytren globally. Methods In this study, systematic review and meta-analysis have been conducted on the previous studies focused on the prevalence of the Dupuytren disease. The search keywords were Prevalence, Prevalent, Epidemiology, Dupuytren Contracture, Dupuytren and Incidence. Subsequently, SID, MagIran, ScienceDirect, Embase, Scopus, PubMed and Web of Science databases and Google Scholar search engine were searched without a lower time limit and until June 2020. In order to analyse reliable studies, the stochastic effects model was used and the I2 index was applied to test the heterogeneity of the selected studies. Data analysis was performed within the Comprehensive Meta-Analysis Software version 2.0. Results By evaluating 85 studies (10 in Asia, 56 in Europe, 2 in Africa and 17 studies in America) with a total sample size of 6628506 individuals, the prevalence of Dupuytren disease in the world is found as 8.2% (95% CI 5.7–11.7%). The highest prevalence rate is reported in Africa with 17.2% (95% CI 13–22.3%). According to the subgroup analysis, in terms of underlying diseases, the highest prevalence was obtained in patients with type 1 diabetes with 34.1% (95% CI 25–44.6%). The results of meta-regression revealed a decreasing trend in the prevalence of Dupuytren disease by increasing the sample size and the research year (P < 0.05). Conclusion The results of this study show that the prevalence of Dupuytren disease is particularly higher in alcoholic patients with diabetes. Therefore, the officials of the World Health Organization should design measures for the prevention and treatment of this disease.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Hassanabadi
- Lecturer in International Business & Strategy, Faculty of Business & Law, University of Northampton, Northampton, UK
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nikzad Farshchian
- Department of Otolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Yousef Solaymaninasab
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Alireza Daneshkhah
- School of Computing, Electronics and Maths, Coventry University, London, UK
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13
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Dutta A, Jayasinghe G, Deore S, Wahed K, Bhan K, Bakti N, Singh B. Dupuytren's Contracture - Current Concepts. J Clin Orthop Trauma 2020; 11:590-596. [PMID: 32684695 PMCID: PMC7355095 DOI: 10.1016/j.jcot.2020.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022] Open
Abstract
Dupuytren's contracture is a common condition that has the potential to be debilitating. It presents in a variety of manners and can be mild or more aggressive in its progression. There are a large number of management options currently available. In this review of the evidence, non-operative and operative management options are examined, with a consideration of post-operative rehabilitation and complications. A summary of the current concepts in the management of Dupuytren's contracture is presented.
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Affiliation(s)
| | | | | | | | | | - Nik Bakti
- East Kent University NHS Foundation Trust, UK
| | - Bijayendra Singh
- Medway NHS Foundation Trust, UK,Corresponding author. Medway Hospital, Windmill Rd, Gillingham, ME7 5NY, UK.
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14
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Löfvendahl S, Schelin MEC, Jöud A. The value of the Skåne Health-care Register: Prospectively collected individual-level data for population-based studies. Scand J Public Health 2019; 48:56-63. [PMID: 31814536 DOI: 10.1177/1403494819868042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aims: This study aimed to examine the population-based Skåne Health-care Register (SHR) regarding feasibility for scientific research and also strengths and weaknesses. Methods: To analyse the feasibility of the SHR, we performed a bibliographic search for peer-reviewed articles based on SHR data from 2000 to 2018. To analyse strengths and weaknesses, we used original SHR data about coverage and validity. Results: We identified 58 articles based on SHR data, covering different study designs and disorders. Most studies focused on musculoskeletal disorders with a cohort design. The majority of all consultations recorded in the SHR have an assigned diagnosis. However, this differs between the levels of care and between types of consultation. For inpatient care, the proportion of consultations with an assigned diagnosis was close to 100% between 1998 and 2017. The proportion of consultations with an assigned diagnosis was lowest within primary care, although the proportion markedly increased in 2004 when the prerequisite for consultation reimbursement was linked to the requirement for an assigned diagnosis. Limitations are that the SHR does not cover health-care provided within nursing homes and equivalent facilities or treatments received by the population of Skåne outside the region. Conclusions: The SHR may be used as a reliable data source for analyses of clinical changes and improvements. Extended use of the SHR in a research context may highlight important shortcomings within the register and thus serve as a way of indirect quality control. To enhance the use of the SHR further, better harmonisation between registers, within and outside of the region and internationally, is of crucial importance.
