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Palmer KT, D'Angelo S, Syddall H, Griffin MJ, Cooper C, Coggon D. Dupuytren's contracture and occupational exposure to hand-transmitted vibration. Occup Environ Med 2014; 71:241-5. [PMID: 24449599 PMCID: PMC3963601 DOI: 10.1136/oemed-2013-101981] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS The relation between Dupuytren's contracture and occupational exposure to hand-transmitted vibration (HTV) has frequently been debated. We explored associations in a representative national sample of workers with well-characterised exposure to HTV. METHODS We mailed a questionnaire to 21 201 subjects aged 16-64 years, selected at random from the age-sex registers of 34 general practices in Great Britain and to 993 subjects chosen randomly from military pay records, asking about occupational exposure to 39 sources of HTV and about fixed flexion contracture of the little or ring finger. Analysis was restricted to men at work in the previous week. Estimates were made of average daily vibration dose (A(8) root mean squared velocity (rms)) over that week. Associations with Dupuytren's contracture were estimated by Poisson regression, for lifetime exposure to HTV and for exposures in the past week >A(8) of 2.8 ms(-2) rms. Estimates of relative risk (prevalence ratio (PR)) were adjusted for age, smoking status, social class and certain manual activities at work. RESULTS In all 4969 eligible male respondents supplied full information on the study variables. These included 72 men with Dupuytren's contracture, 2287 with occupational exposure to HTV and 409 with A(8)>2.8 ms(-2) in the past week. PRs for occupational exposure to HTV were elevated 1.5-fold. For men with an A(8)>2.8 ms(-2) in the past week, the adjusted PR was 2.85 (95% CI 1.37 to 5.97). CONCLUSIONS Our findings suggest that risk of Dupuytren's contracture is more than doubled in men with high levels of weekly exposure to HTV.
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Affiliation(s)
- Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Karkampouna S, Kruithof BP, Kloen P, Obdeijn MC, van der Laan AM, Tanke HJ, Kemaladewi DU, Hoogaars WM, 't Hoen PA, Aartsma-Rus A, Clark IM, Ten Dijke P, Goumans MJ, Kruithof-de Julio M. Novel Ex Vivo Culture Method for the Study of Dupuytren's Disease: Effects of TGFβ Type 1 Receptor Modulation by Antisense Oligonucleotides. MOLECULAR THERAPY-NUCLEIC ACIDS 2014; 3:e142. [PMID: 24448195 PMCID: PMC3912325 DOI: 10.1038/mtna.2013.69] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/02/2013] [Indexed: 11/26/2022]
Abstract
Dupuytren's disease (DD) is a benign fibroproliferative disease of the hand. It is characterized by the excessive production of extracellular matrix (ECM) proteins, which form a strong fibrous tissue between the handpalm and fingers, permanently disrupting the fine movement ability. The major contractile element in DD is the myofibroblast (MFB). This cell has both fibroblast and smooth muscle cell-type characteristics and causes pathological collagen deposition. MFBs generate contractile forces that are transmitted to the surrounding collagen matrix. Μajor profibrotic factors are members of the transforming growth factor-β (TGFβ) pathway which directly regulate the expression levels of several fibrous proteins such as collagen type 1, type 3, and α-smooth muscle actin. Molecular modulation of this signaling pathway could serve as a therapeutic approach. We, therefore, have developed an ex vivo “clinical trial” system to study the properties of intact, patient-derived resection specimens. In these culture conditions, Dupuytren's tissue retains its three-dimensional (3D) structure and viability. As a novel antifibrotic therapeutic approach, we targeted TGFβ type 1 receptor (also termed activin receptor-like kinase 5) expression in cultured Dupuytren's specimens by antisense oligonucleotide-mediated exon skipping. Antisense oligonucleotides targeting activin receptor-like kinase 5 showed specific reduction of ECM and potential for clinical application.
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Affiliation(s)
- Sofia Karkampouna
- Department of Molecular Cell Biology, Cancer Genomics Centre and Centre for Biomedical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Boudewijn Pt Kruithof
- Department of Molecular Cell Biology, Cancer Genomics Centre and Centre for Biomedical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Kloen
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Miryam C Obdeijn
- Department of Plastic, Reconstructive, and Handsurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Annelies Ma van der Laan
- Department of Molecular Cell Biology, Cancer Genomics Centre and Centre for Biomedical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans J Tanke
- Department of Molecular Cell Biology, Cancer Genomics Centre and Centre for Biomedical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dwi U Kemaladewi
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Mh Hoogaars
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Ac 't Hoen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ian M Clark
- School of Biological Sciences, University of East Anglia, Norwich Research Park, UK
| | - Peter Ten Dijke
- Department of Molecular Cell Biology, Cancer Genomics Centre and Centre for Biomedical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Cancer Genomics Centre and Centre for Biomedical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marianna Kruithof-de Julio
- Department of Molecular Cell Biology, Cancer Genomics Centre and Centre for Biomedical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Usó SMRS, Sanson ACS, Covolo-Santana FDS, Marcos EVC, Marques T, Filho MC, Ura S. Contribuição das moléculas de antígeno de histocompatibilidade leucocitária (HLA) para a contratura de Dupuytren em uma população do Sudeste do Brasil. REVISTA BRASILEIRA DE REUMATOLOGIA 2014. [DOI: 10.1016/j.rbr.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Dupuytren's disease is a complex condition, with both genetic and environmental factors contributing to its aetiology. We aimed to quantify the extent to which genetic factors predispose to the disease, through the calculation of sibling recurrence risk (ls), and to calculate the proportion of heritability accounted for by currently known genetic loci. From 174 siblings of patients with surgically confirmed disease, 100 were randomly selected. Controls were recruited from patients attending an ophthalmology outpatient clinic for eye conditions unrelated to diabetes. There were no statistically significant differences in baseline characteristics between the case and control groups. In siblings, 47% had Dupuytren's disease, compared with 10% of controls, giving a ls of 4.5. Currently known loci that predispose to Dupuytren's disease account for 12.1% of the total heritability of the disease. Dupuytren's disease was significantly more common in siblings than in controls. These results accurately quantify the magnitude of the genetic predisposition to Dupuytren's disease.
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Affiliation(s)
- R Capstick
- Nuffield Department of Surgical Sciences, University of Oxford, UK
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Forrester HB, Temple-Smith P, Ham S, de Kretser D, Southwick G, Sprung CN. Genome-wide analysis using exon arrays demonstrates an important role for expression of extra-cellular matrix, fibrotic control and tissue remodelling genes in Dupuytren's disease. PLoS One 2013; 8:e59056. [PMID: 23554969 PMCID: PMC3595223 DOI: 10.1371/journal.pone.0059056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 02/11/2013] [Indexed: 01/15/2023] Open
Abstract
Dupuytren's disease (DD) is a classic example of pathological fibrosis which results in a debilitating disorder affecting a large sector of the human population. It is characterized by excessive local proliferation of fibroblasts and over-production of collagen and other components of extracellular matrix (ECM) in the palmar fascia. The fibrosis progressively results in contracture of elements between the palmar fascia and skin causing flexion deformity or clawing of the fingers and a severe reduction in hand function. While much is known about the pathogenesis and surgical treatment of DD, little is known about the factors that cause its onset and progression, despite many years of research. Gene expression patterns in DD patients now offers the potential to identify genes that direct the pathogenesis of DD. In this study we used primary cultures of fibroblasts derived from excisional biopsies of fibrotic tissue from DD patients to compare the gene expression profiles on a genome-wide basis with normal control fibroblasts. Our investigations have identified genes that may be involved with DD pathogenesis including some which are directly relevant to fibrosis. In particular, these include significantly reduced expression levels of three matrix metallopeptidases (MMP1, MMP3, MMP16), follistatin, and STAT1, and significantly increased expression levels of fibroblast growth factors (FGF9, FGF11), a number of collagen genes and other ECM genes in DD patient samples. Many of these gene products are known to be involved in fibrosis, tumour formation and in the normal processes of tissue remodelling. In addition, alternative splicing was identified in some DD associated genes. These highly sensitive genomic investigations provide new insight into the molecular mechanisms that may underpin the development and progression of DD.
