Treatment of Dupuytren’s Contracture in the Young

Abstract

The term diathesis has been described and characterized by Hueston, referring to a certain subset of patients exhibiting characteristics of a more aggressive form of Dupuytren’s disease (Hueston, Eur Med Bibliogr 1:7–16, 1991). Initially defined components of Dupuytren’s diathesis included ethnicity, bilateral disease, positive family history, and ectopic fibromatosis. Male gender and age of onset <50 years were subsequently added factors for diathesis (Hindocha et al., J Hand Surg Am 31:1626–1634, 2006). In this chapter, treatment of three representative patient types is described: the young patient with widespread palmar disease, the young patient with isolated small joint contracture, and a young patient with a combination of the above. Dermofasciectomy, treatment through excision of diseased palmar fascia and full-thickness skin grafting (FTSG), is one surgical technique aimed to limit contracture recurrence. Longitudinal follow-up is offered for the case of dermofasciectomy in a right hand dominant female with early onset, widespread Dupuytren’s disease. Short-term results demonstrated marked improvement in range of motion and strength. Outcome at the 20-year time point, however, highlights the progressive, often relentless nature of the disease in the younger patients affected with Dupuytren’s. This chapter also describes a rare example of isolated ring finger distal interphalangeal joint involvement in a 23-year-old medical student treated with limited fasciectomy, primary closure, and K-wire stabilization of the DIPJ in extension. Finally, the case of a patient with radial-sided palmar disease and index finger interphalangeal joint contracture treated at multiple time points is reviewed to demonstrate the utility of a combined interventional approach as well as the aggressive nature of the disease in young people.