The quantitative role of flexor sheath incision in correcting Dupuytren proximal interphalangeal joint contractures.
Controversy exists regarding intra-operative treatment of residual proximal interphalangeal joint contractures after Dupuytren's fasciectomy. We test the hypothesis that a simple release of the digital flexor sheath can correct residual fixed flexion contracture after subtotal fasciectomy. We prospectively enrolled 19 patients (22 digits) with Dupuytren's contracture of the proximal interphalangeal joint. The average pre-operative extension deficit of the proximal interphalangeal joints was 58° (range 30-90). The flexion contracture of the joint was corrected to an average of 28° after fasciectomy. In most digits (20 of 21), subsequent incision of the flexor sheath further corrected the contracture by an average of 23°, resulting in correction to an average flexion contracture of 4.7° (range 0-40). Our results support that contracture of the tendon sheath is a contributor to Dupuytren's contracture of the joint and that sheath release is a simple, low morbidity addition to correct Dupuytren's contractures of the proximal interphalangeal joint. Additional release of the proximal interphalangeal joint after fasciectomy, after release of the flexor sheath, is not necessary in many patients.


METHODS
IV (Case Series, Therapeutic).
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA pblazar@partners.org.
P E
PE
Blazar
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
E W
EW
Floyd
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
B E
BE
Earp
D004387:Dupuytren Contracture / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000071938:Fasciotomy; D005384:Finger Joint; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome
Contracture; Dupuytren; fasciectomy; proximal interphalangeal joint