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Static Versus Dynamic External Fixation to Augment Dupuytren Fasciectomy
Isabel A. Snee, BS
1, John Waggoner, MD
2, Alayna Vaughan, MD
3, Richard Hum, MS
1, James P. Higgins, MD
1; Aviram M. Giladi, MD, MS
1(1)The Curtis National Hand Center, Baltimore, MD, (2)Naval Medical Center San Diego, San Diego, CA, (3)Rothman Institute at Thomas Jefferson University, Philadelphia, PA
INTRODUCTION: Limited consensus exists regarding the optimal surgical management of Dupuytren disease involving severe proximal interphalangeal joint contractures. While fasciectomy remains the surgical gold standard, the role of adjunctive external fixation remains poorly defined. This study compares postoperative outcomes, demography, and complications among patients treated with open fasciectomy combined with static versus dynamic external fixation.
METHODS: We performed a retrospective matched cohort study on 76 patients undergoing surgical treatment for Dupuytren disease from 2015-2024. Patients with clinically relevant proximal interphalangeal contractures were included and grouped by treatment of fasciectomy with static external fixation or fasciectomy with dynamic external fixation. Patients were matched for age, smoking status, ethnicity, BMI, and degree of preoperative joint contracture. Various statistical tools were then applied to derive primary outcomes comparing postoperative range of motion and patient-reported outcomes. Secondary outcomes compared complications, demography, and surgical revision rates.
RESULTS: 60 patients were treated concurrently with static external fixation and compared to 16 patients treated concurrently with dynamic external fixation: There were no significant differences in final postoperative range of motion improvements or patient-reported outcomes. Secondary analyses comparing demography showed no statistical differences related to age, BMI, sex, ethnicity, or smoking status. Secondary analyses comparing postoperative complications demonstrated higher surgical-site infections in the dynamic external fixator cohort but no differences in recurrence or surgical revision rates.
CONCLUSION: Despite limitations inherent to retrospective studies, this matched comparison of patients undergoing fasciectomy with external fixator augmentation for severe Dupuytren contracture suggests no difference in clinical improvement between static versus dynamic fixator types but a higher pin-site complication rate when dynamic devices are employed. Future clinical studies should further delineate the role of external fixator augmentation in the surgical management of Dupuytren disease.
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