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Liu D, Grisdela P, Zhang D, Dyer G, Blazar P, Earp B. Utility of Routine Pathologic Examination for Fasciectomy for Dupuytren Contracture. J Hand Surg Am 2023; 48:1273.e1-1273.e5. [PMID: 35933252 DOI: 10.1016/j.jhsa.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/03/2022] [Accepted: 04/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to examine the routine pathologic examination of surgical specimens obtained during fasciectomy for Dupuytren contracture. METHODS A total of 376 consecutive patients who underwent surgical limited fasciectomy with the excised tissue sent for histopathologic evaluation were identified. Patients were excluded for miscoded procedures, cases where no tissue was sent for pathologic review, and excisions of nodules only. Repeat surgeries in the same patient during the study period were excluded. The rates of concordant, discrepant, and discordant diagnoses were reported. Discrepant diagnoses were defined as different clinical diagnosis and pathologic diagnosis that did not change clinical management. Discordant diagnoses were defined as a different clinical diagnosis and a pathologic diagnosis that altered the treatment plan. The reference standard for final clinical decision-making was the pathologic diagnosis. RESULTS The prevalence of concordant diagnoses was 97.1% (365 of 376), of discrepant diagnoses was 2.9% (11 of 376), and there were no discordant diagnoses. Of 376 patients, 43 underwent previous surgical fasciectomy before the study surgery, and pathologic examination was obtained in 10 of these patients. All 10 patients had concordant diagnoses. CONCLUSIONS Our results suggest that routine pathologic examination did not alter the future treatment plan for patients who underwent limited fasciectomy. Discrepant diagnoses were encountered infrequently, and rarely in the setting of revision fasciectomy. Discordant diagnoses did not occur. Given the cost associated with pathologic evaluation, this raises the question of whether routine pathologic evaluation is necessary for Dupuytren surgery, where the capability of the treating surgeon to make a clinical diagnosis accurately may render confirmatory pathologic assessment redundant. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- David Liu
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Philip Grisdela
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - George Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Brandon Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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2
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Grüner JS, Cai A, Pingel I, Horch RE, Beier JP, Arkudas A. Prospective analysis of grip strength and load distribution after surgical treatment of common diseases of the hand with novel's manugraphy ® system. Arch Orthop Trauma Surg 2023; 143:6477-6485. [PMID: 37486446 PMCID: PMC10491509 DOI: 10.1007/s00402-023-04984-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Carpal tunnel syndrome, A1 annular pulley stenosis and Dupuytren's contracture are among the most common conditions of the hand. In this study, we investigated the impact of surgical procedure on hand grip strength and high-resolution spatial load distribution in individuals suffering from those diseases over a follow-up period of one year. MATERIALS AND METHODS In this prospective study, data of 9 patients with carpal tunnel syndrome, 12 patients with A1 annular pulley stenosis and 7 patients with Dupuytren's contracture were evaluated. Only patients with unilateral disease were included providing the contralateral hand as an intra-individual control. Grip strength was measured with cylindrical instruments in two different sizes with respect to the hand size of the patients. Maximum and average values of grip strength as well as spatial load distribution in each finger, thenar, hypothenar and palm were analyzed. Data of the affected patients were collected preoperatively and 6 weeks, 6 months and 1 year postoperatively. Grip strength and spatial load distribution were compared preoperatively to postoperatively. In addition, DASH score, Levine score, 2-point discrimination and degree of flexion contracture were assessed. RESULTS The patients with A1 annular pulley stenosis showed a significant increase in grip strength 6 months and one year postoperatively. Patients with carpal tunnel syndrome and Dupuytren's contracture showed no significant difference in grip strength over the course of time. An increase in the percentual grip strength of the thenar in patients with carpal tunnel disease and within the affected finger in A1 annular pulley stenosis was observed over the course of time. The DASH score was significantly lower in all patient cohorts one year postoperatively. CONCLUSION Surgical procedure in carpal tunnel syndrome, A1 annular ligament stenosis and Dupuytren's contracture improves the functionality of the hand in everyday life. Some areas of the hand seem to compensate other weaker areas in grip strength.
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Affiliation(s)
- Jasmin S Grüner
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg FAU, Krankenhausstr 12, 91054, Erlangen, Germany.
| | - Aijia Cai
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg FAU, Krankenhausstr 12, 91054, Erlangen, Germany
| | - Isabel Pingel
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg FAU, Krankenhausstr 12, 91054, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg FAU, Krankenhausstr 12, 91054, Erlangen, Germany
| | - Justus P Beier
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg FAU, Krankenhausstr 12, 91054, Erlangen, Germany
- Department of Plastic Surgery and Hand Surgery - Burn Center, University Hospital RWTH, Aachen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg FAU, Krankenhausstr 12, 91054, Erlangen, Germany
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3
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Qiu B, Hammert W, Wilbur D. External Fixation Prior to Fasciectomy Leads to Substantial Improvement of Advanced Dupuytren's PIP Contractures at Mean Follow-up 15 Months. Hand (N Y) 2023:15589447231175512. [PMID: 37269101 DOI: 10.1177/15589447231175512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The Digit Widget is an external fixation device that can be used to reverse proximal interphalangeal joint (PIPJ) contractures in the hand. Our hypothesis is that usage of the Digit Widget prior to fasciectomy in patients with severe Dupuytren's proximal interphalangeal (PIP) contractures will result in short-term improvement and maintenance of the PIPJ contracture after fasciectomy. METHODS Patients who underwent placement of the Digit Widget soft tissue distractor prior to fasciectomy for Dupuytren's disease were identified between January 2015 and December 2018. Multiple fingers were considered separately. Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), Pain Interference, and Depression scores were collected. Patients treated for contractures from etiologies other than Dupuytren's were not included. Multiple linear regression was used to compare initial PIP contractures, PF scores, and final contractures. RESULTS There were 28 fingers in 24 patients with average age of 56 ± 12 (30.5-69.9) years. Initial mean PIPJ contracture was 81° (50°-120°), which had corrected to 23° at time of removal. Average time between application and fasciectomy was 58 (28-112) days. At final follow-up, average 449 (58-1641) days, the average contracture was 39° (0°-105°). Contracture immediately following fasciectomy was found to be strongly correlated with the contracture at final follow-up. There was no statistical relationship between final PROMIS PF scores and final change in contracture. CONCLUSIONS Digit Widget external fixation is an effective treatment for the correction of advanced PIPJ contractures related to Dupuytren's disease, with an average of 52% improvement in contracture at 15 months.
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Affiliation(s)
- Bowen Qiu
- University of Rochester Medical Center, NY, USA
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4
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Cárdenas-León CG, Mäemets-Allas K, Klaas M, Maasalu K, Jaks V. Proteomic Analysis of Dupuytren's Contracture-Derived Sweat Glands Revealed the Synthesis of Connective Tissue Growth Factor and Initiation of Epithelial-Mesenchymal Transition as Major Pathogenetic Events. Int J Mol Sci 2023; 24. [PMID: 36674597 DOI: 10.3390/ijms24021081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Dupuytren's contracture (DC) is a chronic and progressive fibroproliferative disorder restricted to the palmar fascia of the hands. Previously, we discovered the presence of high levels of connective tissue growth factor in sweat glands in the vicinity of DC nodules and hypothesized that sweat glands have an important role in the formation of DC lesions. Here, we shed light on the role of sweat glands in the DC pathogenesis by proteomic analysis and immunofluorescence microscopy. We demonstrated that a fraction of sweat gland epithelium underwent epithelial-mesenchymal transition illustrated by negative regulation of E-cadherin. We hypothesized that the increase in connective tissue growth factor expression in DC sweat glands has both autocrine and paracrine effects in sustaining the DC formation and inducing pathological changes in DC-associated sweat glands.
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5
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Denkler KA, Cheng J, Song S, Hansen S. Botulinum toxin as an adjunct for severe Dupuytren's contracture treated with collagenase injections. Arch Clin Cases 2022; 9:133-135. [PMID: 36628168 PMCID: PMC9769080 DOI: 10.22551/2022.37.0904.10218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Even with Dupuytren's proximal interphalangeal joint (PIPJ) contractures successfully released, volar flexor muscle memory can contribute to persistent contracture. We report using botulinum toxin (BoNTA) to the flexor digitorum superficialis muscle (FDS) to reduce flexor tone during recovery. Case Description. Two Collagenase clostridium histolyticum (CCH) injections were given to a patient with a -90° (PIPJ) contracture and a -35° degree distal interphalangeal joint (DIPJ) contracture. At the first CCH injection, 20 μ total of the Botulinum toxin was placed into the FDS muscle. Manipulation occurred at one week. A second injection of CCH followed by manipulation one week later occurred at two months, but no additional BoNTA was given. The final follow-up measurements at 53 months showed a PIPJ of -30° and a DIPJ of 0°. Total active motion improved from 140° to 240°. Outcomes of any treatment for severe Dupuytren's PIPJ contractures of the little finger are unpredictable and are often considered for staged external expansion or even salvage procedures. BoNTA injections weaken flexor tone in tendon repairs and for treating hypertonic muscles after strokes. Conclusion. We hypothesized that BoNTA injection could enhance the outcomes of DC treatment by inhibiting volar flexion forces during the recovery phase. The following case illustrates that using a BoNTA injection may have helped treat a severe PIPJ contracture. BoNTA injections need further research and controlled clinical trials to discover their proper role in Dupuytren's contractures treated via CCH injections, fasciotomies, and fasciectomies.
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Affiliation(s)
- Keith A. Denkler
- Correspondence: Keith A. Denkler, Plastic and Reconstructive Surgery Clinic, University of California, 350 Parnassus Ave Suite 509, San Francisco, CA 94143, USA.
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van den Berg C, van der Zwaard B, Halperin J, van der Heijden B. Factors associated with conversion to surgical release after a steroid injection in patients with a trigger finger. Bone Joint J 2022; 104-B:1142-1147. [PMID: 36177636 DOI: 10.1302/0301-620x.104b10.bjj-2022-0058.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this retrospective study was to evaluate the rate of conversion to surgical release after a steroid injection in patients with a trigger finger, and to analyze which patient- and trigger finger-related factors affect the outcome of an injection. METHODS The medical records of 500 patients (754 fingers) treated for one or more trigger fingers with a steroid injection or with surgical release, between 1 January 2016 and 1 April 2020 with a follow-up of 12 months, were analyzed. Conversion to surgical release was recorded as an unsuccessful treatment after an injection. The effect of patient- and trigger finger-related characteristics on the outcome of an injection was assessed using stepwise manual backward multivariate logistic regression analysis. RESULTS Treatment with an injection was unsuccessful in 230 fingers (37.9%). Female sex (odds ratio (OR) 1.87 (95% confidence interval (CI) 1.21 to 2.88)), Quinnell stage IV (OR 16.01 (95% CI 1.66 to 154.0)), heavy physical work (OR 1.60 (95% CI 0.96 to 2.67)), a third steroid injection (OR 2.02 (95% CI 1.06 to 3.88)), and having carpal tunnel syndrome (OR 1.59 (95% CI 0.98 to 2.59)) were associated with a higher risk of conversion to surgical release. In contrast, an older age (OR 0.98 (95% CI 0.96 to 0.99)), smoking (OR 0.39 (95% CI 0.24 to 0.64)), and polypharmacy (OR 0.39, CI 0.12 to 1.12) were associated with a lower risk of conversion. The regression model predicted 15.6% of the variance found for the outcome of the injection treatment (R2 > 0.25). CONCLUSION Factors associated with a worse outcome following a steroid injection were identified and should be considered when choosing the treatment of a trigger finger. In women with a trigger finger, the choice of treatment should take into account whether there are also one or more patient- or trigger-related factors that increase the risk of conversion to surgery.Cite this article: Bone Joint J 2022;104-B(10):1142-1147.
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Affiliation(s)
- Catherine van den Berg
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Babette van der Zwaard
- Department of Orthopedic Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Joni Halperin
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands.,Department of Plastic and Reconstructive Surgery and Hand Surgery, UMC Utrecht, GA Utrecht, the Netherlands
| | - Brigitte van der Heijden
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands.,Department of Plastic and Reconstructive Surgery and Hand Surgery, Radboudumc, Nijmegen, the Netherlands
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7
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Samulenas G, Insodaite R, Kunceviciene E, Poceviciute R, Masionyte L, Zitkeviciute U, Pilipaityte L, Smalinskiene A. The Role of Functional Polymorphisms in the Extracellular Matrix Modulation-Related Genes on Dupuytren's Contracture. Genes (Basel) 2022; 13:743. [PMID: 35627129 PMCID: PMC9141853 DOI: 10.3390/genes13050743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: genetic variations, localized in the functional regions of the extracellular matrix (ECM) modulation-related genes, may alter the transcription process and impact the Dupuytren's contracture (DC). The present study investigated the association of single nucleotide polymorphisms (SNPs), localized in the functional regions of the MMP8, MMP14, and CHST6 genes, with DC risk. (2) Methods: we enrolled 219 genomic DNA samples, which were extracted from 116 patients with DC and 103 healthy controls. Genotyping of selected SNPs was performed using TaqMan single nucleotide polymorphisms genotyping assay. Three polymorphisms (MMP8 rs11225395, MMP14 rs1042704, and CHST6 rs977987) were analyzed. All studied SNPs were in Hardy-Weinberg equilibrium. (3) Results: significant associations of the studied SNPs with the previous onset of the disease were observed between the CHST6 rs977987 minor T allele (p = 0.036) and the MMP14 rs1042704 mutant AA genotype (p = 0.024). Significant associations with the previous onset of the disease were also observed with a positive family history of the DC (p = 0.035). Moreover, risk factor analysis revealed that a combination of major disease risk factors (smoking and manual labor) and the MMP14 minor A allele increases the risk of DC development by fourteen times (p = 0.010). (4) Conclusions: our findings suggest that CHST6 rs977987, MMP14 rs1042704, and positive family history are associated with the previous onset of Dupuytren's contracture. In addition, the combination of the MMP14 minor A allele and additional risk factors increase the likelihood of the manifestation of the DC.
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Affiliation(s)
- Gediminas Samulenas
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, LT 50009 Kaunas, Lithuania; (G.S.); (L.P.)
| | - Ruta Insodaite
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
| | - Edita Kunceviciene
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
| | - Roberta Poceviciute
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
| | - Lorena Masionyte
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
| | - Urte Zitkeviciute
- Faculty of Medicine, Lithuanian University of Health Sciences, LT 44307 Kaunas, Lithuania;
| | - Loreta Pilipaityte
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, LT 50009 Kaunas, Lithuania; (G.S.); (L.P.)
| | - Alina Smalinskiene
- Institute of Biology Systems and Genetics Research, Lithuanian University of Health Sciences, LT 50103 Kaunas, Lithuania; (E.K.); (R.P.); (L.M.); (A.S.)
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Abstract
This study aimed to determine the association between the echogenicity of Dupuytren's disease nodules and myofibroblast load, and between echogenicity and nodule hardness. Thirty-eight nodules were assessed sonographically. The echogenicity of nodules was measured objectively with Image J (grey-value) and subjectively by visual inspection (hypo-, mixed and hyper-echogenicity). These findings were compared with myofibroblast load measured by histopathological analysis. In a different cohort, 97 nodules were assessed for grey-value and nodule hardness using a tonometer. There was a moderate, significant, negative association between grey-value and myofibroblast load and the subjective visual measurements corresponded to this finding. There was also a moderate, significant, negative association between grey-value and nodule hardness. Ultrasound and tonometry may be useful in the selection of patients for possible future preventive treatments.
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Affiliation(s)
- Sanne Molenkamp
- Department of Plastic Surgery, University of Groningen, Groningen, The Netherlands,S. Molenkamp, Department of Plastic Surgery, UMCG, BB81, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Whangzao Song
- Department of Pathology, University of Groningen, Groningen, The Netherlands
| | | | - Dieuwke C. Broekstra
- Department of Plastic Surgery, University of Groningen, Groningen, The Netherlands
| | - Paul M. N. Werker
- Department of Plastic Surgery, University of Groningen, Groningen, The Netherlands
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9
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Fitzpatrick AV, Moltaji S, Ramji M, Martin S. Systematic Review Comparing Cost Analyses of Fasciectomy, Needle Aponeurotomy, and Collagenase Injection for Treatment of Dupuytren's Contracture: Une analyse de coûts systématique comparant la fasciectomie, l'aponévrotomie percutanée à l'aiguille et l'injection de collagénase pou traiter la maladie de Dupuytren. Plast Surg (Oakv) 2021; 29:257-264. [PMID: 34760842 DOI: 10.1177/2292550320963111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Surgeons now have a variety of treatment options for Dupuytren's contracture including traditional partial fasciectomy (PF), percutaneous needle aponeurotomy (PNA), and collagenase Clostridium histolyticum (CCH) injection. An important factor in clinical decision making is the cost-effectiveness of the various modalities, as will be discussed in this article. Methods A literature search was performed by 2 independent reviewers. A total of 14 articles and 3 abstracts met inclusion criteria. Papers were excluded for non-English language, insufficient breakdown of costs by treatment type, promotional materials, or works-in-progress. Cost data were extracted and subsequently converted to US dollars. Weighted means were used to objectively pool data that were sufficiently similar in methodology and population. Results Seven observational cohort studies were pooled and found to have a weighted mean cost in favour of PNA at US$3335 per patient as compared to CCH at US$3673.14 and PF at US$4734.14. Two expected-value decision analysis models were in agreement that PF is not cost-effective, but they differed on whether PNA or CCH was the most cost-effective strategy. Two cost minimization studies agreed that CCH was less costly than PF by US$486. One cost-benefit analysis found no significant cost benefit to CCH or PF, but found significant indirect benefit to CCH. Overall 10 of 17 studies found CCH to be superior with respect to direct cost, indirect cost, or both. Only 2 of the 17 studies found PF to be the most cost-effective method. Of the 7 studies that considered PNA, 4 found it to be lowest cost. Conclusion The vast majority of studies found PF to be the most costly treatment modality; however, it is still the treatment of choice in certain clinical scenarios. It is difficult to compare CCH to PNA, as many studies did not consider PNA. More studies, especially considering indirect costs, are required to be able to accurately determine which method is most cost-effective.
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Affiliation(s)
| | - Syena Moltaji
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Maleka Ramji
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Division of Plastic Surgery, Department of Surgery, University of Calgary, Alberta, Canada
| | - Stuart Martin
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Dias J, Arundel C, Tharmanathan P, Keding A, Welch C, Corbacho B, Armaou M, Leighton P, Bainbridge C, Craigen M, Flett L, Gascoyne S, Hewitt C, James E, James S, Johnson N, Jones J, Knowlson C, Radia P, Torgerson D, Warwick D, Watson M. Dupuytren's interventions surgery versus collagenase (DISC) trial: study protocol for a pragmatic, two-arm parallel-group, non-inferiority randomised controlled trial. Trials 2021; 22:671. [PMID: 34593024 PMCID: PMC8481756 DOI: 10.1186/s13063-021-05595-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Dupuytren’s contracture is a fibro-proliferative disease of the hands affecting over 2 million UK adults, particularly the white, male population. Surgery is the traditional treatment; however, recent studies have indicated that an alternative to surgery—collagenase clostridium histolyticum (collagenase)—is better than a placebo in the treatment of Dupuytren’s contracture. There is however no robust randomised controlled trial that provides a definitive answer on the clinical effectiveness of collagenase compared with limited fasciectomy surgery. Dupuytren’s intervention surgery vs collagenase trial (DISC) trial was therefore designed to fill this evidence gap. Methods/design The DISC trial is a multi-centre pragmatic two-arm parallel-group, randomised controlled trial. Participants will be assigned 1:1 to receive either collagenase injection or surgery (limited fasciectomy). We aim to recruit 710 adult participants with Dupuytren’s contracture. Potential participants will be identified in primary and secondary care, screened by a delegated clinician and if eligible and consenting, baseline data will be collected and randomisation completed. The primary outcome will be the self-reported patient evaluation measure assessed 1 year after treatment. Secondary outcome measures include the Unité Rhumatologique des Affections de la Main Scale, the Michigan Hand Questionnaire, EQ-5D-5L, resource use, further procedures, complications, recurrence, total active movement and extension deficit, and time to return to function. Given the limited evidence comparing recurrence rates following collagenase injection and limited fasciectomy, and the importance of a return to function as soon as possible for patients, the associated measures for each will be prioritised to allow treatment effectiveness in the context of these key elements to be assessed. An economic evaluation will assess the cost-effectiveness of treatments, and a qualitative sub-study will assess participants’ experiences and preferences of the treatments. Discussion The DISC trial is the first randomised controlled trial, to our knowledge, to investigate the clinical and cost-effectiveness of collagenase compared to limited fasciectomy surgery for patients with Dupuytren’s contracture. Trial registration Clinical.Trials.gov ISRCTN18254597. Registered on April 11, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05595-w.
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Affiliation(s)
- Joseph Dias
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Ada Keding
- York Trials Unit, University of York, York, UK
| | | | | | - Maria Armaou
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | - Lydia Flett
- York Trials Unit, University of York, York, UK
| | | | | | - Elaine James
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Nick Johnson
- University Hospitals of Leicester NHS Trust, Leicester, UK.,University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - Judy Jones
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Priya Radia
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Hirase T, Suresh R, Cotton MO, Han A, Burn MB, Harris JD, Liberman SR. Percutaneous Needle Fasciotomy versus Collagenase Injection for Dupuytren's Contracture: A Systematic Review of Comparative Studies. J Hand Microsurg 2021; 13:150-156. [PMID: 34511831 DOI: 10.1055/s-0040-1721876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction The purpose of this study was to review and compare clinical outcomes between percutaneous needle fasciotomy (PNF) and collagenase Clostridium histolyticum (CCH) injection for the treatment of Dupuytren's contracture. Materials and Methods A systematic review was performed including all level I-III evidence studies investigating the clinical outcomes of PNF and CCH injection in the treatment of Dupuytren's contracture. Results Five studies (278 CCH patients, 225 PNF patients; 285 CCH fingers, 246 PNF fingers, 405 males, and 98 females) were analyzed. Two randomized studies were level I evidence, one randomized study was level II, and two nonrandomized studies were level III. Two studies analyzed a total of 205 patients, each demonstrating statistically superior outcomes in one outcome measure (contracture improvement and Michigan Hand Questionnaire (MHQ) satisfaction subscore) with PNF, while the remaining three studies demonstrated no significant differences in outcomes between the two techniques. Three studies reported a statistically higher rate of minor complications (local pain, edema, ecchymosis, lymphadenopathy, pruritis) with CCH, while the remaining two studies demonstrated no significant difference in complication rates. Conclusion For the treatment of Dupuytren's contracture, there is some evidence that suggests superior clinical outcomes of PNF compared with CCH and a higher minor complication rate with CCH.
