Treatment of Severe Dupuytren Disease in Two Steps: Progressive Distraction With External Fixator and Percutaneous Needle Fasciotomy

Abstract

Purpose

Severe Dupuytren disease (DD) remains a surgical challenge. Several minimally invasive treatment methods exist, including the use of a distractible angular external fixator (DAEF) followed by collagenase injection. The purpose of this study was to investigate the combination of DAEF followed by percutaneous needle fasciotomy (PNF) in patients with advanced stage of DD.

Methods

This prospective observational study evaluated the outcomes of 52 patients (56 DAEF implanted) with DD in stages III–IV according to the Tubiana classification, who underwent progressive extension on the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints through the application of DAEF followed by PNF in the palm and proximal phalangeal volar side. A postoperative splint was applied. Patients were evaluated at 1-year follow-up by measuring the angle of extension deficit, pain, and the Disability of the Arm, Shoulder, and Hand (DASH) score.

Results

The distraction lasted 21.9 ± 3.8 days (minimum 16 days, maximum 29 days). Considering the average pretreatment deficit (MP 94° ± 29°, PIP 67° ± 28°), a statistically significant improvement in PIP joint extension was observed after the DAEF treatment (MP 90° ± 28°, PIP 12° ± 19°) and of the MP joint extension after the PNF procedure (MP 29° ± 21°, PIP 11° ± 18°). The DAEF distraction was not painful (numeric rating scale 1.6 ± 1.2). The correction angle achieved was maintained at the 1-year postprocedure follow-up (MP 11° ± 12°, PIP 12° ± 15°). Compared with the average pretreatment DASH score (80.2 ± 11.7 points), a statistically significant improvement was found at 6 months (9.7 ± 6.7 points). No complications were reported.

Conclusions

Progressive distraction with DAEF followed by PNF was effective in patients with advanced-stage DD.

Type of study/level of evidence

Therapeutic IV.