title: Clinical outcomes following collagenase injections compared to fasciectomy in the treatment of Dupuytren's contracture.
abstract: BACKGROUND
  The aim of this study is to compare the efficacy of collagenase injections with that of fasciectomy in the treatment of Dupuytren's contracture.
  
  
  METHODS
  This is a case-control retrospective study. We reviewed the electronic medical records from January 2009 through January 2013, identifying 142 consecutive patients who underwent either fasciectomy or collagenase injection. Exclusion criteria for both groups were age <18 years, pregnant women, and arthroplasty or arthrodesis of the treated joint. Follow-up data beyond 1-year duration was available for 117 of the patients: 44 patients who had undergone fasciectomy, and 73 patients who had received collagenase injection. The primary outcome measure in this study was resolution of joint contracture to 0-5° deficit of full extension. Data was analyzed using two-sample t tests for continuous data and chi-square test for categorical data. A significant P value was set at <0.05.
  
  
  RESULTS
  At the latest follow-up, significantly more joints treated with fasciectomy met the primary outcome measure. Metacarpophalangeal (MP) joints responded better than the proximal interphalangeal (PIP) joints for both treatments. At the latest follow-up (14.2 months for collagenase, 16.3 months for fasciectomy), 46 % of MP joints treated with collagenase and 68 % of MP joints treated with fasciectomy maintained resolution of joint contracture. Sub-analysis of the affected joints based on the severity of initial contracture demonstrated that MP and PIP joints with contractures <45° responded better than more severely contracted joints (>45°).
  
  
  CONCLUSIONS
  Fasciectomy yields a greater mean magnitude of correction for digital contractures at the latest follow-up when compared to collagenase. Both treatments were more effective for treatment of MP joint contracture compared to PIP joint contracture.
  
  
  METHODS
  Level III, therapeutic.
authors.affiliation: Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA USA ; 2000 Washington Street Blue Building, Suite 201, Newton, MA 02462 USA.
authors.forename: Raghuveer C
authors.initials: RC
authors.lastname: Muppavarapu
authors.affiliation: Royal Adelaide Hospital, Adelaide, South Australia 5000 Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Waters
authors.affiliation: Hand Surgery, P.C., Newton-Wellesley Hospital, Tufts University School of Medicine, Boston, MA USA.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Leibman
authors.affiliation: Hand Surgery, P.C., Newton-Wellesley Hospital, Tufts University School of Medicine, Boston, MA USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Belsky
authors.affiliation: Hand Surgery, P.C., Newton-Wellesley Hospital, Tufts University School of Medicine, Boston, MA USA ; Division of Hand Surgery, Newton-Wellesley Hospital, Newton, MA USA ; Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Ruchelsman
keywords: Collagenase; Dupuytren’s disease; Faciectomy; Finger joint contracture; Xiaflex