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Affiliation(s)
- Takashi Hirase
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Rishi Suresh
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Michael O Cotton
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Alex Han
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Matthew B Burn
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Shari R Liberman
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
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Ciernik IF, Goldschmidt P, Wösle M, Winter J. Feasibility of aponeurectomy in combination with perioperative 192Ir high dose rate brachytherapy for Dupuytren's disease. Strahlenther Onkol 2021; 197:903-8. [PMID: 34491382 DOI: 10.1007/s00066-021-01801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Partial aponeurectomy (PA) is a standard procedure for Dupuytren's contracture (DC). Here we report a novel approach using surgery combined with perioperative high dose rate (192Ir-HDR) brachytherapy. METHODS AND PATIENTS From March 2018 until February 2020, thirteen rays of 6 patients with Dupyutren's contractures underwent PA followed by HDR brachytherapy. After removal of fibrous tissue and mobilization of the tendons, one to three catheters per patient were placed intraoperatively. Immediately after surgery, a planning computer tomography with 3D-planning was performed. Then 10-12 Gy were given to 0-2 mm from the catheters' surface and the catheters were removed 6-12 h after brachytherapy. RESULTS No complications were observed. The mean contractures were reduced from 55.4° (standard error SE 19.6) to 15.4° (SE 6.7; p < 0.01). One patient showed progressive fibrosis of a nontreated ray during follow-up. CONCLUSIONS HDR brachytherapy in combination with surgery is feasible and harbors the potential for combined modality therapy to reduce relapse rates of advanced or relapsing DC. Controlled studies are warranted to investigate the role of bimodal therapy compared with PA alone.
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13
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Forget NJ, Higgins J, Rivard M, Harris PG. Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture. J Hand Ther 2021; 33:305-313. [PMID: 31492480 DOI: 10.1016/j.jht.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a cross-sectional clinical measurement. INTRODUCTION There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities. PURPOSE OF THE STUDY The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO. METHODS The development process involved consultation of 45 individuals with DC and 7 health professionals, existing literature, and DC-specific PRO. RESULTS The DIF-CHUM is composed of 2 sections: section 1, Activity and Participation includes 8 items per hand, scored on Difficulty and Change scales; section 2, General Impact includes up to 18 items, scored on Difficulty, Importance, Change and Satisfaction scales. Preliminary evidence suggests that the DIF-CHUM demonstrates good content validity. DISCUSSION The DIF-CHUM is designed to be a patient-centered measure of Activity and Participation and Functional Competence for individuals with DC that will provide hand therapists with a unique perspective of the impact of DC on patients' lives. CONCLUSION Further validation of the DIF-CHUM, including its scoring, is under way.
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Affiliation(s)
- Nancy J Forget
- Public Health PhD Program, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
| | - Johanne Higgins
- School of Rehabilitation, University of Montreal, Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Michèle Rivard
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Public Health Research Institute, University of Montreal, Montreal, Quebec, Canada
| | - Patrick G Harris
- Plastic Surgery Service, Department of Surgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Samulėnas G, Smalinskienė A, Rimdeika R, Braziulis K, Fomkinas M, Paškevičius R. Evaluation of WNT Signaling Pathway Gene Variants WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 in Patients with Dupuytren's Contracture. Genes (Basel) 2021; 12:1293. [PMID: 34573275 DOI: 10.3390/genes12091293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Dupuytren’s contracture (DC) represents a chronic fibroproliferative pathology of the palmar aponeurosis, which leads to flexion contractures of finger joints and hand disability. In recent decades, the WNT signaling pathway has been revealed to play a significant role in the manifestation and pathogenesis of DC. Our study aimed to evaluate the associations between Dupuytren’s contracture and WNT-related single-nucleotide polymorphisms: Wnt Family Member 7B (WNT7B) rs6519955 (G/T), Secreted Frizzled Related Protein 4 (SFRP4) rs17171229 (C/T) and R-spondin 2 (RSPO2) rs611744 (A/G). We enrolled 216 patients (113 DC cases and 103 healthy controls), and DNA samples were extracted from the peripheral blood. Genotyping of WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 was performed using the Real-Time PCR System 7900HT from Applied Biosystems. WNT7B rs6519955 genotype TT carriers were found to possess a higher prevalence of DC (OR = 3.516; CI = 1.624–7.610; p = 0.001), whereas RSPO2 rs611744 genotype GG appears to reduce the likelihood of the manifestation of DC nearly twofold (OR = 0.484, CI = 0.258–0.908, p = 0.024). In conclusion, SNPs WNT7B rs6519955 and RSPO2 rs611744 are associated with the development of Dupuytren’s contracture: WNT7B rs6519955 TT genotype increases the chances by 3.5-fold, and RSPO2 rs611744 genotype GG appears to attenuate the likelihood of the manifestation of DC nearly twofold. Findings of genotype distributions among DC patients and control groups suggest that SFRP4 rs17171229 is not significantly associated with development of the disease.
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15
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Stirling PHC, Ng N, Jenkins PJ, Clement ND, Duckworth AD, McEachan JE. Hand-arm vibration and outcomes of surgery for Dupuytren's contracture. Occup Med (Lond) 2021; 71:219-222. [PMID: 34104973 DOI: 10.1093/occmed/kqab070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dupuytren's contracture was recently designated a prescribed occupational disease when it occurs in patients with previous hand-arm vibration (HAV) exposure. AIMS The aims of this study were to describe the impact of self-reported HAV exposure on upper limb function and satisfaction following surgery for Dupuytren's contracture. METHODS Paired pre- and postoperative Quick version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) and patient satisfaction questionnaires were prospectively collected from all patients undergoing surgery for Dupuytren's contracture over a 6-year period. Patients self-reported HAV exposure duration. RESULTS Results were available for 425 hands (65%) at mean 13 months postoperatively. There were 111 patients (26%) that reported HAV exposure. The prevalence of HAV exposure was significantly greater in male compared with female patients (32% versus 4%; P < 0.001). A statistically significant difference in preoperative (difference 7.47; 95% confidence interval 4.78-10.17; P < 0.001) and postoperative QuickDASH score (difference 6.78; 95% confidence interval 2.69-10.88; P < 0.001) was observed between the two groups, but difference in QuickDASH improvement was not significantly different (difference 1.76; 95% confidence interval -1.58 to 5.10; P > 0.05). No significant difference in satisfaction rate or return to work was observed between the two groups. CONCLUSIONS Previous HAV exposure influenced the pre and postoperative function in patients undergoing surgery for Dupuytren's contracture, but had no effect on satisfaction or return to work. Further prospective research will be required to determine whether the introduction of a compensatory framework will have a more profound effect on the functional outcomes of surgery.
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Affiliation(s)
- P H C Stirling
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.,Fife Virtual Hand Clinic, UK
| | - N Ng
- Fife Virtual Hand Clinic, UK
| | | | - N D Clement
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - A D Duckworth
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - J E McEachan
- Fife Virtual Hand Clinic, UK.,Queen Margaret Hospital, Dunfermline KY12 0SU, UK
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Mi S, Zhang X, Han M, Ma X, Yu Y, Shao X. Modified dynamic high-frequency ultrasound-guided needle aponeurotomy for Dupuytren's contracture. Hand Surg Rehabil 2021:S2468-1229(21)00155-9. [PMID: 34029764 DOI: 10.1016/j.hansur.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022]
Abstract
The aim of this report was to introduce the use of modified dynamic high-frequency ultrasound-guided needle aponeurotomy for Dupuytren's contracture. From January 2014 to February 2019, the technique was used in 42 consecutive patients who suffered from Dupuytren's contracture: 38 male and 4 female; mean age, 57 years (range, 32-80 years). Assessments comprised total active extension deficit and total active flexion of the fingers, active range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) score, and EQ-5D index. Recurrence was defined as ≥20° flexion contracture. Compared to the opposite hand, preoperative total active extension deficit and total active flexion were 105° ± 32° and 221° ± 33°, respectively. The mean active range of motion of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints was 42° ± 24°, 37° ± 26° and 62° ± 14°, respectively. Mean follow-up was 27 months (range, 24-35 months). There were no cases of tendon rupture or neurovascular injury. Total active extension deficit and total active flexion at the final follow-up were 17° ± 11° and 225° ± 32°, respectively. The mean active range of motion of metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints was 73° ± 28°, 89° ± 24° and 63° ± 16°, respectively. The pre- and post-operative DASH scores were 18 ± 10 and 5 ± 2, respectively. Health-related quality of life on EQ-5D index improved from 0.72 ± 0.28 pre-operatively to 0.88 ± 0.72 post-operatively (p < 0.05). Recurrence rates in the metacarpophalangeal joint and proximal interphalangeal joint were 7% and 11%, respectively. The modified dynamic high-frequency ultrasound-guided needle aponeurotomy is a safe and effective way to treat Dupuytren's contractures. Ultrasound visualization ensures that the cords can be completely transected. Dynamic ultrasound decreases the risk of iatrogenic injury to the neurovascular bundles and tendons, and decreases the recurrence rate. LEVEL OF EVIDENCE: Therapeutic study, level IV.
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Aguilella L, Pérez-Giner R, Higueras-Guerrero V, Belloch-Ramos E, Cuenca-Torres M, Juan ELS. Can collagenase effectiveness in Dupuytren's contracture be improved by using ultrasound-guided Injection? A comparative study. J Plast Surg Hand Surg 2021; 56:23-29. [PMID: 33840343 DOI: 10.1080/2000656x.2021.1901723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to compare the effectiveness of ultrasound-guided injection of collagenase Clostridium histolyticum (CCH) in patients with Dupuytren's contracture (DC), with the standard injection. We hypothesised that the ultrasound-guided Injection of CCH is more effective than the standard injection. A prospective cohorts study in patients with DC was done. We treated consecutively 47 fingers with the standard injection and 43 with the ultrasound-guided. Patients in both groups had the same inclusion criteria. The degrees of contracture of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were measured before treatment and after three months. We compared the effectiveness of each type of injection in respect to obtaining a complete finger extension and to the percentage of improvement in each finger and in each joint. With ultrasound-guided injection, complete finger extension was obtained in 54% of cases and an 81% mean percentage of correction of the finger contracture; with standard injection 49% and 77%, respectively. In the MCP joint, the mean percentage of correction was 92.5 % in the ultrasound-guided Injection group and 84% in the standard injection group. In the PIP joint, it was 75.1% in the ultrasound-guided injection group and 65.3% in the standard injection group. These results showed no statistical significance. Hand surgeons must balance the possible benefits of the ultrasound-guided injection with the complexity and resources needed to perform the technique.
