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Harbrecht A, Honigmann P, Löw S, Müller LP, Unglaub F, Spies CK. [Dupuytren's disease : Epidemiology, diagnosis, treatment, outcome]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024:10.1007/s00132-024-04553-z. [PMID: 39320513 DOI: 10.1007/s00132-024-04553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/26/2024]
Abstract
Dupuytren's contracture is a fibroproliferative systemic disease that cannot be stopped by medication. The overall prevalence is 7-8%. Men are affected 3-4 times more frequently. The cause of the disease is not known. A genetic disposition and thus familial clustering are being discussed. Risk factors for the development of a Dupuytren's contracture are work-related stress (microtrauma), nicotine and alcohol consumption, epilepsy and diabetes mellitus as well as advanced age. The prognosis is poor in cases with a positive family history, bilateral involvement, age < 50 years and male gender. Several treatment options are available. Conservative therapy has no lasting benefit. Minimally invasive procedures include partial needle aponeurectomy or the injection of collagenase. Surgical procedures range from partial aponeurectomy to dermatoaponeurectomy. The recurrence risk of the gold standard treatment of surgery (partial aponeurectomy) is 20.9%.
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Affiliation(s)
- A Harbrecht
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Schwerpunkt für Unfall‑, Hand- und Ellenbogenchirurgie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Honigmann
- Hand- und periphere Nervenchirurgie, Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland, 4101, Bruderholz, Liestal, Laufen, Schweiz
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, Universität Basel, Basel, Schweiz
- Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, Niederlande
| | - S Löw
- Praxis für Handchirurgie und Unfallchirurgie, Ledermarkt 8-10, 97980, Bad Mergentheim, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Schwerpunkt für Unfall‑, Hand- und Ellenbogenchirurgie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpius Straße 29, 74906, Bad Rappenau, Deutschland
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - C K Spies
- Handchirurgie, Spital Langenthal, Spitalregion Oberaargau SRO AG, St. Urbanstr. 67, 4900, Langenthal, Schweiz.
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Jahn A, Andersen JH, Descatha A, Dalbøge A. Dupuytren's disease and occupational mechanical exposures: a systematic review and meta-analysis. Occup Environ Med 2024:oemed-2024-109649. [PMID: 39317441 DOI: 10.1136/oemed-2024-109649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/06/2024] [Indexed: 09/26/2024]
Abstract
The risk of developing Dupuytren's disease among workers exposed to occupational mechanical exposures has been reported in few systematic reviews, mainly related to vibration. Expanding the investigation to all occupational mechanical exposures is essential for advancing scientific knowledge, health policies and improving workplace safety. The aim of this systematic review and meta-analysis was to study the association between occupational mechanical exposures and Dupuytren's disease.We conducted a systematic review and meta-analysis using guidelines stated by PRISMA. The systematic literature search was performed in Medline, EMBASE, CINAHL, Cochrane Library and Web of Science databases in April 2023. Inclusion criteria were conducted using the PECOS. Two independent authors conducted the literature screening, data extraction and risk of bias assessment. In the meta-analyses, data was pooled using random-effects models and stratified by the risk of bias and study design. The level of evidence was evaluated using GRADE.The literature search identified 563 unique articles and 15 were deemed eligible for inclusion, categorised into hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. Exposure to hand-transmitted vibration showed an OR of 2.0 (95% CI 1.5 to 2.7, I2=64%), lifting/carrying loads had an OR of 1.5 (95% CI 1.1 to 2.0, I2=77%) and combined mechanical exposures had an OR of 2.1 (95% CI 1.4 to 3.1, I2=94%). When grading the level of evidence, we found moderate evidence for hand-transmitted vibration, while low evidence was found for lifting/carrying loads and combined mechanical exposures.We found an association between hand-transmitted vibration, lifting/carrying loads and combined mechanical exposures. The level of evidence was considered moderate for hand-transmitted vibration and low for lifting/carrying loads and combined mechanical exposures.
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Affiliation(s)
- Alexander Jahn
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Regional Hospital Goedstrup, Herning, Denmark
- Aarhus University Department of Clinical Medicine, Aarhus, Denmark
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, IRSET-ESTER, SFR ICAT, CAPTV CDC, Angers, France
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Aarhus University Department of Clinical Medicine, Aarhus, Denmark
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Yoneda H, Curley J, Yamamoto M, Hirata H. Impact of Collagenase Injection on Dupuytren Disease Treatment in Japan: A Comprehensive Survey of Trends. Ann Plast Surg 2024:00000637-990000000-00534. [PMID: 39150793 DOI: 10.1097/sap.0000000000004076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
BACKGROUND Collagenase Clostridium histolyticum (CCH) injection, an effective enzymatic fasciotomy treatment for Dupuytren disease (DD), was abruptly withdrawn from the healthcare market outside the United States in 2020. The impact on patients, physicians and hospitals of this helpful surgical alternative no longer being available has been little studied. METHODS To investigate the impact of the withdrawal of CCH in Japan, we used the National Database Open Data Japan from 2014 to 2020. Published by the government, it contains summary data of the National Database of Health Insurance Claims and Specific Health Checkups of Japan. We extracted the numbers of CCH injections with Xiaflex, the product name in Japan, and surgeries identified by "Dupuytren contracture surgery codes." Each treatment was further parsed into one of 12 predefined regions in which it had taken place and by whether it had been delivered on an inpatient or outpatient basis. RESULTS From its introduction in 2015, the number of DD patients treated with CCH increased in each successive year, reaching a peak in 2019, while the number of surgeries decreased with time. After the withdrawal in 2020, the number of surgeries increased to 1.5 times the 2019 number notwithstanding the impact of COVID-19, but the total number of patients treated decreased by 43%. In the initial regional analysis, CCH accounted for approximately 40% of all DD treatments in the less populous areas, with the exception of the Tohoku region, and more than 50% in the other regions. By 2019, the share of CCH treatment had increased in all regions. There was no significant correlation between the number of hand surgeons authorized to use CCH and the number of CCH cases within each region. CONCLUSIONS CCH increased treatment options for patients and surgeons. The withdrawal of this valuable pharmaceutical resulted in an increase in the number of surgeries amidst a decrease in the total number of treatments and lost opportunities for patients.
