Contemporary management of dupuytren contracture.
Dupuytren contracture is a condition that affects the palmar fascia. It most commonly affects men of northern European ancestry and initially presents at middle age. The diseased fascia may form cords that extend into the digits, resulting in limited motion and function. Treatment is aimed at either releasing or removing the diseased cord so that the finger can extend fully. Common interventions include surgery, needle aponeurotomy, and collagenase injection. Surgery remains the gold standard in treatment and most commonly includes a limited fasciectomy. Although often successful, surgery carries inherent risks and may involve a lengthy recovery with extensive therapy. Needle aponeurotomy and collagenase injections are office-based alternatives that aim to weaken the cord and release the contracture. Needle aponeurotomy involves repeated needling along the cord in intervals and collagenase injections to dissolve a portion of the cord. Despite being less invasive, problems such as nerve and/or tendon injury, skin tears, and autoimmune reactions have been reported. Regardless of treatment, recurrence remains a concern.
Associate Professor, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Marco
M
Rizzo
Peter J
PJ
Stern
Prosper
P
Benhaim
Lawrence C
LC
Hurst
D000367:Age Factors; D017364:Collagenases / Q000627:therapeutic use; D004387:Dupuytren Contracture / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000071938:Fasciotomy; D006801:Humans; D012737:Sex Factors; D016038:Skin Transplantation; D016896:Treatment Outcome
D017364:Collagenases