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Hozack BA, Rayan GM. Surgical Treatment for Recurrent Dupuytren Disease. Hand (N Y) 2023; 18:641-647. [PMID: 34963318 PMCID: PMC10233643 DOI: 10.1177/15589447211060447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Revision procedures for recurrent Dupuytren disease (DD) can be difficult and carry a high risk of complications. Our goal was to describe surgical strategies used for cases of recurrence and report on their outcomes. METHODS We reviewed 1 surgeon's operative cases for recurrent DD performed at 1 institution. Prior procedures included collagenase injection, percutaneous needle fasciotomy, or open surgical fasciectomy in the same digit or area of the hand. RESULTS From January 1981 to December 2020, 54 procedures were performed on 33 patients for recurrent DD. Most patients were men (82%), had bilateral involvement (64%) and family history (52%), and some had ectopic disease in their feet (24%). The small finger was involved in 76% of the cases, and the proximal interphalangeal (PIP) joint was involved in 83% of these digits. The procedures included 38 partial fasciectomies (72%), 12 dermofasciectomies (23%), 3 radical fasciectomies (6%), 1 of each needle fasciotomy, ray amputation, and PIP joint arthrodesis (2%). Twenty-three patients (43%) required full thickness skin grafts with an average area of 7.1 cm2 (range: 1-20 cm2). CONCLUSIONS This study highlights the complexity of recurrent DD case management and found the treatment required for 95% of patients in this series was open partial fasciectomy with or without demofasciectomy. Full thickness skin grafting was necessary in nearly half of the cases.
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Abstract
AIMS With novel promising therapies potentially limiting progression of Dupuytren's disease (DD), better patient stratification is needed. We aimed to quantify DD development and progression after seven years in a population-based cohort, and to identify factors predictive of disease development or progression. METHODS All surviving participants from our previous prevalence study were invited to participate in the current prospective cohort study. Participants were examined for presence of DD and Iselin's classification was applied. They were asked to complete comprehensive questionnaires. Disease progression was defined as advancement to a further Iselin stage or surgery. Potential predictive factors were assessed using multivariable regression analyses. Of 763 participants in our original study, 398 were available for further investigation seven years later. RESULTS We identified 143/398 (35.9%) participants with DD, of whom 56 (39.2%) were newly diagnosed. Overall, 20/93 (21.5%) previously affected participants had disease progression, while 6/93 (6.5%) patients showed disease regression. Disease progression occurred more often in patients who initially had advanced disease. Multivariable regression analyses revealed that both ectopic lesions and a positive family history of DD are independent predictors of disease progression. Previous hand injury predicts development of DD. CONCLUSION Disease progression occurred in 21.5% of DD patients in our study. The higher the initial disease stage, the greater the proportion of participants who had disease progression at follow-up. Both ectopic lesions and a positive family history of DD predict disease progression. These patient-specific factors may be used to identify patients who might benefit from treatment that prevents progression. Cite this article: Bone Joint J 2021;103-B(4):704-710.
