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Harrison S, Ogollah R, Hollingworth W, Mills N, Karantana A, Blazeby J, Montgomery A, Shafayat A, Jarrett H, Davis T. Needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren's contractures of the fingers (Hand-2): study protocol for a randomised controlled trial. Trials 2024; 25:398. [PMID: 38898458 PMCID: PMC11186219 DOI: 10.1186/s13063-024-08003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Dupuytren's contractures (DC) are fibrous cords under the skin of the hand that cause one or more fingers to curl gradually and irreversibly towards the palm. These contractures are usually painless but can cause a loss of hand function. Two treatments for Dupuytren's contractures are widely used within the National Health Service (NHS) in the UK: removal of the contractures via surgery (limited fasciectomy) and division of the contractures via a needle inserted through the skin (needle fasciotomy). This study aims to establish the clinical and cost-effectiveness of needle fasciotomy (NF) versus limited fasciectomy (LF) for the treatment of DC in the NHS, in terms of patient-reported hand function and resource utilisation. METHODS/DESIGN Hand-2 is a national multi-centre, two-arm, parallel-group randomised, non-inferiority trial. Patients will be eligible to join the trial if they are aged 18 years or older, have at least one previously untreated finger with a well-defined Dupuytren's contracture of 30° or greater that causes functional problems and is suitable for treatment with either LF or NF. Patients with a contracture of the distal interphalangeal joint only are ineligible. Eligible consenting patients will be randomised 1:1 to receive either NF or LF and will be followed up for 24 months post-treatment. A QuinteT Recruitment Intervention will be used to optimise recruitment. The primary outcome measure is the participant-reported assessment of hand function, assessed by the Hand Health Profile of the Patient Evaluation Measure (PEM) questionnaire at 12 months post-treatment. Secondary outcomes include other patient-reported measures, loss of finger movement, and cost-effectiveness, reported over the 24-month post-treatment. Embedded qualitative research will explore patient experiences and acceptability of treatment at 2 years post-surgery. DISCUSSION This study will determine whether treatment with needle fasciotomy is non-inferior to limited fasciectomy in terms of patient-reported hand function at 12 months post-treatment. TRIAL REGISTRATION International Standard Registered Clinical/soCial sTudy ISRCTN12525655. Registered on 18th September 2020.
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Affiliation(s)
- Samantha Harrison
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK.
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - William Hollingworth
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Nicola Mills
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Alexia Karantana
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - Jane Blazeby
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
- Bristol and Weston Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - Aisha Shafayat
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - Hugh Jarrett
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - Tim Davis
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
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El Naggar TEDM, Maaty AIE, Mohamed AE. Effectiveness of radial extracorporeal shock-wave therapy versus ultrasound-guided low-dose intra-articular steroid injection in improving shoulder pain, function, and range of motion in diabetic patients with shoulder adhesive capsulitis. J Shoulder Elbow Surg 2020; 29:1300-1309. [PMID: 32553435 DOI: 10.1016/j.jse.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023]
Abstract
UNLABELLED To compare the efficacy of radial extracorporeal shock-wave therapy (rESWT) vs. an ultrasound-guided low-dose intra-articular steroid injection in pain reduction and functional improvement in diabetic patients with shoulder adhesive capsulitis (AC). METHODS This was a 2-parallel-group, active-control, assessor-blinded, randomized trial. We randomized 103 diabetic patients with shoulder AC to receive either 4 sessions of rESWT, 1 week apart (rESWT group, n = 52), or a single ultrasound-guided low-dose intra-articular steroid injection of 20 mg of triamcinolone acetonide (steroid group, n = 51). The primary outcome measure was functional improvement evaluated by the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) score. Secondary outcome measures were pain evaluated by the visual analog scale score and shoulder range of motion (ROM). An assessor who was blinded to treatment assignment assessed both groups at baseline and at 4, 8, and 12 weeks thereafter. RESULTS By 12 weeks, both groups demonstrated a significant reduction in the qDASH score and pain severity, as well as improvement in ROM. However, significantly improved function (qDASH score, 40.4 ± 12.9 vs. 50.5 ± 13.3; P < .001) and shoulder pain reduction (visual analog scale score, 1.6 ± 1.2 vs. 2.8 ± 1.7; P < .001) were found in the rESWT group vs. the steroid group. Similar improvement in shoulder ROM was observed in both groups. CONCLUSION At short-term follow-up, rESWT was superior to a low-dose intra-articular steroid injection in improving function and pain in diabetic patients with shoulder AC. Therefore, rESWT might be considered a safe alternative to steroid injections in diabetic patients with shoulder AC.
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Affiliation(s)
| | - Ahmed Ibrahim Elsayed Maaty
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Aly Elsayed Mohamed
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
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Abdulsalam AJ, Shehab D, Elhady AA, Abraham M. High-energy focused extracorporeal shockwave therapy relieved pain in Dupuytren's disease: a series of seven hands. Eur J Phys Rehabil Med 2018; 55:862-864. [PMID: 30370754 DOI: 10.23736/s1973-9087.18.05498-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dupuytren's disease of the hand is characterized by progressive thickening and shortening of palmar fascia resulting in flexion deformities of the digits and hence limitation of hand function. The objective of this study was to evaluate the effectiveness of shock-wave therapy on patients with Dupuytren's disease of the hand. CASE REPORT A case series study observed a total of four patients with Dupuytren's disease of the hand. All 4 patients had diabetes. Three patients had bilateral hand involvement. Two patients had flexion deformity. High-energy focused extracorporeal shockwave therapy was applied using a Storz Duolith SD1 (2000 impulses, 3 Hz, 1.24 mJ/mm2) in 5 sessions with 7 days between. Outcome measured included pain score, tender score, hand grip, and nodule size from the Michigan Hand Outcome Questionnaire, JAMAR hand held dynamometer, and ultrasonography. Data was collected at the entry and conclusion of the study at 0 and 8 weeks. CLINICAL REHABILITATION IMPACT Significant statistical improvement was observed for pain score 8.7±0.5 vs. 2.0±0.9, P<0.001 and for tender score 8.5±0.5 vs. 2.5±0.9, P<0.009 after the therapy. Decrease in size of nodules with improvement of flexion deformity was observed in one patient who had multiple bilateral nodules. No adverse effects were noted. Extracorporeal shockwave therapy was beneficial in relieving symptoms in Dupuytren's disease of the hand.
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Affiliation(s)
| | - Dia Shehab
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Adlia A Elhady
- Department of Physical Medicine, Jahra Hospital, Al Jahra, Kuwait
| | - Mini Abraham
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Clemons TD, Bradshaw M, Toshniwal P, Chaudhari N, Stevenson AW, Lynch J, Fear M, Wood FM, Iyer KS. Coherency image analysis to quantify collagen architecture: implications in scar assessment. RSC Adv 2018; 8:9661-9669. [PMID: 35540841 PMCID: PMC9078703 DOI: 10.1039/c7ra12693j] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/27/2018] [Indexed: 11/21/2022] Open
Abstract
A novel technique for the fast and robust quantification of collagen architecture following scarring.