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Affiliation(s)
- Luis Aguilella
- Department of Orthopaedic Surgery, Hospital Universitario de La Ribera, Alzira, Valencia, Spain
| | - Rosana Pérez-Giner
- Department of Orthopaedic Surgery, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | | | - Elena Belloch-Ramos
- Department of Radiology, Hospital Universitario de La Ribera, Alzira, Valencia, Spain
| | | | - Eva Llopis-San Juan
- Department of Radiology, Hospital Universitario de La Ribera, Alzira, Valencia, Spain
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18
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Cooper TB, Poonit K, Yao C, Jin Z, Zheng J, Yan H. The efficacies and limitations of fasciectomy and collagenase clostridium histolyticum in Dupuytren's contracture management: A meta-analysis. J Orthop Surg (Hong Kong) 2021; 28:2309499020921747. [PMID: 32484064 DOI: 10.1177/2309499020921747] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We intend to assess the efficacies and limitations of collagenase clostridium histolyticum (CCH) and fasciectomy in treating Dupuytren's contracture, and the associated complications and rate of recurrences aiming to present a treatment algorithm. METHODS A literature search within the PubMed, Web of Sciences, Cochrane Library, and EMBASE databases was performed using the combined key words 'Dupuytren, palmar aponeurosis contracture, collagenase clostridium histolyticum and fasciectomy', including all possible studies with a set of predefined inclusion and exclusion criteria. RESULTS Thirty studies were assessed for eligibility from 215 identified records. Seventeen publications satisfied the inclusion criteria including 2142 joints in 1784 patients. The mean follow-up time was 18.0 months (3-60). CONCLUSION Acceptable contractures release was obtained in both techniques. Severe complications associated with fasciectomy outrank those of CCH, whereas the low rate of recurrence favors the fasciectomy technique.
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Affiliation(s)
- Tokai B Cooper
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and YuYing Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Keshav Poonit
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and YuYing Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chenglun Yao
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and YuYing Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zeyuan Jin
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and YuYing Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingwei Zheng
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and YuYing Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hede Yan
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and YuYing Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Samulėnas G, Rimdeika R, Braziulis K, Fomkinas M, Paškevičius R. Dupuytren's Contracture: Incidence of Injury-Induced Cases and Specific Clinical Expression. ACTA ACUST UNITED AC 2020; 56:medicina56070323. [PMID: 32629785 PMCID: PMC7404801 DOI: 10.3390/medicina56070323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
Background and objectives: Dupuytren’s contracture is a chronic fibroproliferative hand disorder with a varying pattern of genetic predisposition across different regions and populations. Traumatic events have been found to have influence on the development of this illness and are likely to trigger different clinical forms of this disease. The aim of this study was to evaluate the phenomenon of development of Dupuytren’s contracture (DC) following an acute injury to the hand, and to observe the incidence and clinical diversity of such cases in daily clinical practice. Materials and Methods: We collected data of patients presenting with primary Dupuytren’s contracture in the Lithuanian population and evaluated the occurrence and clinical manifestation of this specific type of DC, arising following acute hand trauma. The diagnosis of DC was based on clinical signs and physical examination. Digit contractures were measured by goniometry, and the staging was done according to Tubiana classification. Injury-induced (injury-related) cases were identified using the “Criteria for recognition of Dupuytren’s contracture after acute injury” (established by Elliot and Ragoowansi). Results: 29 (22%) of a total of 132 cases were injury-induced DCs. Twenty-six of 29 patients in this group presented with stage I–II contractures. Duration of symptoms was 6 (SD 2.2) and 3.8 (SD 2.2) years in the injury-related and injury-unrelated DC groups, respectively. Mean age on the onset of symptoms in the injury-induced and non-injury-induced groups was 52 (SD 10.7) and 56 (SD 10.9), respectively. Patients from both groups expressed strong predisposition towards development of DC. Conclusions: Around one-fifth of patients seeking treatment for primary Dupuytren’s contracture seemed to suffer from injury-induced Dupuytren’s contracture. We noted that injury to the wrist and hand seems to trigger the development of less progressive Dupuytren’s contracture in younger age. Prospective randomized studies are required to confirm our findings.
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Affiliation(s)
- Gediminas Samulėnas
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
- Correspondence: (G.S.); (R.R.)
| | - Rytis Rimdeika
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
- Correspondence: (G.S.); (R.R.)
| | - Kęstutis Braziulis
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Eivenių str.2, LT 50009 Kaunas, Lithuania;
| | - Mantas Fomkinas
- Faculty of Medicine, Lithuanian University of Health Sciences, Eivenių str. 2, LT 50009 Kaunas, Lithuania; (M.F.); (R.P.)
| | - Rokas Paškevičius
- Faculty of Medicine, Lithuanian University of Health Sciences, Eivenių str. 2, LT 50009 Kaunas, Lithuania; (M.F.); (R.P.)
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Orenstein JM. An ultrastructural pathologist's views on fibroblasts, modified smooth muscle cells, wound healing, stenosing arteriopathies, Kawasaki disease, Dupuytren's contracture, and the stroma of carcinomas. Ultrastruct Pathol 2020; 44:2-14. [PMID: 32154752 DOI: 10.1080/01913123.2019.1704332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It wasn't until 1960 that the dense bodies of the peripheral actin arrays of fibroblasts were finally visualized, i.e., stress fibers (SFs). Mistakenly assumed that its SFs turned the fibroblast into a unique cell situated somewhere in a continuum between it and a smooth muscle cell (SMC), it was descriptively named a "myofibroblast" (MF). Automatically, spindle cells with SFs and/or smooth muscle actin by SMA IHC-staining, became MFs, although endothelial cells, pericytes, modified SMCs (mSMC), and myoepithelial cells all contain SFs. An invisible "intermediate" cell was hypothesized to exist somewhere between SMA-negative and positive fibroblasts, and named a "proto-myofibroblast". The sub-epithelial spindle cells of normal and malignant tumors of the GI, GU, and respiratory tracts are all fibroblasts with SFs. The second erroneous myofibroblast came from a 1971 rat wound healing study and its 1974 human counterpart. Updated analysis of the papers' TEMs proved that the cells are mSMCs and not fibroblasts (AKA: MFs). The pathognomonic cells of Dupuytren's contracture are mSMCs and fibroblasts and that of the stenosing arteriopathy of Kawasaki Disease and other similar arteriopathies are mSMCs. TEM remains a powerful tool.
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Okano J, Arakawa A, Ogino S, Suzuki Y. Bilateral plantar fibromatosis complicated by Dupuytren's contracture. J Surg Case Rep 2020; 2020:rjz402. [PMID: 32128110 PMCID: PMC7048903 DOI: 10.1093/jscr/rjz402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/19/2019] [Indexed: 11/12/2022] Open
Abstract
Plantar fibromatosis (PF) is a rare benign disease. Here we report bilateral PF accompanied by Dupuytren's contracture in the right palm. Magnetic resonance imaging was useful in diagnosing PF, although biopsy was needed to rule out hemangioma. As the patient had been receiving female hormone therapy since orchiectomy, there may be a possibility that estrogen accelerated the growth of PF. Local excision with a 1-cm margin was performed, followed by primary wound closure. Neither complication nor recurrence had occurred 6 months after the surgery.
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Affiliation(s)
- Junko Okano
- Department of Plastic and Reconstructive Surgery, Shiga University of Medical Science, Otsu-city, Japan
| | - Atsuhiro Arakawa
- Department of Plastic and Reconstructive Surgery, Shiga University of Medical Science, Otsu-city, Japan
| | - Shuichi Ogino
- Department of Plastic and Reconstructive Surgery, Shiga University of Medical Science, Otsu-city, Japan
| | - Yoshihisa Suzuki
- Department of Plastic and Reconstructive Surgery, Shiga University of Medical Science, Otsu-city, Japan
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Davis TRC, Tan W, Harrison EF, Hollingworth W, Karantana A, Mills N, Hepburn T, Sprange K, Duley L, Blazeby JM, Bainbridge CG, Murali SR, Montgomery AA. A randomised feasibility trial comparing needle fasciotomy with limited fasciectomy treatment for Dupuytren's contractures. Pilot Feasibility Stud 2020; 6:7. [PMID: 32021696 PMCID: PMC6993423 DOI: 10.1186/s40814-019-0546-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study is to assess the feasibility of conducting a large, multicentre randomised controlled trial (RCT) comparing needle fasciotomy with limited fasciectomy for treatment of Dupuytren’s contractures. Design The design of this study is a parallel, two-arm, multicentre, randomised feasibility trial with embedded QuinteT Recruitment Intervention. Participants Patients aged 18 years or over who were referred from primary to secondary care for treatment of a hand with Dupuytren’s contractures of one or more fingers of more than 30° at the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints and well-defined cord(s). Patients were excluded if they had undergone previous Dupuytren’s contracture surgery on the same hand. Methods Potential participants were screened for eligibility. Recruited participants randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy and followed-up for up to 6 months after treatment. Data on recruitment rates, completion of follow-up, and procedure costs were collected. Four patient reported outcome measures (PROMs) and objective outcome measures were collected before intervention and 6 weeks and 6 months afterwards. Results One hundred and fifty-three of 267 (57%) primary-care referrals for Dupuytren’s contractures met the eligibility criteria for the study. Seventy-one of the 153 (46%) agreed to participate and were randomly allocated to treatment with needle fasciotomy or limited fasciectomy. Sixty-seven of these underwent their allocated treatment, two were crossovers from limited fasciectomy to needle fasciotomy, and two (both allocated limited fasciectomy) received no treatment. Fifty-nine participants (85%) completed 6-month follow-up PROMs. Participants felt the MYMOP, PEM and URAM PROMs allowed them to better describe how their treatment affected their hand function than the DASH PROM. The estimated costs of limited fasciectomy (in an operating theatre) and needle fasciotomy (in a clinic room) were £777 and £111 respectively. Conclusion A large RCT comparing treatment of Dupuytren’s contractures by needle fasciotomy and limited fasciectomy is feasible. Data from this study will help determine the number of sites and duration of recruitment required to complete an adequately powered RCT and will assist the selection of PROMs in future studies on the treatment of Dupuytren’s contractures. (Level 1 feasibility study). Trial registration Trial registered with ISRCTN (registration number: ISRCTN11164292), date assigned - 28/08/2015.