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Affiliation(s)
- Bente A van den Berge
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Dieuwke C Broekstra
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, the Netherlands
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Samulėnas G, Rimdeika R, Braziulis K, Fomkinas M, Paškevičius R. Dupuytren's Contracture: Incidence of Injury-Induced Cases and Specific Clinical Expression. ACTA ACUST UNITED AC 2020; 56:medicina56070323. [PMID: 32629785 PMCID: PMC7404801 DOI: 10.3390/medicina56070323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
Background and objectives: Dupuytren’s contracture is a chronic fibroproliferative hand disorder with a varying pattern of genetic predisposition across different regions and populations. Traumatic events have been found to have influence on the development of this illness and are likely to trigger different clinical forms of this disease. The aim of this study was to evaluate the phenomenon of development of Dupuytren’s contracture (DC) following an acute injury to the hand, and to observe the incidence and clinical diversity of such cases in daily clinical practice. Materials and Methods: We collected data of patients presenting with primary Dupuytren’s contracture in the Lithuanian population and evaluated the occurrence and clinical manifestation of this specific type of DC, arising following acute hand trauma. The diagnosis of DC was based on clinical signs and physical examination. Digit contractures were measured by goniometry, and the staging was done according to Tubiana classification. Injury-induced (injury-related) cases were identified using the “Criteria for recognition of Dupuytren’s contracture after acute injury” (established by Elliot and Ragoowansi). Results: 29 (22%) of a total of 132 cases were injury-induced DCs. Twenty-six of 29 patients in this group presented with stage I–II contractures. Duration of symptoms was 6 (SD 2.2) and 3.8 (SD 2.2) years in the injury-related and injury-unrelated DC groups, respectively. Mean age on the onset of symptoms in the injury-induced and non-injury-induced groups was 52 (SD 10.7) and 56 (SD 10.9), respectively. Patients from both groups expressed strong predisposition towards development of DC. Conclusions: Around one-fifth of patients seeking treatment for primary Dupuytren’s contracture seemed to suffer from injury-induced Dupuytren’s contracture. We noted that injury to the wrist and hand seems to trigger the development of less progressive Dupuytren’s contracture in younger age. Prospective randomized studies are required to confirm our findings.
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Affiliation(s)
- Gediminas Samulėnas
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
- Correspondence: (G.S.); (R.R.)
| | - Rytis Rimdeika
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
- Correspondence: (G.S.); (R.R.)
| | - Kęstutis Braziulis
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
| | - Mantas Fomkinas
- Faculty of Medicine, Lithuanian University of Health Sciences, Eivenių str. 2, LT 50009 Kaunas, Lithuania; (M.F.); (R.P.)
| | - Rokas Paškevičius
- Faculty of Medicine, Lithuanian University of Health Sciences, Eivenių str. 2, LT 50009 Kaunas, Lithuania; (M.F.); (R.P.)
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Rodrigues JN, Becker GW, Ball C, Zhang W, Giele H, Hobby J, Pratt AL, Davis T. Surgery for Dupuytren's contracture of the fingers. Cochrane Database Syst Rev 2015; 2015:CD010143. [PMID: 26648251 PMCID: PMC6464957 DOI: 10.1002/14651858.cd010143.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dupuytren's disease is a benign fibroproliferative disorder that causes the fingers to be drawn into the palm via formation of new tissue under the glabrous skin of the hand. This disorder causes functional limitations, but it can be treated through a variety of surgical techniques. As a chronic condition, it tends to recur. OBJECTIVES To assess the benefits and harms of different surgical procedures for treatment of Dupuytren's contracture of the index, middle, ring and little fingers. SEARCH METHODS We initially searched the following databases on 17 September 2012, then re-searched them on 10 March 2014 and on 20 May 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, the British Nursing Index and Archive (BNI), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Latin American Caribbean Health Sciences Literature (LILACS), Ovid MEDLINE, Ovid MEDLINE-In-Process and Other Non-Indexed Citations, ProQuest (ABI/INFORM Global and Dissertations & Theses), the Institute for Scientific Information (ISI) Web of Science and clinicaltrials.gov. We reviewed the reference lists of short-listed articles to identify additional suitable studies. SELECTION CRITERIA We included randomised clinical trials and controlled clinical trials in which groups received surgical intervention