Abstract
Introduction
In recent years, the enzyme collagenase has been developed for the percutaneous treatment of Dupuytren’s contracture, allowing management of the condition as an outpatient. We present early results on the treatment of Dupuytren’s contracture using injectable collagenase.
Methods
Patients awaiting Fasciectomy for Dupuytren's Contracture were selected for enrolment. Contracture cords were then marked and injected with collagenase in the outpatients department. Twenty-four hours later, patients returned for an extension procedure, performed under regional anaesthesia. Hand therapy was then commenced as for surgical release. Contracture angles were measured pre-injection and at follow-up.
Results
Thirteen fingers were treated in 10 patients with a mean age of 66 years. Eight little fingers and five ring fingers were treated. Four fingers had isolated metacarpophalangeal joint (MCPJ) contracture, one finger had isolated proximal interphalangeal joint (PIPJ) contracture and the remainder had combined contractures. Mean pre-treatment MCPJ contracture was 58.6° and the mean pre-treatment PIPJ contracture was 39°. Post-treatment contracture was 4.23° and 9° for the MCPJ and PIPJ, respectively. All patients were satisfied with their results.
Complications
Significant post-injection bruising occured in one patient. Skin tears occurred in 11 digits, and in all cases healed without intervention. No tendon rupture occurred.
Conclusions
Collagenase is a safe and effective outpatient-based treatment for Dupuytren’s contracture, which may be useful in controlling surgical waiting lists. We recommend its use as first-line treatment in patients who are unsuitable more invasive treatment alternatives.
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References
Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA et al (2009) Injectable collagenase Clostridium histolyticum for Dupuytren’s contracture. N Engl J Med 361(10):968–979
Witthaut J, Bushmakin AG, Gerber RA, Cappelleri JC, Le Graverand-Gastineau MP (2011) Determining clinically important changes in range of motion in patients with Dupuytren’s contracture: secondary analysis of the randomized, double-blind, placebo-controlled CORD I study. Clin drug investig 31(11):791–798
Gilpin D, Coleman S, Hall S, Houston A, Karrasch J, Jones N (2010) Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren’s disease. J Hand Surg Am 35(12):2027 e1–2038 e1
Zhang AY, Curtin CM, Hentz VR (2011) Flexor tendon rupture after collagenase injection for Dupuytren contracture: case report. J Hand Surg 36(8):1323–1325
Peimer CA, Blazar P, Coleman S, Kaplan FT, Smith T, Tursi JP et al (2013) Dupuytren contracture recurrence following treatment with collagenase Clostridium histolyticum (CORDLESS study): 3-year data. J Hand Surg Am 38(1):12–22
Coleman S, Gilpin D, Tursi J, Kaufman G, Jones N, Cohen B (2012) Multiple concurrent collagenase Clostridium histolyticum injections to Dupuytren’s cords: an exploratory study. BMC Musculoskelet Disord 13:61
Skirven TM, Bachoura A, Jacoby SM, Culp RW, Osterman AL (2013) The effect of a therapy protocol for increasing correction of severely contracted proximal interphalangeal joints caused by dupuytren disease and treated with collagenase injection. J Hand Surg Am 38(4):684–689
Raven RB 3rd, Kushner H, Nguyen D, Naam N, Curtin C (2013) Analysis of efficacy and safety of treatment with collagenase Clostridium histolyticum among subgroups of patients with Dupuytren contracture. Ann Plast Surg. [Epub ahead of print]
Horsley W (2011) Collagenase (Xiapex) for Dupuytren’s contracture. NHS North East Treatment Advisory Group
Chen NC, Shauver MJ, Chung KC (2011) Cost-effectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture. J Hand Surg 36(11):1826 e32–1834 e32
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Considine, S., Heaney, R. & Hirpara, K.M. Early results of the use of collagenase in the treatment of Dupuytren’s contracture. Ir J Med Sci 184, 323–327 (2015). https://doi.org/10.1007/s11845-014-1111-6
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DOI: https://doi.org/10.1007/s11845-014-1111-6