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Affiliation(s)
- Sofia Löfvendahl
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Faculty of Medicine, Sweden.,Health Technology Assessment Skåne, Skåne University Hospital, Sweden
| | - Maria E C Schelin
- Department of Clinical Sciences Lund, Institute for Palliative Care, Lund University, Sweden.,Department for Research and Development, Skåne University Hospital, Sweden
| | - Anna Jöud
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Faculty of Medicine, Sweden.,Department for Research and Development, Skåne University Hospital, Sweden.,Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Sweden
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15
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Nordenskjöld J, Lauritzson A, Åkesson A, Atroshi I. Collagenase injections for Dupuytren disease: 3-year treatment outcomes and predictors of recurrence in 89 hands. Acta Orthop 2019; 90:517-522. [PMID: 31500473 PMCID: PMC6844429 DOI: 10.1080/17453674.2019.1663472] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Few prospective studies have reported the long-term effect durability of collagenase injections for Dupuytren disease. We assessed the 3-year treatment outcome of collagenase injections and predictors of recurrence.Patients and methods - We conducted a single-center prospective cohort study. Indication for collagenase injection was palpable Dupuytren's cord and active extension deficit (AED) ≥ 20° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. From November 2012 through June 2013, we treated 86 consecutive patients (92 hands, 126 fingers). A hand therapist measured joint contracture before, 5 weeks, and 3 years after injection. The patients rated their treatment satisfaction. Primary outcome was proportion of treated joints with ≥ 20° AED worsening between the 5-week and 3-year measurements. We analyzed predictors of recurrence.Results - 3-year outcomes were available for 83 of the 86 patients (89 hands, 120 treated fingers). Between the 5-week and 3-year measurements, AED worsened by ≥ 20° in 17 MCP (14%) and 28 PIP (23%) joints. At 3 years, complete correction (passive extension deficit 0-5°) was present in 73% of MCP and 35% of PIP joints. Treatment of small finger PIP joint contracture, greater pretreatment contracture severity, and previous fasciectomy on the treated finger were statistically significant predictors of recurrence. Treatment satisfaction was rated as very satisfied or satisfied in 59 of 87 hands. No long-term treatment-related adverse events were observed.Interpretation - 3 years after collagenase injections for Dupuytren disease, improvement was maintained and treatment satisfaction reported in two-thirds of the treated hands, with no adverse events. Complete contracture correction was achieved in 3 of 4 MCP joints, but in only a third of the PIP joints.
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Affiliation(s)
- Jesper Nordenskjöld
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm; ,Department of Clinical Sciences—Orthopedics, Lund University, Lund, Sweden,Correspondence:
| | - Anna Lauritzson
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm; ,Department of Rehabilitation, Hässleholm Hospital, Hässleholm;
| | - Anna Åkesson
- Clinical Studies Sweden—Forum South, Skåne University Hospital, Lund;
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm; ,Department of Clinical Sciences—Orthopedics, Lund University, Lund, Sweden
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16
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Aglen T, Matre KH, Lind C, Selles RW, Aßmus J, Taule T. Hand therapy or not following collagenase treatment for Dupuytren's contracture? Protocol for a randomised controlled trial. BMC Musculoskelet Disord 2019; 20:387. [PMID: 31455312 PMCID: PMC6712875 DOI: 10.1186/s12891-019-2712-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background Dupuytren’s contracture (DC) is a fibrotic hand condition in which one or more fingers develop progressive flexion deformities. Quality of life is diminished due to disabling limitations in performing everyday activities. For DC patients treated with collagenase, referral for subsequent hand therapy is inconsistent. It is unknown whether subsequent hand therapy is beneficial compared to no therapy. The purpose of this study is to determine whether hand therapy improves DC patients’ performance of and satisfaction with performing everyday activities one year after collagenase treatment. Methods We will conduct a randomised controlled trial with two treatment groups (hand therapy vs. control) of DC patients who have received collagenase treatment. DC patients with contracted metacarpophalangeal joint(s) (MCPJ) (hand therapy, n = 40; control, n = 40) and those with proximal interphalangeal joint(s) (PIPJ) involvement (hand therapy, n = 40; control, n = 40) comprise two subgroups, and we will study if the treatment effect will be different between both groups (n = 160). Patients with a previous injury or treatment for DC in the treatment finger are excluded. Hand therapy includes oedema and scar management, splinting, movement exercises, and practice of everyday activities. The main outcome variable is patients’ performance of and satisfaction with performing everyday activities, as assessed with the Canadian Occupational Performance Measure. Secondary outcomes are DC-specific activity problems, as assessed with the Unité Rhumatologique des Affections de la Main scale, and active/passive flexion/extension of treated joints and grip force using standard measuring tools, and self-reported pain level. Demographic and clinical variables, degree of scarring, cold hypersensitivity, number of occupational sick-leave days are collected. Self-reported global impression of change will be used to assess patient satisfaction with change in hand function. Assessments are done pre-injection and 6 weeks, 4 months, and 1 year later. Standard univariate and multivariate statistical analyses will be used to evaluate group differences. Discussion This study aims to assess whether hand therapy is beneficial for activity-related, biomechanical, and clinical outcomes in DC patients after collagenase treatment. The results will provide an objective basis for determining whether hand therapy should be conducted after collagenase treatment. Trial registration This study has been registered at ClinicalTrials.gov as NCT03580213 (April 5, 2018).