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Affiliation(s)
- T R C Davis
- 1Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH UK
| | - W Tan
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - E F Harrison
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - W Hollingworth
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - A Karantana
- 4Centre for Evidence Based Hand Surgery, Academic Orthopaedics Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - N Mills
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - T Hepburn
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - K Sprange
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - L Duley
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - J M Blazeby
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - C G Bainbridge
- 5Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE UK
| | - S R Murali
- 6Wrightington, Wigan and Leigh NHS Foundation Trust, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP UK
| | - A A Montgomery
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
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Nagura I, Kanatani T, Harada Y, Inui A, Mifune Y, Kuroda R, Lucchina S. OPTIMAL INJECTION DEPTH FOR COLLAGENASE CLOSTRIDIUM HISTOLYTICUM DETERMINED BY ULTRASONOGRAPHY IN THE TREATMENT OF DUPUYTREN´S DISEASE. Acta Chir Plast 2020; 62:64-67. [PMID: 33685199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION A non-surgical procedure for the treatment of Dupuytrens disease is a palmar injection of Collagenase Clostridium Histolyticum to the recommended depth of “around 2-3 mm”. However, there is little supporting evidence from the literature to substantiate this. The aim of this study was to evaluate the “optimal depth” for injection of Collagenase Clostridium Histolyticum by ultrasonography for the treatment of Dupuytrens disease. MATERIAL AND METHODS A total of 43 patients were enrolled in this study. We marked the collagenase injection point on the skin above the cord before injection. We then measured the distance from the surface of the skin to the middle of the cord by ultrasonography long axis imaging and defined this as the “optimal depth”. RESULTS The average depth from the skin to the centre of the cord was 2.4 mm. The average distance from the surface of the skin to the proximal surface of the cord was 1.0 mm and the average thickness of the cord was 2.7 mm. CONCLUSION By precise measurement of individual cases utilising ultrasonography we were able to confirm that the recommendations for injection depth as provided by the supplier of Collagenase Clostridium Histolyticum (2-3 mm) were in agreement with our findings. However no objective guide was supplied as with regards to interindividual variability between patients and we suggest that the use of preliminary ultrasonography will likely provide improved outcomes.
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24
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Dutta A, Jayasinghe G, Deore S, Wahed K, Bhan K, Bakti N, Singh B. Dupuytren's Contracture - Current Concepts. J Clin Orthop Trauma 2020; 11:590-596. [PMID: 32684695 PMCID: PMC7355095 DOI: 10.1016/j.jcot.2020.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022] Open
Abstract
Dupuytren's contracture is a common condition that has the potential to be debilitating. It presents in a variety of manners and can be mild or more aggressive in its progression. There are a large number of management options currently available. In this review of the evidence, non-operative and operative management options are examined, with a consideration of post-operative rehabilitation and complications. A summary of the current concepts in the management of Dupuytren's contracture is presented.
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Affiliation(s)
| | | | | | | | | | - Nik Bakti
- East Kent University NHS Foundation Trust, UK
| | - Bijayendra Singh
- Medway NHS Foundation Trust, UK,Corresponding author. Medway Hospital, Windmill Rd, Gillingham, ME7 5NY, UK.
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25
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Moog P, Buchner L, Cerny MK, Schmauss D, Megerle K, Erne H. Analysis of recurrence and complications after percutaneous needle fasciotomy in Dupuytren's disease. Arch Orthop Trauma Surg 2019; 139:1471-1477. [PMID: 31367843 DOI: 10.1007/s00402-019-03247-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The partial aponeurectomy for treatment of Dupuytren's contracture represents the gold standard for treatment of Dupuytren's contracture. In selected cases, the alternative is the percutaneous needle fasciotomy (PNF). MATERIALS AND METHODS Between 2008 and 2018, 80 rays in 64 patients were treated using PNF. 53 patients (68 rays) were reviewed with a mean follow-up of 31 months. RESULTS The recurrence rate was 18.9%. 49 patients with 62 rays had a totally free extension intra-operatively (92.4%). There were no complications. Only one patient reported a transient dysesthesia (1.8%) in the zone of operation. 86% of all patients would undergo the treatment again, if necessary. Patients were able to return to their job in an average of 5.5 days. CONCLUSIONS PNF is reliable and relatively simple to perform compared to partial aponeurectomy. Therefore, the PNF could be seen as a serious alternative for selected cases.
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Affiliation(s)
- P Moog
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - L Buchner
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - M K Cerny
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - D Schmauss
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.,Department for Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale Di Lugano, Lugano, Switzerland
| | - K Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - H Erne
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
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26
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Abstract
PURPOSE The aim of this study was to analyze long-term results after limited fasciectomy for Dupuytren's contracture. METHODS The study included 34 patients (52 rays), with an average follow-up of 9.5 years (range: 7-13 years). Range of motion, functional status, recurrence, and complications were recorded. RESULTS Preoperative metacarpophalangeal joint (MCPJ) contracture (median: 35°, range: 0-90°) improved postoperatively to full extension in all but one patient, with no recurrence at the most recent follow-up. Preoperative proximal interphalangeal joint (PIPJ) contractures (median: 52°, range: 5-100°) were initially corrected, but recurred with time (median: 25°, range 0°-80°). Hand function was assessed using the Disabilities of the Arm, Shoulder and Hand questionnaire. Postoperative hand function improved (median: 0, range: 0-27), compared to preoperative function (median: 20, range: 0-51). Hand function worsened with time (at most recent follow-up: median: 3, range: 0-40), mainly due to PIPJ contracture recurrence, but function remained better than before surgery. CONCLUSION Limited fasciectomy is an effective treatment method for MCPJ, with full correction achievable in both the short and long term. Regarding the PIPJ, treatment outcomes seem to be multifactorial. Further clarification is required to distinguish between local recurrence and remaining contracture of the PIPJ.
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Affiliation(s)
- Marko Bergovec
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia.,2 Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Josko Jelicic
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Oljaca
- 2 Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Ranko Bilic
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
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27
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Kawano Y, Hagiwara T, Tanaka N, Nakamura T, Takeda H, Itabashi T, Furukawa M, Kikuchi K, Okuyama K. Vascular Complication after Collagenase Injection and Manipulation for Dupuytren's Contracture: A Case Report. JMA J 2019; 2:196-199. [PMID: 33615032 PMCID: PMC7889785 DOI: 10.31662/jmaj.2018-0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/19/2019] [Indexed: 11/25/2022] Open
Abstract
A case of a vascular complication after collagenase injection and manipulation for Dupuytren's contracture in a 57-year-old Japanese man is described. The patient presented with a 10-year history of worsening primary Dupuytren's contracture. The metacarpophalangeal joint of his left little finger had a flexion contracture of 40° and was treated by collagenase injection. When the patient returned to our hospital for manipulation 24 hours later, however, his left little finger was almost completely improved because he hit his finger on the car's gear lever. Then, 9 months after collagenase injection, in the first winter, he complained of a painful and pale left little finger occurring a few times a day, lasting for about 10 minutes. Now, two years after collagenase injection, the episodes of Raynaud's phenomenon remain. Although Raynaud's phenomenon after collagenase injection and manipulation for Dupuytren's contracture is considered rare, it is a complication to be noted.
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Affiliation(s)
- Yusuke Kawano
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Takeshi Hagiwara
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Nobuyuki Tanaka
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Takumi Nakamura
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Hiroki Takeda
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Tadashi Itabashi
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Mitsuru Furukawa
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Kentaro Kikuchi
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Kunimasa Okuyama
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
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28
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Patel DP, Christensen MB, Hotaling JM, Pastuszak AW. A review of inflammation and fibrosis: implications for the pathogenesis of Peyronie's disease. World J Urol 2019; 38:253-261. [PMID: 31190155 DOI: 10.1007/s00345-019-02815-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/17/2019] [Indexed: 01/07/2023] Open
Abstract
Peyronie's disease (PD) is a superficial fibrosing disorder that causes penile deformity and can interfere with sexual intercourse and reproduction, as well as diminish quality of life. While the exact mechanism of PD is still being investigated, there is likely a genetic component to the predisposition to penile plaque formation. Ultimately, however, perturbations in normal wound healing and aberrant deposition of extracellular matrix components lead to fibrotic tissue deposition. Fibrosis in PD is regulated by a complex pathway of inflammatory and fibrotic mediators. Currently there are no treatments for PD that address an underlying cause or disease progression. In this review, we provide an overview of the known inflammatory and fibrotic mediators of PD and explore the pathophysiology of other human superficial fibrosing disorders to develop further insights into PD.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Michael B Christensen
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, 30 N 1900 E, Rm # 3B420, Salt Lake City, UT, 84132, USA.
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29
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Zhou C, Zeldin Y, Baratz ME, Kathju S, Satish L. Investigating the effects of Pirfenidone on TGF-β1 stimulated non-SMAD signaling pathways in Dupuytren's disease -derived fibroblasts. BMC Musculoskelet Disord 2019; 20:135. [PMID: 30927912 PMCID: PMC6441192 DOI: 10.1186/s12891-019-2486-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/03/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dupuytren's disease (DD) is a progressive, debilitating condition of the hand that can eventually cause contractures of the affected fingers. Transforming growth factor- β1 (TGF-β1) has been reported to play a key role in DD pathology. Increased expression of TGF-β1 has shown to be the main stimulator of myofibroblast activity and in DD contractures. Pirfenidone (PFD), a small active molecule possess the ability to inhibit TGF-β1-mediated action in various fibrotic disorders. Our recent published findings show that PFD reduced TGF-β1-mediated cellular functions implicated in DD through SMAD signaling pathways. In the present study, the effect of PFD on TGF-β1-mediated non-SMAD signaling pathways were investigated in both carpal tunnel (CT) - and DD-derived fibroblasts. METHODS Fibroblasts harvested from Dupuytren's disease (DD) and carpal tunnel (CT) tissues were cultured in the presence or absence of TGF-β1 (10 ng/ml) and/or PFD (800 μg/ml). Cell lysates were analyzed using Western blots. Equal amounts of proteins were loaded to determine the phosphorylation levels of phosphatidylinositol-3 kinase (PI3K/AKT), extracellular regulated kinases (ERK1/2), p38 mitogen-activated protein kinase and Rho family related myosin light chain (MLC). RESULTS We show that the TGF-β1-induced phosphorylation of AKT was significantly decreased by the addition of PFD (800 μg/mL) in both CT- and DD-derived fibroblasts. Interestingly, there was no significant difference in the phosphorylation levels of both ERK and p38 on TGF-β1- induced cells in both CT-and DD-derived fibroblasts. But, PFD significantly decreased the TGF- β1-induced phosphorylation levels of ERK1/2 in both CT- and DD- cells. In contrast, PFD significantly decreased the basal and TGF- β1-induced phosphorylation levels of p38 in DD-derived fibroblasts. TGF- β1-induced phosphorylation levels of MLC was decreased by PFD in DD-derived fibroblasts. CONCLUSIONS These in-vitro results indicate for the first time that PFD has the potential to inhibit TGF-β1-induced non-SMAD signaling pathways in both CT- and DD-derived fibroblasts but pronounced statistically significant inhibition on all molecules was observed only in DD-derived fibroblasts. Our previous studies show that PFD can inhibit TGF-β1- induced SMAD signaling pathway proteins, namely p- SMAD2/SMAD3. These broad and complementary actions suggest PFD as a promising candidate to inhibit the TGF-β1- mediated molecular mechanisms leading to DD fibrosis.
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Affiliation(s)
- Chaoming Zhou
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Yael Zeldin
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Mark E Baratz
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Sandeep Kathju
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, 15219, USA.,Lumix Biomedical and Surgical Consulting, Pittsburgh, PA, USA
| | - Latha Satish
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, 15261, USA. .,Shriners Hospitals for Children-Cincinnati, Cincinnati, OH, 45229, USA. .,Department of Pathology and Laboratory Medicine, University of Cincinnati, 3229 Burnet Avenue, Cincinnati, OH, 45229, USA.
