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Background: Our main goal was to see if treatment with collagenase injection is safe and effective and to assess patient satisfaction with this new treatment.

Methods: We prospectively followed 77 consecutive patients, treated for contracture in 91 fingers and 142 joints that received total of 109 collagenase injections. The patients were reviewed on the first and second day and at 4 and 12 months. A contracture reduced to five degrees or less at 12 months after the last injection, was considered to be a successful outcome.

Results: A mean of 1.2 injections were used per patient and 0.8 injections per joint. There was a significant improvement in mean passive extension deficit. Out of the 142 joints treated, 84 (59%) met our criterion for a successful outcome; 56 (80%) out of 70 MCP joints and 28 (39%) out of 72 PIP joints. There were also significant improvements in both hand function and pain. No serious adverse events were observed. The mean patient satisfaction with the treatment at the 12-month follow up was a VAS score of 78 (0 = none; 100 = complete) and only 11% stated that they would not have consented to the treatment if they had known the outcome in advance.

Conclusions: Treatment of Dupuytren's disease with collagenase injection is both safe and effective. It is now our primary treatment for Dupuytren's disease.

Background: Collagenase Clostridium histolyticum (collagenase) is an injectable treatment option for Dupuytren disease. The current study was designed to investigate the safety and ensure the effectiveness of collagenase for the treatment of Dupuytren disease, with or without concomitant antithrombotic usage.

Methods: One hundred and forty-eight patients with Dupuytren disease were treated with collagenase during this period; 49 taking antithrombotics and 99 not taking antithrombotics. The primary outcomes were clinical success (a reduction in joint contracture to < 5°) and clinical improvement (a reduction in joint contracture by equal to or more than 50%).

Results: No statistically significant difference in either clinical success or clinical improvement was found between those taking and those not taking antithrombotics. No significant difference was found in the incidence of any adverse effects or skin splits between the two cohorts.

Conclusions: Collagenase can be safely and effectively used to treat patients with Dupuytren disease who take antithrombotics.

Background: Percutaneous needle fasciotomy (PNF) has been successfully used for the treatment of contracture bands in the hand in patients with Dupuytren disease. The aim of this study is to determine aesthetic and functional outcomes at 2 weeks following PNF in patients with Dupuytren contracture.

Methods: Seventy-five patients undergoing PNF for Dupuytren disease during a 4-month period were included. Patients completed the Visual Analogue Appearance Score (VAAS), Derriford Appearance Score (DAS), and the quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH) preoperatively and at 2 weeks after surgery. In addition, VAAS was done in the immediate postoperative period as well.

Results: Seventy-four (99%) patients completed the immediate postoperative VAAS scores and 51 (68%) completed the VAAS, DAS, and QuickDASH at 2 weeks. Preoperative VAAS fell from 6.01 to 1.53 (p < 0.0001) immediately post operation. Two weeks later, VAAS increased to 2.91 but was still significantly lower than preoperatively (p < 0.0001). DAS was unchanged. QuickDASH decreased from 22.4 preoperatively to 12.1 2 weeks later (p = 0.001).

Conclusion: PNF for Dupuytren contracture resulted in improvement in both aesthetic and functional outcomes at 2 weeks. Longer term follow-up is required to determine whether these improvements are sustained.

Level of Evidence: Level IV (Therapeutic)

Background: Collagenase clostridium histolyticum has become a widely used treatment in the management of Dupuytren disease. The aims of this study are to assess the immediate success of treatment of Dupuytren contracture with collagenase injection, to measure long-term patient-rated outcomes, to determine whether the risk factors for the disease impacted outcomes and to report complications of collagenase treatment.

Methods: A prospective study was performed in a tertiary referral centre. Measurements were recorded pre-treatment, day 1 and day 90. Patient-rated outcome scores were measured using Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Michigan Hand Questionnaire (MHQ) at minimum 36 months post-injection.

Results: The study included 45 patients with 53 hands with a mean age of 65.7 years. The treatment was successful in 62% of patients with the greatest improvement in the metacarpal-phalangeal joint of the little finger. Diabetes, epilepsy, gender, alcohol intake and positive family history had no statistically significant predictive value on successful outcomes. Patient satisfaction at 41 months was high with mean MHQ score of 97.3.

Conclusions: Collagenase is effective in the treatment of Dupuytren contracture, with disease involving the little finger showing the greatest benefit. Risk factors for development of Dupuytren disease had no effect on successful outcome and long-term satisfaction rates are high.

Level of Evidence: Level III (Therapeutic)

Pulley injuries and Dupuytren disease are quite common in rock climbing. We report a rock climber who was treated for a Dupuytren contracture with collagenase injection therapy. Two months later, he developed a traumatic pulley injury during climbing and was treated with a ring orthosis. However, the finger contracture deteriorated and both a recurrent pulley rupture and a second pulley rupture were diagnosed. We were unable to find any reports on the use of collagenase in rock climbers with Dupuytren disease. We report a case of pulley rupture in a rock climber, treated for Dupuytren contracture in the treated and an adjacent finger, 2 months after the injection of collagenase.

Level of Evidence: Level V (Therapeutic)