A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study.
OBJECTIVE
The demand for percutaneous needle fasciotomy (PNF) as treatment for Dupuytren's disease is increasing because of its limited invasiveness, good outcome, limited number of complications, quick recovery, and overall patient satisfaction. This randomized controlled trial was designed to test whether these short-term expectations are sound by comparing this treatment with limited fasciectomy (LF) with regard to these aspects.


METHODS
We treated 166 rays: 88 by PNF and 78 by LF. Total passive extension deficit (TPED) improvement at 1 week and at 6 weeks were the primary outcome parameters; patient satisfaction, hand-function recovery, and complication rate were secondary outcome parameters. We used the Disabilities of the Arm, Shoulder, and Hand questionnaire to measure disabilities of the upper extremity before and after treatment and all adverse effects and complications were recorded.


RESULTS
Overall TPED improvement was best at 6 weeks. In the PNF group TPED improved by 63% versus 79% in the LF group; this difference was statistically significant. Results at the proximal interphalangeal joint were worse than those at the metacarpophalangeal and distal interphalangeal joints for both the PNF and LF groups. The rays classified before surgery as Tubiana stages I and II showed no difference between these treatments, but for rays higher than stage II LF clearly was superior to PNF as a treatment modality. The rate of major complications in the LF group was 5% versus 0% in the PNF group. Patient satisfaction was almost equal but direct hand function after treatment was considered better in the PNF group, as was the degree of discomfort that patients experienced. This was underscored by the Disabilities of the Arm, Shoulder, and Hand scores in the PNF group, which were significantly lower than those in the LF group at all time points measured.


CONCLUSIONS
In the short term and in cases with a TPED of 90 degrees or less PNF is a good treatment alternative to LF for treatment of Dupuytren's disease.


METHODS
Therapeutic, Level I.
van Rijssen
Annet L
AL
Department of Plastic, Reconstructive, and Hand Surgery, Isala Clinics, Zwolle, the Netherlands.
Gerbrandy
Feike S J
FS
Ter Linden
Hein
H
Klip
Helen
H
Werker
Paul M N
PM
D004387:Dupuytren Contracture / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D020127:Recovery of Function; D016896:Treatment Outcome