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30
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Abstract
We present the case of a fit and well 62-year-old male with Dupuytren's disease in the right hand who underwent percutaneous needle fasciotomy (PNF) for a moderate flexion contracture of the right little finger. 18 months later he developed a pain-free soft tissue swelling at the distal previous needling site. A fasciectomy procedure identified a cyst within the pre-tendinous cord, which was confirmed as a dermoid inclusion cyst on histological analysis. Dermoid inclusion cysts may occur in the hands at the site of penetrating trauma but we are unaware of any report of an inclusion cyst at the site of PNF surgery. We present this unique case of a dermoid inclusion cyst following percutaneous needle fasciotomy as a novel complication.
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Affiliation(s)
- Jenny Reid
- 1 Department of Plastic Surgery, St John's Hospital, Edinburgh, UK
| | - Jill Baker
- 1 Department of Plastic Surgery, St John's Hospital, Edinburgh, UK
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31
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Shchudlo NA, Stupina TA, Varsegova TN, Shchudlo MM, Kirsanova AJ, Kostin VV. [Variants of clinical course of Dupuytren's contracture and palmar aponeurosis tissue composition in patients of different age groups.]. Adv Gerontol 2019; 32:812-818. [PMID: 32145174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
For the purpose of comparative analysis of the clinical course of fascial fibromatosis and tissue composition of the palmar aponeurosis in patients of different age groups сase reports and histological surgical material from 179 Dupuytren's contracture patients treated in 2014-2018 were analyzed. Patients were distributed in age groups: the 1st - younger than 50 years, the 2nd - 50-65 years, the 3rd - over 65 years old. In all groups four variants of Dupuytren's contracture clinical course were noted: swift, fast, benign and deffered. The rates of third-fourth levels of contracture in age groups were 50, 54 and 76% respectively. In groups 2 and 3 the volume per cents of hyperplastic connective tissue and adipocytes in palmar aponeurosis were decreased though body mass indexes were increased in comparison with group 1 (p<0,005). The signs of fat tissue vascularity and perivascular inflammatory infiltration were most pronounced in group 1, in group 3 per cent of vessels with adventitial fibrosis was significantly increased. The obtained data may be used for age-oriented treatment protocols and individual prognosis of fascial fibromatosis recurrence and spread.
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Affiliation(s)
- N A Shchudlo
- G.A.Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopaedics», 6 M.Ulyanovoi str., Kurgan 640014, Russian Federation, e-mail:
| | - T A Stupina
- G.A.Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopaedics», 6 M.Ulyanovoi str., Kurgan 640014, Russian Federation, e-mail:
| | - T N Varsegova
- G.A.Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopaedics», 6 M.Ulyanovoi str., Kurgan 640014, Russian Federation, e-mail:
| | - M M Shchudlo
- G.A.Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopaedics», 6 M.Ulyanovoi str., Kurgan 640014, Russian Federation, e-mail:
| | - A J Kirsanova
- G.A.Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopaedics», 6 M.Ulyanovoi str., Kurgan 640014, Russian Federation, e-mail:
| | - V V Kostin
- G.A.Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopaedics», 6 M.Ulyanovoi str., Kurgan 640014, Russian Federation, e-mail:
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32
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Sefton AK, Smith BJ, Stewart DA. Cost Comparison of Collagenase Clostridium Histolyticum and Fasciectomy for Treatment of Dupuytren's Contracture in the Australian Health System. J Hand Surg Asian Pac Vol 2018; 23:336-341. [PMID: 30282551 DOI: 10.1142/s2424835518500327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dupuytren's disease results in contracted cords in the hand that lead to deformity and disability. Current treatment options include fasciectomy and an injectable, collagenase clostridium histolyticum. No cost comparison studies have been published within the Australian health care environment. METHODS A retrospective review of all patients treated for Dupuytren's disease in a major teaching hospital was undertaken to compare the costs of treatment by fasciectomy or collagenase injection. RESULTS Eighteen patients underwent fasciectomy and 21 collagenase clostridium histolyticum injections were performed during the study period and were eligible for inclusion under the review criteria. Of the 39 patients, 36 were male and 3 were female with an average age 66.4 years (50-85). Twenty-five digits were treated by fasciectomy in 18 patients, and 23 digits were treated by collagenase in 21 patients. The fasciectomy group attended an average 9.2 visits (5-22), incurring an average costing of US$5738.12 per patient ($3181.18-$9618.10). The collagenase group attended an average 3.8 visits (3-8), incurring an average costing of US$2076.83 per patient ($1842.24-$3929.57). CONCLUSIONS Collagenase treatment of Dupuytren's contracture represents a significant reduction in cost relative to fasciectomy, with 64% savings, length of follow up and number of visits. This is a similar finding to studies in other countries.
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Affiliation(s)
- Andrew K Sefton
- * Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Belinda J Smith
- * Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David A Stewart
- * Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
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33
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Poelstra R, Selles RW, Slijper HP, van der Oest MJ, Feitz R, Hovius SE, Porsius JT. Better patients' treatment experiences are associated with better postoperative results in Dupuytren's disease. J Hand Surg Eur Vol 2018; 43:848-854. [PMID: 29911473 PMCID: PMC6139991 DOI: 10.1177/1753193418780187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This prospective study investigates the extent to which a better experience with healthcare delivery is associated with better postoperative treatment outcomes after surgery for Dupuytren's contracture. Patients undergoing limited fasciectomy or percutaneous needle fasciotomy for Dupuytren's contractures completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery, together with a patient reported experience measure, while hand therapists assessed the straightness of the finger with a goniometer. Regression analyses were used to examine associations. We found that a better experience with healthcare delivery was associated with better patient-reported outcomes, while association with residual extension deficit was minimal. Strongest associations were seen with communication of the physician, postoperative care and information about the treatment. Experience with the treatment explained up to 12% of the variance in treatment outcome. These findings suggest that patient reported treatment outcomes in Dupuytren's disease can be improved by improving the treatment context. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ralph Poelstra
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands,Department of Rehabilitation
Medicine, Erasmus University Medical Centre, Rotterdam, The
Netherlands,Ralph Poelstra, Department of
Plastic, Reconstructive and Hand Surgery, Erasmus University Medical
Centre, Room EE 15.91b, Dr. Molewaterplein 50, 3015 GE Rotterdam, The
Netherlands.
| | - Ruud W. Selles
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Department of Rehabilitation
Medicine, Erasmus University Medical Centre, Rotterdam, The
Netherlands
| | - Harm P. Slijper
- Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands
| | - Mark J.W. van der Oest
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands,Department of Rehabilitation
Medicine, Erasmus University Medical Centre, Rotterdam, The
Netherlands
| | - Reinier Feitz
- Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands
| | - Steven E.R. Hovius
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands
| | - Jarry T. Porsius
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands,Department of Rehabilitation
Medicine, Erasmus University Medical Centre, Rotterdam, The
Netherlands
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Shchudlo N, Varsegova T, Stupina T, Dolganova T, Shchudlo M, Shihaleva N, Kostin V. Assessment of palmar subcutaneous tissue vascularization in patients with Dupuytren’s contracture. World J Orthop 2018; 9:130-137. [PMID: 30254969 PMCID: PMC6153130 DOI: 10.5312/wjo.v9.i9.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the structural and functional characteristics of palmar hypodermal tissue vascularization in Dupuytren’s contracture patients of different age groups.
METHODS Eighty-seven Dupuytren’s contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old (Y-group, n = 22); the others were 55 and older (O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.
RESULTS Frequency of cases with rapid development of contracture (less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels (more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.
CONCLUSION Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.
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Affiliation(s)
- Nathalia Shchudlo
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Tatyana Varsegova
- Laboratory of Morphology of Federal State Budget Institution, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Tatyana Stupina
- Laboratory of Morphology of Federal State Budget Institution, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Tamara Dolganova
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Michael Shchudlo
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Nathalia Shihaleva
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
| | - Vadim Kostin
- Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
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Abstract
Aims Dupuytren's contracture is a benign, myoproliferative condition affecting the palmar fascia that results in progressive contractures of the fingers. Despite increased knowledge of the cellular and connective tissue changes involved, neither a cure nor an optimum form of treatment exists. The aim of this systematic review was to summarize the best available evidence on the management of this condition. Materials and Methods A comprehensive database search for randomized controlled trials (RCTs) was performed until August 2017. We studied RCTs comparing open fasciectomy with percutaneous needle aponeurotomy (PNA), collagenase clostridium histolyticum (CCH) with placebo, and CCH with PNA, in addition to adjuvant treatments aiming to improve the outcome of open fasciectomy. A total of 20 studies, involving 1584 patients, were included. Results PNA tended to provide higher patient satisfaction with fewer adverse events, but had a higher rate of recurrence compared with limited fasciectomy. Although efficacious, treatment with CCH had notable recurrence rates and a high rate of transient adverse events. Recent comparative studies have shown no difference in clinical outcome between patients treated with PNA and those treated with CCH. Conclusion Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. Cite this article: Bone Joint J 2018;100-B:1138-45.
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Affiliation(s)
- E Soreide
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA and Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - M H Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - J M Denbeigh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - E A Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA and Department of Biological Sciences, Hampton University, Hampton, Virginia, USA
| | - A Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - L Nordsletten
- Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - A J van Wijnen
- Department of Orthopedic Surgery and Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - S Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
UNLABELLED Radiotherapy has been advocated as an alternative treatment in early Dupuytren's disease. We have systematically reviewed the evidence on the use of radiotherapy in Dupuytren's disease. Only six articles met a minimum set standard, five of which were retrospective cohort studies and one a randomized controlled study. A total of 770 Dupuytren's hands, nearly all with Tubiana stage 0-1 disease, were irradiated with an average 30 Gy. Disease regression ranged from 0%-56%, stability from 14%-98% and progression from 2%-86%. Salvage surgery was successful in all cases of disease progression post-radiotherapy. There were no reports of adverse wound healing problems associated with such surgery or radiotherapy-associated malignancy. On balance, radiotherapy should be considered an unproven treatment for early Dupuytren's disease due to a scarce evidence base and unknown long-term adverse effects. Well-designed randomized controlled studies are required to confirm the benefits of radiotherapy treatment. LEVEL OF EVIDENCE II.