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Affiliation(s)
- T. D. Clemons
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
| | - M. Bradshaw
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
| | - P. Toshniwal
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
| | - N. Chaudhari
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
| | - A. W. Stevenson
- Fiona Wood Foundation and Burn Injury Research Unit
- The University of Western Australia, M318
- Crawley
- Australia
| | - J. Lynch
- Fiona Wood Foundation and Burn Injury Research Unit
- The University of Western Australia, M318
- Crawley
- Australia
- Royal College of Surgeon's of Ireland
| | - M. W. Fear
- Fiona Wood Foundation and Burn Injury Research Unit
- The University of Western Australia, M318
- Crawley
- Australia
| | - F. M. Wood
- Fiona Wood Foundation and Burn Injury Research Unit
- The University of Western Australia, M318
- Crawley
- Australia
| | - K. Swaminathan Iyer
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
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Evidence-Based Medicine: Options for Dupuytren's Contracture: Incise, Excise, and Dissolve. Plast Reconstr Surg 2017; 139:240e-255e. [PMID: 28027258 DOI: 10.1097/prs.0000000000002857] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand updates in the basic science, epidemiology, and treatment of Dupuytren's disease. 2. Understand treatment with needle aponeurotomy, collagenase, and fasciectomy. 3. Understand advanced needle techniques for Dupuytren's contracture. 4. Understand the safety and effectiveness of a new treatment, collagenase. SUMMARY The literature on Dupuytren's disease encompasses many specialties. Its treatment is generally by perforating, excising, or dissolving the affected tissues. This article reviews the changing understanding of this disease and treatment options.
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Collagenase Clostridium histolyticum in Dupuytren’s contracture: a guide to its use in the EU. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0291-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up. Burns 2015; 42:e1-e7. [PMID: 26652220 DOI: 10.1016/j.burns.2015.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/12/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis. PATIENTS AND METHODS In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire. RESULTS No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14. DISCUSSION The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring.
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Peimer CA, Blazar P, Coleman S, Kaplan FTD, Smith T, Lindau T. Dupuytren Contracture Recurrence Following Treatment With Collagenase Clostridium histolyticum (CORDLESS [Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-Year Data. J Hand Surg Am 2015; 40:1597-605. [PMID: 26096221 DOI: 10.1016/j.jhsa.2015.04.036] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study was a 5-year noninterventional follow-up study to determine long-term efficacy and safety of collagenase clostridium histolyticum (CCH) treatment for Dupuytren contracture. METHODS Patients from previous CCH clinical studies were eligible. Enrolled patients were evaluated annually for contracture and safety at 2, 3, 4, and 5 years after their first injection (0.58 mg) of CCH. In successfully treated joints (≤ 5° contracture following CCH treatment), recurrence was defined as 20° or greater worsening (relative to day 30 after the last injection) with a palpable cord or any medical/surgical intervention to correct new/worsening contracture. A post hoc analysis was also conducted using a less stringent threshold (≥ 30° worsening) for comparison with criteria historically used to assess surgical treatment. RESULTS Of 950 eligible patients, 644 enrolled (1,081 treated joints). At year 5, 47% (291 of 623) of successfully treated joints had recurrence (≥ 20° worsening)-39% (178 of 451) of metacarpophalangeal and 66% (113 of 172) of proximal interphalangeal joints. At year 5, 32% (198 of 623) of successfully treated joints had 30° or greater worsening (metacarpophalangeal 26% [119 of 451] and proximal interphalangeal 46% [79 of 172] joints). Of 105 secondary interventions performed in the successfully treated joints, 47% (49 of 105) received fasciectomy, 30% (32 of 105) received additional CCH, and 23% (24 of 105) received other interventions. One mild adverse event was attributed to CCH treatment (skin atrophy [decreased ring finger circumference from thinning of Dupuytren tissue]). Antibodies to clostridial type I and/or II collagenase were found in 93% of patients, but over the 5 years of follow-up, this did not correspond to any reported clinical adverse events. CONCLUSIONS Five years after successful CCH treatment, the overall recurrence rate of 47% was comparable with published recurrence rates after surgical treatments, with one reported long-term treatment-related adverse event. Collagenase clostridium histolyticum injection proved to be an effective and safe treatment for Dupuytren contracture. For those receiving treatment during follow-up, both CCH and fasciectomy were elected options. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Clayton A Peimer
- College of Human Medicine, Michigan State University, East Lansing, MI; UP Health System-Marquette/Duke-LifePoint, Marquette, MI.
