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Randomized Prospective Clinical Trial Comparing Manipulation of Dupuytren's Contracture at 7 days versus 1 day Following Collagenase Injection
Shelley S. Noland, MD1; Andrew J. Watt, MD2; Dayne Mickelson, MD1; Kathleen M. Kollitz, BS1; Nicholas B. Vedder, MD1; Jerry I. Huang, MD1
1Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA; 2The Buncke Clinic, California Pacific Medical Center, San Francisco, CA

Introduction: The use of collagenase injection, followed by manipulation at 24 hours has become a common nonsurgical treatment option for Dupuytren's contracture. We hypothesize that manual manipulation at 7 days versus 1 day following collagenase injection has similar efficacy in treatment of Dupuytren's contracture.

Materials & Methods: Eligible patients were enrolled in a randomized prospective trial comparing manual manipulation of Dupuytren's contracture at 7 days versus 1 day following collagenase injection. Pre-injection metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint contractures were measured. Injection and manipulation pain scores were recorded. Immediate and 28 day post-manipulation MCP and PIP joint contractures were measured. Means were compared using paired and unpaired t-tests.

Results: Twenty-eight patients were enrolled and randomized 16 to the 7 day group and 12 to the 1 day group. There were 24 males and 4 females with average age 62. The most commonly affected digit was the small finger (n=15). There were no significant differences between groups for initial MCP/PIP contracture, pre-manipulation MCP/PIP contracture, post-manipulation MCP/PIP contracture, and 28 days post-injection MCP/PIP contracture (Graph 1). The average decrease in MCP contracture post-manipulation was 21 degrees for 7 days and 27 degrees for 1 day (p=0.49). The average decrease in PIP contracture post-manipulation was 34 degrees for both 7 days and 1 day (p=0.99). There were no significant differences in injection pain (4.2 vs. 4.5, p=0.76) or manipulation pain (1.5 vs. 2.1, p=0.63) between the 7 day and 1 day groups. Six skin tears were noted in the 7 day group (37.5%) and 4 skin tears were noted in 1 day group (33%) (relative risk for seven days 1.1, 95% CI 0.4-3.1). There were no flexor tendon ruptures.

Conclusion: The effectiveness of collagenase and manipulation in achieving correction of Dupuytren's contractures is preserved at 7 days versus 1 day. There is no difference in pain scores or skin tears between the 7 day group and the 1 day group. This data suggests that manipulation can be scheduled at the convenience of the patient and surgeon between the 1 day and 7 day time points.

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