External Screw-Threaded Traction Device Helps Optimize Finger Joint Mobility in Severe Stage III and IV Dupuytren Disease

Full-thickness skin grafting in preventing recurrence of Dupuytren's disease: A systematic review

Dupuytren's disease is a progressive hand disorder characterized by the formation of pathologic nodules and cords in the palm, often leading to progressive flexion contractures. Hand surgery is currently the only efficient treatment to restore hand function, however, reported recurrence rates vary widely. Currently, it remains unclear which type of fasciectomy is associated with the lowest recurrence rate. Therefore, a systematic review was conducted to compare recurrence rates after limited fasciectomy, open palm technique, or dermofasciectomy with a full-thickness skin graft. 79 studies were included, and results suggest that a dermofasciectomy with a full-thickness skin graft is associated with a lower recurrence rate. However, most studies were case series in which a wide range of definitions of recurrence was used. Moreover, all studies had a high risk of bias. Therefore, additional comparative clinical trials are recommended that use an unambiguous definition of recurrence. LEVEL OF EVIDENCE III: .

Continuous Passive Elongation Through an External Fixator: A Versatile and Beneficial Adjunct Technique to Treat Severe and Recurrent Cases of Dupuytren Contracture

Dupuytren disease and its associated digit contracture often negatively impact the quality of life for patients. Severe cases of Dupuytren contracture and symptom recurrence are both difficult for hand surgeons to treat. Improved treatment options are therefore needed. One method is continuous passive elongation (CPE). In CPE, a device is affixed to the digit, which applies a continuous extending force to pull the affected finger out of flexion. Multiple external fixators used to induce CPE have been reported. However, a low-profile, hand-specific external fixator, the DigiFix, provides benefits over previously reported devices. We present the technique of CPE using DigiFix as a beneficial and versatile adjunct treatment for severe and recurrent cases of Dupuytren contracture.

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.