Skip to main content
SpringerLink
Log in

Dupuytren’s disease of ring and little finger

  • Published:
Orthopedics and Traumatology

Abstract

Objective

Resection of fibrous digitopalmar connective tissues to improve finger function.

Indications

Dupuytren’s disease in Tubiana’s stage >III. Partial fasciectomy: at any age, for localized involvement, unlimited degree of contracture, and for recurrences. Complete fasciectomy: extension lag <45° of an individual finger, favorable skin condition, and progressing Dupuytren’s disease.

Contraindications

Poor general health.

State after stroke.

Infection or eczema of hand.

Excessive alcohol intake.

Uncooperative patient.

Relative: HIV infection.

Surgical Technique

Antegrade dissection of the fibrous tissue from palm to distal interphalangeal joint through a Y-shaped palmar incision or longitudinal digital incision interrupted by Z-plasties at the level of flexion creases. Dissection starts at the radial healthy side. For partial fasciectomy, the fibrous tissue is removed including a safety margin. During complete fasciectomy, the entire triangular palmar fascia including the vertical septae is excised.

The so-called open palm technique is a particular form of a partial fasciectomy whereby transverse incisions are not closed as opposed to longitudinal incisions which are always sutured.

Results

In a prospective study, 48/239 patients were followed up >2 years. Recurrence rate was 39.7% while hand function improved by 70–86% in ulnar type.

Complications observed in a retrospective study (1982–1991) of 566 patients (two thirds partial, one third complete fasciectomy): wound healing disturbance 3%, hematoma 2.5%, vessel injury 1.2%, nerve injury 1.8%, infection 0.7%, persisting edema 0.7%, scar contracture 0.2%.

87% of all recurrences appeared within 24 months. Their incidence after 2–10 years varied after partial or complete fasciectomy between 12.5 and 66%, and 21.4 and 39.7%, respectively. Only a small percentage of these needed a revision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allieu Y, Teissier J. La technique de la »paume ouverte« dans le traitement de la maladie de Dupuytren. In: Tubiana R, Hueston JH, éds. La maladie de Dupuytren. Paris: Expansion Scientifique Française, 1986:160–4.

    Google Scholar 

  2. Andrew JG, Beare RLB. NRM. Segmental aponeurectomy for Dupuytren’s disease. A prospective study. J Hand Surg [Br] 1991;16:255–7.

    CAS  Google Scholar 

  3. Badois FJ, Lermusiaux JL, Masse C, Kuntz D. “Non-surgical” treatment of Dupuytren’s disease using needle fasciotomy. Rev Rhum Ed Fr 1993;60:808–13.

    PubMed  CAS  Google Scholar 

  4. Berger A, Flory H-J, Brenner P. Klinik und chirurgische Therapie der Dupuytrenschen Kontraktur. Unfallchirurg 1990;93:181–5.

    PubMed  CAS  Google Scholar 

  5. Bower M, Nelson M, Gozzard BG. Dupuytren’s contracture in patients infected with HIV. Br Med J 1990;300:164–5.

    Article  CAS  Google Scholar 

  6. Brandes G, Körner T, Brenner P, Reale E. Histochemical localization of glycoconjugates in the palmar aponeurosis of Dupuytren’s patients. J Submicrosc Cytol Pathol 1991;23:551–8.

    PubMed  CAS  Google Scholar 

  7. Brandes G, Körner T, Brenner P, Reale E. Interactions between proteoglycans and collagen fibrils in the palmar fascia in Dupuytren’s disease. In: Berger A, Delbrück A, Brenner P, Hinzmann R, eds. Dupuytren’s disease. Pathobiochemistry and clinical management. Berlin-Heidelberg-New York: Springer, 1994;16–23.

    Google Scholar 

  8. Brenner P. Vergleich von Ulnar- und Radialtypen des Morbus Dupuytren (Stadium IV). Klinische Studie zu Glykosaminoglykanen, Lichtmikroskopie und Immunhistochemie der extrazellulären Matrix. Medizinische Hochschule Hannover: Habilitationsschrift, 1994.

  9. Brenner P. Dupuytren-Kontraktur. In: Berger A, Hrsg. Plastische Chirurgie-Handchirurgie. Breitnersche Operationslehre Bd XIV. München-Wien-Baltimore: Urban & Schwarzenberg, 1997:215–22.

    Google Scholar 

  10. Brenner P, Gässler N, Berger A. Fasziale und plasmatische Glykosaminoglykanmuster beim Radial- und Ulnartyp der Dupuytrenschen Kontraktur. Acta Chir Austriaca 1994;26:Suppl:79–80.

    Google Scholar 

  11. Brenner P, Krause-Bergmann A, Ha Van V. Die Dupuytrensche Kontraktur in Norddeutschland — epidemiologische Erfassungs-studie an Hand von 500 Fällen. Unfallchirurg 2001;104:303–11.

    Article  PubMed  CAS  Google Scholar 

  12. Benner P, Mailänder P, Berger A. Epidemiology of Dupuytren’s disease. In: Berger A, Delbrück A, Brenner P, Hinzmann R, eds. Dupuytren’s disease. Pathobiochemistry and clinical management. Berlin-Heidelberg-New York: Springer, 1994:2444–54.

    Google Scholar 

  13. Brenner P, Sachse C, Reichert B, Berger A. Expression von diversen monoklonalen Antikörpern im Knoten- und Strangstadium des Morbus Dupuytren. Handchir Mikrochir Plast Chir 1996;28:322–7.

    PubMed  CAS  Google Scholar 

  14. Brotherston TM, Balakrishanan C, Milner RH, Brown HG. Long term follow-up of dermatofasciectomy for Dupuytren’s contracture. Br J Plast Surg 1994;47:440–7.

    Article  PubMed  CAS  Google Scholar 

  15. Bruner JM. Incisions for plastic and reconstructive surgery in the hand. Br J Plast Surg 1954;4:48.

    Article  Google Scholar 

  16. Cavalli-Sforza LL. Stammbaum von Völkern und Sprachen. Spektrum Wiss 1990;1:90–8.

    Google Scholar 

  17. Cavalli-Sforza LL, Feldman MW. Cultural transmission and evolution: a quantitative approach. Princeton: Princeton University Press, 1981.

    Google Scholar 

  18. Dahl Chin P, De Smet L, Sciot R, Van Damme B, Han de Berge H. Trisomy 7 and trisomy 8 in dividing and non-dividing tumor cells in Dupuytren’s disease. Cancer Genet Cytogenet 1999;108:137–40.

    Article  Google Scholar 

  19. Dellon ES, Keller K, Moratz V, Dellon AL. The relationship between skin hardness, pressure perception and two-point discrimination in the fingertip. J Hand Surg [Br] 1995;20:44–8.

    CAS  Google Scholar 

  20. De Maglio A, Timo R, Feliziani G. Recidive ed estensioni nel morbo di Dupuytren trattato con aponeurectomie selettiva. Revisone clinica di 124 casi. Chir Organi Mov 1996;86:43–8.

    Google Scholar 

  21. Donato RR, Morrison WA. Dupuytren’s disease in the feet causing flexion contracture in the toes. J Hand Surg [Br] 1996;21:364–6.

    CAS  Google Scholar 

  22. Dupuytren G. Leçons orales de clinique chirurgicale. Faites à l’Höpital-Dieu de Paris. Paris-Londres: Baillière, 1832:1–24.

    Google Scholar 

  23. Egawa T. Dupuytren’s contracture in Japan. Incidental study on outpatients in a private practice of general orthopaedics. J Jpn Soc Surg Hand 1985;2:536–9.

    Google Scholar 

  24. Enzinger FM, Weiss SW. Fibromatosis. In: Enzinger FM, Weiss SW. Soft tissue tumors. St. Louis: Mosby, 1983:45–70.

    Google Scholar 

  25. Foucher G, Cornil C, Lenoble E. La technique de la »plaie ouverte« dans la maladie de Dupuytren. Chirurgie 1992;118:189–96.

    PubMed  CAS  Google Scholar 

  26. Geldmacher J. Limited fasciectomy. In: Berger A, Delbrück A, Brenner P, Hinzmann R, eds. Dupuytren’s disease. Pathobiochemistry and clinical management. Berlin-Heidelberg-New York: Springer, 1994.

    Google Scholar 

  27. Gonzalez MH, Sobeski J, Grindel S, Chunprapah B, Weinzweig N. Dupuytren’s disease in African-Americans. J Hand Surg [Br] 1998;23:306–7.

    CAS  Google Scholar 

  28. Hall PN, Fitzgerald A, Sterne GD, Logan AM. Skin replacement in Dupuytren’s disease. J Hand Surg [Br] 1997;22:193–7.

    CAS  Google Scholar 

  29. Hueston JT. Limited fasciectomy for Dupuytren’s contracture. Plast Reconstr Surg 1961;27:569–85.

    Article  CAS  Google Scholar 

  30. Hueston JT. Table top test. Med J Aust 1976;2:189–90.

    PubMed  CAS  Google Scholar 

  31. Hueston JT. Dupuytren’s contracture. In: Flynn JE, ed. Hand surgery. Baltimore-Philadelphia-London: Williams & Wilkins, 982:797–822.

  32. Hueston JT. The role of skin in Dupuytren’s disease. Ann R Coll Surg Engl 1985;67:372–5.

    PubMed  CAS  Google Scholar 

  33. Hurst LC. Dupuytren’s fasciectomy. Zig-zag plasty technique. In: Blair WF, Steyers CM, eds. Techniques in hand surgery. Baltimore-Philadelphia-London: Williams & Wilkins, 1996:519–29.

    Google Scholar 

  34. Irwin LR, Naylor LL, Holms W. The contractility of knuckle pads. An in vitro study. J Hand Surg [Br] 1997;22:110–2.

    CAS  Google Scholar 

  35. Iselin F, Cardenas-Baron L, Gouget-Audry I, Peze W. La maladie de Dupuytren dorsale. Ann Chir Main 1988;7:247–50.

    Article  PubMed  CAS  Google Scholar 

  36. Jordan GH. Surgery for Peronie’s disease. In: Libertino JA, ed. Reconstructive urologic surgery. St. Louis-Baltimore-Carlsbad: Mosby, 1998:539–51.

    Google Scholar 

  37. Ketchum LD, Hixon FP. Dermatofasciectomy and full-thickness grafts in the treatment of Dupuytren’s contracture. J Hand Surg [Am] 1987;12:659–63.

    CAS  Google Scholar 

  38. Leclercq C, Tubiana R. Recurrence in Dupuytren’s disease. In: Berger A, Delbrück A, Brenner P, Hinzmann R, eds. Dupuytren’s disease. Pathobiochemistry and clinical management. Berlin-Heidelberg-New York: Springer, 1994:272–4.

    Google Scholar 

  39. Lermusiaux J-L, Lellouche H, Badois J-F, Kuntz D. How should Dupuytren’s disease be managed in 1997? Rev Rhum Engl Ed 1997;64:775–6.

    PubMed  CAS  Google Scholar 

  40. Lettin AW. Dupuytren’s diathesis. J Bone Joint Surg Br 1964;46:220–5.

    PubMed  CAS  Google Scholar 

  41. Lubahn JD. Dupuytren’s fasciectomy: open palm technique. In: Blair WF, Steyers CM, eds. Techniques in hand surgery. Baltimore-Philadelphia-London: Williams & Wilkins, 1966:508–8.

    Google Scholar 

  42. Luck JV. Dupuytren’s contracture. A new concept of the pathogenesis correlated with surgical management. J Bone Joint Surg Am 1959;41:635–64.

    PubMed  Google Scholar 

  43. Mackinnon SE, Dellon AL. Surgery of the peripheral nerve. New York: Thieme, 1988.

    Google Scholar 

  44. Mailänder P, Brenner P, Berger A. Clinical findings in Dupuytren’s disease. In: Berger A, Delbrück A, Brenner P, Hinzmann R, eds. Dupuytren’s disease. Pathobiochemistry and clinical management. Berlin-Heidelberg-New York: Springer, 1994:237–43.

    Google Scholar 

  45. McCash CR. The open palm technique in Dupuytren’s contracture. Br J Plast Surg 1964;17:271–80.

    Article  PubMed  CAS  Google Scholar 

  46. McCash CR. The open palm technique in Dupuytren’s disease. In: Hueston JT, Tubiana R, eds. Dupuytren’s disease. Edinburgh-London-Melbourne: Churchill Livingstone, 1985:136–41.

    Google Scholar 

  47. McFarlane RM, Botz JS. The results of treatment. In: McFarlane RM, McGrouther DA, Flint MH, eds. Dupuytren’s disease. Biology and treatment. Edinburgh-London-Melbourne: Churchill Livingstone, 1990:387–93.

    Google Scholar 

  48. McGrouther DA. Dupuytren’s contracture. In: Green DP, Hotchkiss RN, Pederson WC. Green’s operative hand surgery. New York-Edinburgh-London: Churchill Livingstone, 1999:563–91.

    Google Scholar 

  49. McIndoe A, RL. The surgical management of Dupuytren’s contracture. Am J Surg 1958;95:197–203.

    Article  PubMed  CAS  Google Scholar 

  50. Millesi H. Zur Pathogenese und Therapie der Dupuytrenschen Kontraktur. (Eine Studie an Hand von mehr als 500 Fällen.) Ergeb Orthop 1965;47:51–101.

    Google Scholar 

  51. Millesi H. Dupuytren-Kontraktur. In: Nigst H, Buck-Gramcko D, Millesi H, Hrsg. Handchirurgie, Bd 1: Allgemeines, Wahloperationen. Stuttgart: Thieme, 1981:15.1–57.

    Google Scholar 

  52. Moermans JP. Segmental aponeurectomy in Dupuytren’s disease. J Hand Surg [Br] 1991;16:243–54.

    CAS  Google Scholar 

  53. Moermans JP. Long-term results after segmental aponeurectomy for Dupuytren’s disease. J Hand Surg [Br] 1996;21:797–800.

    CAS  Google Scholar 

  54. Narotte G, Apoil A, Travers V. Résultats à plus de dix ans de la maladie de Dupuytren. À propos de cinquante-huit observations. Ann Chir 1988;7:277–81.

    Article  Google Scholar 

  55. Noble J, Harrison DH. Open palm technique for Dupuytren’s contracture. Hand 1976;8:272–8.

    Article  PubMed  CAS  Google Scholar 

  56. Schneider LH, Hankin FM, Eisenberg T. Surgery of Dupuytren’s disease: a review of the open palm method. J Hand Surg [Am] 1986;11:23–7.

    CAS  Google Scholar 

  57. Sennwald GR. Fasciectomy for treatent of Dupuytren’s disease and early complications. J Hand Surg [Am] 1990;15:755–61.

    Article  CAS  Google Scholar 

  58. Shaw DL, Wise DI, Holms W. Dupuytren’s disease treated by palmar fasciectomy and an open palm technique. J Hand Surg [Br] 1996;21:484–5.

    CAS  Google Scholar 

  59. Stuhler T, Stankovic P, Kaiser R. Dupuytren’sche Kontraktur: Komplikationen und Langzeitergebnisse. Handchir Mikrochir Plast Chir 1975;7:9–13.

    Google Scholar 

  60. Thomine J-M. The development and anatomy of the digital fascia. In: Hueston JT, Tubiana R, eds. Dupuytren’s disease. Edinburgh-London-Melbourne: Churchill Livingstone, 1985:3–12.

    Google Scholar 

  61. Tonkin MA, Burke FD, Varian JPW. Dupuytren’s contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients. J Hand Surg [Br] 1984;9:156–62.

    CAS  Google Scholar 

  62. Tubiana R, Hueston JH. La maladie de Dupuytren. Paris: Expansion Scientifique Francçaise, 1986.

    Google Scholar 

  63. Tubiana R, Michon J. Evaluation chiffrée de la déformation dans la maladie de Dupuytren. Mem Acad Chir 1961;87:887–8.

    Google Scholar 

  64. Van den Kerckhove E. Kinesitherapeutische behandlingsschema’s van verschillende aandoeningen van de hand. Hand Therapie Leuven. Kinesitherapie, Katholieke Universiteit Leuven: Eigendruck, 2000.

    Google Scholar 

  65. Zancolli EA, Cozzi EP. Atlas of surgical anatomy of the hand. New York-Edinburgh-London: Churchill Livingstone, 1992.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. the Department of Plastic, Reconstructive and Esthetic Surgery, University Hospital Gasthuisberg, Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium

    Peter Brenner (Head)

Authors
  1. Peter Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Brenner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brenner, P. Dupuytren’s disease of ring and little finger. Orthop Traumatol 10, 138–158 (2002). https://doi.org/10.1007/s00065-002-1044-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00065-002-1044-x

Key Words

Search

Navigation