title: Collagenase Clostridium Histolyticum versus Limited Fasciectomy for Dupuytren's Contracture: Outcomes from a Multicenter Propensity Score Matched Study.
abstract: BACKGROUND
  Controversy exists about the relative effectiveness of injectable collagenase (collagenase clostridium histolyticum) and limited fasciectomy in the treatment of Dupuytren's contracture. The authors compared the effectiveness of both techniques in actual clinical practice.
  
  
  METHODS
  This study evaluated all subjects treated with collagenase clostridium histolyticum or limited fasciectomy for metacarpophalangeal and/or proximal interphalangeal joint contractures between 2011 and 2014 at seven practice sites. The authors compared the degree of residual contracture (active extension deficit), Michigan Hand Outcomes Questionnaire scores, and adverse events at follow-up visits occurring between 6 and 12 weeks after surgery or the last injection with the use of propensity score matching.
  
  
  RESULTS
  In 132 matched subjects who were treated with collagenase (n = 66) or fasciectomy (n = 66), the degree of residual contracture at follow-up for affected metacarpophalangeal joints was not significantly different (13 degrees versus 6 degrees; p = 0.095) and affected proximal interphalangeal joints had significantly worse residual contracture in the collagenase group compared with those in the fasciectomy group (25 degrees versus 15 degrees; p = 0.010). Collagenase subjects experienced fewer serious adverse events than did fasciectomy subjects and reported larger improvements in the Michigan Hand Outcomes Questionnaire subscores evaluating satisfaction with hand function, activities of daily living, and work performance.
  
  
  CONCLUSIONS
  This propensity score-matched study showed that collagenase clostridium histolyticum was not significantly different from limited fasciectomy in reducing metacarpophalangeal joint contractures, whereas proximal interphalangeal joint contractures showed slightly better reduction following limited fasciectomy. Collagenase provided a more rapid recovery of hand function than did fasciectomy and was associated with fewer serious adverse events.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Rotterdam and Hilversum, The Netherlands From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC; and the Department of Hand and Wrist Surgery, Xpert Clinic.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhou
authors.forename: Steven E R
authors.initials: SER
authors.lastname: Hovius
authors.forename: Harm P
authors.initials: HP
authors.lastname: Slijper
authors.forename: Reinier
authors.initials: R
authors.lastname: Feitz
authors.forename: Christianne A
authors.initials: CA
authors.lastname: Van Nieuwenhoven
authors.forename: Adriana J
authors.initials: AJ
authors.lastname: Pieters
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Selles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004387:Dupuytren Contracture / Q000628:therapy*; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D016555:Matched-Pair Analysis; D003012:Microbial Collagenase / Q000627:therapeutic use*; D008875:Middle Aged; D057216:Propensity Score; D057566:Self Report; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003012:Microbial Collagenase
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