title: Functional outcome of collagenase injections compared with fasciectomy in treatment of Dupuytren's contracture.
abstract: BACKGROUND
  This study was designed to provide comparative information on the safety and efficacy of injection with collagenase clostridium histolyticum (CCH) and fasciectomy for patients with Dupuytren's contracture (DC).
  
  
  METHODS
  A single-center, retrospective, observational, longitudinal chart review was conducted of 25 patients treated with CCH injections and 21 patients undergoing fasciectomy. Patients were assessed at 1 week, monthly for 3 months and then yearly for a minimum of 2 years after treatment for changes in contracture and range of motion, time to return to work/normal activities, patient satisfaction, and Disabilities of Arm, Shoulder and Hand (DASH) score.
  
  
  RESULTS
  Post-procedure follow-up averaged 32 months for the injection group compared with 39 months for fasciectomy group. For the CCH group, the mean postinjection contracture was 3.6° for the metacarpophalangeal and 17.5° for the proximal interphalangeal joints compared with 3.7° and 8.1° in the fasciectomy group, respectively. Patients treated with injections returned to normal activities after a mean of 1.9 days compared with 37.4 days for fasciectomy patients (p < 0.0001). DASH scores for 13 CCH and 15 fasciectomy patients were obtained. The mean DASH score was significantly lower in the injection group in the first 3 months (p < 0.01). At the 2-year follow-up visit, patients were satisfied with their outcomes following either treatment (92 % and 96 % of CCH and fasciectomy patients, respectively).
  
  
  CONCLUSIONS
  CCH injections are safe and effective and may be a viable alternative to fasciectomy for treating DC. It also allows earlier return to work and daily activities.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Southern Illinois University, Southern Illinois Hand Center, 901 Medical Park Dr, Suite 100, Effingham, IL 62401 USA.
authors.forename: Nash H
authors.initials: NH
authors.lastname: Naam
keywords: Collagenase; Dupuytren’s contracture; Fasciectomy