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Temporal Effects of Collagenase Clostridium Histolyticum Injection and Therapy on PIPJ Contractures in Dupuytren's Disease
Kelsea Smith; Abdo Bachoura, MD; Lauren DeTullio; Sidney M. Jacoby, MD; Randall W. Culp, MD; A. Lee Osterman, MD; Terri M. Skirven, CHT;
Philadelphia Hand Center

Introduction: Collagenase clostridium histolyticum for Dupuytren's disease remains a new non-surgical treatment modality, and new data on its effects and outcomes continue to surface. The standard protocol for use of collagenase clostridium histolyticum is to inject a palpable cord, wait 24 hours for the enzyme to weaken the cord, and then manually rupture the cord. Following cord rupture, it is unknown whether the enzyme continues to degrade adjacent collagen fibers and how long its action persists. The purpose of this study was to determine the temporal effect of collagenase injection coupled with therapy on proximal interphalangeal joint (PIPJ) contracture.

Materials & Methods: Following injection of the PIPJ contracture and cord rupture, a certified hand therapist evaluated and treated each patient based on a defined treatment protocol. Our protocol consisted of orthotic intervention to address residual PIPJ contracture. In addition, exercises emphasizing reverse blocking for PIPJ extension and DIPJ flexion exercises were initiated. Patient PIP contractures were prospectively assessed prior to injection, at cord rupture, at 1-week post cord rupture and at 4-weeks post cord rupture. One way repeated measures ANOVA was used to determine statistically significant differences in PIP contracture at the four time points. A p value less than 0.05 was considered statistically significant. A Bonferroni post hoc test was used when applicable.

Results: There were 19 digits in 18 patients: 16 males and 2 females. The mean age was 65.9 years. The PIP contracture at baseline, cord rupture, 1week after rupture and 4 weeks after rupture were 51.6, 22.7, 9.3, and 4.7 degrees, respectively (Figure 1). The differences in PIP contracture were statistically significant at all time points except when comparing the means at 1 week versus 4 weeks post injection.

Discussion: Our results demonstrate that the effects of collagenase injection and therapy continue to improve PIP contractures for at least one week following cord rupture. It is possible that collagenase regimented therapy protocol during this critical period appears to have desirable patient outcomes.

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