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Examining the efficacy and maintenance of contracture correction after collagenase clostridium histolyticum treatment for Dupuytren’s disease

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HAND

Abstract

Background

This study examined the efficacy, complications, and contracture recurrence in patients who received injectable collagenase clostridium histolyticum (CCH) for Dupuytren’s-induced metacarpophalangeal (MP) and proximal interphalangeal (PIP) joint contractures.

Methods

A retrospective chart review at one center compared the degree of MP and PIP joint contracture pre-injection, post-cord rupture, and at final follow-up after a minimum duration of 6 months. Recurrence was defined as a 20 ° or greater increase in contracture above the minimum value achieved.

Results

Of 102 eligible patients, 48 patients (47 %) (31 males, 17 females) were available for review. 53 digits and 64 joints (46 MP joints and 18 PIP joints) were studied. The mean patient age was 66 years (range, 48–87 years) and mean follow-up duration was 15 months (range, 6 to 25 months). The mean MP joint contracture was 51 ± 20 ° at baseline, 4 ± 8 ° post-cord rupture, and 9 ± 15 ° at latest follow-up. The mean PIP joint contracture was 39 ± 23 ° at baseline, 14 ± 14 ° at cord rupture, and 29 ± 20 ° at latest follow-up. Of the 46 MP joints and 18 PIP joints, 11 MP (24 %) and 7 (39 %) PIP joints met the recurrence criteria. Of 102 patients, 1 patient had a small finger flexor tendon rupture.

Conclusions

Despite the dramatic initial reduction in contracture, recurrence developed in a high proportion of patients over the study period. While initially effective, CCH may not provide durable contracture reduction. However, CCH remains a viable nonsurgical treatment for Dupuytren’s disease.

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Acknowledgments

We would like to acknowledge Mrs. Jennifer Kuruc for her assistance with data acquisition.

Conflict of Interests

A. Lee Osterman: Consultant and speaker on bureau for Auxilium Pharmaceuticals; Randall W. Culp: Paid speaker for Auxilium Pharmaceuticals; Sidney M. Jacoby: Paid speaker for Auxilium Pharmaceuticals. None of the other coauthors have any conflicts of interest.

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Authors and Affiliations

  1. The Philadelphia Hand Center, Thomas Jefferson University, 700 South Henderson Road, Suite 200, King of Prussia, PA, 19406, USA

    Heather A. McMahon, Abdo Bachoura, Sidney M. Jacoby, David S. Zelouf, Randall W. Culp & A. Lee Osterman

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  1. Heather A. McMahon
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  2. Abdo Bachoura
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  3. Sidney M. Jacoby
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  4. David S. Zelouf
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  5. Randall W. Culp
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  6. A. Lee Osterman
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Corresponding author

Correspondence to Sidney M. Jacoby.

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McMahon, H.A., Bachoura, A., Jacoby, S.M. et al. Examining the efficacy and maintenance of contracture correction after collagenase clostridium histolyticum treatment for Dupuytren’s disease. HAND 8, 261–266 (2013). https://doi.org/10.1007/s11552-013-9524-7

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  • DOI: https://doi.org/10.1007/s11552-013-9524-7

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