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Collagenase for Dupuytren's Disease in the U.K. N.H.S. - The Royal Orthopaedic Hospital Experience
Eleonore E. Breuning, MBBCh, MD, FRCS; Elizabeth George, MD; Anuj Mishra, MD; Marianne Yousif, MD; Richard Pinder, MD; Claire Simpson, MD; Michael Craigen, MD; Subodh Deshmukh, MD; Michael Waldram, MD; Mark Brewster, MD
Hand Surgery Department, Royal Orthopaedic Hospital, Birmingham, United Kingdom

Introduction: Collagenase injection is a new alternative to surgery in the management of Dupuytren’s Disease (DD). We describe the results of our experience of its use in the NHS since its introduction in our unit in July 2012.

Methods: A prospective study of all patients who underwent Collagenase injections for DD was undertaken between July 2012 and December 2013. Degree of contracture was assessed pre-procedure, and at six weeks, three, six, and 12 months post procedure. Complications and side effects were noted. A visual analogue scale of patient satisfaction was assessed at 6 weeks.

Results: Over a seventeen month period 205 injections were performed in 157 patients (forty-three patients had more than one injection) with a mean age of 64 years. 86% were male. Five patients had a second injection for the same cord. 115 patients attended 6 week follow-up. Skin tear (23%), bruising (16%) and axillary discomfort (5%) were common complications. One patient had a localised allergic reaction after their third injection. Patient satisfaction was very high for the injections, and in comparison to surgery (VAS mean 9.1/10 & 8.3/10 respectively). Results for degrees of correction of contracture and % correction for 6 weeks, 3, 6 and 12 months are detailed in the table below.

Conclusion: Collagenase injection is a procedure with good results and well tolerated by patients. Average joint correction was good for both MCPJs and PIPJs, and was well maintained for 1 months in MCPJs. PIPJ correction was also well maintained with time, though there was a slight tendency towards recurrence of contracture between 6 and 12 months. Side effects of bruising and skin tear were common, but serious complications rare.

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