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Injectable collagenase Clostridium histolyticum as a nonsurgical treatment for Dupuytren’s disease

Injizierbare Kollagenase Clostridium histolyticum zur nichtchirurgischen Behandlung der Dupuytren-Kontraktur

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Abstract

Objective

Nonsurgical treatment of Dupuytren’s disease using collagenase Clostridium histolyticum (CCH).

Indications

Metacarpophalangeal (MP) joint (20–100°) and proximal interphalangeal (PIP) joint (20–80°) contractures.

Contraindications

Pregnancy, previous hypersensitivity to collagenase or excipients, anticoagulant use within 7 days prior to treatment.

Injection technique

CCH injected directly into the Dupuytren’s cord weakening the contracted cord. After injection, the patient returns the following day to allow CCH to lyse the collagen within the cord. An extension force is then applied to the involved finger to disrupt the weakened cord.

Postmanipulation management

Use of extension splint at night, movement instructions during the day.

Results

A total of 120 patients (107 men; 13 women; mean age 62 years, range 30–84 years) were treated. In 49 % the little finger, in 44 % the ring finger, in 4 % the middle finger, and in 3 % the index finger was treated. Full release was achieved in 71 %, partial release in 26 %, and no change in 3 % of patients. The median pretreatment contracture for the MP joint was 37° (range 25–100°) and PIP joint 51° (range 30–97°). At 12 months, the mean contracture for the MP joint was 9° (range 0–25°) and for the PIP joint 21° (range 10–36°). Adverse events observed in 96 % of patients for 3 months . No tendon ruptures, anaphylactic reactions, or nerve or ligament injuries observed.

Zusammenfassung

Behandlungsziel

Nichtchirurgische Behandlung der Dupuytren-Kontraktur mittels Kollagenase Clostridium histolyticum (CCH).

Indikationen

Beugekontraktur des Fingergrund- (20–100°) und des Fingermittelgelenks (20–80°).

Kontraindikationen

Schwangerschaft, Hypersensitivität gegenüber Kollagenasen oder Bestandteilen, Einsatz von Antikoagulanzien 7 Tage vor Behandlung.

Injektionstechnik

Direkte CCH-Injektion in Dupuytren-Strang in die Handfläche. Manuelle Fingerstreckung etwa 24 h nach Injektion unter Lokalanästhetikum und Lösen des Dupuytren-Strangs.

Weiterbehandlung

Anlage einer Nachtlagerungsschiene, Bewegungsanleitung tagsüber.

Ergebnisse

Insgesamt wurden 120 Patienten (107 Männer, 13 Frauen) mit einem durchschnittlichen Lebensalter von 62 Jahren (Spanne 30–84 Jahre) behandelt. Behandlung des Kleinfingers in 49 %, des Ringfingers in 44 %, des Mittelfingers in 4 % und des Zeigefingers in 3 %. In 71 % wurde eine komplette Stranglösung, in 26 % eine partielle Stranglösung und in 3 % keine Veränderung erzielt. Die durchschnittliche Beugekontraktur vor Behandlung betrug 37° (Spanne 25–100°) für das Fingergrund- und 51° (Spanne 30–97°) für das Fingermittelgelenk. Nach 12 Monaten betrug die durchschnittliche Beugekontraktur des Fingergrundgelenks 9° (Spanne 0–25°) und die des Fingermittelgelenks 21° (Spanne 10–36°). Unerwünschte Ereignisse wurden in 96 % der Patienten bis zur 3-Monats-Kontrolle beobachtet. Beugesehnenrupturen oder allergische Reaktionen traten nicht auf.

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Authors and Affiliations

  1. Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Tirol, Österreich

    R. Arora, P. Kaiser, T.-J. Kastenberger, G. Schmiedle, S. Erhart & M. Gabl

Authors
  1. R. Arora
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  2. P. Kaiser
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  3. T.-J. Kastenberger
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  4. G. Schmiedle
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  5. S. Erhart
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  6. M. Gabl
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Corresponding author

Correspondence to R. Arora.

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Conflict of interest

R. Arora, P. Kaiser, T.-J. Kastenberger, G. Schmiedle, S. Erhart, and M. Gabl state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Editor

F. Unglaub, Bad Rappenau

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R. Himmelhan, Mannheim

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Arora, R., Kaiser, P., Kastenberger, TJ. et al. Injectable collagenase Clostridium histolyticum as a nonsurgical treatment for Dupuytren’s disease. Oper Orthop Traumatol 28, 30–37 (2016). https://doi.org/10.1007/s00064-015-0434-4

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  • DOI: https://doi.org/10.1007/s00064-015-0434-4

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