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Affiliation(s)
- M Kadhum
- 1 St George's University of London, London, UK
| | - E Smock
- 2 Plastic and Reconstructive Surgery, St Georges Hospital NHS Trust, London, UK
| | - A Khan
- 2 Plastic and Reconstructive Surgery, St Georges Hospital NHS Trust, London, UK
| | - A Fleming
- 2 Plastic and Reconstructive Surgery, St Georges Hospital NHS Trust, London, UK
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Harrison E, Tan W, Mills N, Karantana A, Sprange K, Duley L, Elliott D, Blazeby J, Hollingworth W, Montgomery AA, Davis T. A feasibility study investigating the acceptability and design of a multicentre randomised controlled trial of needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren's contractures of the fingers (HAND-1): study protocol for a randomised controlled trial. Trials 2017; 18:392. [PMID: 28841903 PMCID: PMC5574125 DOI: 10.1186/s13063-017-2127-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dupuytren's contractures are fibrous cords under the skin of the palm of the hand. The contractures are painless but cause one or more fingers to curl into the palm, resulting in loss of function. Standard treatment within the NHS is surgery to remove (fasciectomy) or divide (fasciotomy) the contractures, and the treatment offered is frequently determined by surgeon preference. This study aims to determine the feasibility of conducting a large, multicentre randomised controlled trial to assess the clinical and cost-effectiveness of needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren's contracture. METHODS/DESIGN HAND-1 is a parallel, two-arm, multicentre, randomised feasibility trial. Eligible patients aged 18 years or over who have one or more fingers with a Dupuytren's contracture of more than 30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints, well-defined cord(s) causing contracture, and have not undergone previous surgery for Dupuytren's on the same hand will be randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy. Participants will be followed-up for up to 6 months post surgery. Feasibility outcomes include number of patients screened, consented and randomised, adherence with treatment, completion of follow-up and identification of an appropriate patient-reported outcome measure (PROM) to use as primary outcome for a main trial. Embedded qualitative research, incorporating a QuinteT Recruitment Intervention, will focus on understanding and optimising the recruitment process, and exploring patients' experiences of trial participation and the interventions. DISCUSSION This study will assess whether a large multicentre trial comparing the clinical and cost-effectiveness of needle fasciotomy and limited fasciectomy for the treatment of Dupuytren's contractures is feasible, and if so will provide data to inform its design and successful conduct. TRIAL REGISTRATION International Standard Registered Clinical/soCial sTudy Number: ISRCTN11164292 . Registered on 28 August 2015.
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Affiliation(s)
- Eleanor Harrison
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Nicola Mills
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Alexia Karantana
- Department of Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Daisy Elliott
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jane Blazeby
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - William Hollingworth
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Tim Davis
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
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38
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Abstract
INTRODUCTION Dupuytren's disease can be a challenging condition for both patients and surgeons. Injectable collagen clostridium histolyticum was approved for clinical use by the Food and Drug Administration in 2010. A number of side effects have been described. In this case report, we present a complication of a proximal phalanx fracture which occurred during attempted release post injection. To the best of our knowledge, this is the first reported case of this particular complication. CASE REPORT The patient is an 80-year-old right-hand dominant retired male with bilateral hand contractures and palmar fibromatosis. His medical history is notable for Type II diabetes mellitus and metastatic thyroid cancer. The patient underwent Xiaflex injection of the left small finger and returned 4 days later for planned release. An appreciable release of the contracture was noted; however, there was a concern for plastic deformation of the proximal phalanx as a result of the manipulation. X-rays confirmed the fracture and apex volar angulation at the base of the proximal phalanx. The fracture appeared amenable to non-operative treatment. The patient has been followed closely and has had no pain or tenderness at the fracture site and minimal swelling. X-rays at 1 week and 1 month showed maintained alignment and signs of consolidation at the fracture site. The patient is currently 4-month post-fracture, and no further intervention has been pursued. CONCLUSIONS This report represents an additional potential complication associated with the use of Xiaflex. We recommend judicious use in elderly patients with severe contractures and/or multiple comorbidities. It is important to appreciate the possibility of this complication at the time of release.
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Affiliation(s)
- Laura W Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Murphy LE, Murphy KM, Kilpatrick SM, Thompson NW. The use of Collagenase Clostridium Histolyticum in the management of Dupuytren's contracture-outcomes of a pilot study in a District General Hospital setting. Ulster Med J 2017; 86:94-8. [PMID: 29535479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Collagenase Clostridium Histolyticum (CCH) is a recognised treatment option for adult patients presenting with Dupuytren's contracture (DC). PATIENTS AND METHODS Twenty male patients with established DC were treated using CCH. The average metacarpophalangeal (MCP) joint and proximal interphalangeal joint (PIP) contractures pre-treatment were 520 (range, 0 - 750) and 350 (range, 0 - 840) respectively. The average DASH score pre-treatment was 24.2 points (range, 0 - 68.2 points). Patients were reviewed at lmonth, 3months and at an average of 23 months (17 to 27 months). RESULTS MCP joint contractures significantly improved compared to pre-treatment and the improvement was maintained at latest follow up. PIP joint contractures did significantly improve but to a lesser degree and there was no significant improvement compared to pre-treatment beyond 3months. A trend for MCP and PIP joint contracture recurrence was observed at latest follow up but did not reach statistical significance. DASH scores significantly improved from pre-treatment and the improvement was maintained at latest follow up. At 3months, the average patient satisfaction score was 9.5 (range, 6 - 10), which decreased to 8.6 (range, 6 - 10) at latest follow up. We estimated a potential cost saving of approximately £70,000 by treating 20 patients using CCH compared to inpatient operative fasciectomy. CONCLUSION CCH is a useful option in the management of DC in appropriately selected patients. Cost-effectiveness in the treatment of DC should be carefully considered.
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40
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Rodrigues JN, Zhang W, Scammell BE, Davidson D, Fullilove S, Chakrabarti I, Russell PG, Davis TRC. Recovery, responsiveness and interpretability of patient-reported outcome measures after surgery for Dupuytren's disease. J Hand Surg Eur Vol 2017; 42:301-309. [PMID: 27872343 DOI: 10.1177/1753193416677712] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This prospective cohort study investigated the responsiveness and interpretability of the Disabilities of the Arm, Shoulder and Hand (DASH) and Unité Rhumatologique des Affections de la Main (URAM) outcome measures for assessing recovery after fasciectomy and dermofasciectomy for Dupuytren's disease. DASH outcome scores at 1 year were significantly better than at 6 weeks, suggesting that recovery is not complete by 6 weeks. Of the 101 patients recruited to the DASH cohort, 71 completed preoperative, 6 week and 1 year postoperative DASH scores; 68 of them completed preoperative and 1 year postoperative DASH scores and an external anchor question. In the URAM cohort, 30/44 completed the preoperative and the 1 year postoperative URAM scores and the anchor question. The DASH score exhibited moderate responsiveness but poor interpretability on receiver operating characteristic curve analysis, such that a minimal important change could not be estimated. The URAM score showed acceptable responsiveness, and an MIC of 10.5 on receiver operating characteristic analysis. LEVEL OF EVIDENCE II.
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Affiliation(s)
- J N Rodrigues
- 1 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Zhang
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D Davidson
- 3 St John's Hospital at Howden, Livingston, UK
| | | | | | - P G Russell
- 6 Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
| | - T R C Davis
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
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41
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Khurana S, Wadhwa V, Chhabra A, Amirlak B. MRI in flexor tendon rupture after collagenase injection. Skeletal Radiol 2017; 46:237-240. [PMID: 27885382 DOI: 10.1007/s00256-016-2524-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/11/2016] [Accepted: 10/27/2016] [Indexed: 02/02/2023]
Abstract
Flexor tendon rupture is an unusual complication following collagenase injection to relieve contractures. These patients require a close follow-up and in the event of tendon rupture, a decision has to be made whether to repair the tendon or manage the complication conservatively. The authors report the utility of MRI in the prognostication and management of a patient with Dupuytren's contracture, who underwent collagenase injection and subsequently developed flexor digitorum profundus tendon rupture.
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Affiliation(s)
| | - Vibhor Wadhwa
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avneesh Chhabra
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA.,Johns Hopkins University, Baltimore, MD, USA
| | - Bardia Amirlak
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
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42
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Rodrigues JN, Zhang W, Scammell BE, Chakrabarti I, Russell PG, Fullilove S, Davidson D, Davis TRC. Functional outcome and complications following surgery for Dupuytren's disease: a multi-centre cross-sectional study. J Hand Surg Eur Vol 2017; 42:7-17. [PMID: 27474501 DOI: 10.1177/1753193416660045] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Variables associated with recurrent Dupuytren's disease, or a 'diathesis', have been investigated, but those associated with functional outcome and complications are less well studied. Outcomes 1 or 5 years after an aponeurotomy, fasciectomy or dermofasciectomy were assessed by patient interview and examination at five UK centres. A total of 432 procedures were studied. The reoperation rate did not differ at 1 year ( p = 0.396, Chi-square test with Monte Carlo simulation), but was higher after aponeurotomy in the 5-year group (30%, versus 6% after fasciectomy and 0% after dermofasciectomy, p = 0.003, Chi square test with Monte Carlo simulation). Loss of function (DASH>15) did not differ between procedures at 5 years, even when reoperation and other variables were controlled. Diabetes, female gender and previous ipsilateral surgery were associated with poorer function in logistic regression analysis. The variables associated with poor function after treatments differ from diathesis variables. Aponeurotomy had lower complication rates than fasciectomy and dermofasciectomy. This may counterbalance the former's higher recurrence rate and explain why aponeurotomy demonstrated similar long-term functional outcome compared with excisional surgery in this study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J N Rodrigues
- 1 Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK
| | - W Zhang
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - P G Russell
- 4 Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
| | | | - D Davidson
- 6 St John's Hospital at Howden, Livingston, UK
| | - T R C Davis
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
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Hirata H, Tanaka K, Sakai A, Kakinoki R, Ikegami H, Tateishi N. Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren's contracture in non-Caucasian Japanese patients (CORD-J Study): the first clinical trial in a non-Caucasian population. J Hand Surg Eur Vol 2017; 42:30-38. [PMID: 27313184 DOI: 10.1177/1753193416653249] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED To assess the efficacy, safety and pharmacokinetics of 0.58 mg collagenase Clostridium histolyticum injections for the treatment of Dupuytren's contracture in Japanese patients, we conducted a phase III, multicentre, uncontrolled, open-label clinical study in patients with Dupuytren's contracture. Of the 77 patients, 66 achieved clinical success in the primary treated joint (86%; 95% confidence interval: 76% to 93%), confirming the efficacy of collagenase Clostridium histolyticum injections. More improvement was seen in the metacarpophalangeal joints than in the proximal interphalangeal joints (94% versus 73%). The main adverse reaction was a local reaction in the injected hand. No tendon rupture or anaphylactic reactions were seen. The concentrations of collagenase Clostridium histolyticum were below the lower limit of quantification in plasma samples at all time points. As seen in global studies in Caucasian patients, a corrective effect on Dupuytren's contracture and good tolerance were observed in most non-Caucasian (Asian) Japanese patients. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- H Hirata
- 1 Department of Hand Surgery, Graduate School of Nagoya University, Nagoya, Japan
| | - K Tanaka
- 2 Department of Plastic and Reconstructive Surgery, Nagasaki University, Nagasaki, Japan
| | - A Sakai
- 3 Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - R Kakinoki
- 4 Department of Rehabilitation Medicine, Kyoto University Hospital, Kyoto, Japan.,a Current address: Department of Orthopaedic Surgery, Kindai University, Osaka, Japan
| | - H Ikegami
- 5 Department of Orthopedic Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - N Tateishi
- 6 Development Planning, Clinical Development Center, Asahi Kasei Pharma Corporation, Tokyo, Japan
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44
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Matsui Y, Kon S, Funakoshi T, Miyashita T, Matsuda T, Iwasaki N. Increased expression of αv integrin as a regulator of fibrosis in Dupuytren's nodules. J Hand Surg Eur Vol 2017; 42:18-25. [PMID: 26969686 DOI: 10.1177/1753193416635489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Although Dupuytren's contracture is characterized by increased transforming growth factor-β1 (TGF-β1) and fibrosis in the palmar fascia, the relationship between TGF-β1 and integrins, which are considered to be related to fibrosis, remains unclear. We investigated the involvement of TGF-β1 and integrins in the pathological palmar fascia of Dupuytren's contracture. Seven patients underwent partial fasciectomy for treatment of this disease. The nodule and cord were isolated from the fascial tissues of the patients. Control fasciae were obtained from seven patients with carpal tunnel syndrome. Immunohistochemical analysis was performed to detect the fibrosis marker α-smooth muscle actin and integrins in the fascial tissues. The expression of TGF-β1 and integrins was assessed by real-time polymerase chain reaction. The results suggest that nodules may be areas involved in activation of fibrosis in the fascia, associated with increased expression of TGF-β1 and αv integrin. Thus, αv integrin may contribute to fibrosis in Dupuytren's contracture by activating TGF-β1. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Y Matsui
- 1 Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Kon
- 2 Department of Immunology, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - T Funakoshi
- 1 Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Miyashita
- 2 Department of Immunology, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - T Matsuda
- 2 Department of Immunology, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - N Iwasaki
- 1 Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Zhou C, Liu F, Gallo PH, Baratz ME, Kathju S, Satish L. Anti-fibrotic action of pirfenidone in Dupuytren's disease-derived fibroblasts. BMC Musculoskelet Disord 2016; 17:469. [PMID: 27835939 PMCID: PMC5106805 DOI: 10.1186/s12891-016-1326-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/03/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dupuytren's disease (DD) is a complex fibro-proliferative disorder of the hand that is often progressive and eventually can cause contractures of the affected fingers. Transforming growth factor beta (TGF-β1) has been implicated as a key stimulator of myofibroblast activity and fascial contraction in DD. Pirfenidone (PFD) is an active small molecule shown to inhibit TGF-β1-mediated action in other fibrotic disorders. This study investigates the efficacy of PFD in vitro in inhibiting TGF-β1-mediated cellular functions leading to Dupuytren's fibrosis. METHODS Fibroblasts harvested from (DD) and carpal tunnel (CT)- tissues were treated with or without TGF-β1 and/or PFD and were subjected to cell migration, cell proliferation and cell contraction assays. ELISA; western blots and real time RT-PCR assays were performed to determine the levels of fibronectin; p-Smad2/Smad3; alpha-smooth muscle actin (α-SMA), α2 chain of type I collagen and α1 chain of type III collagen respectively. RESULTS Our results show that PFD effectively inhibits TGF-β1-induced cell migration, proliferation and cell contractile properties of both CT- and DD-derived fibroblasts. TGF-β1-induced α-SMA mRNA and protein levels were inhibited at the higher concentration of PFD (800 μg/ml). Interestingly, TGF-β1 induction of type I and type III collagens and fibronectin was inhibited by PFD in both CT- and DD- derived fibroblasts, but the effect was more prominent in DD cells. PFD down-regulated TGF-β1-induced phosphorylation of Smad2/Smad3, a key factor in the TGF-β1 signaling pathway. CONCLUSION Taken together these results suggest the PFD can potentially prevent TGF-β1-induced fibroblast to myofibroblast transformation and inhibit ECM production mainly Type I- and Type III- collagen and fibronectin in DD-derived fibroblasts. Further in-vivo studies with PFD may lead to a novel therapeutic application in preventing the progression or recurrence of Dupuytren's disease.