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Affiliation(s)
- Helen B. Forrester
- Centre for Innate Immunology and Infectious Disease, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Peter Temple-Smith
- Department of Obstetrics and Gynaecology, Southern Clinical School, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
- Prince Henry's Institute, Clayton, Victoria, Australia
- Melbourne Institute of Plastic Surgery, Malvern, Victoria, Australia
| | - Seungmin Ham
- Department of Obstetrics and Gynaecology, Southern Clinical School, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
- Prince Henry's Institute, Clayton, Victoria, Australia
| | - David de Kretser
- Centre for Reproduction and Development, Monash Institute of Medical Research, Clayton, Victoria, Australia
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Graeme Southwick
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
- Melbourne Institute of Plastic Surgery, Malvern, Victoria, Australia
| | - Carl N. Sprung
- Centre for Innate Immunology and Infectious Disease, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
- * E-mail:
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van Dijk D, Finigan P, Gerber RA, Szczypa PP, Werker PMN. Recognition, diagnosis and referral of patients with Dupuytren's disease: a review of current concepts for general practitioners in Europe. Curr Med Res Opin 2013; 29:269-77. [PMID: 23320611 DOI: 10.1185/03007995.2013.766163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dupuytren's disease (DD) is a fairly prevalent yet under-recognised disorder of the palmar fascia, resulting in fixed-flexion contractures of joints in the hand. Numerous population-based studies have been conducted in countries around the world, and published prevalence estimates vary widely. Nevertheless, most studies have shown that the prevalence of DD increases with age. Because the global population is aging, the prevalence of DD will also continue to increase. SCOPE Patients with DD typically present to a variety of physicians, generalists and specialists alike. Thus, it is critical that providers have clear guidance on the early recognition of signs and symptoms, comprehensive evaluation of potential risk factors, differential diagnosis and when to refer a patient for treatment. Treatment options range from minimally invasive injections with collagenase to surgery. FINDINGS Results from a large-scale study of the surgical management of DD in Europe indicate that most DD diagnoses and referrals are made by general practitioners, but there is much inter-country variation. Different patient- and physician-based factors affect diagnosis rates and referral pathways. Different healthcare systems and regulations are also influential. A simple management algorithm is provided herein and explained. CONCLUSION It is important for generalists to understand the natural history of DD and the potential benefits of early referral and treatment. General practitioners should diagnose and/or refer patients with DD to a specialist as early as possible to optimise disease management and treatment outcomes.
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Chan WC, Wan SH, Ip FK. Review of Partial Fasciectomy for Dupuytren's Contracture in Southern Chinese Patients. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2012. [DOI: 10.1016/j.jotr.2012.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Vargas A, Chiapas-Gasca K, Hernández-Díaz C, Canoso JJ, Saavedra MÁ, Navarro-Zarza JE, Villaseñor-Ovies P, Kalish RA. Clinical Anatomy of the Hand. ACTA ACUST UNITED AC 2012; 8 Suppl 2:25-32. [DOI: 10.1016/j.reuma.2012.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/24/2012] [Indexed: 01/14/2023]
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Werker PMN, Pess GM, van Rijssen AL, Denkler K. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions. J Hand Surg Am 2012; 37:2095-2105.e7. [PMID: 22938804 DOI: 10.1016/j.jhsa.2012.06.032] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 06/26/2012] [Accepted: 06/27/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. METHODS This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English. RESULTS The search returned 218 studies, of which 21 had definitions, quantitative results for contracture correction and recurrence, and a sample size of at least 20 patients. Definitions for correction of contracture and recurrence varied greatly among articles and were almost always qualitative. Percentages of patients who achieved correction of contracture (ie, responder rate) when evaluated at various times after completion of surgery ranged from 15% to 96% for fasciectomy/aponeurectomy. Responder rates were not reported for fasciotomy/aponeurotomy. Recurrence rates ranged from 12% to 73% for patients treated with fasciectomy/aponeurectomy and from 33% to 100% for fasciotomy/aponeurotomy. Review of these reports underscored the difficulty involved in comparing correction of contracture and recurrence rates for different surgical interventions because of differences in definition and duration of follow-up. CONCLUSIONS Clearly defined objective definitions for correction of contracture and for recurrence are needed for more meaningful comparisons of results achieved with different surgical interventions. CLINICAL RELEVANCE Recurrence after surgical intervention for Dupuytren contracture is common. This study, which evaluated reported rates of recurrence following surgical treatment of Dupuytren contracture, provides clinicians with practical information regarding expected long-term outcomes of surgical treatment choices. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and decision analysis III.
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Affiliation(s)
- Paul M N Werker
- University of Groningen, University Medical Centre Groningen, The Netherlands.
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60
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Kemler MA, Houpt P, van der Horst CMAM. A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren's disease. J Hand Surg Eur Vol 2012; 37:733-7. [PMID: 22311918 DOI: 10.1177/1753193412437631] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Before surgery for Dupuytren's contracture, 54 patients with a proximal interphalangeal (PIP) joint flexion contractures of at least 30° were randomized to receive either a 3-month splinting protocol together with hand therapy under the direct supervision of hand therapists, or the same hand therapy alone. Extension deficit of the PIP joint (primary outcome measure), global perceived effect, pain intensity, comfort and complications were assessed at baseline and 1 year after surgery. In an intention-to-treat analysis, the group assigned to splint-plus-hand therapy had a mean reduction of 21° in flexion contracture after 1 year, compared with 29° in the group receiving hand therapy alone (p = 0.1). There was no difference between the groups regarding other parameters. After operative release of a Dupuytren's contracture, a postoperative protocol using a splint and hand therapy was no better than hand therapy alone in minimizing postoperative flexion contractures.
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Affiliation(s)
- M A Kemler
- Department of Plastic Surgery, Martini Hospital, Groningen, The Netherlands.
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Larocerie-Salgado J, Davidson J. Nonoperative treatment of PIPJ flexion contractures associated with Dupuytren's disease. J Hand Surg Eur Vol 2012; 37:722-7. [PMID: 21965179 DOI: 10.1177/1753193411422680] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Post-surgical outcomes in patients with Dupuytren's disease causing flexion contractures of the proximal interphalangeal joint can be inconsistent and are often associated with protracted rehabilitation, reduced flexion, recurrence of the contracture, and patient dissatisfaction. An alternative treatment option, comprised of splinting and soft tissue mobilization techniques, was introduced to stabilize early contractures of the proximal interphalangeal joint in the hopes of delaying or obviating surgery. Over the course of approximately 12.6 months (± 7.8), thirteen patients were followed at the hand clinic at Hotel Dieu Hospital in Kingston. One patient was unable to complete the course of therapy. Of the remaining patients, analysis showed significant improvement in active proximal interphalangeal joint extension of approximately 14.6° (SD: ± 5.1°; range: 5-25°) over the course of the treatment (p < .05). Nighttime static extension splinting and soft tissue mobilization techniques appear to delay and possibly prevent the need for surgery in individuals with flexion contractures of the proximal interphalangeal joint due to Dupuytren's disease.
