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Functional outcome of collagenase injections compared with fasciectomy in treatment of Dupuytren’s contracture

  • Surgery Articles
  • Published:
HAND

Abstract

Background

This study was designed to provide comparative information on the safety and efficacy of injection with collagenase clostridium histolyticum (CCH) and fasciectomy for patients with Dupuytren’s contracture (DC).

Methods

A single-center, retrospective, observational, longitudinal chart review was conducted of 25 patients treated with CCH injections and 21 patients undergoing fasciectomy. Patients were assessed at 1 week, monthly for 3 months and then yearly for a minimum of 2 years after treatment for changes in contracture and range of motion, time to return to work/normal activities, patient satisfaction, and Disabilities of Arm, Shoulder and Hand (DASH) score.

Results

Post-procedure follow-up averaged 32 months for the injection group compared with 39 months for fasciectomy group. For the CCH group, the mean postinjection contracture was 3.6° for the metacarpophalangeal and 17.5° for the proximal interphalangeal joints compared with 3.7° and 8.1° in the fasciectomy group, respectively. Patients treated with injections returned to normal activities after a mean of 1.9 days compared with 37.4 days for fasciectomy patients (p < 0.0001). DASH scores for 13 CCH and 15 fasciectomy patients were obtained. The mean DASH score was significantly lower in the injection group in the first 3 months (p < 0.01). At the 2-year follow-up visit, patients were satisfied with their outcomes following either treatment (92 % and 96 % of CCH and fasciectomy patients, respectively).

Conclusion

CCH injections are safe and effective and may be a viable alternative to fasciectomy for treating DC. It also allows earlier return to work and daily activities.

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Acknowledgement

The author thanks Jennifer Kent, PhD, of MedVal Scientific Information Services, LLC, for providing medical writing and editorial assistance. Independent statistical analysis was provided by Greg Maislin of Biomedical Statistical Consulting. This manuscript was prepared according to the International Society for Medical Publication Professionals’ Good Publication Practice for Communicating Company-Sponsored Medical Research: the GPP2 Guidelines. Study drug was provided by Auxilium Pharmaceuticals, and support for the preparation of this manuscript was provided by Auxilium Pharmaceuticals.

Disclosure

The author of this manuscript is a consultant for Auxilium Pharmaceuticals.

Statement of Human Rights

The procedures described in this manuscript were in accordance with the ethical standards of the local and national responsible committees on human experimentation and with the Helsinki Declaration of 1975 as revised in 2000.

Statement of Informed Consent

All patients included in this study were given detailed informed consent. All patients expressed their understanding of the details of the consents before signing then. Every patient signed the informed consent.

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Authors and Affiliations

  1. Department of Surgery, Division of Plastic and Reconstructive Surgery, Southern Illinois University, Southern Illinois Hand Center, 901 Medical Park Dr, Suite 100, Effingham, IL, 62401, USA

    Nash H. Naam

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  1. Nash H. Naam
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Correspondence to Nash H. Naam.

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Naam, N.H. Functional outcome of collagenase injections compared with fasciectomy in treatment of Dupuytren’s contracture. HAND 8, 410–416 (2013). https://doi.org/10.1007/s11552-013-9540-7

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  • DOI: https://doi.org/10.1007/s11552-013-9540-7

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