A new finger-preserving procedure as an alternative to amputation in recurrent severe Dupuytren contracture of the small finger

Collagenase Treatment for Dupuytren Contracture of the Metacarpophalangeal Joint After Arthrodesis of the Proximal Interphalangeal Joint

Successful collagenase (Xiaflex) treatment of Dupuytren's contracture in the metacarpophalangeal joint is possible in the presence of previous arthrodesis of the proximal interphalangeal joint.

Shortening arthrodesis combined with limited fasciectomy in severe recurrent Dupuytren's disease of the fifth finger

OBJECTIVE

Management of recurrent Dupuytren's disease of the little finger is challenging. Various treatment modalities have been proposed: external fixation, local skin flap, dermofasciectomy, or even amputation. An alternative surgical technique was introduced by Honecker et al. in 2016 and refined by Raimbeau et al. in 2019, consisting in resection of the middle phalanx and shortening arthrodesis. We modified the technique by combining arthrodesis with a limited fasciectomy of the abductor and/or pretendinous cord in the fifth ray to improve cosmetic and functional outcomes.

METHODS

Patients with severe recurrent Dupuytren's disease of the little finger (Tubiana stage III/IV) were treated with proximodistal interphalangeal arthrodesis, combined with limited fasciectomy. Range of motion was assessed preoperatively and postoperatively. QuickDASH and a VAS were assessed to determine overall function and pain respectively. Radiographic evaluation was made at 6 and 12 weeks postoperatively.

RESULTS

Thirteen patients were eligible for inclusion. Mean age was 69 years (range 49 - 87). Radiographic consolidation was obtained at a mean 58 days (range 27-97). Full extension of the metacarpophalangeal joint was achieved in 11 patients and full adduction in 12. Mean active flexion was 94 ° (range 90-100). QuickDASH scores decreased from 18 to 12 after surgery. Pain scores were low and unchanged.

CONCLUSION

By combining proximodistal interphalangeal arthrodesis with limited fasciectomy through a volar approach, finger extension improved, and fixed abduction was also treated. The combined volar and dorsal approach did not induce vascular impairment or other complications.

A Personalized Approach to Treat Advanced Stage Severely Contracted Joints in Dupuytren’s Disease with a Unique Skeletal Distraction Device—Utilizing Modern Imaging Tools to Enhance Safety for the Patient

Background: While surgical therapy for Dupuytren’s disease is a well-established standard procedure, severe joint flexion deformities in advanced Dupuytren’s disease remain challenging to treat. Skeletal distraction has proven to be an additional treatment option. Methods: We analyzed the surgical treatment algorithm, including the application of a skeletal distraction device, in patients with a flexion deformity due to Dupuytren’s disease, Iselin stage III or IV, who were operated on from 2003 to 2020 in our department. Results: From a total of 724 patients, we included the outcome of 55 patients’ fingers in this study, who had undergone additional skeletal joint distraction with our Erlangen device. Additional fasciotomy or fasciectomy, in a one- or two-staged procedure, was performed in all patients, according to the individual findings and necessities. The range of motion of the PIP joint improved from 12° to 53°. A number of complications, in all steps of the treatment, were noted in a total of 36.4% of patients, including the development of fractures (16.4%), followed by vessel injury, pin infections, and complex regional pain syndrome (5%). Conclusions: Additional skeletal distraction improves the range of motion of severely contracted joints in Dupuytren’s disease. Nevertheless, careful patient selection is necessary, due to the moderate rate of complications.

Finger shortening for Dupuytren's disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases

When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren’s disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren’s disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.

The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis

Background

The Dupuytren disease is a benign fibroproliferative disorder that leads to the formation of the collagen knots and fibres in the palmar fascia. The previous studies reveal different levels of Dupuytren’s prevalence worldwide; hence, this study uses meta-analysis to approximate the prevalence of Dupuytren globally.

Methods

In this study, systematic review and meta-analysis have been conducted on the previous studies focused on the prevalence of the Dupuytren disease. The search keywords were Prevalence, Prevalent, Epidemiology, Dupuytren Contracture, Dupuytren and Incidence. Subsequently, SID, MagIran, ScienceDirect, Embase, Scopus, PubMed and Web of Science databases and Google Scholar search engine were searched without a lower time limit and until June 2020. In order to analyse reliable studies, the stochastic effects model was used and the I² index was applied to test the heterogeneity of the selected studies. Data analysis was performed within the Comprehensive Meta-Analysis Software version 2.0.

Results

By evaluating 85 studies (10 in Asia, 56 in Europe, 2 in Africa and 17 studies in America) with a total sample size of 6628506 individuals, the prevalence of Dupuytren disease in the world is found as 8.2% (95% CI 5.7–11.7%). The highest prevalence rate is reported in Africa with 17.2% (95% CI 13–22.3%). According to the subgroup analysis, in terms of underlying diseases, the highest prevalence was obtained in patients with type 1 diabetes with 34.1% (95% CI 25–44.6%). The results of meta-regression revealed a decreasing trend in the prevalence of Dupuytren disease by increasing the sample size and the research year (P < 0.05).

Conclusion

The results of this study show that the prevalence of Dupuytren disease is particularly higher in alcoholic patients with diabetes. Therefore, the officials of the World Health Organization should design measures for the prevention and treatment of this disease.