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Comparing Treatment Approaches for Dupuytren's Contracture: Percutaneous Needle Fasciotomy with and without Corticosteroids
Evan S Pistone, BBA; Samer W Majeed, BS; Grant Torres, MS; John Faillace, MD
University of Texas Medical Branch, Galveston, TX
IntroductionPercutaneous needle fasciotomy (PNF) is a standard treatment for Dupuytren's contracture. In some instances, clinicians involve intraoperative corticosteroids (ICS) and/or postoperative corticosteroids (PCS) in addition to PNF. However, there lacks investigations in the efficacy ICS and/or PCS as an adjuvant therapy with PNF. The purpose of this study was to review clinical outcomes between PNF and combined PNF and corticosteroid administration in the treatment of Dupuytren's contracture.
MethodsA systematic review of all level I-IV studies investigating clinical outcomes of PNF, PNF/ICS, and PNF/PCS in treating Dupuytren's contracture was conducted in February 2024 using SCOPUS and OVID. Data from PNF/ICS and PNF/PCS patients were combined to form the PNF with general corticosteroid use (PNF/GCS) group. Outcomes of interest included range of motion (ROM) improvement for phalangeal joints on the treated hand and complication rates. Secondary outcomes investigated included Quick Disabilities of Arm, Shoulder and Hand (DASH) scores and Unité Rhumatologique des Affections de la Main (URAM) scores.
Results Twenty-six studies (3,203 PNF patients, 840 PNF/ICS patients, 81 PNF/PCS patients, and 921 PNF/GCS patients) were selected for analysis. The PNF group was the largest cohort of the three treatment groups and demonstrated the superior improvement in DIP range of motion (ROM), URAM, and DASH measures, but had greatest and most varied rate of complications. The PNF/ICS group demonstrated the most significant improvement for total joint measures ROM at final follow-up. PNF/PCS demonstrated the largest increases of PIP and MCP ROM at final follow-up. The PNF/GCS group demonstrated superior ROM for all joints compared to PNF without steroid use, with fewer complications.
Conclusion Using ICS and/or PCS with PNF showed superior ROM improvement in most studied joints. PNF with steroid treatment had a lower complication rate compared to no steroid treatment.
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