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Marchalik D, Lipsky A, Petrov D, Harvell JD, Milgraum SS. Dermatologic Presentations of Orthopedic Pathologies. Am J Clin Dermatol 2012; 13:293-310. [DOI: 10.2165/11595880-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Cross-frictional therapy and stretching for the treatment of palmar adhesions due to Dupuytren’s contracture: A prospective case study. ACTA ACUST UNITED AC 2012; 17:479-82. [DOI: 10.1016/j.math.2011.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/02/2011] [Accepted: 11/05/2011] [Indexed: 11/20/2022]
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Azzopardi E, Boyce DE. Clostridium histolyticum collagenase in the treatment of Dupuytren's contracture. Br J Hosp Med (Lond) 2012; 73:432-6. [PMID: 22875519 DOI: 10.12968/hmed.2012.73.8.432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Dupuytren's disease is a common, costly and recurrent health issue. This review compares Clostridium histolyticum collagenase with current operative treatments. Collagenase management is an effective non-surgical alternative associated with lower risks of serious adverse events, but higher incidence of non-serious adverse events.
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Affiliation(s)
- Ernest Azzopardi
- Hand Surgery Unit, Welsh Centre for Burns and Plastic Surgery, Morrison Hospital, Swansea SA6 6NL, UK
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Rozen WM, Edirisinghe Y, Crock J. Late complications of clinical clostridium histolyticum collagenase use in Dupuytren's disease. PLoS One 2012; 7:e43406. [PMID: 22912868 PMCID: PMC3422241 DOI: 10.1371/journal.pone.0043406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/23/2012] [Indexed: 12/02/2022] Open
Abstract
Introduction While Dupuytren's disease can cause disabling contractures requiring open surgery, a less-invasive option using Clostridium Histolyticum collagenase (CHC) via percutaneous injection was recently reported. A recent prospective, randomized trial demonstrated few complications during 90 days follow-up, however did not assess any longer term follow-up for these patients. Long-term outcomes in this setting have not been adequately reported, and the current manuscript aims to identify late complications from the clinical use of percutaneous CHC. Methods The current manuscript reports an extended 12-month follow-up for a cohort of twelve of patients enrolled in the original prospective, randomized trial, treated at a single institution. An analysis of complications requiring surgical intervention was undertaken. Results Two of twelve patients reported debilitating pain and triggering requiring surgical intervention. Extensive deep-tissue scarring and adhesions were identified, providing the first visual and qualitative analysis of the pathologic effects of CHC. Conclusion Late complications from CHC use can and have occurred, outside the follow-up period of the initial phase III trials. Longer term follow-up of such patients is thus essential, and further investigation and characterization of the late effects of CHC use is warranted.
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Affiliation(s)
- Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, Dandenong, Victoria, Australia.
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Current trends in the surgical management of Dupuytren's disease in Europe: an analysis of patient charts. ACTA ACUST UNITED AC 2012; 3:31-41. [PMID: 22611457 PMCID: PMC3338000 DOI: 10.1007/s12570-012-0092-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/25/2012] [Indexed: 01/25/2023]
Abstract
INTRODUCTION: Dupuytren's disease (DD) causes progressive digital flexion contracture and is more common in men of European descent. METHODS: Orthopaedic and plastic surgeons in 12 European countries (the Czech Republic, Denmark, Finland, France, Germany, Hungary, Italy, The Netherlands, Poland, Spain, Sweden and the UK) with >3 and <30 years experience reviewed the medical charts of five consecutive patients they had treated surgically for DD in 2008. Descriptive statistics are reported. RESULTS: In total, 3,357 patient charts were reviewed. Mean (standard deviation) patient age was 61.9 (10.2) years; 81% were men. At the time of the procedure, 11% of patients were at Tubiana stage Ia (0-20° total flexion); 30%, stage Ib (21-45°); 34%, stage II (46-90°); 17%, stage III (91-135°); and 5%, stage IV (>135°). Percutaneous needle fasciotomy was performed in 10%, fasciotomy in 13%, fasciectomy in 69% and dermofasciectomy (DF) in 6% of patients. After surgery, fingers improved a mean of 1.9 Tubiana stages, and 54% of patients had no nodules or contracture. The rate of reported complications during the procedure was 4% overall (11% in patients undergoing DF). The most common postoperative complications reported were haematoma (8%), wound healing complications (6%) and pain (6%). No postoperative complications were reported in 77% of patients. CONCLUSIONS: In this European study of more than 3,000 patients with DD, most patients were diagnosed at Tubiana stage I or II, the majority received fasciectomy and more than half had no nodules or contracture remaining after surgery. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12570-012-0092-z) contains supplementary material, which is available to authorized users.
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Descatha A, Bodin J, Ha C, Goubault P, Lebreton M, Chastang JF, Imbernon E, Leclerc A, Goldberg M, Roquelaure Y. Heavy manual work, exposure to vibration and Dupuytren's disease? Results of a surveillance program for musculoskeletal disorders. Occup Environ Med 2012; 69:296-9. [PMID: 22213840 DOI: 10.1136/oemed-2011-100319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION This study aimed to determine the prevalence of Dupuytren's disease in men and its relationship with work exposure, particularly heavy manual work with and without significant use of vibrating tools, using data from a surveillance program for musculoskeletal disorders. METHOD This cross-sectional study was conducted in France between 2002 and 2005. Dupuytren's disease was diagnosed clinically by one of 83 occupational physicians. Exposure in relation to work status and occupational risk factors was assessed with a self-administered questionnaire, and categorised according to vibration exposure (defined as use of vibrating tools for ≥2 h/day), heavy manual work without vibration exposure (defined as use of hand tools for ≥2 h/day (use of vibrating tools for ≥2 h/day excluded) and Borg scale ≥15/20) and no such exposure. Bivariate and multivariate associations using logistic models were recorded in men and in those with >10 years in the same job. RESULTS Of 2161 men, 1.3% (n=27) had Dupuytren's disease (mean age 47.1±6.7 years). Heavy manual work without vibration exposure was significantly associated with the condition (adjusted OR (aOR) 3.9; 95% CI 1.3 to 11.5) adjusted on age and diabetes), as was use of vibrating tools (aOR 5.1; 2.1 to 12.2). These associations remained significant among subjects with >10 years in the same job, with increases in aOR of 6.1 (1.5 to 25.0) and 10.7 (3.4 to 34.6), respectively. CONCLUSION Despite the limited number of cases, occupational exposure, including both vibration exposure and heavy manual work without significant vibration exposure, was associated with Dupuytren's disease.
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Affiliation(s)
- Alexis Descatha
- Université de Versailles St-Quentin, UMRS 1018, Centre for Research in Epidemiology and Population Health, Population-Based Epidemiological Cohorts Research Platform, Villejuif, France.
