title: What is the better treatment for single digit dupuytren's contracture: surgical release or collagenase clostridium histolyticum (Xiapex) injection?
abstract: The purpose of this study was to compare the initial and final outcome range of motion in the MCP-J and PIP-J of single digit Dupuytren's Contracture treated with either open surgical excision or manipulation after collagenase clostridium histolyticum (CCH; Xiapex) injection.
  
  
  METHODS
  Ten patients in either group. The range of motion measurements were statistically compared using the student t-test with a p-value of 0.05. There was no statistical difference in the pre-treatment status of the total active range of movement (TAM) between the two groups.
  
  
  RESULTS
  Open surgical release achieved a statistically better initial outcome in combined total passive range of movement than the xiapex group (p = 0.0047), but at the final outcome the better TAM measurement at the MCP-J after surgery was not statistically significant. However, the total active range of movement was statistically better at the PIP-J level in the xiapex group (p = 0.01) and the MCP-J and PIP-J combined total active range of movement was statistically better in the xiapex group (p = 0.0258).
  
  
  CONCLUSIONS
  Surgery achieved better initial outcome at both MCP-J and PIP-J levels, and at discharge, only extension in the MCP-J level was statistically better after open excision. However the final outcome was statistically better at the PIP-J level in extension (p = 0.006) and total active movement (TAM) (p = 0.008) after treatment with collagenase clostridium histolyticum. Further studies are required to assess the long-term differences between the two groups and to investigate the outcomes for patients with multi-digit involvement.
authors.affiliation: London Hand Clinic, London Bridge Hospital, London, UK.
authors.forename: Bo
authors.initials: B
authors.lastname: Povlsen
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Povlsen
mesh_terms: D017364:Collagenases / Q000627:therapeutic use*; D019299:Decompression, Surgical; D004387:Dupuytren Contracture / Q000628:therapy*; D000071938:Fasciotomy; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017364:Collagenases; C570746:xiapex
keywords: Comparison; Dupuytren's Contracture; Outcome; Recovery; Surgical Release; Xiapex Injection