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Affiliation(s)
- Hidemasa Yoneda
- From the Department of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Aissvarya S, Ling KH, Arumugam M, Thilakavathy K. Molecular genetics of Dupuytren's contracture. EFORT Open Rev 2024; 9:723-732. [PMID: 39087497 PMCID: PMC11370717 DOI: 10.1530/eor-23-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Dupuytren's contracture (DC) is a fibroproliferative disorder of the palmar fascia characterised by the digits' flexion contractures and is associated with abnormal build-up of type III collagen. The prevalence of the disease is reported to be highest among Northern European descendants. However, the disease is widespread globally with varying prevalence. DC is a multifactorial disease, having both genetic and environmental factors contributing to the causality of the disease. Over the years, various studies have been conducted to understand the molecular mechanism and genetic aspects of DC but there is a lack of reports on the variants found in the exonic regions. Most reports are backdated making it necessary to re-evaluate the variants to further understand the genetic aetiology of DC. In this review, we first highlight the genetic aspects and previous genetic studies on DC. The report is followed by a discussion on the molecular pathways suggested to be associated with DC and a summary of the genetic variants in the exonic regions found in DC and their connections with the molecular pathways. A total of nine variants were reported originating from six genes comprising three pathways. Most variants reported are involved in the Wnt signalling pathway. Moreover, all variants identified are in European/Caucasian subjects and the variants found in the exonic regions are missense variants. A comparison of these findings with variants from populations of other regions can be conducted to identify the variants with the most occurrence to act as biomarkers or therapeutic targets for DC.
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Affiliation(s)
- Shankar Aissvarya
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - King-Hwa Ling
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Manohar Arumugam
- Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- School of Medicine, Faculty of Medicine and Health Sciences, Taylor's University, Selangor, Malaysia
| | - Karuppiah Thilakavathy
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Lenzi LGS, Gomes dos Santos JB, Cavalheiro RP, Mendes A, Kobayashi EY, Nader HB, Faloppa F. Alterations in the Structure, Composition, and Organization of Galactosaminoglycan-Containing Proteoglycans and Collagen Correspond to the Progressive Stages of Dupuytren's Disease. Int J Mol Sci 2024; 25:7192. [PMID: 39000302 PMCID: PMC11241189 DOI: 10.3390/ijms25137192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/07/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Dupuytren's disease (DD) is a prevalent fibroproliferative disorder of the hand, shaped by genetic, epigenetic, and environmental influences. The extracellular matrix (ECM) is a complex assembly of diverse macromolecules. Alterations in the ECM's content, structure and organization can impact both normal physiological functions and pathological conditions. This study explored the content and organization of glycosaminoglycans, proteoglycans, and collagen in the ECM of patients at various stages of DD, assessing their potential as prognostic indicators. This research reveals, for the first time, relevant changes in the complexity of chondroitin/dermatan sulfate structures, specifically an increase of disaccharides containing iduronic acid residues covalently linked to either N-acetylgalactosamine 6-O-sulfated or N-acetylgalactosamine 4-O-sulfated, correlating with the disease's severity. Additionally, we noted an increase in versican expression, a high molecular weight proteoglycan, across stages I to IV, while decorin, a small leucine-rich proteoglycan, significantly diminishes as DD progresses, both confirmed by mRNA analysis and protein detection via confocal microscopy. Coherent anti-Stokes Raman scattering (CARS) microscopy further demonstrated that collagen fibril architecture in DD varies importantly with disease stages. Moreover, the urinary excretion of both hyaluronic and sulfated glycosaminoglycans markedly decreased among DD patients.Our findings indicate that specific proteoglycans with galactosaminoglycan chains and collagen arrangements could serve as biomarkers for DD progression. The reduction in glycosaminoglycan excretion suggests a systemic manifestation of the disease.
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Affiliation(s)
- Luiz Guilherme S. Lenzi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04038-032, SP, Brazil; (L.G.S.L.); (J.B.G.d.S.); (F.F.)
| | - João Baptista Gomes dos Santos
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04038-032, SP, Brazil; (L.G.S.L.); (J.B.G.d.S.); (F.F.)
| | - Renan P. Cavalheiro
- Molecular Biology Program, Instituto de Farmacologia e Biologia Molecular, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, SP, Brazil; (R.P.C.); (A.M.); (E.Y.K.)
- Faculdade de Medicina ABC, Centro Universitário, Santo André 09060-870, SP, Brazil
| | - Aline Mendes
- Molecular Biology Program, Instituto de Farmacologia e Biologia Molecular, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, SP, Brazil; (R.P.C.); (A.M.); (E.Y.K.)
| | - Elsa Y. Kobayashi
- Molecular Biology Program, Instituto de Farmacologia e Biologia Molecular, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, SP, Brazil; (R.P.C.); (A.M.); (E.Y.K.)
| | - Helena B. Nader
- Molecular Biology Program, Instituto de Farmacologia e Biologia Molecular, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, SP, Brazil; (R.P.C.); (A.M.); (E.Y.K.)
| | - Flavio Faloppa
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04038-032, SP, Brazil; (L.G.S.L.); (J.B.G.d.S.); (F.F.)
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Yazdani A, Nasri P, Baradaran Mahdavi S. The Effects of Shock Wave Therapy on the Symptoms and Function of Individuals With Dupuytren Disease: A Systematic Review. Arch Phys Med Rehabil 2024:S0003-9993(24)01050-5. [PMID: 38866227 DOI: 10.1016/j.apmr.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/20/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE To systematically evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, clinical and functional outcomes, and satisfaction of patients with Dupuytren disease. DATA SOURCES A thorough search for all the study types published in English was conducted in PubMed, Scopus, Web of Science, and Embase from inception to August 31, 2022. STUDY SELECTION Title and abstract and then full-text screening against eligibility criteria was performed independently by 2 reviewers, and a third reviewer achieved consensus. DATA EXTRACTION Reviewers identified 26 studies, of which 6 were included in the analysis (145 cases). The methodological quality was assessed using the National Heart, Lung, and Blood Institute and the Joanna Briggs Institute checklists. The certainty of evidence was evaluated using the Grading of Recommendation Assessment, Development, and Evaluation. DATA SYNTHESIS Assessments represented a remarkable improvement in the pain and function through the measurements including the visual analog scale, the Disabilities of Arm Shoulder and Hand Questionnaire, the Michigan Hand Outcome Questionnaire, and Mayo Wrist Score. Patients' satisfaction was also favorable using the Roles and Maudsley score. The hand grip strength improvement was noted in one study measured via a Jamar dynamometer. In addition, the ultrasonographic assessment of the nodules revealed a decrease in the size of the nodules in a patient with multiple bilateral nodules after the treatment. The quality of the included studies was good for all studies except for one that was fair. The certainty of evidence was moderate for pain and function and was low for patients' satisfaction and ultrasonographic findings. CONCLUSIONS ESWT can lead to significant pain improvement, functional rehabilitation, and patient satisfaction with no adverse effect in the management of Dupuytren disease. Pain may return over time, but not to that severity before the intervention. ESWT-related characteristics and the need for continuation of treatment remain to be fully elucidated in future large clinical trials.