for Dupuytren's disease of the index, middle, ring or little finger versus control, or versus another intervention (surgical or otherwise). We excluded the thumb, as cords form on the radial aspect of the thumb and thus are not readily accessible in terms of angular deformity. Furthermore, thumb disease is rare. DATA COLLECTION AND ANALYSIS A minimum of two review authors independently reviewed search results to select studies for inclusion by using pre-specified criteria, assessed risk of bias of included studies and extracted data from included studies.We grouped outcomes into the following categories: (1) hand function, (2) other patient-reported outcomes (e.g. satisfaction, pain), (3) early objective outcomes (e.g. correction of angular deformity), (4) late objective outcomes (e.g. recurrence) and (5) adverse effects. MAIN RESULTS We included 14 articles describing 13 studies, comprising 11 single-centre studies and two multi-centre studies. These studies involved 944 hands of 940 participants; of these, 93 participants were reported twice in separate articles describing early and late outcomes of one trial. Three papers reported the outcomes of two trials comparing different procedures. One trial compared needle fasciotomy versus fasciectomy (125 hands, 121 participants), and the other compared interposition firebreak skin grafting versus z-plasty closure of fasciectomy (79 participants). The other 11 studies reported trials of technical refinements of procedures or rehabilitation adjuncts. Of these, three investigated effects of postoperative splinting on surgical outcomes.Ten studies (11 articles) were randomised controlled trials (RCTs) of varying methodological quality; one was a controlled clinical trial. Trial design was unclear in two studies awaiting classification. All trials had high or unclear risk of at least one type of bias. High risks of performance and detection bias were particularly common. We downgraded the quality of evidence (Grades of Recommendation, Assessment, Development and Evaluation - GRADE) of outcomes to low because of concerns about risk of bias and imprecision.Outcomes measured varied between studies. Five articles assessed recurrence; two defined this as reappearance of palpable disease and two as deterioration in angular deformity; one did not explicitly define recurrence.Hand function on the Disabilities of the Arm, Shoulder and Hand (DASH) Scale (scores between 0 and 100, with higher scores indicating greater impairment) was 5 points lower after needle fasciotomy than after fasciectomy at five weeks. Patient satisfaction was better after fasciotomy at six weeks, but the magnitude of effect was not specified. Fasciectomy improved contractures more effectively in severe disease: Mean percentage reduction in total passive extension deficit at six weeks for Tubiana grades I and II was 11% lower after needle fasciotomy than after fasciectomy, whereas for grades III and IV disease, it was 29% and 32% lower.Paraesthesia (defined as subjective tingling sensation without objective evidence of altered sensation) was more common than needle fasciotomy at one week after fasciectomy (228/1000 vs 67/1000), but reporting of complications was variable.By five years, satisfaction (on a scale from 0 to 10, with higher scores showing greater satisfaction) was 2.1/10 points higher in the fasciectomy group than in the fasciotomy group, and recurrence was greater after fasciotomy (849/1000 vs 209/1000). Firebreak skin grafting did not improve outcomes more than fasciectomy alone, although this procedure took longer to perform.One trial investigated four weeks of day and night splinting followed by two months of night splinting after surgery. The other two trials investigated three months of night splinting after surgery, but participants in 'no splint' groups with early deterioration at one week were issued a splint for use. All three studies demonstrated no benefit from splinting. The two trials investigating postoperative night splinting were suitable for meta-analysis, which demonstrated no benefit from splinting: Mean DASH score in the splint groups was 1.15 points lower (95% confidence interval (CI) -2.32 to 4.62) than in the no splint groups. Mean total active extension in the splint groups was 2.21 degrees greater (95% CI -3.59 to 8.01 degrees) than in the no splint groups. Mean total active flexion in the splint groups was 8.42 degrees less (95% CI 1.78 to 15.07 degrees) than in the no splint groups. AUTHORS' CONCLUSIONS Currently, insufficient evidence is available to show the relative superiority of different surgical procedures (needle fasciotomy vs fasciectomy, or interposition firebreak skin grafting vs z-plasty closure of fasciectomy). Low-quality evidence suggests that postoperative splinting may not improve outcomes and may impair outcomes by reducing active flexion. Further trials on this topic are urgently required.
