[Dupuytren's contracture: percutaneous needle aponeurotomy is an alternative to surgery].
Dupuytren's contracture is a retractile fibrosis of the superficial palmar aponeurosis of the hand, resulting in a progressive and fixed flexion of the fingers that may result in severe limitation of hand function. It affects several millions of people in Europe and North America. Risk factors are genetic and sometimes related to mellitus diabetes. There is no spontaneous remission. Until recently, surgery was the only treatment, but now needle aponeurotomy emerges as a therapeutic alternative. It should be performed as first line treatment by a trained practitioner. Short and long-term results of needle aponeurotomy appear identical to those of surgery, with milder complications. It is indicated in palmar, palmo-digital, as well as in strictly digital forms of the disorder. The "table-test" is used to assess the loss of extension of the digit and to select the indication to needle aponeurotomy. A medico-surgical consensus should define the optimum treatment strategy in this affection.
Manet
M-P
MP
Service de rhumatologie et médecine interne, groupe hospitalier Diaconnesses, croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. mpmanet@hopital-dcss.org
Roulot
E
E
Teyssedou
J-P
JP
Lahalle
S
S
Ziza
J-M
JM
D048909:Diabetes Complications / Q000453:epidemiology; D004387:Dupuytren Contracture / Q000453:epidemiology / Q000601:surgery*; D005060:Europe / Q000453:epidemiology; D000071938:Fasciotomy; D006801:Humans; D026301:Manipulation, Osteopathic; D019060:Minimally Invasive Surgical Procedures; D009339:Needles; D009656:North America / Q000453:epidemiology; D018579:Patient Selection; D012307:Risk Factors; D018667:Tilt-Table Test; D016896:Treatment Outcome