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Affiliation(s)
- Amid Yazdani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Ordibehesht Health Center, Isfahan, Iran; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
| | - Parsa Nasri
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran; Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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Osterloh J, Müller-Seubert W, Cai A, Arkudas A, Horch RRE. Is there an impact of a video-based patient informed consent in elective hand surgery? Arch Orthop Trauma Surg 2024; 144:2899-2903. [PMID: 38850419 PMCID: PMC11211158 DOI: 10.1007/s00402-024-05291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/17/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Patient informed consent is a crucial subject in preoperative care of patients before elective hand surgery, ensuring that patients have the necessary information and a comprehensive understanding to make autonomous decisions. The use of video-based informed consent systems is an innovative concept to enhance the consent process with multimedia tools. In addition to the conventional process, mostly relying on verbal communication and written documents, the video-based approach aims to present information in a standardized and visually appealing format. METHODS In this study, 33 patients were asked to watch a video on a tablet about the planned elective hand surgery after a conventional pre-treatment consultation including informed consent throughout verbal explanations and paper forms by an attending physician or resident. All patients were asked to complete a questionnaire after watching the video. RESULTS An overwhelming majority of participants, specifically 97.0%, stated that the video improved their understanding of the upcoming surgery. 90.9% of the participant would refer the video to other patients undergoing elective hand surgery, while 72.7% of participants indicated that they would have appreciated the opportunity to view an informational video before undergoing different types of surgeries in the past. CONCLUSION The use of a video-based patient information system in elective hand surgery had a positive impact on patient education and satisfaction with the informed consent process. Therefore, it is a powerful tool in preoperative management to guarantee a standardized and educative informed consent.
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Affiliation(s)
- Justus Osterloh
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Wibke Müller-Seubert
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Aijia Cai
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raymund R E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Steppe C, Cinclair R, Lies S. A 10-Year Review of Collagenase Versus Fasciectomy in the Treatment of Dupuytren Contracture. Ann Plast Surg 2024; 92:642-646. [PMID: 38717148 DOI: 10.1097/sap.0000000000003913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Dupuytren disease (DD) is one of the most common disorders of the hand, affecting 5.7% to 11.7% of the global population. This study seeks to evaluate the 10-year efficacy of the 2 most prominent treatment modalities for DD in Veterans Affairs hospitals, injectable collagenase Clostridium histolyticum versus open fasciectomy. METHODS A retrospective review was conducted of all electronic medical records of patients who underwent open fasciectomy or collagenase injection to treat their persistent Dupuytren contracture between April 2011 and April 2021. All procedures were performed by 1 of 5 senior surgeons at the same Veterans Affairs Hospital. RESULTS A total of 232 patients were treated for DD, with 247 collagenase injections and 44 open fasciectomies performed in this sample. Collagenase patients were, on average, 6.51 years after intervention at the time of review. Open fasciectomy patients were, on average, 4.56 years after operation at the time of review. Collagenase decreased contractures, on average, by 29.40 degrees, whereas open fasciectomy decreased contractures, on average, by 38.59 degrees. Of the contractures that were initially classified as resolved, 50 of 155 (32.2%) treated with collagenase and 6 of 56 (10.7%) treated with open fasciectomy recurred. The use of open fasciectomy compared with collagenase injections to treat contracture was associated with a 74.2% decrease in the likelihood of recurrence. CONCLUSIONS This study found that treatment of DD with collagenase injection is associated with a significantly lower degree of deformity correction, lower rate of resolution, and increased rate of recurrence when compared with open fasciectomy.
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Affiliation(s)
- Cyrus Steppe
- From the Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Pess GM, Hurley D, Verheyden JR, Benhaim P. Collagenase Clostridium Histolyticum for the Treatment of Dupuytren Disease: A Delphi-Based Consensus Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:151-158. [PMID: 38903838 PMCID: PMC11185883 DOI: 10.1016/j.jhsg.2023.10.011] [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: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose The aim of this study was to establish the consensus recommendations among hand surgeons who were experts in the use of collagenase clostridium histolyticum (CCH) on the appropriate treatment of Dupuytren disease in well-defined patient populations with varying degrees of disease severity and functional impairment. Methods A three-round, blinded, modified Delphi process examined panelists' approaches to CCH treatment of metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contractures involving one or two fingers with varying degrees of severity. Clinical scenarios related to poor-quality skin, postfasciectomy scarring, boutonnière deformity, closed capsulotomy, and blood thinner use were also presented for panelist consideration. Panelists provided responses to clinical scenarios using a 5-point Likert scale or a yes/no response. Consensus was defined as ≥66.7% panelist agreement or disagreement. Results Twenty panelists completed round 1; 19 of the 20 panelists completed rounds 2 and 3. Panelists achieved a high level of consensus for using CCH for the treatment of patients with palpable cords and varying severity contractures representing one- or two-finger MP joint contractures, most one- or two-finger PIP joint contractures, and most combined MP and PIP joint contractures. Consensus for the treatment of PIP joint contractures was mostly achieved, but clinical scenarios related to recurrent PIP contracture with poor-quality skin and/or significant postfasciectomy scarring, boutonnière deformity, PIP contractures >70°, closed capsulotomy, and blood thinner use were modified, and then most (95.3%) statements reached consensus for agreement in round 2. In round 3, open-ended responses indicated that panelists considered CCH appropriate for most patients with Dupuytren disease. Conclusions Consensus-based findings among expert hand surgeons with substantial CCH experience indicated that CCH has a wide-ranging application for the treatment of Dupuytren disease in patients with varying degrees of disease severity and functional impairment. Type of study/level of evidence Therapeutic V.