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Beaudreuil J, Lellouche H, Orcel P, Bardin T. Needle aponeurotomy in Dupuytren's disease. Joint Bone Spine 2012; 79:13-6. [DOI: 10.1016/j.jbspin.2011.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 03/08/2011] [Indexed: 11/26/2022]
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Macaulay D, Ivanova J, Birnbaum H, Sorg R, Skodny P. Direct and indirect costs associated with Dupuytren's contracture. J Med Econ 2012; 15:664-71. [PMID: 22369346 DOI: 10.3111/13696998.2012.670678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare direct (medical and drug) and indirect (work loss) costs between privately insured US employees with Dupuytren's contracture (DC) and demographically matched controls without DC. METHODS Employees aged 18-64 with ≥ 1 DC diagnosis (ICD-9-CM: 728.6, 718.44) with service dates 1/1/2000-3/31/2009 were selected from a de-identified, privately insured claims database (n∼3,000,000). The index date was defined as the most recent DC diagnosis with continuous eligibility for 6 months prior (baseline period) and 1 year after (study period) diagnosis. Employees with DC were matched 1:1 on age, region, gender, and index date to controls without DC, Peyronie's, or Ledderhose disease diagnoses in their claims histories. Descriptive analyses compared demographic characteristics, comorbidities, resource utilization, direct costs, and indirect costs inflated to 2009 dollars. RESULTS DC employees (n=1406, mean age 49 years) with matched controls met the inclusion criteria. DC employees compared with controls had significantly (all p<0.05) higher baseline comorbidities, including hyperlipidemia (21.1% vs 15.6%), hypothyroidism (3.5% vs 2.0%), cancer (3.1% vs 1.5%), and diabetes (8.1% vs 3.6%). During the study period, DC employees had significantly (all p<0.01) higher rates of inpatient stays (7.7% vs 5.3%), emergency department visits (19.8% vs 13.9%), outpatient visits (100.0% vs 78.4%), physical therapy visits (30.2% vs 7.2%), and any prescription use (85.0% vs 69.2%), as well as higher mean work loss days (14.2 vs 7.3). DC employees had on average significantly (all p<0.01) higher annual direct costs ($5974 vs $3175), indirect costs ($2737 vs $1309), and total costs ($8712 vs $4485) compared with controls during the study period. LIMITATIONS Findings did not account for lost productivity at work and were based on a privately insured, employed population, which may not be generalizable to all DC patients. CONCLUSIONS Employees with DC had substantially higher comorbidity rates, utilization, and direct and indirect costs compared with demographically matched controls.
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Beaudreuil J, Allard A, Zerkak D, Gerber RA, Cappelleri JC, Quintero N, Lasbleiz S, Bernabé B, Orcel P, Bardin T. Unité Rhumatologique des Affections de la Main (URAM) scale: development and validation of a tool to assess Dupuytren's disease-specific disability. Arthritis Care Res (Hoboken) 2011; 63:1448-55. [PMID: 21786431 DOI: 10.1002/acr.20564] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To our knowledge, no functional outcome measure has been developed and validated for Dupuytren's disease. We aimed to develop and validate a patient-reported functional outcome measure for Dupuytren's disease. METHODS Patients with Dupuytren's disease (n = 9) and medical experts (n = 7) provided input and opinions about limiting activities that were difficult to perform because of Dupuytren's disease for item generation. The provisional scale was studied in an independent sample of patients (n = 85) for item reduction according to response distribution, reliability, redundancy, and loading in a 1-factor solution. The final scale was evaluated as follows: reliability using Cronbach's alpha coefficient and test-retest intraclass correlation coefficient from the previous 85-patient population, and construct validity and responsiveness after needle aponeurotomy in another independent 53-patient sample. For construct validity, convergent validity and divergent validity were tested. The clinically important change was estimated relative to a 1-point categorical change on the Tubiana scale. RESULTS A 52-item provisional scale was generated and reduced to the final 9-item scale called the Unité Rhumatologique des Affections de la Main (URAM) scale (total score 0-45). The scale showed good to excellent reliability and suitable construct validity. The URAM score improved after needle aponeurotomy: the standardized effect size was 0.56. The estimated clinically important change of the URAM scale was 2.9 points. CONCLUSION We provide the first patient-reported functional measure for Dupuytren's disease. The URAM scale demonstrated suitable psychometric properties, and is short and convenient enough for easy use in daily practice and in clinical studies.
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Affiliation(s)
- Johann Beaudreuil
- Unité Rhumatologique des Affections de la Main (URAM), Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Université Paris 7, Paris, France.
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Affiliation(s)
- Alexis Descatha
- UVSQ AP-HP, U1018-Inserm, Population-Based Epidemiological Cohorts, Research Platform, Occupational Health Unit SAMU92, Garches, France
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Overbeek JA, Penning-van Beest FJ, Heintjes EM, Gerber RA, Cappelleri JC, Hovius SE, Herings RM. Dupuytren's contracture: a retrospective database analysis to determine hospitalizations in the Netherlands. BMC Res Notes 2011; 4:402. [PMID: 21992150 PMCID: PMC3203074 DOI: 10.1186/1756-0500-4-402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 10/12/2011] [Indexed: 11/24/2022] Open
Abstract
Background Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's contracture. In this study we determined the prevalence of patients with a hospitalization for Dupuytren's contracture in the Netherlands and characterized their (re)hospitalizations. Methods From the PHARMO database, which consists of multiple observational databases linked on a patient level, all patients hospitalized for Dupuytren's contracture between 2004 and 2007 were included in the source population (ICD-9-CM code 728.6). Numbers from this source population were used to provide estimates of hospitalizations for Dupuytren's contracture in the Netherlands. Patients with a medical history in the PHARMO database of at least 12 months before their hospitalization were included in the study cohort and followed until end of data collection, death, or end of study period, whichever occurred first. Type of admission, length of stay, recorded procedures, treating specialty, number of rehospitalizations for Dupuytren's contracture, and time to first rehospitalization were assessed. Results Of 3, 126 patients included in the source population, 3, 040 were included in the study population. The overall prevalence of patients with a hospitalization for Dupuytren's contracture was 0.04%, with the highest prevalence (0.25%) among 60-79 year old males. The majority (85%) of all hospitalizations were day-case admissions. Of the admitted inpatients (15%) the majority (81%) had one overnight stay in the hospital. The most common recorded procedure was fasciectomy (87%) and 78% of patients was treated by a plastic surgeon. During a median (IQR) follow-up of 2.9 (1.8-4.0) years, 523 patients were rehospitalized for Dupuytren's contracture. The median (IQR) time to first rehospitalization was 0.8 (0.4-1.9) years. Conclusions This study is a first exploration of Dupuytren's contracture in the Netherlands based on hospitalizations, showing a prevalence of 0.25% among 60-79 year old males. Future studies should also address outpatient procedures to get a complete picture of the treatment of Dupuytren's contracture. In addition, patients not yet treated should be included to be able to estimate the prevalence of Dupuytren's contracture.
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Khashan M, Smitham PJ, Khan WS, Goddard NJ. Dupuytren's Disease: Review of the Current Literature. Open Orthop J 2011; 5 Suppl 2:283-8. [PMID: 21886694 PMCID: PMC3149852 DOI: 10.2174/1874325001105010283] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/14/2011] [Accepted: 04/23/2011] [Indexed: 11/22/2022] Open
Abstract
Dupuytren’s disease is one of the most common condition seen by hand surgeons. It is not only prevalent but can also be a most debilitating condition resulting in significant loss of function of the fingers involved. The cause of this disease, however still remains largely unknown although some recent evidence suggests a stem cell etiology. This review article summarizes the current known knowledge of Dupuytren’s as well as the clinical findings, investigations and treatments available.