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Affiliation(s)
- Jeremy N Rodrigues
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
| | - Giles W Becker
- University of Arizona Medical CenterDepartment of Surgery1501 N Campbell AvenueTucsonArizonaUSA85724
| | - Cathy Ball
- University of OxfordKennedy Institute of RheumatologyRoosevelt DriveHeadingtonOxfordUKOX3 7FY
| | - Weiya Zhang
- The University of NottinghamDivision of Academic RheumatologyClinical Sciences BuildingCity HospitalNottinghamEnglandUKNG5 1PB
| | - Henk Giele
- Oxford University HospitalsDepartment of Plastic, Reconstructive and Hand SurgeryOxfordOxfordshireUKOX3 9DU
| | - Jonathan Hobby
- North Hampshire HospitalTrauma and Orthopaedic SurgeryAldermaston RoadBasingstokeHampshireUKRG24 9NA
| | - Anna L Pratt
- Brunel UniversityCollege of Health and Life SciencesKingston LaneUxbridgeMiddlesexUKUB8 3PH
| | - Tim Davis
- Nottingham University HospitalsTrauma and OrthopaedicsQueens Medical CampusNottinghamUKNG7 2UH
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Diep GK, Agel J, Adams JE. Prevalence of palmar fibromatosis with and without contracture in asymptomatic patients. J Plast Surg Hand Surg 2015; 49:247-50. [PMID: 25854281 DOI: 10.3109/2000656x.2015.1034724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This retrospective study documents the proportion of hand clinic patients presenting with palmar fibromatosis with and without contracture. METHODS All "new" patients >18 years presenting to a single surgeon's hand clinic over a 16-month period were included, and information was abstracted from chart review regarding patient demographics, reason for presentation, presence or absence of palmar fibromatosis, contracture, and prior known diagnosis of Dupuytren's disease. The percentage of asymptomatic patients with palmar fibromatosis was calculated. RESULTS Of 827 patients, 306 had palmar fibromatosis. Among all patients, 33% of male and 40% of female patients had palmar fibromatosis. Only 8% had contractures, while 92% had palmar fibromatosis without contracture. Among those who had contractures, 81% presented with a primary complaint of Dupuytren's disease (symptomatic contracture). Prevalence of palmar fibromatosis increased with increasing age. CONCLUSION The findings demonstrate that Dupuytren's palmar fibromatosis is common and often present without overt contractures.
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Affiliation(s)
- Gustave K Diep
- University of Minnesota Medical School , Minneapolis, MN , USA
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Sweet S, Blackmore S. Surgical and therapy update on the management of Dupuytren's disease. J Hand Ther 2014; 27:77-83; quiz 84. [PMID: 24388681 DOI: 10.1016/j.jht.2013.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/01/2013] [Accepted: 10/30/2013] [Indexed: 02/09/2023]
Abstract
Advancements in surgical and therapy management for Dupuytren's disease are highlighted. Indications for treatment and various surgical options for Dupuytren's disease are described. Non-surgical techniques are also presented. Therapy interventions are reviewed. Treatment techniques for the management of secondary problems resulting from prolonged digit flexion are presented. The benefits, limitations and outcomes of treatments are reviewed to assist the reader to link patient specific problems and goals to the most appropriate treatment choice.
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Affiliation(s)
- Stephanie Sweet
- The Philadelphia and South Jersey Hand Centers, 700 S. Henderson Road, Suite 200, King of Prussia, PA 19406, USA
| | - Susan Blackmore
- The Philadelphia and South Jersey Hand Centers, 700 S. Henderson Road, Suite 200, King of Prussia, PA 19406, USA.
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Findlay I, Tahmassebi R. Posttraumatic disease of the palmar fascia. J Hand Surg Am 2014; 39:2086-8. [PMID: 25124087 DOI: 10.1016/j.jhsa.2014.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Iain Findlay
- Department of Orthopaedics, King's College Hospital, London, UK.