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Räisänen MP, Leppänen OV, Soikkeli J, Reito A, Malmivaara A, Buchbinder R, Kautiainen H, Kaivorinne A, Stjernberg-Salmela S, Lappalainen M, Luokkala T, Pönkkö A, Taskinen HS, Pääkkönen M, Jaatinen K, Juurakko J, Karjalainen VL, Karjalainen T. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial. Ann Intern Med 2024; 177:280-290. [PMID: 38346307 DOI: 10.7326/m23-1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Surgery, needle fasciotomy, and collagenase injection are used to treat Dupuytren contracture. The treatment decision requires balancing initial morbidity and costs of surgery against its potential long-term benefits over needle fasciotomy and collagenase. OBJECTIVE To compare the effectiveness of surgery, needle fasciotomy, and collagenase injection at 3 months and 2 years (secondary time points of the trial). DESIGN A multicenter, randomized, outcome assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT03192020). SETTING 6 public hospitals in Finland. PARTICIPANTS 302 persons with treatment-naive Dupuytren contracture (contracture angle <135°). INTERVENTION Surgery (n = 101), needle fasciotomy (n = 101), or collagenase (n = 100). MEASUREMENTS The primary outcome was the success rate, defined as greater than 50% contracture release and patients reaching the patient acceptable symptom state. Secondary outcomes included hand function, pain, quality of life, patient satisfaction, residual contracture angle, finger flexion, risk for retreatment, and serious adverse events. RESULTS A total of 292 (97%) and 284 (94%) participants completed the 3-month and 2-year follow-ups. Success rates were similar at 3 months: 71% (95% CI, 62% to 80%) for surgery, 73% (CI, 64% to 82%) for needle fasciotomy, and 73% (CI, 64% to 82%) for collagenase. At 2 years, surgery had superior success rates compared with both needle fasciotomy (78% vs. 50%; adjusted risk difference [aRD], 0.30 [CI, 0.17 to 0.43]) and collagenase (78% vs. 65%; aRD, 0.13 [CI, 0.01 to 0.26]). Secondary analyses paralleled with the primary analysis. LIMITATION Participants were not blinded. CONCLUSION Initial outcomes are similar between the treatments, but at 2 years success rates were maintained in the surgery group but were lower with both needle fasciotomy and collagenase despite retreatments. PRIMARY FUNDING SOURCE Research Council of Finland.
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Affiliation(s)
- Mikko Petteri Räisänen
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, and Tampere University, Tampere, Finland (M.P.R.)
| | - Olli V Leppänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Janne Soikkeli
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Aleksi Reito
- Department of Orthopedics, Tampere University Hospital, Tampere, Finland (A.R.)
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare and Orton Orthopedic Hospital, Helsinki, Finland (A.M.)
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (R.B.)
| | | | - Antti Kaivorinne
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Susanna Stjernberg-Salmela
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, Finland (S.S.)
| | | | - Toni Luokkala
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Annele Pönkkö
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Hanna-Stiina Taskinen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Markus Pääkkönen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Kati Jaatinen
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Joona Juurakko
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | | | - Teemu Karjalainen
- Department of Hand Surgery and Microsurgery, Tampere University Hospital, Tampere, Finland, and Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (T.K.)
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11
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Kang Y, Stewart M, Patel M, Furniss D, Wiberg A. Modifiable Risk Factors for Prevention in Dupuytren Disease: A UK Biobank Case-Control Study. Plast Reconstr Surg 2024; 153:363e-372e. [PMID: 37257135 DOI: 10.1097/prs.0000000000010774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Dupuytren disease is associated with significant comorbidity and mortality, and it has no existing prevention strategies. It is unclear which modifiable risk factors are most amenable for prevention. This study aimed to determine the strength of modifiable risk factors for Dupuytren disease, and to investigate associations with other diseases. METHODS Using UK Biobank data, this case-control study analyzed the association between phenotypic variables and Dupuytren disease through multivariable logistic regression. Exposures assessed were age, sex, body mass index, waist-to-hip ratio, Townsend deprivation index, smoking status, alcohol intake, diabetes mellitus, hypertension, cancer, liver disease, respiratory disease, rheumatoid arthritis, epilepsy, psoriasis, and gout. RESULTS There were 4148 cases and 397,425 controls. Male sex (OR, 3.23; 95% CI, 2.90 to 3.60; P = 1.07 × 10 -100 ), increasing age (OR, 1.08; 95% CI, 1.07 to 1.08; P = 6.78 × 10 -167 ), material deprivation (OR, 1.01; 95% CI, 1.00 to 1.02; P = 0.0305), high-density lipoprotein cholesterol (OR, 1.76; 95% CI, 1.58 to 1.96; P = 3.35 × 10 -24 ), smoking exposure, and alcohol intake were all associated with increased odds of Dupuytren disease. With increasing obesity class, there was approximately 25% decreased odds (OR, 0.774; 95% CI, 0.734 to 0.816; P = 4.71 × 10 -21 ). Diabetes with microvascular or end-organ complications was associated with more than 2.5 times increased odds of Dupuytren disease (OR, 2.59; 95% CI, 1.92 to 3.44; P = 1.92 × 10 -10 ). Within this group, increasing hemoglobin A1c values by 10 mmol/mol, or 0.9%, increased the odds by 31% (OR, 1.31; 95% CI, 1.13 to 1.51; P = 2.19 × 10 -4 ). CONCLUSION Diabetes and poor glycemic control are major risk factors for Dupuytren disease, which present an opportunity for prevention. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Youngjoo Kang
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Max Stewart
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Manal Patel
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
| | - Dominic Furniss
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital
| | - Akira Wiberg
- From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital
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12
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Alhebshi ZA, Bamuqabel AO, Alqurain Z, Dahlan D, Wasaya HI, Al Saedi ZS, Alqarni GS, Alqarni D, Ghalimah B. Comparing Complications and Patient Satisfaction Following Injectable Collagenase Versus Limited Fasciectomy for Dupuytren's Disease: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53147. [PMID: 38420076 PMCID: PMC10900279 DOI: 10.7759/cureus.53147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Dupuytren's disease (DD) is a fibroproliferative disorder that manifests as an abnormal growth of myofibroblasts, causing nodule formation and contractures and affecting digit function. If left untreated, these contractures can lead to a loss of mobility and potentially impact hand function. This systematic review critically compares and evaluates the existing literature on the complications and patient satisfaction following injectable collagenase Clostridium histolyticum (CCH) versus limited fasciectomy (LF) for DD. We performed a comprehensive search of the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), The Cochrane Library, and Excerpta Medica database (EMBASE) databases from 2006 to August 2023. This research targeted all clinical studies involving adults who underwent injectable collagenase and/or limited fasciectomy in the management of DD. Out of the 437 identified studies, only 53 were considered eligible for our analysis, and merely 14 met our inclusion criteria. These selected studies encompassed a total of 967 patients with 1,344 treated joints, with an average follow-up duration of 19.22 (ranging from one to 84.06) months. Within this cohort, 498 joints from 385 patients underwent LF, while 846 joints from 491 patients received CCH injections. Notably, among the 491 patients treated with CCH, 1,060 complications were reported, averaging 2.15 complications per patient, with the most common being contusion/bruising/hematoma/ecchymosis (22.54%), and edema/swelling (18.96%). In contrast, among the 385 patients treated with LF, only 97 complications were reported, translating to 0.25 complications per patient, with the most frequent being paraesthesia or numbness (23.7%), scar sequelae like skin laceration, tear, fissure, or hypertrophic scar (23.7%), and neuropraxia or nerve injury (22.6%). Our meta-analysis indicates that paraesthesia or numbness is more frequently observed in LF than CCH injections, although without statistical significance, with a risk ratio (RR) of 0.39 (95% confidence interval (CI) 0.13-1.18, p-value 0.1). However, scar sequelae (hypertrophic scar, skin laceration, tear, or fissure) show a contrasting pattern, being more commonly associated with CCH injections than LF, with an RR of 1.98 (95% CI 0.26-14.85, p-value 0.51), which, upon eliminating the source of heterogeneity, becomes statistically significant, with an RR of 4.98 (95% CI 1.40-17.72, p-value 0.01). Our data revealed a higher frequency of complications with CCH compared to LF, although more severe adverse effects were observed in the LF group, such as neuropraxia or nerve injury. Scar sequelae were more common with CCH injections. Despite both treatments showing increased patient satisfaction at the final follow-up, CCH injection resulted in earlier improvements in satisfaction.