| | - Philip Blazar
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | | | | | - Ted Smith
- Auxilium Pharmaceuticals, Inc., Chesterbrook, PA
| | - Tommy Lindau
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
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Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis. J Shoulder Elbow Surg 2014; 23:1843-1851. [PMID: 25441567 DOI: 10.1016/j.jse.2014.08.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/28/2014] [Accepted: 08/13/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of adhesive capsulitis is a dilemma for orthopaedic rehabilitation specialists. In this study, we assessed whether extracorporeal shockwave therapy (ESWT) improves the functional outcome of primary shoulder adhesive capsulitis. METHODS In this prospective, randomized, controlled, single-blind clinical trial, we enrolled 40 patients with primary adhesive capsulitis to assess whether ESWT can improve the functional outcome of primary adhesive capsulitis better than oral steroid therapy. Patients were allocated to the oral steroid group or ESWT group with randomization. Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Oxford Shoulder Score. RESULTS Both groups showed significant improvement in the Oxford Shoulder Score evaluation throughout the study period. In the ESWT group, the total CSS and range of motion (ROM) parameter of the CSS in the ESWT group showed significant improvement from the fourth week that was better than that in the steroid group; the activities–of–daily living (ADL) parameter of the CSS achieved significance and was better than that in the steroid group at the sixth week. For the steroid group, pain was significantly reduced from baseline to the fourth week of the study; ADL and ROM improved at the fourth to 12th week. For the ESWT group, ADL and ROM improvements were significant from baseline to the sixth week. CONCLUSION Our results showed that ESWT can be an alternative treatment, at least in the short-term, for primary adhesive capsulitis of the shoulder. In addition, all of the side effects of ESWT were transient and tolerable.
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Eckerdal D, Nivestam A, Dahlin LB. Surgical treatment of Dupuytren's disease - outcome and health economy in relation to smoking and diabetes. BMC Musculoskelet Disord 2014; 15:117. [PMID: 24694095 PMCID: PMC3976502 DOI: 10.1186/1471-2474-15-117] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/31/2014] [Indexed: 11/17/2022] Open
Abstract
Background The conventional treatment for Dupuytren’s disease is surgery. The introduction of alternative treatment strategies creates a need to track outcomes and costs relating to surgical treatment and risk factors, such as smoking and diabetes. This was the aim of the present study. Methods In a prospective study, the outcome of open surgical treatment for finger flexion contracture in Dupuytren’s disease (175 patients; 182 surgical procedures) was studied by evaluating valid QuickDASH forms answered by subjects before surgery and one year postoperatively. Data were also obtained from medical records, and preoperative declarations concerning health. Results In all subjects (median [25% - 75% percentiles] age 68 [62-73]), the QuickDASH score improved from 22 [9-36] to 5 [0-18]. Smokers (27/179 procedures) were younger and had a more severe degree of disease and dysfunction preoperatively than non-smokers, but the outcome of surgery did not differ between the groups. Subjects with diabetes (20/181 procedures) were younger than those without diabetes, but their disease severity or outcome did not differ. Hand specialists operated faster than residents, but the surgical outcome did not differ. Healthcare costs for surgery for Dupuytren’s contracture were $ 2392 (€ 1859), which were not higher among smokers or subjects with diabetes. Only 22 patients remained in hospital (2 [1-2.3] days) and 28 patients needed sick leave (28 [21-31] days). The occurrence of necrosis of skin flaps (12%) or infections (6%) was no more frequent among smokers or those with diabetes. Conclusions There is no difference in surgical outcome for finger flexion contracture in Dupuytren’s disease between smokers and non-smokers or between subjects with or without diabetes, although smokers had more severe preoperative contracture. The costs for surgical treatment for finger flexion contracture in Dupuytren’s disease should be viewed in relation to that for other treatment strategies.
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Affiliation(s)
| | | | - Lars B Dahlin
- Department of Clinical Sciences Malmö - Hand Surgery, Lund University and Skåne University Hospital, Malmö, Sweden.