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Becker K, Tinschert S, Lienert A, Bleuler PE, Staub F, Meinel A, Rößler J, Wach W, Hoffmann R, Kühnel F, Damert HG, Nick HE, Spicher R, Lenze W, Langer M, Nürnberg P, Hennies HC. The importance of genetic susceptibility in Dupuytren's disease. Clin Genet 2014; 87:483-7. [PMID: 24749973 DOI: 10.1111/cge.12410] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/28/2022]
Abstract
Dupuytren's disease (DD) is a progressive fibromatosis that causes the formation of nodules and cords in the palmar aponeurosis leading to flexion contracture of affected fingers. The etiopathogenesis is multifactorial with a strong genetic predisposition. It is the most frequent genetic disorder of connective tissues. We have collected clinical data from 736 unrelated individuals with DD who underwent surgical treatment from Germany and Switzerland. We evaluated a standardised questionnaire, assessed the importance of different risk factors and compared subgroups with and without positive family history. We found that family history clearly had the strongest influence on the age at first surgery compared to environmental factors, followed by male sex. Participants with a positive family history were on average 55.9 years of age at the first surgical intervention, 5.2 years younger than probands without known family history (p = 6.7 × 10(-8) ). The percentage of familial cases decreased with age of onset from 55% in the 40-49 years old to 17% at age 80 years or older. Further risk factors analysed were cigarettes, alcohol, diabetes, hypertension, and epilepsy. Our data pinpoint the importance of genetic susceptibility for DD, which has long been underestimated.
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Affiliation(s)
- K Becker
- Cologne Center for Genomics; Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases, University of Cologne, Cologne, Germany
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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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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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11
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Ojwang JO, Adrianto I, Gray-McGuire C, Nath SK, Harley JB, Rayan GM, Harley JB, Rayan GM. Genome-wide association scan of Dupuytren's disease. J Hand Surg Am 2010; 35:2039-45. [PMID: 20971583 PMCID: PMC2998563 DOI: 10.1016/j.jhsa.2010.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/20/2010] [Accepted: 08/09/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Dupuytren's disease (DD) has a strong genetic component that is suggested by population studies and family clustering. Genetic studies have yet to identify the gene(s) involved in DD. The purpose of this study was to identify regions of the entire genome (chromosomes 1-23) associated with the disease by performing a genome-wide association scan on DD patients and controls. METHODS We isolated genomic DNA from saliva collected from 40 unrelated DD patients and 40 unaffected controls. We conducted the genotyping using CytoSNP-Infinium HD Ultra genotyping assay on the Illumina platform. Using both log regression and mapping by admixture linkage disequilibrium analysis methods, we analyzed the single nucleotide polymorphism genotyping data. RESULTS Single nucleotide polymorphism analysis revealed a significant association in regions for chromosomes 1, 3 through 6, 11, 16, 17, and 23. Mapping by admixture linkage disequilibrium analysis showed ancestry-associated regions in chromosomes 2, 6, 8, 11, 16, and 20, which may harbor DD susceptibility genes. Both analysis methods revealed loci association in chromosomes 6, 11, and 16. CONCLUSIONS Our data suggest that chromosomes 6, 11, and 16 may contain the genes for DD and that multiple genes may be involved in DD. Future genetic studies on DD should focus on these areas of the genome.