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Affiliation(s)
- Zainah A Alhebshi
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Aya O Bamuqabel
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Zainab Alqurain
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Dana Dahlan
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Hanan I Wasaya
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Ziyad S Al Saedi
- College of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Gutaybah S Alqarni
- College of Medicine, Faculty of Medicine, University of Jeddah, Jeddah, SAU
| | - Danah Alqarni
- College of Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Bayan Ghalimah
- Department of Orthopaedic Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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13
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Gordon AM, Nian PP, Miller C, Schwartz JM, Choueka J. Comparison of Patient Demographics, Utilization Trends, and Costs of Treatment for Dupuytren's Disease in the United States From 2012 to 2019. Ann Plast Surg 2023; 91:547-552. [PMID: 37624871 DOI: 10.1097/sap.0000000000003665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Dupuytren's disease is a fibroproliferative disorder of the palm leading to flexion deformities of the digits that impair hand function. Studies have evaluated treatment trends for patients with Dupuytren's disease; however, most conclude in 2012 shortly after collagenase clostridium histolyticum (CCH) injection was introduced to the market. It is unknown how provider preferences have been influenced since its introduction. We aimed to compare treatment options with regard to (1) patient demographics, (2) annual utilization rates, and (3) costs. METHODS The PearlDiver nationwide administrative claims database from 2012 to 2019 was analyzed for patients diagnosed with Dupuytren's disease (N = 47,813). Patients receiving procedural treatment were identified using codes for percutaneous needle aponeurotomy (PNA) (current procedural terminology [CPT] 26040), open fasciotomy (CPT 26045), open fasciectomy (CPT 26121, 26123, 26125), and CCH injection (CPT 20527). Fasciectomies were further analyzed by examining the number of patients receiving release of 1 or more digits (CPT 26123, 26125) versus palmar-only surgery (CPT 26121). Outcomes included comparing patient comorbidities comprising the Elixhauser Comorbidity Index (ECI), frequencies of each procedure annually, and costs. Linear regressions evaluated changes in utilization over time. Analysis of variance compared costs. P values less than 0.05 were significant. RESULTS Patient demographics for each treatment differed with respect to age, sex, and the presence of multiple comorbidities comprising the ECI. Open fasciectomy (60.7%) was the predominant treatment, followed by CCH injection (22.9%), PNA (10.1%), and open fasciotomy (6.3%) ( P < 0.001). Multiple patient comorbidities comprising the ECI differed for each treatment. Relative to total annual procedures from 2012 to 2019, PNA declined (10.2% to 9.5%, P = 0.037), open fasciotomy declined (6.8% to 5.6%, P = 0.007), palmar fasciectomy remained constant (14.5% to 14.2%, P = 0.710), fasciectomy of digits increased (46.3% to 47.5%, P = 0.030), and CCH injection remained constant (22.2% to 23.3%, P = 0.623). Day of procedure costs were significantly different for PNA ($573), open fasciotomy ($1176), palmar open fasciectomy ($1410), open fasciectomy digits ($1560), and CCH injection ($1250) ( P < 0.001). CONCLUSIONS The overall annual Dupuytren's disease treatment did not change over time. Treatment with open fasciectomy continues to be preferred. Collagenase clostridium histolyticum utilization has remained constant since its introduction. This study may assist hand surgeons in educating patients on the treatment and costs related to Dupuytren's disease.
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Affiliation(s)
| | | | - Chaim Miller
- From the Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Jake M Schwartz
- From the Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Jack Choueka
- From the Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY
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14
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Wang Z, Wang Z, Yan Z, Xu Z, Gao A. Smoking, alcohol consumption and risk of Dupuytren's disease: a Mendelian randomization study. BMC Med Genomics 2023; 16:212. [PMID: 37679690 PMCID: PMC10483747 DOI: 10.1186/s12920-023-01650-4] [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: 06/26/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The correlation between smoking and alcohol consumption and the development of Dupuytren's disease (DD) has been acknowledged. However, the definitive causal relationship between these two factors and DD remains elusive. In order to establish a causal connection, we employed the two-sample Mendelian randomization method to evaluate the relationship between smoking and alcohol consumption and DD. METHODS Based on publicly available genome-wide association studies (GWAS), two-sample univariate MR analyses were performed to assess the causal effects of drinks per week, cigarettes per day, smoking initiation, age of initiation, and smoking cessation on DD. We used inverse variance weighted (IVW) to generate the primary results for the MR analysis. Furthermore, we performed sensitivity MR analyses based on various methods to assess the robustness of estimations. Bidirectional MR analyses were used to study the interaction between smoking and alcohol consumption. Multivariate MR analyses were used to obtain independent causal effects of smoking or drinking on DD. RESULTS Our two-sample MR, which was predominately based on IVW, revealed a causal relationship between drinks per week and DD (OR = 2.948, 95%CI: 1.746-4.975, P = 5.16E-05). In addition, there is no causal association between cigarettes per day, smoking initiation, age of initiation, smoking cessation and DD. Similar conclusions were reached by other MR methods. The results of the bidirectional MR analyses showed that the causal relationships between age of initiation and drinks per week were robust and significant. Multivariate MR results indicated that the causal effect of alcohol consumption on DD was independent of smoking. CONCLUSION Our Mendelian Randomization study indicated that there is a causality between drinking alcohol and DD, but no such causality was found between smoking and DD. This is the first study to prove that drinking alcohol could cause DD. This could help people who are trying to prevent DD from happening in the first place.
