External Fixation Prior to Fasciectomy Leads to Substantial Improvement of Advanced Dupuytren's PIP Contractures at Mean Follow-up 15 Months.

IF 1.8 Q2 ORTHOPEDICS HAND Pub Date : 2024-11-01 Epub Date: 2023-06-02 DOI:10.1177/15589447231175512
Bowen Qiu, Warren Hammert, Danielle Wilbur
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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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在筋膜切除术前进行外固定,可在平均随访 15 个月后显著改善晚期杜普伊特伦趾挛缩症。
背景:Digit Widget是一种外固定装置,可用于扭转手部近端指间关节(PIPJ)挛缩。我们的假设是,在对患有严重杜普伊特伦氏近端指间关节(PIP)挛缩的患者进行筋膜切除术之前使用 Digit Widget,将在短期内改善并在筋膜切除术后维持 PIPJ挛缩:在2015年1月至2018年12月期间,确定了因杜普伊特伦氏病在筋膜切除术前接受Digit Widget软组织牵引器置入术的患者。多指分别考虑。收集了患者报告结果测量信息系统(PROMIS)的身体功能(PF)、疼痛干扰和抑郁评分。除杜普伊特伦氏症外,因其他病因导致挛缩而接受治疗的患者不包括在内。采用多元线性回归比较最初的PIP挛缩、PF评分和最终的挛缩:24名患者共有28个手指,平均年龄为56±12(30.5-69.9)岁。最初的 PIPJ 平均挛缩度为 81°(50°-120°),切除时已矫正为 23°。从使用到筋膜切除的平均时间为 58(28-112)天。在最后平均 449(58-1641)天的随访中,平均挛缩度为 39°(0°-105°)。研究发现,筋膜切除术后的挛缩与最终随访时的挛缩密切相关。最终的PROMIS PF评分与最终的挛缩变化之间没有统计学关系:Digit Widget外固定是矫正杜普伊特伦氏病相关晚期PIPJ挛缩的有效治疗方法,15个月时挛缩平均改善52%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
HAND
HAND Medicine-Surgery
CiteScore
3.30
自引率
0.00%
发文量
209
期刊介绍: HAND is the official journal of the American Association for Hand Surgery and is a peer-reviewed journal featuring articles written by clinicians worldwide presenting current research and clinical work in the field of hand surgery. It features articles related to all aspects of hand and upper extremity surgery and the post operative care and rehabilitation of the hand.
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