title: Preliminary soft-tissue distraction versus checkrein ligament release after fasciectomy in the treatment of dupuytren proximal interphalangeal joint contractures.
abstract: BACKGROUND
  Checkrein ligament release for treatment of proximal interphalangeal joint Dupuytren contractures does not address the shortened arteries or deficient skin. The Digit Widget uses soft-tissue distraction to overcome these issues. This study compares checkrein ligament release after fasciectomy versus preliminary soft-tissue distraction, followed by operative release, for treatment of proximal interphalangeal joint Dupuytren contractures.
  
  
  METHODS
  The authors compared operative and postoperative characteristics of patients treated with either fasciectomy plus checkrein ligament release or Digit Widget distraction between 2001 and 2008. Seventeen patients (20 digits) underwent ligament release (mean contracture, 55.9 degrees); six of these 20 were reoperations. Thirteen patients (17 digits) underwent distraction (mean contracture, 67.6 degrees); 10 of 17 were reoperations.
  
  
  RESULTS
  The 20 digits treated with fasciectomy plus ligament release had an average extension improvement of 31.4 degrees (range, -4 to 70 degrees). Digits treated with distraction had an average extension improvement of 53.4 degrees (range, 30 to 75 degrees) (p<0.001 versus ligament release). Three digits treated with distraction improved to full proximal interphalangeal extension. Initial contractures of 60 degrees or less treated by ligament release (n=12) or distraction (n=7) improved by means of 28.8 degrees and 47.7 degrees, respectively (p=0.048). Contractures greater than 60 degrees treated by ligament release (n=8) or distraction (n=10) improved by means of 35.3 degrees and 57.3 degrees, respectively (p=0.02).
  
  
  CONCLUSIONS
  Soft-tissue distraction followed by operative release showed greater correction than Dupuytren fasciectomy plus checkrein ligament release.
  
  
  METHODS
  Therapeutic, III.
authors: Scottsdale, Ariz. From the Department of Surgery, the Division of Plastic and Reconstructive Surgery, and the Department of Orthopedics, Mayo Clinic.
authors: Randall O
authors: RO
authors: Craft
authors: Anthony A
authors: AA
authors: Smith
authors: Brandon
authors: B
authors: Coakley
authors: William J
authors: WJ
authors: Casey
authors: Alanna M
authors: AM
authors: Rebecca
authors: Scott F M
authors: SFM
authors: Duncan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004387:Dupuytren Contracture / Q000175:diagnosis / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D005384:Finger Joint / Q000601:surgery; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D009989:Orthotic Devices; D011182:Postoperative Care / Q000295:instrumentation; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome