Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture: A Prospective, Randomized, Controlled Trial Surgical management of Dupuytren's contracture in Europe: regional analysis of a surgeon survey and patient chart review. Injectable Collagenase Versus Percutaneous Needle Fasciotomy for Dupuytren Contracture in Proximal Interphalangeal Joints: A Randomized Controlled Trial. The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial.
Background : As an alternative to needle aponeurotomy release and limited fasciectomy treatment of Dupuytren ’s contracture , the authors introduced an extensive percutaneous aponeurotomy and lipofilling ( PALF ) procedure . In their previous study , the authors reported that contractures significantly improved and most patients returned to normal use of the h and within 2 to 4 weeks . To establish the safety and efficacy of PALF , the authors compared it to the st and ard limited fasciectomy in a single-blind , multicenter , prospect i ve , r and omized , controlled trial . Methods : Patients with a primary Dupuytren ’s contracture were assigned r and omly to the limited fasciectomy group or the PALF group . Patients were measured at baseline and at 2 weeks , 3 weeks , 6 months , and 1 year postoperatively . Primary outcome of the trial was contracture correction and convalescence time . Groups were compared using a mixed models approach . Results : Eighty patients were r and omized to PALF or limited fasciectomy . In both groups , almost full metacarpophalangeal joint contracture correction was obtained , whereas for the proximal interphalangeal joint , some residual contracture remained . Patients in the PALF group returned significantly earlier to their normal daily activity . At 1 year after surgery , no significant differences in recurrence rate or h and function were present . However , limited fasciectomy seems to have a higher incidence of permanent complications . Conclusions : PALF demonstrates a significantly shorter convalescence , similar operative contracture correction , lower incidence of long-term complications , and no significant difference regarding 1-year postoperative results compared with limited fasciectomy . It is therefore a valuable , minimally invasive alternative to limited fasciectomy in the treatment of Dupuytren ’s disease . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , II AIM We explored regional variations in the surgical management of patients with Dupuytren 's contracture ( DC ) in 12 European countries using a surgeon survey and patient chart review . METHODS Twelve countries participated : Denmark , Finl and , Sweden ( Nordic region ) ; Czech Republic , Hungary , Pol and ( East ) ; France , Germany , the Netherl and s , UK ( West ) ; Italy , Spain ( Mediterranean ) . For the survey , a r and om sample of orthopaedic/plastic surgeons ( n = 687 ) with 3 - 30 years ' experience was asked about DC procedures performed during the previous 12 months . For the chart review ( n = 3357 ) , information from up to five consecutive patients was extracted . Descriptive statistics are reported . RESULTS Ninety-five per cent of all surgeons used fasciectomy for DC , followed by fasciotomy ( 70 % ) , dermofasciectomy ( 38 % ) and percutaneous needle fasciotomy ( 35 % ) . Most surgeons were satisfied with fasciectomy over other procedures . Recommended time away from work and duration of physical therapy  increased with the invasiveness of the procedure . The intra-operative complication rate was 4.0 % ; the postoperative complication rate was 34 % . Overall , ≥ 97 % of the procedures were rated by surgeons as having a positive outcome . Across all regions , 54 % of patients had no nodules or contracture after the procedures . Only 2 % of patients required retreatment within the first year of surgery . Important inter- and intraregional differences in these aspects of patient management are described . CONCLUSIONS Underst and ing current regional treatment patterns and their relationships to country-specific health systems may facilitate earlier identification of , and intervention for , DD and help to optimise the overall treatment for patients with this chronic condition PURPOSE Collagenase Clostridium histolyticum ( CCH ) injection was introduced commercially as a treatment for Dupuytren contracture following initial phase-3 investigations in 2009 with promising results . However , the efficacy of CCH has not been prospect ively investigated in a direct comparison to other active treatments of Dupuytren contracture with more than 1-year follow-up , despite a wide and increasing clinical use . METHOD In this prospect i ve , independent , open-label , r and omized controlled trial , ( Clinical trials.gov ; NCT 01538017 ) , percutaneous needle fasciotomy ( PNF ) was directly compared with CCH .  Fifty patients with primary isolated proximal interphalangeal joint Dupuytren contractures were enrolled and followed for 2 years . The primary outcome was clinical improvement defined as a reduction in contracture by 50 % or more relative to baseline . Secondary outcomes included change in contracture , recurrence , adverse events , complications , and Disabilities of the Arm , Shoulder , and H and question naire score . RESULTS Clinical improvement at 2 years was maintained in 7 % of CCH patients ( 2 of 29 ) and 29 % of PNF patients ( 6 of 21 ) . Collagenase Clostridium histolyticum led to more , mainly transient , complications , in 93 % of patients versus 24 % of the patients treated with PNF . No other differences were observed . CONCLUSIONS This study provides evidence that CCH is not superior to PNF in the treatment of isolated proximal interphalangeal joint Dupuytren contracture regarding clinical outcome , and it led to more complications than PNF . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic PURPOSE To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture . METHODS We conducted a single-center , r and omized , controlled trial to investigate the effect of night extension orthoses on finger range of motion and h and function for 3 months following surgical release of Dupuytren contracture . We also wanted to determine how well finger extension was maintained in the total sample . We r and omized 56 patients to receive a night extension orthosis plus h and therapy  ( n = 26 ) or h and therapy alone ( n = 30 ) . The primary outcome was total active extension of the operated fingers ( ° ) . Secondary outcomes were total active flexion of the operated fingers ( ° ) , active distal palmar crease ( cm ) , grip strength ( kg ) , and self-reported h and function using the Disabilities of the Arm , Shoulder , and H and question naire ( 0 - 100 scale ) . RESULTS There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes . Between the first postoperative measure and 3 months after surgery , 62 % of little fingers had maintained or improved total active extension . CONCLUSIONS The use of a night extension orthosis in combination with st and ard h and therapy has no greater effect on maintaining finger extension than h and therapy alone in the 3 months following surgical release of Dupuytren contracture . Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery . Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients
There are only three Level I studies comparing surgical techniques for the treatment of primary Dupuytren ’s contracture , and the evidence does not support one procedure above another , other than to show a particularly high recurrence rate after needle fasciotomy .
There is no consensus on the most effective operation for primary Dupuytren ’s contracture .
This systematic review evaluates the reported rates of recurrence and complications , as well as the strength of evidence , for individual procedures .