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Affiliation(s)
- Chaoming Zhou
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Fang Liu
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Phillip H. Gallo
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Mark E. Baratz
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261 USA
| | - Sandeep Kathju
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Latha Satish
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA USA
- Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace Street, Scaife Hall, S685.2, Pittsburgh, PA 15261 USA
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46
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Rodrigues J, Zhang W, Scammell B, Russell P, Chakrabarti I, Fullilove S, Davidson D, Davis T. Validity of the Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and the Quickdash when used in Dupuytren's disease. J Hand Surg Eur Vol 2016; 41:589-99. [PMID: 26307142 DOI: 10.1177/1753193415601350] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 07/17/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study investigated aspects of the validity and reliability of the 30-item Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and its relationship with the shorter 11-item QuickDASH in patients with Dupuytren's disease.Seven hundred and fifty-nine DASH questionnaires were studied, covering pre- and postoperative patients undergoing different treatments for Dupuytren's disease. Items related to pain rose early after treatment before returning to baseline, suggesting that studying pain is relevant during postoperative recovery. Across all 759 sets of responses, the QuickDASH agreed closely with the DASH. In exploratory factor analysis, the DASH was not unidimensional, questioning the validity of the DASH summary score in Dupuytren's disease.Further validation of existing PROMs for use in Dupuytren's disease is needed. These data suggest that pain is a relevant symptom to study during postoperative recovery following treatment for Dupuytren's disease. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - W Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - B Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - P Russell
- Pulvertaft Hand Centre, Royal Derby Hospital, Uttoxeter New Road, Derby, UK
| | | | | | - D Davidson
- St John's Hospital at Howden, Livingston, UK
| | - T Davis
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Crivello KM, Potter HG, Moon ES, Rancy SK, Wolfe SW. Does collagenase injection disrupt or digest the Dupuytren's cord: a magnetic resonance imaging study. J Hand Surg Eur Vol 2016; 41:614-20. [PMID: 26768221 DOI: 10.1177/1753193415626113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 11/01/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Collagenase clostridium histolyticum has been extensively studied as a treatment modality for Dupuytren's contracture. Its mechanism of action has been documented. It is unknown whether injected collagenase weakens the Dupuytren's cord sufficiently to cause failure during manipulation or if there is digestion and reduction in cord volume. We examined five patients with isolated contractures of the ring or middle metacarpalphalangeal (MP) joint using magnetic resonance imaging (MRI) prior to injection with collagenase and again 1 month following injection. All patients had full correction after manipulation which was maintained at follow-up. The Dupuytren's cord was evaluated with respect to volume, signal intensity, inflammatory changes and continuity. Additionally, signal intensity changes of the flexor tendons and neurovascular structures were recorded. MRI demonstrated cord discontinuity, significant reduction of cord volume and a significant increase in cord signal intensity after treatment with collagenase. There was a slight increase in flexor tendon signal intensity that was not significant. These findings suggest that there may be local chemical dissolution of the cord. Future studies may establish whether or not this will have prognostic implications in terms of correction and recurrence following collagenase injection. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- K M Crivello
- Mercer Bucks Orthopaedics, Lawrenceville, NJ, USA
| | - H G Potter
- The Hospital for Special Surgery, New York, NY, USA
| | - E S Moon
- Mt. Tam Orthopedics and Sports Medicine, Larkspur, CA, USA
| | - S K Rancy
- The Hospital for Special Surgery, New York, USA
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Rubin G, Rinott M, Wolovelsky A, Rosenberg L, Shoham Y, Rozen N. A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release. Bone Joint Res 2016; 5:175-7. [PMID: 27174554 PMCID: PMC4921045 DOI: 10.1302/2046-3758.55.bjr-2016-0072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/14/2016] [Indexed: 01/26/2023] Open
Abstract
Objectives Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren’s cords. Materials and Methods Specially prepared medical grade IBS was injected into fresh Dupuytren’s cords excised from patients undergoing surgical fasciectomy. These cords were tested by tension-loading them to failure with the Zwick 1445 (Zwick GmbH & Co. KG, Ulm, Germany) tension testing system. Results We completed a pilot concept-validation study that proved the efficacy of IBS to induce enzymatic fasciotomy in ten cords compared with control in ten cords. We then completed a dosing study with an additional 71 cords injected with IBS in descending doses from 150 mg/cc to 0.8 mg/cc. The dosing study demonstrated that the minimal effective dose of 0.5 cc of 6.25 mg/cc to 5 mg/cc could achieve cord rupture in more than 80% of cases. Conclusions These preliminary results indicate that IBS may be effective in enzymatic fasciotomy in Dupuytren’s contracture. Cite this article: Dr G. Rubin. A new bromelain-based enzyme for the release of Dupuytren’s contracture: Dupuytren’s enzymatic bromelain-based release. Bone Joint Res 2016;5:175–177. DOI: 10.1302/2046-3758.55.BJR-2016-0072.
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Affiliation(s)
- G Rubin
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - M Rinott
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - A Wolovelsky
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - L Rosenberg
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - Y Shoham
- Plastic and Reconstructive Surgery Department and Hand Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - N Rozen
- Plastic and Reconstructive Surgery Department and Hand Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Joyce CW, Joyce KM, Rahmani G, Carroll SM, Kelly JL, Regan PJ. Dupuytren's Contracture: A Bibliometric Study of the Most Cited Papers. Hand Surg 2015; 20:402-9. [PMID: 26388001 DOI: 10.1142/s0218810415500318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The literature on Dupuytren's contracture is vast yet little information is known as to which papers have been the most influential. The purpose of this study was to identify the 50 most cited papers on Dupuytren's contracture and perform a citation analysis. Utilizing the Web of Science, 23 surgical, medical, plastic and hand surgery journals were searched for papers on Dupuytren's contracture. Resulting articles were ranked in order of times cited and each paper was analyzed for article-type, year of publication, country of origin, institution and level of evidence. The 50 most cited articles represent many important landmarks in Dupuytren's treatment and contain several seminal works by experts in the field. Whilst the top 50 list highlights the important papers on the condition, they certainly do not provide information about the quality of the evidence of the research, as most papers presented level 4 or 5 evidence.
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Affiliation(s)
- Cormac Weekes Joyce
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - Kenneth Mary Joyce
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - George Rahmani
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland
| | - Sean Michael Carroll
- † Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Jack Laurence Kelly
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland.,‡ Department of Plastic, Reconstructive and Hand Surgery, National University of Ireland, Galway, Ireland
| | - Padraic James Regan
- * Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway, Ireland.,‡ Department of Plastic, Reconstructive and Hand Surgery, National University of Ireland, Galway, Ireland
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50
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Iqbal S, Iqbal R, Iqbal F. A Bitendinous Palmaris Longus: Aberrant Insertions and Its Clinical Impact - A Case Report. J Clin Diagn Res 2015; 9:AD03-5. [PMID: 26155469 DOI: 10.7860/jcdr/2015/12182.5954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/19/2015] [Indexed: 11/24/2022]
Abstract
Palmaris longus, phylogenetically a retrogressive muscle, exhibits significant anatomical variations compared to other muscles of the upper extremity. It is of great surgical importance because, it is the first option tendon for graft procedures in various cosmetic, plastic and reconstructive surgeries. It has also been widely used in various tendon transfer procedures in treating facial paralysis, ptosis correction, lip augmentation and digital pulley reconstruction. We report a rare variant pattern of Palmaris longus with duplicated tendons and with multiple insertions to thenar and hypothenar muscles, fasciae and the flexor retinaculum along with its normal continuation as palmar aponeurosis. Variations in its insertions not only contribute, but also augment the various pathological processes such as Dupuytren's contracture, Carpal tunnel and Guyon's syndromes. So it is of utmost importance for surgeons, physicians and radiologists, to be aware of these variations, well in advance.
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Affiliation(s)
- S Iqbal
- Professor, Department of Anatomy, Amala Institute of Medical Sciences , Thrissur, Kerala, India
| | - Raiz Iqbal
- Medical Under Graduate, Government Medical College , Kozhikode, Kerala, India
| | - Faiz Iqbal
- Medical Under Graduate, Government Medical College , Kozhikode, Kerala, India
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