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Affiliation(s)
- Terese Aglen
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway.
| | - Karin Hoegh Matre
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway
| | - Cecilie Lind
- Department for Plastic-, Hand-, Reconstructive surgery and National burn unit, Surgery Clinic, Haukeland University Hospital (HUH), Bergen, Norway
| | - Ruud W Selles
- Department of Rehabilitation Medicine and department of Plastic and Reconstructive Surgery Hand Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Jörg Aßmus
- Centre for Clinical Research, HUH, Bergen, Norway
| | - Tina Taule
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway
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17
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Eiriksdottir A, Atroshi I. A new finger-preserving procedure as an alternative to amputation in recurrent severe Dupuytren contracture of the small finger. BMC Musculoskelet Disord 2019; 20:323. [PMID: 31288790 PMCID: PMC6617564 DOI: 10.1186/s12891-019-2701-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/01/2019] [Indexed: 11/24/2022] Open
Abstract
Background Recurrent severe Dupuytren contracture of the small finger’s proximal interphalangeal (PIP) joint is a difficult problem. Further surgery carries high risk of complications and poor outcome. Patients are often offered finger amputation. We have devised a novel surgical procedure consisting of middle phalanx monoblock resection and ligament reconstruction to create a new functioning interphalangeal joint. Methods Two patients requesting small-finger amputation because of severe PIP joint contracture after multiple treatments for Dupuytren contracture were offered and accepted this new procedure. Through a dorsal incision the extensor tendon is incised longitudinally exposing the middle phalanx and interphalangeal joints. The collateral ligaments of both interphalangeal joints are detached from the middle phalanx. The middle phalanx is dissected from soft tissues (including the flexor digitorum superficialis tendon) and removed. The distal phalanx is brought proximally and the ends of the collateral ligaments are sutured with non-absorbable sutures with the joint held in full extension and congruency. The two patients were evaluated at 18 months and 15 months after surgery, respectively. Results Both patients regained good finger posture with almost full extension and had normal sensation and no pain. Active flexion in the new interphalangeal joint was 60 degrees and 35 degrees, respectively. Both patients had full metacarpophalangeal joint flexion and extension, normal 2-point discrimination in the small finger and higher grip strength in the treated than the contralateral hand. Radiographs showed a congruent new interphalangeal joint. Both patients were very satisfied with the outcome. Conclusions In patients with Dupuytren disease and severe PIP joint contracture after multiple treatments, this novel procedure consisting of middle-phalanx excision and ligament reconstruction creating a new functioning interphalangeal joint has good short-term outcomes and is a favorable alternative to finger amputation. Longer follow-up will show whether these results are durable.
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Affiliation(s)
- Asa Eiriksdottir
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, SE-28125, Hässleholm, Sweden.
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, SE-28125, Hässleholm, Sweden.,Department of Clinical Sciences - Orthopedics, Lund University, SE-22100, Lund, Sweden
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18
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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.
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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
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19
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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.
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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
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20
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Kalliainen LK, Wisecarver I, Cummings A, Stone J. Sex Bias in Hand Surgery Research. J Hand Surg Am 2018; 43:1026-1029. [PMID: 29703685 DOI: 10.1016/j.jhsa.2018.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/19/2018] [Indexed: 02/02/2023]
Abstract
It has been long recognized that sex-based biases related to participant inclusion exist in research. To help address inequities in research participation, the National Institutes of Health Revitalization Act was passed into law in 1993. Although this act was primarily designed to increase inclusion of females and minorities in research funded by National Institutes of Health, it has also helped raise global awareness of the value of routinely including females and minority groups in research. Subsequent work has demonstrated a continued gap in inclusion of females in medical and surgical research and female animals and cell lines in basic science research. Hand surgeons have recognized that certain conditions have greater incidence in one sex over the other, but there has been no widespread discussion on whether, when, and how sex should be used as an outcomes variable. This review investigated the recent hand surgery literature to assess for equity in inclusion of both sexes in research as well as whether outcomes were analyzed based on sex.
