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Nichlos E, Wölfle O, Marzi I, Frank J, Sommer K. [Medium-term Results after percutaneous Needle Fasciotomy in Dupuytren's Disease]. HANDCHIR MIKROCHIR P 2023; 55:330-335. [PMID: 37429329 PMCID: PMC10513775 DOI: 10.1055/a-2055-1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 11/19/2022] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Dupuytren's disease often leads to an increasing limitation in finger extension in affected patients. As the incidence rises with age, the number of cases is expected to rise in the future due to the demographic change. Therefore, an easy and patient-oriented treatment is required. In the following study, we investigated the short and medium-term results after percutaneous needle fasciotomy (PNF). PATIENTS AND METHODS Overall, 65 fingers of 40 patients were treated with PNF. We evaluated the total passive deficit of extension (TPED), the passive deficit of extension of the joints (PED), the Buck-Gramcko score, rate of recurrence, DASH score and patient satisfaction. The average age of the patients was 65,9 years. Most of the patients (82%) were male. RESULTS Directly after the PNF, extension in the treated fingers improved significantly (TPED before PNF 74,6°±41,1 SD to 32,8°±29,0 SD after the procedure). By the time of the follow-up examination (30,2±13,9 SD months), TPED had increased again (52,7°±40,2 SD). The rate of recurrence was 29,7%, and a higher Tubiana stage before the procedure correlated significantly with a higher recurrence rate. Nevertheless, patients demonstrated a very high level of satisfaction with the procedure and almost all patients would choose to undergo PNF again. CONCLUSION Although it is associated with a relatively high recurrence rate, PNF represents an effective and patient-oriented treatment of Dupuytren's contracture.
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Affiliation(s)
- Emmanouil Nichlos
- Klinik für Plastische, Hand und Rekonstruktive Chirurgie,
Varisano Krankenhaus, Bad Soden, Bad Soden, Germany
| | - Olaf Wölfle
- Klinik für Plastische, Hand und Rekonstruktive Chirurgie,
Varisano Krankenhaus, Bad Soden, Bad Soden, Germany
| | - Ingo Marzi
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie,
Universitätsklinikum Frankfurt am Main, Frankfurt am Main,
Germany
| | - Johannes Frank
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie,
Universitätsklinikum Frankfurt am Main, Frankfurt am Main,
Germany
| | - Katharina Sommer
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie,
Universitätsklinikum Frankfurt am Main, Frankfurt am Main,
Germany
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Alencar FHUD, Perini JA, Monteiro AV, Duarte MEL, Motta GDR, Guimarães JAM. Epidemiology of Dupuytren disease and Patients Undergoing Selective Fasciectomy. Rev Bras Ortop 2021; 56:478-484. [PMID: 34483392 PMCID: PMC8405273 DOI: 10.1055/s-0040-1721839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022] Open
Abstract
Objective
To describe the epidemiological and clinical profile of patients with Dupuytren disease treated by selective fasciectomy and the factors associated with the severity of the disease.
Methods
Retrospective descriptive observational study involving 247 patients with Dupuytren disease, from 2013 to 2019. Multivariate logistic regression was performed for data analysis.
Results
Most patients were male (83.8%), self-declared white (65.2%), alcoholics (59.6%) and 49% were smokers, with a mean age of 66 ± 9 years old, with 77.2% presenting symptoms of the disease after the age of 51 years old. Approximately 51.9, 29.6 and 17.3%, respectively, had arterial hypertension, diabetes mellitus and dyslipidemia comorbidities. Bilateral involvement of the hands was observed in 73.3% of the patients. The rate of intra- and post-selective fasciectomy complications was of 0.6 and 24.3%, respectively, with 5.2% of the patients needing reintervention after 1 year of follow-up. After multivariate analysis, males were associated with bilateral involvement of the hands (odds ratio [OR] = 2.10; 95% confidence interval [CI]: 1.03–4.31) and with a greater number of affected rays (OR = 3.41; 95% CI: 1.66–7.03). Dyslipidemia was associated with reintervention (OR = 5.7; 95% CI = 1.03–31.4) and bilaterality with a higher number of complications (35.7 versus 19.7%).
Conclusion
A low rate of reintervention and operative complications was observed in patients with Dupuytren disease treated by selective fasciectomy. Male gender was associated with severe disease (bilaterality and more than two affected rays), and dyslipidemia with reintervention.
