title: New insights into the immediate outcome of collagenase injections for Dupuytren's contracture.
abstract: Collagenase clostridium histolyticum is now established as an effective and safe option to treat patients with a single joint affected with Dupuytren's contracture. We have extended its use to natatory and combined cords. In a prospective consecutive series of 298 cords in 237 patients, the mean total extension loss improved in cords crossing the metacarpophalangeal joint from 46° to 1°, in cords crossing the proximal interphalangeal joint from 56° to 7°, in natatory cords from 130° to 25° and in combined cords from 102° to 16°. The immediate correction of combined cords and natatory cords was less reliable than that obtained in cords crossing the metacarpophalangeal joint or proximal interphalangeal joint. Less severe pre-intervention contractures tended to correct better. We found a high complication rate, which may cause alarm. A total of 21% developed skin splits, with the risk of skin splits generally increasing with more severe pre-injection deformity. Blood blisters were only encountered after manipulation of the more severe contractures. A total of 23 patients (8%) had a spontaneous rupture and 57 patients (19%) had a partial spontaneous rupture. Only 4.9% needed a second injection. We noticed a learning curve, with seven of the first 20 cords (35%) needing a second injection to achieve a satisfactory correction and then only seven (2.5%) in the rest.
  
  
  METHODS
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authors: Hand Unit, University Hospital Southampton, Southampton, UK Musculoskeletal Research Unit, University Hospital Southampton and University of Southampton, Southampton, UK davidwarwick@handsurgery.co.uk.
authors: D J
authors: DJ
authors: Warwick
authors: Hand Unit, University Hospital Southampton, Southampton, UK.
authors: D
authors: D
authors: Graham
authors: Musculoskeletal Research Unit, University Hospital Southampton and University of Southampton, Southampton, UK.
authors: P
authors: P
authors: Worsley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004387:Dupuytren Contracture / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005384:Finger Joint; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008662:Metacarpophalangeal Joint; D003012:Microbial Collagenase / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003012:Microbial Collagenase
keywords: Dupuytren’s disease; collagenase; complications; outcome