musculoskeletal and connective tissue disorders
Dupuytren Contracture
Treatment of Dupuytren Contracture
Corticosteroid injection (before contractures develop) Surgery for disabling contractures Injection of clostridialcollagenasefor certain contractures Injection of a corticosteroid suspension into the nodule may relieve local tenderness if begun before contractures develop. However, this tenderness is self-limiting and often resolves with no intervention. If the hand cannot be placed flat on a table or, especially, when significant contracture develops at the proximal interphalangeal (PIP) joints, surgery is usually indicated. Surgical options include percutaneous needle fasciotomy, temporary application of a dynamic external fixator for PIP joint contractures, and open palmar/digital fasciectomy. For severe disease with multiple finger involvement, open surgery with excision of the diseased fascia is the best treatment; excision must be meticulous because the tissue surrounds neurovascular bundles and tendons. Incomplete excision or new disease results in recurrent contracture, especially in patients who are young at disease onset or who have a family history, Garrod pads, Peyronie disease, or plantar foot involvement. may reverse some contractures ( Treatment references , 1.Hurst LC, Badalamente MA, Hentz VR, et al: InjectablecollagenaseClostridium histolyticumfor Dupuytren's contracture.N Engl J Med361(10):968–979, 2009. doi: 10.1056/NEJMoa0810866. 2.Witthaut J, Jones G, Skrepnik N, et al: Efficacy and safety ofcollagenaseClostridium histolyticuminjection for Dupuytren contracture: Short-term results from 2 open-label studies.J Hand Surg Am38(1):2–11, 2013. doi: 10.1016/j.jhsa.2012.10.008. 3.Zhou C, Hovius SE, Slijper HP, et al:CollagenaseClostridium histolyticumversus limited fasciectomy for Dupuytren's contracture: Outcomes from a multicenter propensity score matched study.Plast Reconstr Surg136(1):87–97, 2015. doi: 10.1097/PRS.0000000000001320. 