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Affiliation(s)
- Morsi Khashan
- Orthopedic Surgery Department, Tel-Aviv Soursky Medical Center, Tel-Aviv, Israel
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Jerosch-Herold C, Shepstone L, Chojnowski AJ, Larson D, Barrett E, Vaughan SP. Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial. BMC Musculoskelet Disord 2011; 12:136. [PMID: 21693044 PMCID: PMC3146906 DOI: 10.1186/1471-2474-12-136] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 06/21/2011] [Indexed: 11/21/2022] Open
Abstract
Background Dupuytren's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired hand function. Standard treatment involves surgical release or excision followed by post-operative hand therapy and splinting, however the evidence supporting night splinting is of low quality and equivocal. Methods A multi-centre, pragmatic, open, randomised controlled trial was conducted to evaluate the effect of night splinting on self-reported function, finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy. 154 patients from 5 regional hospitals were randomised after surgery to receive hand therapy only (n = 77) or hand therapy with night-splinting (n = 77). Primary outcome was self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes were finger range of motion and patient satisfaction. Primary analysis was by intention to treat. Results 148 (96%) patients completed follow-up at 12 months. No statistically significant differences were observed on the DASH questionnaire (0-100 scale: adjusted mean diff. 0.66, 95%CI - 2.79 to 4.11, p = 0.703), total extension deficit of operated digits (degrees: adjusted mean diff 5.11, 95%CI -2.33 to 12.55, p = 0.172) or patient satisfaction (0-10 numerical rating scale: adjusted mean diff -0.35, 95%CI -1.04 to 0.34, p = 0.315) at 1 year post surgery. Similarly, in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes. Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving hand therapy and only splinted if and when contractures occurred. Given the added expense of therapists' time, thermoplastic materials and the potential inconvenience to patients having to wear a device, the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur. Trial registration The trial was registered as an International Standard Randomised Controlled Trial ISRCTN57079614
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Descatha A, Jauffret P, Chastang JF, Roquelaure Y, Leclerc A. Should we consider Dupuytren's contracture as work-related? A review and meta-analysis of an old debate. BMC Musculoskelet Disord 2011; 12:96. [PMID: 21575231 PMCID: PMC3123614 DOI: 10.1186/1471-2474-12-96] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 05/16/2011] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In view of the conflicting opinions published, a meta-analysis was undertaken on epidemiological studies in order to assess any association between Dupuytren's contracture and work exposure. METHODS Using the key words: "occupational disease", "work" and "Dupuytren contracture" without limitation on language or year of publication, epidemiological studies were selected from four databases (Pub-Med, Embase, Web of science, BDSP) after two rounds (valid control group, valid work exposure). A quality assessment list was constructed and used to isolate papers with high quality methodological criteria (scores of 13 or above, HQMC). Relevant associations between manual work, vibration exposure (at work) and Dupuytren's contracture were extracted from the articles and a metarisk calculated using the generic variance approach (meta-odds ratios, meta-OR). RESULTS From 1951 to 2007, 14 epidemiological studies (including 2 cohort studies, 3 case-control studies, and 9 cross-sectional studies/population surveys) were included. Two different results could be extracted from five studies (based on different types of exposure), leading to 19 results, 12 for manual work (9 studies), and 7 for vibration exposure (5 studies). Six studies met the HQMC, yielding 9 results, 5 for manual work and 4 for vibration exposure. Five studies found a dose-response relationship. The meta-OR for manual work was 2.02[1.57;2.60] (HQMC studies only: 2.01[1.51;2.66]), and the meta-OR for vibration exposure was 2.88 [1.36;6.07] (HQMC studies only: 2.14[1.59;2.88]). CONCLUSION These results support the hypothesis of an association between high levels of work exposure (manual work and vibration exposure) and Dupuytren's contracture in certain cases.
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Affiliation(s)
- Alexis Descatha
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, Villejuif, France
- Université de Versailles St-Quentin, UMRS 1018, France
- AP-HP, Poincaré University Hospital, Occupational Health Unit, Garches, France
| | - Pénélope Jauffret
- AP-HP, Poincaré University Hospital, Occupational Health Unit, Garches, France
| | - Jean-François Chastang
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, Villejuif, France
- Université de Versailles St-Quentin, UMRS 1018, France
| | - Yves Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, Angers, France
| | - Annette Leclerc
- Inserm U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, Villejuif, France
- Université de Versailles St-Quentin, UMRS 1018, France
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Gerber RA, Perry R, Thompson R, Bainbridge C. Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England. BMC Musculoskelet Disord 2011; 12:73. [PMID: 21486483 PMCID: PMC3103491 DOI: 10.1186/1471-2474-12-73] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 04/12/2011] [Indexed: 11/30/2022] Open
Abstract
Background Dupuytren's disease is a fibro-proliferative disorder affecting ~3-5% of the UK population. Current surgical treatments for Dupuytren's contracture (DC) include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over a 5-year period; associated NHS costs were assessed for a 1-year period. Methods Hospital Episode Statistics were extracted from April 2003 to March 2008 for patients with Palmar Fascial Fibromatosis (ICD10 = M720) and DC-related procedures. Variables included demographics, OPCS, patient status and physician specialty. To estimate 2010-2011 costs, HRG4 codes and the National Schedule of Tariff 2010-11-NHS Trusts were applied to the 2007-2008 period. Results Over 5 years, 75,157 DC admissions were recorded; 64,506 were analyzed. Mean admissions per year were 12,901 and stable. Day cases increased from 42% (2003-2004) to 62% (2007-2008). The percent of patients having two or more admissions per year increased from 5.5% in 2003-2004 to 26.1% in 2007-2008. Between 2003 and 2007, 91% of procedures were Fasciectomy. Revision of Fasciectomy and Fasciotomy each accounted for ~4%; Amputation for 1%. In 2007, classification was extended to identify Digital Fasciectomy, its Revision and Dermofasciectomy. In 2007-2008, admissions were: 70% Palmar Fasciectomy, 16% Digital Fasciectomy, 1.3% Other Fasciectomy, 4.4% Revision of Palmar Fasciectomy, 1.3% Revision of Digital Fasciectomy, 3.8% Division of Palmar Fascia, 2.6% Dermofasciectomy and 1.1% Amputation. 79% of cases were overseen by trauma and orthopaedic surgeons, 19% by plastic surgeons. Mean (±SD) inpatient hospital length of stay was 1.5 (±1.4) days in 2003-2004 and 1.0 (±1.3) days in 2007-2008. Total estimated costs for 1 year (2010-2011) were £41,576,141. Per-patient costs were £2,885 (day case) and £3,534 (inpatient). Costs ranged from £2,736 (day-case Fasciectomy) to £9,210 (day-case Revision Digital). Conclusions Between 2003 and 2008, fasciectomy was the most common surgical procedure for DC in England. While procedure rates and physician specialties varied little, there was a reversal in surgical venue: inpatient operations decreased as day-case procedures increased. The change is likely due to economic trends and changes to the healthcare system. Estimated costs for 2010-2011 varied by procedure type and patient status. These findings can be used to understand clinical management of DC and guide healthcare policy.
