J. Stephen Chambers, MD1 Taylor Pate, MD2 James H. Calandruccio, MD1 1
2
University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering Memphis, Tennessee Eastern Virginia Medical School Norfolk, Virginia
Office-Based Percutaneous Fasciotomy for Dupuytren Contracture Dupuytren disease is a chronic progressive disorder that affects connective tissue in various areas and can cause functional issues when significant contractures develop in the palmar and digital fascia. The disease has an autosomal dominant inheritance pattern with variable penetrance, with family history cited as a strong predictor of the disease. The disease is most commonly diagnosed in Caucasian men, with increasing prevalence in men older than 65. Dupuytren disease often is tolerated for many years before the patient presents for evaluation when skin tightness and contour changes progress to form nodules, typically on the palmar aspect of the hand. These nodules produce tension in pretendinous and other cords of the palm and fingers resulting in joint flexion contractures. The contractures occur most often on the ring and small fingers with the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints most commonly affected. Treatment usually is begun for patients when the contractures are significant enough to interfere with daily activities. Primary treatment goals are to completely straighten the affected ray(s) while reducing the risk of recurrence and avoiding complications. Treatments options are of 2 general types: minimally invasive and open surgical procedures. Minimally invasive procedures include percutaneous needle fasciotomy (PNF), cordotomy, and enzymatic fasciotomy. These options typically are more cost-effective, but have higher rates of recurrence compared with open procedures. Open surgical procedures have higher complication rates but lower rates of recurrence and often are preferred as a second line of treatment.
Corresponding Author James H. Calandruccio, MD 1400 S. Germantown Road Germantown, TN 38138 P: 901-759-3210 F: 901-759-3195 jcalandruccio@campbellclinic.com
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Although fasciotomy was described more than 200 years ago, it was seldom used until French rheumatologists described fasciotomy with a percutaneous needle technique (PNF). The technique gained more widespread acceptance after the report by Foucher and colleagues. In 2003, a series of 100 patients treated with PNF resulted in few complications, reoperation rate of 24%, and recurrence at 3-year follow-up of 58%. More recent studies have shown that 79% of patients retain a straight joint after 2 years, but recurrence of the contracture(s) remains frequent, regardless of treatment method. Pess and colleagues reported a recurrence rate of 48% in 1,013 fingers followed for a median of 3 years. In their randomized controlled trial, van Rijssen and colleagues found a recurrence rate of 22% with PNF compared with 5% with limited fasciectomy. Because it is a simple procedure with few complications, PNF can be done repeatedly if necessary. The effectiveness of treatment of Dupuytren contractures can be subjectively assessed using patient-reported outcome measures (PROM). Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) is a commonly used PROM in upper extremity research including Dupuytren disease. It consists of 11 questions that focus on severity of symptoms and This article reproduced with permission from Orthopedic Clinics of North America. Chambers JS, Pate T, Calandruccio JH. Office-Based Percutaneous Fasciotomy for Dupuytren Contracture. 2020 Jul;51(3):369-372. doi: 10.1016/m.ocl.2020.02.008. Epub 2020 Apr 1.
CAMPBELL ORTHOPAEDIC JOURNAL • VOLUME 7, 2021
