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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 11, pp 1623–1631 | Cite as

Range of motion, postoperative rehabilitation and patient satisfaction in MCP and PIP joints affected by Dupuytren Tubiana stage 1–3: collagenase enzymatic fasciotomy or limited fasciectomy? A clinical study in 52 patients

  • Franck M. Leclère
  • Sabine Kohl
  • Cédric Varonier
  • Frank Unglaub
  • Esther Vögelin
Handsurgery
  • 117 Downloads

Abstract

Introduction

In Switzerland, collagenase Clostridium histolyticum therapy (CCH) for Dupuytren’s disease was introduced in 2011. This study analyzes possible differences between CCH and limited fasciectomy (LF) in terms of range of motion, patient satisfaction and postoperative rehabilitation.

Materials and methods

This retrospective study included 52 patients with Dupuytren’s disease stage 1–3 according to Tubiana, treated with CCH or LF between January 2012 and December 2013. Complications were analyzed for each patient. The contracture of each treated joint measured on average at the 3 months and up to 2 years follow-up was compared with the preoperative values. The Michigan Hand score was evaluated at 2 years and the patients were asked to subjectively evaluate the outcome of the treatment and whether they would repeat it if necessary. Postoperative rehabilitation was also precisely quantified.

Results

11 minor complications were reported for a complication rate of 29% in the CCH group. No major complications were reported in both groups. In the CCH group, mean MCP joint contracture was, respectively, 44° ± 20°, 9° ± 2° (gain of mobility compared to the preoperative situation 35°, P < 0.001), and 10° ± 3° (gain 34°, P < 0.001), respectively, before, at the 3 months’ control and at the 2-year clinical control. In the LF group, mean MCP joint contracture was, respectively, 30° ± 21°, 2° ± 0.5° (gain 28°, P < 0.001), and 1° ± 0.5° (gain 29°, P < 0.001) for the same control periods. In the CCH group, mean PIP joint contracture was, respectively, 51° ± 21°, 18° ± 3° (gain of mobility compared to the preoperative situation 33°, P < 0.001), and 32° ± 4° (gain 19°, P < 0.001), respectively, before, at the 3 months’ control and at the 2-year clinical control. In the LF group, mean PIP joint contracture was, respectively, 30° ± 20°, 2° ± 0.5° (gain of mobility compared to the preoperative situation 28°, P < 0.001), and 11° ± 4° (gain 19°, P < 0.001) for the same control periods. Outcomes were compared across the LF and CCH groups: surgery performed better than collagenase for PIP joint treatment at early (P < 0.001) and 2-year follow-up (P = 0.004) controls. However, patient satisfaction was higher in the CCH group: 92% were satisfied or very satisfied of the treatment compared to 71% in the LF group. All patients would reiterate the treatment in the CCH group if necessary compared to only 71% in the LF group. Rehabilitation was highly reduced in the CCH group compared to the LF group.

Conclusion

In this study, surgery performed better than collagenase at early and 2-year follow-up in PIP joints and similar in MCP joints. While surgery seems to achieve better results, collagenase is considered in Switzerland as an off-the-shelf therapy that provides consistent results without scars, with shorter rehabilitation time, minor hand therapy, shorter splinting time, and applicability.

Level of evidence and study type

Level III.

Keywords

Flexion-contracture Dupuytren’s disease Xiapex Limited fasciectomy 

Notes

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

Informed consent

The research protocol was approved by the appropriate ethical committee. Informed consent of all involved patients was obtained.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Franck M. Leclère
    • 1
    • 2
  • Sabine Kohl
    • 1
  • Cédric Varonier
    • 1
  • Frank Unglaub
    • 3
    • 4
  • Esther Vögelin
    • 1
  1. 1.Department of Plastic- und Hand Surgery, Bern University Hospital, InselspitalUniversity of BernBernSwitzerland
  2. 2.Department of Plastic- and Hand Surgery, Poitiers University HospitalUniversity of PoitiersPoitiersFrance
  3. 3.Handchirurgie, Vulpius KlinikBad RappenauGermany
  4. 4.Medizinische Fakultät MannheimUniversität HeidelbergHeidelbergGermany

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