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Affiliation(s)
- Robert A Gerber
- Clinical Development and Medical Affairs, Pfizer Global Development Headquarters, New London, CT, USA.
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Beaudreuil J, Lermusiaux JL, Teyssedou JP, Lahalle S, Lasbleiz S, Bernabé B, Lellouche H, Orcel P, Bardin T. Multi-needle aponeurotomy for advanced Dupuytren's disease: preliminary results of safety and efficacy (MNA 1 study). Joint Bone Spine 2011; 78:625-8. [PMID: 21353618 DOI: 10.1016/j.jbspin.2011.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022]
Abstract
AIM To assess the safety and efficacy of multi-needle aponeurotomy (MNA) for advanced Duputren's disease. METHODS This prospective study included patients with age more than 17 years, Dupuytren's contracture with palmo-digital or poly-digital involvement, presumed NA number needed to treat>4, and availability for at least 1-month follow-up after MNA. Outcome measures were Tubiana score and passive extension deficit, after MNA and at 1 and 6 months; self-assessed disability and satisfaction at 1 and 6 months; and adverse events (AEs). RESULTS Thirty patients were included. MNA was performed on 37 hands and 99 rays. Among 25 assessed MNA sessions for treatment-related discomfort, patients considered 22 (88%) not at all to moderately painful. Six minor AEs, representing 2 for every 100 NAs, were reported. Tubiana scores at baseline (5.3±2.3, n=35) were improved after treatment (1.7±1.8, n=32, P<0.0001), at 1 month (2.2±1.4, n=26, P<0.0001) and at 6 months (2.8±2.7, n=19, P<0.01). Passive extension deficit was greatly reduced after treatment and persisted at follow-up. Disability scores at baseline (27.6±26.9, n=37) were reduced at 1 month (13.2±19.5, n=26, P=0.02) and at 6 months (5.2±11.6, n=20, P<0.001). Patients were highly satisfied at 1 month (100%, n=25) and 6 months (95%, n=19). CONCLUSION MNA appears safe and effective for advanced Dupuytren's disease. It could become a treatment of reference and contribute to reducing the need for surgery in this indication.
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Affiliation(s)
- Johann Beaudreuil
- Unité rhumatologique des affections de la main, service de rhumatologie, Université Paris-7, Paris, France.
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Pervulesko N, Schöffl V, Gormasz C. Evaluation of a self-diagnostic tool for Dupuytren's disease in rock climbers. HAND THERAPY 2011. [DOI: 10.1258/ht.2010.010027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To determine the validity of a self-diagnostic questionnaire for Dupuytren's disease among rock climbers. Methods A simple, self-diagnostic questionnaire for Dupuytren's disease was freely distributed to climbers in Austria and Germany. None of the subjects were medically prescreened. The questionnaire consisted of four questions with pictures concerning their present diagnosis and the differential diagnosis for Dupuytren's disease. Medical experts then clinically examined those climbers who completed the questionnaire for Dupuytren's disease. Results Sixty-one climbers (46 men, 15 women; mean age 32 [13] years; climbing for 10 [11] years) participated in the survey; 16 participants were competition climbers. Clinical diagnosis of Dupuytren's disease was confirmed in five cases (8.2%). The questionnaire produced no false-negatives, but there were three (4.8%) false-positive results in this sample. The correlation between the self-diagnostic tool and the clinical examination was r = 0.62 ( P = 0.005). No significant difference ( P = 0.250) was found between the self-diagnostic tool and the clinical examination. The sensitivity of the self-diagnostic tool in a sample of rock climbers was 100%, and its specificity 94.9%. Conclusions The questionnaire is an accurate and precise self-diagnostic tool for rock climbers to determine the diagnosis of Dupuytren's disease.
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Affiliation(s)
- Nora Pervulesko
- Centre of Sport Sciences and University Sports, Department of Preventative and Rehabilitative Sports Medicine and Trainings Science, University of Vienna, Vienna, Austria
| | - Volker Schöffl
- Department of Sportorthopedics, Orthopedics and Traumasurgery, Klinikum Bamberg, Bamberg, Germany
- Medical Commission of UIAA (International Mountaineering and Climbing Federation), Bern, Switzerland
| | - Christian Gormasz
- Centre of Sport Sciences and University Sports, Department of Preventative and Rehabilitative Sports Medicine and Trainings Science, University of Vienna, Vienna, Austria
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Keating RM. Dupuytren's Contracture. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Thomas A, Bayat A. The emerging role of Clostridium histolyticum collagenase in the treatment of Dupuytren disease. Ther Clin Risk Manag 2010; 6:557-72. [PMID: 21127696 PMCID: PMC2988615 DOI: 10.2147/tcrm.s8591] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dupuytren disease (DD) is a common fibroproliferative disease of unknown etiopathogenesis affecting the palmar aponeurosis, causing reduced hand function and resulting in fixed flexion contractures of the digits. Current gold standard treatment for the management of DD is surgical excision involving removal of the affected palmar fascial tissue. However, there are potential complications associated with surgery as it is costly and a positive surgical outcome is often short-lived because the disease tends to recur. Therefore, there is growing interest in nonsurgical, outpatient-based treatments that could be quicker, cheaper, reduce morbidity, show a decreased rate of recurrence, and give DD patients an improved quality of life when compared with traditional surgical management. Of the available nonsurgical options, injectable Clostridium histolyticum collagenase (CHC) has received recent clinical interest. In this article, a brief overview of DD surgical and nonsurgical treatments utilized is given, followed by a detailed examination of the nine papers published to date on the use of CHC in DD (and similar fibrotic disorders). These papers have investigated safe and efficacious doses for the injection of CHC to treat palpable DD cords in adult patients and have shown significant short- to mid-term results for correction to near-full digital extension (≤5° extension) following CHC injection of DD cords. CHC has been shown to target the collagen-based DD cords while sparing surrounding neurovasculature, with a complication profile that appears comparable to that of the surgical methods currently utilized. In conclusion, clostridial collagenase is a novel nonsurgical treatment option of considerable potential in the management of DD when administered by specialist hand surgeons with detailed knowledge of the disease and the relevant anatomy. Nonetheless, there is a need for further data on long-term results, complications, and rate of recurrence with the use of this emerging treatment option.
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Affiliation(s)
- Alexis Thomas
- Plastic and Reconstructive Surgery Research, School of Translational Medicine, University of Manchester, Manchester Interdisciplinary Biocentre, Manchester, UK
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Betz N, Ott OJ, Adamietz B, Sauer R, Fietkau R, Keilholz L. Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years. Strahlenther Onkol 2010; 186:82-90. [PMID: 20127225 DOI: 10.1007/s00066-010-2063-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 10/26/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. PATIENTS AND METHODS Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response. RESULTS According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy. CONCLUSION After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a "salvage" operation is still feasible.