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Affiliation(s)
- Zifeng Wang
- Department of Orthopedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214000, China
- Department of Orthopedics, Taicang Shaxi People's Hospital, Taicang, 215400, China
| | - Zhenyu Wang
- Department of Orthopedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214000, China
| | - Zijian Yan
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zhujie Xu
- Department of Orthopedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214000, China.
| | - Aiguo Gao
- Department of Orthopedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214000, China.
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15
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Nagarkar P, Jain NS, Barr ML, Tang C, Lee D, Chang I, Delong MR, Benhaim P. Assessing the Effect of Time from Injection of Collagenase to Manipulation on Success Rates in Dupuytren Disease. J Hand Surg Am 2023:S0363-5023(23)00390-8. [PMID: 37610395 DOI: 10.1016/j.jhsa.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/09/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Dupuytren disease can be managed with an injection of collagenase Clostridium histolyticum enzyme followed by manual manipulation. Although the recommended time from injection to manipulation is 24-72 hours, patient and physician schedules may not accommodate this time frame. Therefore, we sought to study the impact of time from injection to manipulation on outcomes and complications of collagenase injection. METHODS We performed a review of 309 patients who underwent an injection of collagenase Clostridium histolyticum for Dupuytren disease with manipulation at two, five, or seven days after injection. We compared preinjection and postinjection contracture angles as well as frequency of skin tears and tendon ruptures. RESULTS Of the 309 patients, 207 underwent manipulation at two days, 32 at five days, and 70 at seven days. Patients had similar preinjection contracture angles. All patients demonstrated improvement in contracture after manipulation. Rates of skin tears and tendon ruptures were similar in all three groups. Significant predictors of complications included number of cords injected and history of previous collagenase injection, but not history of previous Dupuytren diagnosis. CONCLUSIONS Although collagenase injection for Dupuytren disease is typically performed with plans for manipulation at 24-72 hours, postinjection manipulation could be performed as late as seven days without adversely affecting the frequency of skin and tendon complications. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Purushottam Nagarkar
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nirbhay S Jain
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA
| | - Meaghan L Barr
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA
| | - Cathy Tang
- Division of Plastic and Reconstructive Surgery, University of California, Irvine, CA
| | - Dong Lee
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA
| | - Irene Chang
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Michael R Delong
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA
| | - Prosper Benhaim
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA; Department of Orthopaedic Surgery, University of California, Los Angeles, CA.
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16
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Reyntiens P, Vanhoenacker FM, Jager T. Tardigrade and Manifold Sign: Two New Signs in Dupuytren's Disease. Semin Musculoskelet Radiol 2023; 27:381-392. [PMID: 37230137 DOI: 10.1055/s-0043-1764287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Dupuytren's disease (DD) is a chronic benign fibroproliferative disorder of the palmar and digital fasciae. It is characterized by formation of nodules and fibrous cords that may eventually lead to contractures with permanent flexion of the finger joints. Correction of the flexion contractures in advanced disease is still performed by open limited fasciectomy; ultrasonography (US)-guided minimally invasive treatment is preferred for early disease.We provide an overview of the detailed anatomy of the palmar aponeurosis and the structures that may be involved in DD. Although magnetic resonance imaging is used as the gold standard, these small anatomical structures are often better visible on US. We describe two new morphological signs due to thickening of these small structures in patients with DD: the tardigrade sign and the manifold sign. Familiarity with detailed imaging anatomy and these new imaging signs of DD will help confirm a correct and early diagnosis and distinguish this disease from various other entities.
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Affiliation(s)
- Pieter Reyntiens
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, ASZ, Aalst, Belgium
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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17
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Ågren R, Patil S, Zhou X, Sahlholm K, Pääbo S, Zeberg H. Major Genetic Risk Factors for Dupuytren's Disease Are Inherited From Neandertals. Mol Biol Evol 2023; 40:msad130. [PMID: 37315093 DOI: 10.1093/molbev/msad130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Dupuytren's disease is characterized by fingers becoming permanently bent in a flexed position. Whereas people of African ancestry are rarely afflicted by Dupuytren's disease, up to ∼30% of men over 60 years suffer from this condition in northern Europe. Here, we meta-analyze 3 biobanks comprising 7,871 cases and 645,880 controls and find 61 genome-wide significant variants associated with Dupuytren's disease. We show that 3 of the 61 loci harbor alleles of Neandertal origin, including the second and third most strongly associated ones (P = 6.4 × 10-132 and P = 9.2 × 10-69, respectively). For the most strongly associated Neandertal variant, we identify EPDR1 as the causal gene. Dupuytren's disease is an example of how admixture with Neandertals has shaped regional differences in disease prevalence.
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Affiliation(s)
- Richard Ågren
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Snehal Patil
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Xiang Zhou
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Kristoffer Sahlholm
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Integrative Medical Biology, Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Svante Pääbo
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
- Human Evolutionary Genomics Unit, Okinawa Institute of Science and Technology, Okinawa, Japan
| | - Hugo Zeberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
- Human Evolutionary Genomics Unit, Okinawa Institute of Science and Technology, Okinawa, Japan
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18
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Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach. Plast Reconstr Surg 2023; 151:255e-266e. [PMID: 36696321 DOI: 10.1097/prs.0000000000009849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patients with Dupuytren contracture can receive a variety of surgical and nonsurgical treatments. The extent to which patients participate in the shared decision-making process is unclear. METHODS An explanatory-sequential mixed-methods study was conducted. Participants completed the Nine-Item Shared Decision-Making Questionnaire and the brief Michigan Hand Outcomes Questionnaire before completing semi-structured interviews in which they described their experience with selecting treatment. RESULTS Thirty participants [25 men (83%) and five women (17%); mean age, 69 years (range, 51 to 84 years)] received treatment for Dupuytren contracture (11 collagenase injection, six needle aponeurotomy, and 13 limited fasciectomy). Adjusted mean scores for the Shared Decision-Making Questionnaire and brief Michigan Hand Outcomes Questionnaire were 71 (SD 20) and 77 (SD 16), respectively, indicating a high degree of shared decision-making and satisfaction. Patients who received limited fasciectomy accepted invasiveness and prolonged recovery time because they believed it provided a long-term solution. Patients chose needle aponeurotomy and collagenase injection because the treatments were perceived as safer and more convenient and permitted rapid return to daily activities, which was particularly valued by patients who were employed or had bilateral contractures. CONCLUSIONS Physicians should help patients choose a treatment that aligns with the patient's preferences for long-term versus short-term results, recovery period and postoperative rehabilitation, and risk of complications, because patients used this information to assist in their treatment selection. Areas of improvement for shared decision-making include equal presentation of all treatments and ensuring realistic patient expectations regarding the chronic and recurrent nature of Dupuytren contracture regardless of treatment received.
