Outcomes of Collagenase Treatment for Dupuytren Contracture of PIP Joint
Craig Dent, M.S.1, Nino Coutelle, M.D.1, Andrew Moore, M.D.2, Matthew Nester, B.S.2, Jason A Nydick, DO3 and Peter Simon, Ph. D.1, (1)Foundation For Orthopaedic Research and Education, Tampa, FL, (2)University of South Florida, Tampa, FL, (3)Florida Orthopaedic Institute, Tampa, FL
Introduction: Dupuytren contracture is a progressive, fibroproliferative disorder characterized by the formation of cords in the palmar and digital fascia. Surgical release has been the gold standard of treatment. Surgical risks led to emergence of non-surgical procedures such as percutaneous needle fasciotomy (PNF) and injectable collagenase clostridium histolyticum (CCH). CCH injection manipulation is effective in treating both metacarpal phalangeal (MCP) and Proximal Interphalangeal (PIP) contractures. The primary aim of this study is to determine the total flexion contractures correction, functionality, and complications of collagenase treatment for Dupuytren contractures of the PIP joint.
Methods: Retrospective chart review for collagenase injection of Dupuytren contracture at a single institution from August 2019 to April 2023 yielded 296 joints (MCP and PIP). Data collected included pre/post treatment total flexion contracture, QuickDASH, most recent follow up and total flexion contracture, and adverse events.
Results: 151 patients were included, totaling 243 joints treated (136 MCP, 107 PIP). The average total flexion contracture prior to injection was 46.3° for the MCP joint and 52.5° for the PIP joint. Average post manipulation flexion contracture was 0.8° for MCP and 6.9° for PIP, an improvement of 45.5° for 45.6° respectively. At average follow up of 4.7 months, average flexion contracture was 5° for MCP and 20.1° for PIP, an improvement of 41.3° and 32.4° respectively. Three different groups were created based on isolated MCP contractures, isolated PIP contractures, and fingers treated with combined MCP and PIP joint contractures. The average improvement from pre and post manipulation contracture between combined and PIP joints was 44.4° and 47.1° respectively. At average follow up of 4.7 months, average improvement of PIP joints for combined and isolated contractures was 34.1° and 29.8° respectively. Average QuickDASH score improvement at most recent follow up was 5.7 (combined MCP and PIP), and 5.0 (Isolated PIP).
Conclusion: PIP joints treated with CCH demonstrate similar improvements in contractures from pre to post manipulation compared to MCP joints. At average follow up of 4.7 months, MCP joint retained a greater degree of contracture correction. Correction retention was also higher for combined joints versus their isolated counterparts. QuickDASH score improvement at most recent follow up was elevated for combined joints (5.7) and isolated joints of MCP (1.2) and PIP (5.0). This suggests that CCH treatment of digits with combined MCP and PIP joints demonstrate greater short-term contracture improvements and patient reported outcomes compared to isolated joints.
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