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Affiliation(s)
- Joshua O. Ojwang
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Indra Adrianto
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Courtney Gray-McGuire
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Swapan K. Nath
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - John B. Harley
- Department of Arthritis and Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA,Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,US Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Ghazi M. Rayan
- Orthopedic Surgery Department Oklahoma University and Division of Hand Surgery, Integris Baptists Medical Center, Oklahoma City, OK, USA,Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,Address correspondence and reprint requests to Ghazi M. Rayan, MD: 3366 NW Expressway, Oklahoma City, OK 73112,
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12
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Rayan GM, Ali M, Orozco J. Dorsal pads versus nodules in normal population and Dupuytren's disease patients. J Hand Surg Am 2010; 35:1571-9. [PMID: 20800974 DOI: 10.1016/j.jhsa.2010.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 05/26/2010] [Accepted: 06/01/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE There is ambiguity about using the term "knuckle pads" in Dupuytren's disease (DD). Clear definitions of dorsal knuckle pads and nodules are lacking and the prevalence of these 2 entities has not been determined. We sought to define these terms and investigate the distribution and frequency of dorsal knuckle pads and dorsal nodules in the normal volunteers and in DD patients. METHODS We assessed 50 consecutive study patients with DD and a convenience sample group of 50 control patients without DD for dorsal cutaneous pads (DCP) (ie, thickening, sclerosis, and loss of skin elasticity) and dorsal Dupuytren's nodules (DDN) (ie, solid tumor-like masses over the digital joints). Demographic information was collected for both groups, including the extent of the disease in DD patients. We examined both groups for the presence of dorsal lesions and their characteristics, and the DD patients for other local and ectopic Dupuytren's lesions and for the level of diathesis. RESULTS None of the control patients had DDN, whereas 9 DD patients had DDN (p = .002). Nine control patients had DCP, whereas 11 DD patients had DCP (p = .803) Among the 9 control patients with DCP, pads were predominantly over the proximal interphalangeal joints and tended to occur in men with physically demanding occupations, and in the dominant hand. The index and long fingers were most frequently affected. Six patients had only DCP, 4 had only DDN, and 5 had both DDN and DCP. In the control and study groups, the DCP characteristics and patients' demographic data were comparable. Patients with DDN were white men with physically undemanding occupations and had lesions over the proximal interphalangeal joints, most frequently in the index finger, with an average size of 6 mm. Neither DCP nor DDN were encountered in the thumb. CONCLUSIONS Future studies should clearly distinguish between DCP and DDN. Although DDN are pathognomonic of DD, DCP demonstrates similar prevalence in normal and DD populations.
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Affiliation(s)
- Ghazi M Rayan
- University of Oklahoma Health Sciences Center/INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, USA.
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13
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Rayan GM. Nonoperative treatment of Dupuytren's disease. J Hand Surg Am 2008; 33:1208-10. [PMID: 18762122 DOI: 10.1016/j.jhsa.2008.05.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 05/26/2008] [Indexed: 02/02/2023]
Abstract
Many approaches to nonoperative treatment of Dupuytren's disease have been tried since the disease was originally described in 1831, and most have been abandoned. Nonetheless, the appeal for nonoperative methods persists, in pursuit of lower morbidity and lesser complications than may be encountered with open surgical treatment. A number of nonoperative treatment modalities are in current use for Dupuytren's disease, despite lack of high-level clinical studies supporting these methods. Some of these can be utilized as an adjunct to surgical treatment rather than a replacement for it. The most commonly used nonoperative treatment methods are briefly reviewed.
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Affiliation(s)
- Ghazi M Rayan
- INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA.
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14
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Dupuytren's disease following acute injury in Japanese patients: Dupuytren's disease or not? J Hand Surg Eur Vol 2007; 32:569-72. [PMID: 17950225 DOI: 10.1016/j.jhse.2007.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 06/10/2007] [Accepted: 06/14/2007] [Indexed: 02/03/2023]
Abstract
This paper reports the development of Dupuytren's disease following acute injury in 16 hands in 14 Japanese patients. The patients included six women and eight men. Five patients developed disease following trauma, one following infection and eight following elective surgery. In the present series, the patient age and sex are irrelevant. The disease was unilateral, confined to a single digital ray, and without ectopic lesions in most cases. Disease presented predominantly in the ring or middle finger rays. There were only three patients who underwent surgery for definite flexion contracture. Diabetes mellitus was the most frequently associated risk factor. Our results suggest that Dupuytren's disease following acute injury could be considered a separate entity from typical Dupuytren's disease. At present, we believe that this condition should be considered a subtype of Dupuytren's disease.
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15
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Affiliation(s)
- Ghazi M Rayan
- Upper Extremity, Hand and Microsurgery Center, Baptist Physicians Building D, 3366 NW Expressway, Suite 700, Oklahoma City, OK 73112, USA
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