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Daniel B, Schmid K, Zajonc H, Eisenhardt S, Dragu A, Alawi SA. Application of fibrin glue for hematoma prophylaxis in selective aponeurectomy in Dupuytren's disease. J Plast Reconstr Aesthet Surg 2023; 77:291-297. [PMID: 36610274 DOI: 10.1016/j.bjps.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/18/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Fibrin glue (FG) can be applied in several surgical procedures at wound closure to reduce postoperative complications such as hematoma formation and wound impairment. The purpose of this study is to assess these preventive surgical benefits in Dupuytren's disease of the hand. PATIENTS AND METHODS We performed a monocentric retrospective cohort study. All patients who underwent selective aponeurectomy for Dupuytren's disease between 2010 and 2020 were included. Patients were divided into two groups: either receiving or not receiving FG. The primary outcome variables were postoperative bleeding, wound healing impairment, and further pooled postoperative complications. RESULTS One hundred and thirty-three patients were included in the analysis of which 108 patients were treated with FG, while 24 did not. There was no statistically significant difference in outcomes regarding postoperative bleeding, infections, or revision surgery. However, in the group receiving FG, there was a tendency toward higher wound healing impairment (13%, p = 0.07). The FG group showed a significantly higher pooled complication rate (18.5%, p < 0.02). Complication in general increased with higher Tubiana classification and number of resected cords. Smoking tripled the risk of impaired wound, while cardiovascular comorbidities increased postoperative bleeding by the factor of 11. CONCLUSION FG did not show a preventive outcome regarding bleeding. The FG group had a tendency for a higher wound healing incidence. Smoking and arterial hypertension correlated with a higher postoperative complication rate. The overall incidence of complications was higher in the FG group. The quality of the surgical intervention as well as accurate hemostasis cannot be corrected by the application of FG.
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Affiliation(s)
- Bassem Daniel
- Department of Plastic and Hand Surgery, Faculty of Medicine, University Medical Center Freiburg, Medical Center - University of Freiburg, University of Freiburg, Breisgau, Germany
| | - Kim Schmid
- Department of Plastic and Hand Surgery, Faculty of Medicine, University Medical Center Freiburg, Medical Center - University of Freiburg, University of Freiburg, Breisgau, Germany
| | - Horst Zajonc
- Department of Plastic and Hand Surgery, Faculty of Medicine, University Medical Center Freiburg, Medical Center - University of Freiburg, University of Freiburg, Breisgau, Germany
| | - Steffen Eisenhardt
- Department of Plastic and Hand Surgery, Faculty of Medicine, University Medical Center Freiburg, Medical Center - University of Freiburg, University of Freiburg, Breisgau, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Germany
| | - Seyed Arash Alawi
- Department of Plastic and Hand Surgery, University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Germany.
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20
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Short-term efficacy and adverse effects of collagenase clostridium histolyticum injections, percutaneous needle fasciotomy and limited fasciectomy in the treatment of Dupuytren’s contracture: a network meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2022; 23:939. [PMID: 36307837 PMCID: PMC9615237 DOI: 10.1186/s12891-022-05894-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/14/2022] [Indexed: 11/24/2022] Open
Abstract
Aims Dupuytren’s contracture (DC) is a chronic debilitating fibroproliferative disorder. Common treatment options include collagenase clostridium histolyticum injections (CI), percutaneous needle fasciotomy (NF) and limited fasciectomy (LF). Superiority of one specific treatment remains controversial. This study aims to assess the short-term efficacy and safety of CI, NF, and LF for the treatment of DC. Methods We included randomized controlled trials of CI compared with placebo, NF and LF for patients with DC. PubMed, Embase and the Cochrane Library were searched from inception to August 2021. Contracture reduction rates in treated joints (within 0–5° of full extension within 30 days), relative reduction in total passive extension deficit (TPED), occurrence of one or more adverse events and number of treatment-related adverse events per patient were the outcomes of interest. The Cochrane risk-of-bias tool was employed for quality assessment of the studies. A network meta-analysis was performed using MetaXL. Results Nine studies met our inclusion criteria (n = 903). Overall, risk bias was mixed and mostly low. Short term TPED reduction achieved with LF was superior compared to CI and NF. Although CI achieved greater TPED reduction compared to NF, it was associated with the highest risk of overall adverse effects. The analyzed data was limited to a maximum three-year follow-up period and therefore insufficient for long-term outcome evaluation. Conclusions In DC, LF may be able to provide patients with severe disease, superior flexion contracture release postoperatively. CI is a valid treatment alternative to NF, however the higher risk of overall adverse effects must be considered. The quality-of-evidence is limited due to short-term follow-up periods and a lack of standardized definitions of complications and adverse events.
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Nath P, Anand AC. Extrahepatic Manifestations in Alcoholic Liver Disease. J Clin Exp Hepatol 2022; 12:1371-1383. [PMID: 36157144 PMCID: PMC9499846 DOI: 10.1016/j.jceh.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/20/2022] [Indexed: 12/12/2022] Open
Abstract
Though liver is the most commonly affected organ in patients with chronic and excessive intake of alcohol, no organ is immune to toxic effects of alcohol and patients with alcohol-related liver disease (ALD) can suffer from a wide list of extrahepatic manifestations involving gastrointestinal tract, central and peripheral nervous systems, cardio vascular system, musculo-skeletal system, disruption of nutritional status, endocrinological abnormalities, hematological abnormalities and immune dysfunction. These extrahepatic organ involvements are usually overlooked by hepatologists and physicians who are mostly focused on managing life threatening complications of ALD. As a result, there is delayed diagnosis, delay in the initiation of appropriate treatment and late referral to other specialists. Some of these manifestations are of utmost clinical importance (e.g. delirium tremans and Wernicke's encephalopathy) because an early diagnosis and treatment can lead to full recovery while delayed or no treatment can result in death. On the other hand, several extrahepatic manifestations are of prognostic significance (such as alcoholic cardiomyopathy and malignancies) in which there is an increased risk of morbidity and mortality. Hence, a clear understanding and awareness of the extrahepatic manifestations of ALD is quintessential for proper management of these patients.