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Affiliation(s)
| | - Jamila Alessandra Perini
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil.,Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brasil
| | - Anderson Vieira Monteiro
- Centro de Cirurgia da Mão, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | - Geraldo da Rocha Motta
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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Rohit A, Peter A, Paul A, Anja B, Christian D, Renate D, Stefan G, Dietmar H, Johannes J, Peter K, Marco K, Martin L, Maximilian N, Christoph P, Gernot S, Gerald S, Tobias S, Matthias W, Armin Z, Markus G. Prospective observation of Clostridium histolyticum collagenase for the treatment of Dupuytren's disease in 788 patients: the Austrian register. Arch Orthop Trauma Surg 2019; 139:1315-1321. [PMID: 31317303 PMCID: PMC6689902 DOI: 10.1007/s00402-019-03226-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Since March 2011, the microbial collagenase of Clostridium histolyticum (Xiapex®, Swedish Orphan Biovitrum AB, Stockholm, Sweden) has become available in the European Union for treatment of Dupuytren's disease. The purpose of this study was to evaluate potential safety risks of Xiapex® and to contribute to a better understanding for its use. METHODS A prospective, non-interventional, observational study using Xiapex® for Dupuytren's disease named XIANIS was conducted between 1.10.2011 and 01.10.2017. Treatment was conducted in accordance to the manufacturer information. Patients were invited for follow-up after 1 week, 1 month, 3 months and 1 year. Demographic data, treatment data, pain levels, anaesthetic application during passive manipulation, subjective function improvement, subjective satisfaction and adverse events were recorded. RESULTS 788 patients with 814 treatments were included who suffered from Dupuytren's contracture for a mean of 64 months. The metacarpophalangeal joint was affected in 57% of cases and the PIP joint in 40.8% with a mean contracture of 39° and 56°, respectively. A change in the contracture down to 0°-5° was reported in 66.5% of cases, while 25.5% achieved a partial improvement. The pain during the injection was rated 4.5 and 3.3 during passive manipulation. Adverse events were reported in the majority of treated patients with skin tears being one main common event (26%). Further adverse outcomes were bleeding/hematoma, joint swelling, injection-site swelling, pressure sensitivity, erythema, injection-site pain, peripheral edema, blood blisters, blisters, painless lymphadenopathy, painful lymphadenopathy, axillary pain, arthralgia and sensory abnormality. There were no reported tendon ruptures, anaphylactic reactions or ligament injuries. On 1-year follow-up, 29% showed an increased contracture of a mean of 24° with the need for surgical treatment in 2% of patients. 74% of patients were very satisfied and 72% showed a high functional improvement. CONCLUSION The injectable collagenase Clostridium histolyticum (Xiapex®) proved to be effective and safe in patients with Dupuytren's disease. Minor adverse events disappeared within 30 days and the need for surgical treatment within 1 year was very low (2%). No major complications or rare side effects were seen in this prospective observational study.
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Affiliation(s)
- Arora Rohit
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Angermann Peter
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | | | - Binter Anja
- 0000 0000 9124 9231grid.415431.6Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Deml Christian
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria ,Sanatorium Kettenbrücke, Innsbruck, Austria
| | | | | | | | | | - Kaiser Peter
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Keller Marco
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria ,Kantonspital Baselland, Basel, Switzerland
| | | | - Neuwirth Maximilian
- 0000 0000 9124 9231grid.415431.6Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Pezzei Christoph
- 0000 0001 0723 5126grid.420022.6Lorenz Böhler Unfallkrankenhaus, AUVA, Wien, Austria
| | - Schmidle Gernot
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | | | | | | | | | - Gabl Markus
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Range of motion, postoperative rehabilitation and patient satisfaction in MCP and PIP joints affected by Dupuytren Tubiana stage 1-3: collagenase enzymatic fasciotomy or limited fasciectomy? A clinical study in 52 patients. Arch Orthop Trauma Surg 2018; 138:1623-1631. [PMID: 30259125 DOI: 10.1007/s00402-018-3034-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In Switzerland, collagenase Clostridium histolyticum therapy (CCH) for Dupuytren's disease was introduced in 2011. This study analyzes possible differences between CCH and limited fasciectomy (LF) in terms of range of motion, patient satisfaction and postoperative rehabilitation. MATERIALS AND METHODS This retrospective study included 52 patients with Dupuytren's disease stage 1-3 according to Tubiana, treated with CCH or LF between January 2012 and December 2013. Complications were analyzed for each patient. The contracture of each treated joint measured on average at the 3 months and up to 2 years follow-up was compared with the preoperative values. The Michigan Hand score was evaluated at 2 years and the patients were asked to subjectively evaluate the outcome of the treatment and whether they would repeat it if necessary. Postoperative rehabilitation was also precisely quantified. RESULTS 11 minor complications were reported for a complication rate of 29% in the CCH group. No major complications were reported in both groups. In the CCH group, mean MCP joint contracture was, respectively, 44° ± 20°, 9° ± 2° (gain of mobility compared to the preoperative situation 35°, P < 0.001), and 10° ± 3° (gain 34°, P < 0.001), respectively, before, at the 3 months' control and at the 2-year clinical control. In the LF group, mean MCP joint contracture was, respectively, 30° ± 21°, 2° ± 0.5° (gain 28°, P < 0.001), and 1° ± 0.5° (gain 29°, P < 0.001) for the same control periods. In the CCH group, mean PIP joint contracture was, respectively, 51° ± 21°, 18° ± 3° (gain of mobility compared to the preoperative situation 33°, P < 0.001), and 32° ± 4° (gain 19°, P < 0.001), respectively, before, at the 3 months' control and at the 2-year clinical control. In the LF group, mean PIP joint contracture was, respectively, 30° ± 20°, 2° ± 0.5° (gain of mobility compared to the preoperative situation 28°, P < 0.001), and 11° ± 4° (gain 19°, P < 0.001) for the same control periods. Outcomes were compared across the LF and CCH groups: surgery performed better than collagenase for PIP joint treatment at early (P < 0.001) and 2-year follow-up (P = 0.004) controls. However, patient satisfaction was higher in the CCH group: 92% were satisfied or very satisfied of the treatment compared to 71% in the LF group. All patients would reiterate the treatment in the CCH group if necessary compared to only 71% in the LF group. Rehabilitation was highly reduced in the CCH group compared to the LF group. CONCLUSION In this study, surgery performed better than collagenase at early and 2-year follow-up in PIP joints and similar in MCP joints. While surgery seems to achieve better results, collagenase is considered in Switzerland as an off-the-shelf therapy that provides consistent results without scars, with shorter rehabilitation time, minor hand therapy, shorter splinting time, and applicability. LEVEL OF EVIDENCE AND STUDY TYPE Level III.
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