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Zoubos AB, Stavropoulos NA, Babis GC, Mavrogenis AF, Kokkalis ZT, Soucacos PN. THE McCASH TECHNIQUE FOR DUPUYTREN'S DISEASE: OUR EXPERIENCE. ACTA ACUST UNITED AC 2014; 19:61-7. [DOI: 10.1142/s0218810414500117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study presents the clinical outcomes of 35 hands with Dupuytren's Disease treated with the McCash technique between 1990 and 2009. Of the 31 patients (28 males and three females, mean age 53 yrs), four patients had bilateral involvement (12.9%). Thirty hands had no previous medical or surgical treatment for the disease, while the remaining five hands had been operated on at least once. The mean contracture of metacarpophalangeal (MCP) joint improved from 42.14° to 1.83°, while that of the proximal interphalangeal (PIP) joint improved from 62.60° to 7.09°. All wounds healed within a mean 9.8 weeks. Sensory evaluation revealed no permanent numbness. With realistic expectations, clear documentation, meticulous surgical technique and implementation of a demanding post-operative rehabilitation program, an acceptable outcome may be achieved with the McCash technique for Dupuytren's disease.
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Affiliation(s)
- Aristides B. Zoubos
- 1st Department of Orthopaedic Surgery, Orthopaedic Research and Educational Centre (OREC), National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Haidari, Athens, Greece
| | - Nikolaos A. Stavropoulos
- 1st Department of Orthopaedic Surgery, Orthopaedic Research and Educational Centre (OREC), National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Haidari, Athens, Greece
| | - George C. Babis
- 1st Department of Orthopaedic Surgery, Orthopaedic Research and Educational Centre (OREC), National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Haidari, Athens, Greece
| | - Andreas F. Mavrogenis
- 1st Department of Orthopaedic Surgery, Orthopaedic Research and Educational Centre (OREC), National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Haidari, Athens, Greece
| | - Zinon T. Kokkalis
- 1st Department of Orthopaedic Surgery, Orthopaedic Research and Educational Centre (OREC), National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Haidari, Athens, Greece
| | - Panayotis N. Soucacos
- 1st Department of Orthopaedic Surgery, Orthopaedic Research and Educational Centre (OREC), National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Haidari, Athens, Greece
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Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren contracture: report of 40 cases. Musculoskelet Surg 2013; 98:225-32. [PMID: 24254968 DOI: 10.1007/s12306-013-0304-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/30/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Dupuytren's disease (DD) is a fibroproliferative pathology that affects the palmar aponeurosis causing the development of nodules and collagen cords and the progressive flexion of the fingers. The standard procedure is surgical fasciectomy, followed by high recurrence rates. Collagenase Clostridium histolyticum (CCH) injection represents an innovative noninvasive approach to the treatment of DD. This prospective study was designed to examine the efficacy and safety of CCH injection performed in the outpatient, using local anesthesia. MATERIALS AND METHODS Forty patients [32 metacarpophalangeal (MP), 8 proximal interphalangeal (PIP)] with Dupuytren's contracture of at least 20° for MP joint and any degree for PIP joint were included. The mean age was 66. All joints were treated with a single vial of collagenase injection and manual breaking of the cord 24 h after. All adverse effects (AEs) were monitored. Patients were checked 7, 30, 90, and 180 days after the injection. Primary endpoint was a reduction in digit contracture within 0°-5° of normal extension. Secondary endpoints were the improvement of range of motion, the evaluation of AEs incidence, and cost-effectiveness of collagenase treatment. RESULTS About 67.5 % of patients obtained a clinical success. At 6 months, a further 7.5% attained the same result. The mean contracture of treated joints was 5.3º for MP and 6.8° for PIP joints. Twenty-three patients had one or more mild-to-moderate side effects. CONCLUSIONS The use of collagenase appears to be an effective and safe method for the treatment of Dupuytren's contracture. Therapeutic success was achieved in a significant percentage of patients. The incidence of side effects was higher, but they were local reactions of short duration. The use of a single collagenase vial in patients treated in day surgery appears more cost-effective than surgery.
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