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Key Words
- ACE, Angiotensin-Converting-Enzyme
- ALD, Alcohol related Liver Disease
- AUD, Alcohol Use Disorder
- GAVE, Gastric Antral Vascular Ectasia
- GERD, Gastro-Esophageal Reflux Disease
- HCC, Hepatocellular Carcinoma
- HIV, Human Immunodeficiency Virus
- IARC, International Agency for Research on Cancer
- IL, Interleukin
- NERD, Non-Erosive Reflux Disease
- PPI, Proton Pump Inhibitors
- TNF, Tumour Necrosis Factor
- UGI, Upper Gastrointestinal
- WHO, World Health Organization
- alcohol use disorder
- alcohol withdrawal syndrome
- alcoholic cardiomyopathy
- alcoholic liver disease
- alcoholic myopathy
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Affiliation(s)
- Preetam Nath
- Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, 751024, India
| | - Anil C. Anand
- Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, 751024, India
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Kondrup F, Gaudreault N, Venne G. The Deep Fascia and its Role in Chronic Pain & Pathological Conditions: A Review. Clin Anat 2022; 35:649-659. [PMID: 35417568 DOI: 10.1002/ca.23882] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The deep fascia is a three-dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings. MATERIALS AND METHODS A state-of-the-art review was conducted in PubMed and Google Scholar following a two-stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy. RESULTS We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra-cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro-inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical. CONCLUSIONS The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.
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Affiliation(s)
- Flemming Kondrup
- Department of Anatomy & Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nathaly Gaudreault
- School of rehabilitation, Faculty of medicine and health sciences, University of Sherbrooke, Sherbrooke, Canada
| | - Gabriel Venne
- Department of Anatomy & Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.,Institute of Health Science Education, Faculty of Medicine, McGill University, Montreal, Canada
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Xu R, Qian Z, Wu J, Liu J, Ren L, Ren L. Noninvasive in vivo study on the morphology and mechanical properties of palmar aponeurosis. J Biomech 2022; 135:111027. [DOI: 10.1016/j.jbiomech.2022.111027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 10/19/2022]
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Taheri P, Salek N, Mousavi M, Maghroori R. The Effect of Shock Wave Therapy on Improving the Symptoms and Function of Patients with Dupuytren's Contracture. Adv Biomed Res 2022; 11:3. [PMID: 35284349 PMCID: PMC8906085 DOI: 10.4103/abr.abr_155_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/28/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the effect of shock wave therapy on the improvement of symptoms and function of patients with Dupuytren's contracture. MATERIALS AND METHODS This research is a pre-post intervention study, conducted among patients referred to the physical medicine clinics of Isfahan during 2019-2020. In this study, subjects experienced shock wave therapy for 6 sessions, each in a week, and improvement of symptoms and function were assessed and compared after the period of study and follow-up (before treatment, 6 weeks after treatment, and 14 weeks after treatment). The pain visual analog scale and disabilities of the arm shoulder and hand questionnaire were completed for all patients at the mentioned time, and the finger contraction angle was also measured by a goniometer over these intervals. RESULTS Twenty patients, 11 (55%) men and 9 (45%) women participated in the study. The mean and standard deviation of their age was 66.6 ± 7.11 years. The trend of pain severity of patients was continuously and significantly decreasing up to 14 weeks, which implies the effectiveness of the intervention (P < 0.05). Moreover, the patients' functional status improved due to the continuation of the intervention, and its trend was decreasing up to 14 weeks (P < 0.05). As for the contraction angle, there was a continuous and significant decreasing trend until week 14, and the intervention was also effective on the contraction angle (P < 0.05). CONCLUSION It can be concluded that shock wave therapy can be effective in improving the symptoms and function of patients with Dupuytren's Contracture.
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Affiliation(s)
- Parisa Taheri
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Najmeh Salek
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Mousavi
- Rheumatology Division, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Maghroori
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Razieh Maghroori, Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Russell MC. An Overview of Dupuytren's Disease for Perioperative Nurses. AORN J 2021; 115:65-78. [PMID: 34958472 DOI: 10.1002/aorn.13574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022]
Abstract
Dupuytren's disease is a fibroproliferative condition that causes shortening, thickening, and fibrosis of the palmar fascia and a flexion deformity of metacarpophalangeal and proximal interphalangeal joints. Although the etiology is unknown, a variety of risk factors, such as age greater than 50 years, male sex, family history, or tobacco and alcohol use may lead to disease development. At the present time there is no cure and symptoms may recur; however, surgical procedures (eg, limited fasciectomy) and nonsurgical treatment (eg, needle aponeurotomy, injection of collagenase clostridium histolyticum) can help patients manage the disease's symptoms. Patients may experience wound-healing complications after fasciectomy and skin fissures after needle aponeurotomy. Recurrence rates for needle aponeurotomy and collagenase clostridium histolyticum injection are similar. Perioperative nurses should provide individualized patient care during procedures, participate in effective team communication regarding patient needs, and provide patient education throughout the perioperative continuum.
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Ruettermann M, Hermann RM, Khatib-Chahidi K, Werker PMN. Dupuytren's Disease–Etiology and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:781-788. [PMID: 34702442 DOI: 10.3238/arztebl.m2021.0325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The worldwide prevalence of Dupuytren's disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and Embase. RESULTS Genetic factors account for 80% of the factors involved in causing this disease. Diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools are also associated with it. Limited fasciectomy is the most common treatment and is considered the reference standard. Possible complications include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6 -39.1% for all complications taken together. The recurrence rate at 5 years is 12-73%. Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy. 85% of patients have a recurrence after an average of 2.3 years. Radiotherapy can be given before contractures arise in patients with high familial risk, or postoperatively in selected patients with a very high individual risk of recurrence. CONCLUSION Although DD is not curable, good treatments are available. Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment. When counseling patients about the available treatment options, particularly the modalities and timing of surgery, the physician must take the patient's degree of suffering into account. Nowadays, fast recovery from surgery and less postoperative pain are a priority for many patients. Different surgical methods can be used in combination. It remains difficult to predict the natural course and the time to postoperative recurrence in individual patients; these matters should be addressed in future studies.
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