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Affiliation(s)
- Loree K Kalliainen
- Division of Plastic and Hand Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
| | - Ian Wisecarver
- Division of Plastic and Hand Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Allison Cummings
- Division of Plastic and Hand Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jennifer Stone
- Division of Plastic and Hand Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
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21
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Nordenskjöld J, Brodén S, Atroshi I. Examiners' influence on the measured active and passive extension deficit in finger joints affected by Dupuytren disease. BMC Med Res Methodol 2018; 18:120. [PMID: 30373511 PMCID: PMC6206839 DOI: 10.1186/s12874-018-0577-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 10/16/2018] [Indexed: 01/01/2023] Open
Abstract
Background The most commonly reported outcome measure in Dupuytren disease is the extension deficit in finger joints. This study aimed to investigate the examiners’ influence on the measured difference between active and passive extension deficit. Methods A prospective cohort study was conducted on 157 consecutive patients (81% men, mean age 70 years) scheduled for collagenase treatment for Dupuytren disease. Before injection, one of three experienced hand therapists measured active extension deficit (AED) and passive extension deficit (PED) in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the affected fingers using a hand-held metal goniometer. We included joints with ≥10° AED, and calculated mean AED and PED in MCP and PIP joints measured by each examiner. For adjusted analysis we used a mixed effects model to determine the relationship between the examiner and the AED-PED difference. Results For all 291 joints measured, mean AED was 46° (SD 21) and mean PED was 37° (SD 23). Mean difference between AED and PED measured by examiner 1 was 6° (SD 6), by examiner 2 was 9° (SD 9), and by examiner 3 was 12° (SD 9). The mixed effects model analysis showed that the identity of the examining therapist was a significant determinant of the AED-PED difference. Conclusions In Dupuytren disease measurement of active and passive extension deficit in finger joint contractures may vary significantly between different examiners. This must be taken into consideration when designing clinical studies and comparing outcomes between studies.
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Affiliation(s)
- Jesper Nordenskjöld
- Department of Orthopedics, Kristianstad-Ystad-Hässleholm Hospitals, Hässleholm, Sweden. .,Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden.
| | - Stina Brodén
- Department of Orthopedics, Kristianstad-Ystad-Hässleholm Hospitals, Hässleholm, Sweden.,Department of Rehabilitation, Kristianstad Hospital, Kristianstad, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Kristianstad-Ystad-Hässleholm Hospitals, Hässleholm, Sweden.,Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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22
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Lee KH, Kim JH, Lee CH, Kim SJ, Jo YH, Lee M, Choi WS. The Epidemiology of Dupuytren's Disease in Korea: a Nationwide Population-based Study. J Korean Med Sci 2018; 33:e204. [PMID: 30069170 PMCID: PMC6062433 DOI: 10.3346/jkms.2018.33.e204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/10/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To date, there have been few reports on the nationwide population-based epidemiology of Dupuytren's disease (DD). We investigated the prevalence and incidence of DD in Korea using the large dataset provided by the Korean Health Insurance Review and Assessment Service. This study is the second nationwide epidemiological study of DD after the study in Taiwan. METHODS Records of patients diagnosed with DD between 2007 and 2014 were extracted from the large dataset by diagnostic code searching (International Classification of Disease 10th revision code M72.0) and were included in the study. We calculated the prevalence and incidence of DD based on the total population of Korea provided by the Korean Statistical Information Service. Diseases associated with DD and the trends in surgery for DD were also analyzed. RESULTS A total 16,630 patients were diagnosed with DD during the study period. The mean annual prevalence was 32.2 per 100,000 population (41.8 per 100,000 for men; 22.5 per 100,000 for women). The mean annual incidence was 1.09 per 100,000 population (1.80 per 100,000 for men; 0.38 per 100,000 for women). The common diseases associated with DD were hypertension (30.5%), diabetes mellitus (26.7%), hyperlipidemia (20.4%), ischemic heart disease (7.9%), and cerebrovascular disease (4.6%). The mean annual proportion of the patients who had surgery for DD was 5.24% of all DD patients. CONCLUSION The prevalence and incidence of DD in Korea were 100-1,000 times lower than those in western countries; however, it was slightly larger than that in Taiwan.
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Affiliation(s)
- Kwang-Hyun Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Joo-Hak Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Chang-Hun Lee
- Department of Orthopaedic Surgery, Eulji University College of Medicine, Seoul, Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Young-Hoon Jo
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Myungsub Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Wan-Sun Choi
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
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