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Efficacy and Safety of Xiaflex Injections for the Treatment of 1st Web Cords in Dupuytren Contractures
F. Thomas D. Kaplan, MD
Indiana Hand to Shoulder Center, Indianapolis, IN

Hypothesis: Clostridial collagenase histolyticum (CCH) is safe and effective for the treatment of 1st web space contractures in patients with Dupuytren disease.

Methods: Patients with Dupuytren contracture involving the 1st web space caused by a palpable cord were prospectively enrolled. All patients received one dose of CCH (0.58mg) and were followed for 90 days. Radial and palmar abduction was measured both pre-injection and at follow-up evaluation at 10, 30, and 90 days post-injection. Adverse events were assessed at the same time points, and the Michigan Hand Questionnaire administered. Primary endpoint was the percentage of patients obtaining a >50% reduction in contracture 30 days after injection. Secondary endpoints were adverse events, change in Michigan Hand Questionnaire (MHQ) score, and patient satisfaction at 90 days.

Results: 7 patients with a 1st web space contracture received CCH injection and 6 returned for 30 day evaluation. One patient was seen at 10 days post-injection, but did not return for further visits. Five of six patients had a 50% or greater reduction in contracture of either palmar abduction (n=1), radial abduction (n=3), or both (n=1). One patient was evaluated at 10 days and had greater than 50% reduction of contracture of both palmar and radial abduction, but did not return for 30 or 90 day evaluation. All patients demonstrated improvement in MHQ score, and all patients were very satisfied with the results of their treatment. Adverse events were comparable to those seen in prior studies. No serious adverse events occurred.


CCH injection is effective in reducing contracture for 1st web space cords in a majority of patients.
Patients successfully treated with CCH for 1st web space contracture show improvement in their MHQ scores, demonstrating hand function improves with increased thumb abduction.
Adverse events are similar to those seen following CCH injection for metacarpophalangeal and proximal interphalangeal joint contractures

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