Clinical Effectiveness of Splinting After Collagenase Clostridium Histolyticum for Dupuytren Contracture
Craig Dent, M.S.1, Nino Coutelle, M.D.1, Rajeev Herekar, D.O.2, Tantien Nguyen, BS3, Jason A Nydick, DO3, Alfred Vincent Hess, MD4, Michael C Doarn, MD5, Jeffrey Stone, MD6, Michael Garcia, MD3 and Peter Simon, Ph. D.1, (1)Foundation For Orthopaedic Research and Education, Tampa, FL, (2)Nova Southeastern University, Davie, FL, (3)Florida Orthopaedic Institute, Tampa, FL, (4)Orthopedic Surgery/ Hand and Wrist, Florida Orthopaedic Institute, Tampa, FL, (5)Hand and Upper Extremity Surgery, Florida Orthopaedic Insititue, Tampa, FL, (6)Florida Orthopaedic Institute, Temple Terrace, FL
Introduction: Dupuytrenâ€™s contracture is a fibroproliferative disorder that leads to the progressive formation of nodules and cords along the palmar and digital fascia. Surgical fasciectomy was gold standard of treatment to release these contractures. Due to surgical risk, several procedures have such as injectable collagenase clostridium histolyticum (CCH) and percutaneous needle fasciotomy (PNF) emerged. The purpose of this study was to determine the effectiveness of using a static night splint after a CCH injection and manipulation compared to no splinting. Main outcomes included improvement in degree of flexion contracture and patient reported outcome measures (Patient Satisfaction, QuickDASH). Current guidelines recommends the use of night time extension orthosis after CCH injection, however, few studies have evaluated its effectiveness
Methods: Prospective randomized control trial conducted at a single institution. All adult patients with Dupuytren contracture of 1 or more digits treated with CCH from May 2021-2023 were screened for inclusion. Eighty patients were enrolled and randomized to splint versus no splint. Baseline joint flexion contracture and QuickDASH, post-manipulation contracture, skin tears, and adverse events were collected. Flexion contracture, QuickDASH, splint compliance and satisfaction surveys were collected at 1 and 4 month. The splint group was told to wear night extension splint until 4 months.
Results: 80 patients enrolled, with 39 in each group receiving collagenase injection. 62 patients completed 4-month follow up, and 75 patients completed 1-month follow up. There were no statistically significant differences in baseline characteristics, pre and post manipulation contractures, or QuickDASH. Baseline total flexion contracture was 48.1° and 56.7° for the splint versus no splint group. There were no statistically significant differences in contracture changes from post manipulation to 1- and 4-month follow up between patients in the splint and no splint groups. At 4-month follow up, separating into MCP and PIP, the no splint group had a statistically significant retention of correction at the MCP (0.3° vs 5.8°), while the no splint group had a non-significant increase in PIP contracture (25.1° vs 13.4°).
Conclusion: Our study demonstrated there were no significant differences between groups in total flexion contracture at 4-month follow up. However, separated into MCP and PIP, no splinting led to greater retention of correction at the MCP joint. Conversely, greater retention of correction was maintained at the PIP joint with splinting. We suggest that use of a splint may be beneficial for PIP joints, while it is unnecessary at the MCP joint.
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