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Affiliation(s)
- Nicolas Betz
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Oliver J Ott
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany. .,Strahlenklinik, Universitätsklinikum Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany.
| | - Boris Adamietz
- Radiologic Institute, University Hospital Erlangen, Erlangen, Germany
| | - Rolf Sauer
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Ludwig Keilholz
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.,Department of Radiotherapy, Klinikum Bayreuth GmbH, Erlangen, Germany
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Denkler K. Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature. EPLASTY 2010; 10:e15. [PMID: 20204055 PMCID: PMC2828055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Excisional surgery is the mainstay of treatment of Dupuytren's disease. Although outcomes are generally good, complications are common. The objective of this study was to evaluate intraoperative and postoperative complications associated with fasciectomy for Dupuytren's disease. METHODS A literature search was conducted to identify published, original research that reported surgical complications associated with fasciectomy from 1988 to 2008. Search results were manually evaluated for relevance. Complication rates according to types of disease (primary or recurrent disease) and according to time (intraoperative vs postoperative) and type were collated. RESULTS A total of 143 articles were identified; 41 met inclusion criteria, and of these, 28 reported overall surgical complication rates ranging from 3.6% to 39.1%. Major complications occurred in 15.7%, including digital nerve injury 3.4%, digital artery injury 2%, infection 2.4%, hematoma 2.1%, and complex regional pain syndrome 5.5%. Other common, more minor injuries included flare reaction in 9.9%, wound healing complications in 22.9%, and a range of other complications. In the few (n = 3) studies in which primary and recurrent diseases were directly compared, digital nerve injuries and digital artery injuries were approximately 10 times more common in patients with recurrent disease (20%) than those with primary disease (approximately 2%), though the numbers are too small for statistical significance. CONCLUSIONS A review of published reports by surgeons shows that surgical fasciectomy for Dupuytren's disease has a high number of complications. Surgeons should be mindful of the potential for intraoperative and postoperative complications and counsel their patients accordingly.
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Affiliation(s)
- Keith Denkler
- UCSF Divison of Plastic Surgery, 275 Magnolia Ave, Larkspur, CA 94939, USA.
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Herweijer H, Dijkstra PU, Nicolai JPA, Van der Sluis CK. Postoperative hand therapy in Dupuytren's disease. Disabil Rehabil 2009; 29:1736-41. [PMID: 17852228 DOI: 10.1080/09638280601125106] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common medical practice to improve outcomes. Until now, patients are referred for postoperative hand rehabilitation on an empirical basis. PURPOSE To evaluate whether referral criteria after surgery because of Dupuytren's disease were actually adhered to, and, to analyse differences in outcomes between patients who were referred according to the criteria (correctly referred) and those who were not referred but should have been (incorrectly not referred). METHODS Referral pattern was evaluated prospectively in 46 patients. Total active/passive range of joint motion (TAM/ TPM), sensibility, pinch force, Disability Arm Shoulder Hand questionnaire (DASH) and Michigan Hand outcomes Questionnaire (MHQ) were used as outcome measures preoperatively and 10 months postoperatively. RESULTS In total 21 patients were referred correctly and 17 patients were incorrectly not referred. Significant improvements on TAM/TPM, DASH and MHQ were found at follow-up for the total group. No differences in outcomes were found between patients correctly referred and patients incorrectly not referred for postoperative hand therapy. CONCLUSION Referral criteria were not adhered to. Given the lack of differences in outcomes between patients correctly referred and patients incorrectly not referred, postoperative hand therapy in Dupuytren's disease should be reconsidered.
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Affiliation(s)
- Hester Herweijer
- Centre for Rehabilitation, University Medical Centre Groningen, The Netherlands
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84
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Abstract
Although fasciae have long interested clinicians in a multitude of different clinical and paramedical disciplines, there have been few attempts to unite the ensuing diverse literature into a single review. The current article gives an anatomical perspective that extends from the gross to the molecular level. For expediency, it deals only with fascia in the limbs and back. Particular focus is directed towards deep fascia and thus consideration is given to structures such as the fascia lata, thoracolumbar fascia, plantar and palmar fascia, along with regional specializations of deep fascia such as retinacula and fibrous pulleys. However, equal emphasis is placed on general aspects of fascial structure and function, including its innervation and cellular composition. Among the many functions of fascia considered in detail are its ectoskeletal role (as a soft tissue skeleton for muscle attachments), its importance for creating osteofascial compartments for muscles, encouraging venous return in the lower limb, dissipating stress concentration at entheses and acting as a protective sheet for underlying structures. Emphasis is placed on recognizing the continuity of fascia between regions and appreciating its key role in coordinating muscular activity and acting as a body-wide proprioceptive organ. Such considerations far outweigh the significance of viewing fascia in a regional context alone.
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Affiliation(s)
- Mike Benjamin
- School of Biosciences, Cardiff University, Cardiff, UK.
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Affiliation(s)
- Anna L Pratt
- Authors: Anna L Pratt, Lecturer in Occupational Therapy, School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex, UK; Geraldine Byrne, PhD, PGCE, RNT, BA(Hons), RN, Research Lead, School of Nursing and Midwifery, University of Hertfordshire, Hertfordshire, UK
| | - Geraldine Byrne
- Authors: Anna L Pratt, Lecturer in Occupational Therapy, School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex, UK; Geraldine Byrne, PhD, PGCE, RNT, BA(Hons), RN, Research Lead, School of Nursing and Midwifery, University of Hertfordshire, Hertfordshire, UK
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Evaluation of activity limitation and digital extension in Dupuytren's contracture three months after fasciectomy and hand therapy interventions. J Hand Ther 2009; 22:21-6; quiz 27. [PMID: 18986794 DOI: 10.1016/j.jht.2008.08.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 08/07/2008] [Accepted: 08/15/2008] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Longitudinal Case Series. INTRODUCTION Dupytren's contracture is thought to result in digital impairments and performance disabilities. No study to date has focused on how patients with Dupuytren's contracture experience limitations in daily activities and the results after surgery. PURPOSE OF THE STUDY Describe which activities patients with Dupuytren's contracture defined as the most disabling, how they rated their activity limitations and determine the relationship between activity limitations and digital extension before and three months after surgery and postoperative hand therapy. METHODS Self-reported rating of activity limitations, performance, and measures of total digital extension. RESULTS The most disabling activities were with self-care (42%), though overall performance was significantly improved following surgery and postoperative hand therapy. The total digital extension was significantly improved 81 degrees and was positively related to performance. CONCLUSIONS The results provide new information about activities that patients with Dupuytren's contracture experience as being difficult to perform and describes positive changes in performance and range of motion. LEVEL OF EVIDENCE 4.
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Larson D, Jerosch-Herold C. Clinical effectiveness of post-operative splinting after surgical release of Dupuytren's contracture: a systematic review. BMC Musculoskelet Disord 2008; 9:104. [PMID: 18644117 PMCID: PMC2518149 DOI: 10.1186/1471-2474-9-104] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 07/21/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Splinting after contracture release for Dupuytren's disease of the hand is widely advocated. The purpose of this systematic review was to evaluate the quantity and quality of evidence regarding the effectiveness of splinting in the post-surgical management of Dupuytren's contractures. METHODS Studies were identified by searching the electronic databases Medline, AMED, CINAHL and EMBASE. Studies were included if they met the following inclusion criteria: prospective or retrospective, experimental, quasi-experimental or observational studies investigating the effectiveness of static or dynamic splints worn day and/or night-time for at least 6 weeks after surgery and reporting either individual joint or composite finger range of motion and/or hand function. The methodological quality of the selected articles was independently assessed by the two authors using the guidelines for evaluating the quality of intervention studies developed by McDermid. RESULTS Four studies, with sample sizes ranging from 23 to 268, met the inclusion criteria for the systematic review. Designs included retrospective case review, prospective observational and one controlled trial without randomisation. Interventions included dynamic and static splinting with a mean follow-up ranging from 9 weeks to 2 years. Pooling of results was not possible due to the heterogeneity of interventions (splint type, duration and wearing regimen) and the way outcomes were reported. CONCLUSION There is empirical evidence to support the use of low load prolonged stretch through splinting after hand surgery and trauma, however only a few studies have investigated this specifically in Dupuytren's contracture. The low level evidence regarding the effect of post-operative static and dynamic splints on final extension deficit in severe PIP joint contracture (>40 degrees ) is equivocal, as is the effect of patient adherence on outcome. Whilst total active extension deficit improved in some patients wearing a splint there were also deficits in composite finger flexion and hand function. The lack of data on the magnitude of this effect makes it difficult to interpret whether this is of clinical significance. There is a need for well designed controlled trials with proper randomisation to evaluate the short-term and long-term effectiveness of splinting following Dupuytren's surgery.
