title: The Use of Residual Collagenase for Single Digits With Multiple-Joint Dupuytren Contractures.
abstract: OBJECTIVE
  Standard 0.58 mg (0.25 mL) collagenase Clostridium histolyticum (CCH) preparations result in unused CCH that is often discarded. Our purpose was to assess the results on Dupuytren contractures affecting both the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in the same digit utilizing an injection containing the maximum CCH volume that can be withdrawn from a single vial.
  
  
  METHODS
  A consecutive series of patients with MCP and PIP cords in the same digit received a single treatment with 2 injections totaling 0.30 mL distributed between the MCP and the PIP cords and underwent manipulation approximately 24 hours later. Reduction in contracture, clinical success, and complications were assessed 30 days after manipulation.
  
  
  RESULTS
  Thirty-one patients (34 digits) had a mean preinjection flexion contracture of 50° at the MCP joint and 53° at the PIP joint. Clinical success (reduction in joint contracture to 0°-5° of full extension 30-days postmanipulation) was noted in 65% of MCP cords and 38% of PIP joint cords. We had a 24% incidence of skin tears, which correlated with the degree of preinjection contracture.
  
  
  CONCLUSIONS
  For Dupuytren contractures involving the MCP and PIP joints in the same digit, distributing the maximum amount of CCH that can be withdrawn from a single vial provides efficacy at both joints that is similar to that reported in previously published series, with a comparable complication rate. Utilizing excess CCH typically discarded may provide cost savings.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA. Electronic address: chris.grandizio@gmail.com.
authors.forename: Louis C
authors.initials: LC
authors.lastname: Grandizio
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Anil
authors.initials: A
authors.lastname: Akoon
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Janice
authors.initials: J
authors.lastname: Heimbach
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Jove
authors.initials: J
authors.lastname: Graham
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Joel C
authors.initials: JC
authors.lastname: Klena
mesh_terms: D000368:Aged; D004387:Dupuytren Contracture / Q000628:therapy*; D005260:Female; D005384:Finger Joint; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008662:Metacarpophalangeal Joint; D003012:Microbial Collagenase / Q000627:therapeutic use*; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003012:Microbial Collagenase
keywords: Collagenase; Dupuytren disease; joint contracture; manipulation