title: Collagenase Treatment for Dupuytren Disease of the Thumb and First Web.
abstract: OBJECTIVE
  To evaluate the short-term effectiveness of collagenase Clostridium histolyticum to treat thumb and first web contractures in Dupuytren disease.
  
  
  METHODS
  We prospectively included 14 thumbs in 12 patients with a contracture at the metacarpophalangeal or interphalangeal joint of at least 20° with a palpable cord in the thumb (n = 8) or an adduction contracture of the thumb with palpable cords in the first web (n = 6). They received an injection containing 0.58 mg of collagenase Clostridium histolyticum in the fibrous cord divided over 3 spots. The contracture was released by carefully manipulating the thumb under local anesthesia 1 day later. The extension and abduction deficits were measured before and after the intervention (follow-up at 7 and 30 days and 6 months). Wilcoxon signed rank test was used to analyze the data.
  
  
  RESULTS
  In the total sample, postintervention extension deficits were statistically significantly lower than preintervention deficits except in one patient who had a recurrence at 6 months compared with the 30-day posttreatment result. Intermetacarpophalangeal head distance (IMD) also improved significantly. In an analysis of subgroups, we compared the separate contributions of treatment of a pretendinous cord and a first web cord on both extension deficit and IMD. Treatment of pretendinous cords significantly affected both extension deficit and IMD. However, treatment of first web contractures did not significantly improve extension or IMD.
  
  
  CONCLUSIONS
  Collagenase Clostridium histolyticum is a good treatment option for pretendinous cords in thumbs affected with Dupuytren disease because it provides good results, is minimally invasive, and has minor adverse events.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: mdreise@gmail.com.
authors.forename: Marieke M
authors.initials: MM
authors.lastname: Dreise
authors.affiliation: Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Stenekes
authors.affiliation: Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Paul M N
authors.initials: PM
authors.lastname: Werker
mesh_terms: D004387:Dupuytren Contracture / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D003012:Microbial Collagenase / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D013933:Thumb; D016896:Treatment Outcome
chemical_list: D003012:Microbial Collagenase
keywords: Collagenase Clostridium histolyticum; Dupuytren disease; first webspace; thumb