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Affiliation(s)
- Debbie Larson
- Department of Occupational Therapy, Norfolk and Norwich University Hospital, NHS Foundation Trust, Norwich, UK
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Jerosch-Herold C, Shepstone L, Chojnowski AJ, Larson D. Splinting after contracture release for Dupuytren's contracture (SCoRD): protocol of a pragmatic, multi-centre, randomized controlled trial. BMC Musculoskelet Disord 2008; 9:62. [PMID: 18447898 PMCID: PMC2386788 DOI: 10.1186/1471-2474-9-62] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 04/30/2008] [Indexed: 11/10/2022] Open
Abstract
Background Splinting as part of the overall post-surgical management of patients after release of Dupuytren's contracture has been widely reported, though there is variation in practice and criteria for using it. The evidence on its effectiveness is sparse, of poor quality and contradictory with studies reporting negative and positive effects. Methods/Design A multi-centre, pragmatic, randomized, controlled trial is being conducted to evaluate the effect of static night splinting for six months on hand function, range of movement, patient satisfaction and recurrence at 1 year after fasciectomy or dermofasciectomy. Using a centrally administered computer randomization system consented patients will be allocated to one of two groups: i) splint group who will be given a static splint at approximately 10 to 14 days after surgery to be worn for 6 months at night time only as well as hand therapy; ii) non-splint group, who will receive hand therapy only. The primary outcome measure is the patient-reported Disabilities of the Arm, Hand and Shoulder Questionnaire (DASH). Secondary outcomes are total active flexion and extension of fingers, patient satisfaction and recurrence of contracture. Outcome measures will be collected prior to surgery, 3 months, 6 months and 1 year after surgery. Using the DASH as the primary outcome measure, where a difference of 15 points is considered to be a clinically important difference a total of 51 patients will be needed in each group for a power of 90%. An intention-to-treat analysis will be used. Discussion This pragmatic randomized controlled trial will provide much needed evidence on the clinical effectiveness of post-operative night splinting in patients who have undergone fasciectomy or dermofasciectomy for Dupuytren's contracture of the hand. Trial Registration Current Controlled Trials ISRCTN 57079614
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Lucas G, Brichet A, Roquelaure Y, Leclerc A, Descatha A. Dupuytren's disease: personal factors and occupational exposure. Am J Ind Med 2008; 51:9-15. [PMID: 18033693 DOI: 10.1002/ajim.20542] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The etiology of Dupuytren's disease is unknown, and the role of occupational exposure is still debated. Our objective was to study the association between occupational exposures, personal risk factors and Dupuytren's disease. METHODS In this cross-sectional survey, nine occupational physicians performed clinical examinations, focused on Dupuytren's disease, of 2,406 French male civil servants employed at the Equipment Ministry in 1998 and interviewed them about medical history, leisure manual exposure and occupational biomechanical exposure to vibrations and manual work. A cumulative occupational exposure score was defined, with three levels of exposure. RESULTS Dupuytren's disease was diagnosed in 212 men (8.8%). The occupational exposure score was significantly higher in this group of cases than in the rest of the sample (377 (SD280) vs. 223 (SD250), respectively; P < 0.0001). Occupational exposure was associated with Dupuytren's disease (adjusted Odds Ratio = 2.20 [1.39-3.45] for the intermediate and 3.10 [1.99-4.84] for the high exposure groups), with adjustment for age, leisure physical activities, alcohol consumption (> or =5 servings per day), history of diabetes, epilepsy, hand trauma, and familial history of Dupuytren's disease. CONCLUSION Manual work exposure was associated with Dupuytren's disease after adjustment for personal risk factors. Longitudinal studies are needed to confirm these results.
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Badalamente MA, Hurst LC. Efficacy and safety of injectable mixed collagenase subtypes in the treatment of Dupuytren's contracture. J Hand Surg Am 2007; 32:767-74. [PMID: 17606053 DOI: 10.1016/j.jhsa.2007.04.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 04/03/2007] [Accepted: 04/04/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE To further evaluate the efficacy and safety of an injectable mixed subtype collagenase for the treatment of Dupuytren's contracture (DC). METHODS Patients with flexion deformities of the metacarpophalangeal (MCP) and/or the proximal interphalangeal (PIP) joints of 20 degrees or greater were randomized in a double-blind, placebo-controlled trial. Patients completing this phase could enter an open-label extension phase. The primary efficacy variable was clinical success: contracture correction to within 5 degrees of normal (normal, 0 degrees ). Additional efficacy variables included the time and number of injections required to achieve success in the primary joint. Recurrence of contracture to 20 degrees or greater in successfully treated joints and adverse events (AEs) were recorded. RESULTS Thirty-three of 35 patients (mean +/- SD, 61 +/- 9 y) entering the double-blind phase completed the study; 19 of them entered the open-label extension. In the double-blind phase, clinical success of the primary joint was achieved in 16 of 23 patients receiving 1 injection and in 21 of 23 patients receiving 3 injections. No placebo-treated patients achieved joint correction. In the open-label extension, 17 of 19 patients achieved clinical success in at least 1 joint. The mean number of injections for clinical success in the double-blind and extension phases was 1.5 and 1.4, respectively; the time to clinical success ranged between 1 and 29 days. Overall, of 62 joints (31 MCP, 31 PIP) treated in 35 patients, 54 joints achieved clinical success. Over the 24-month follow-up period after the last injection, 5 joints had a recurrence. The most frequent treatment-related AEs were local reactions to injections. AEs were mild and resolved over several weeks. There were no serious treatment-related AEs. CONCLUSIONS The collagenase injections safely and effectively corrected MCP and PIP contractures in patients with 1 or more DC-affected joints. Recurrence rates after treatment appear to be low. Data suggest that this collagenase appears to be a viable nonsurgical treatment option for DC.
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Affiliation(s)
- Marie A Badalamente
- Department of Orthopedics, State University of New York at Stony Brook, Health Science Center, Stony Brook, NY 11794-8181, USA.
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Bird B, Ball C, Balasuntharam P. Rehabilitation after surgery for Dupuytren's Contracture. Hippokratia 2007. [DOI: 10.1002/14651858.cd006508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Beverlee Bird
- School of Health Sciences and Social Care; Osterley Campus, Borough Road Isleworth, Middlesex UK TW7 5DU
| | - Cathy Ball
- Imperial College London; Kennedy Institute of Rheumatology; 1 Aspenlea Road London UK W6 8LF
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