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Comparative Outcomes of Collagenase Injection versus Surgical Management for Dupuytren's Contracture: A Propensity-Matched Cohort of 16,888 Patients
Yousef Tanas, M.D.
1, Keyvon Rashidi, BS
1, Samantha Cervantes Valadez, M.D.
1, Stephen Chen, BS
2, Joshua Wang, MS
3, Philong Nguyen, BS
3, Peter Zak, MD
1, Shari R Liberman, M.D.
1; Anthony Echo, MD
1(1)Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, (2)Baylor College of Medicine, Houston, TX, (3)University of Texas Medical Branch, Galveston, TX
Background:Dupuytren's contracture (DC) is a fibroproliferative disorder of the palmar fascia, commonly managed through enzymatic collagenase injections or surgical interventions such as fasciotomy or fasciectomy. This study aimed to compare clinical outcomes and complication rates between patients undergoing collagenase injection and those receiving surgical treatment for DC.
Methods:Using the TriNetX US Collaborative Network, a retrospective cohort study was conducted including 8,444 patients who underwent collagenase injection and 8,444 propensity score-matched patients who received surgical management for DC. Key outcomes assessed included postoperative infection, hematoma, nerve injury, reoperation rates, functional outcomes (occupational therapy utilization), and emergency room (ER) visits. Risk differences, risk ratios, and odds ratios were calculated using risk analysis.
Results:Collagenase treatment was associated with significantly lower risks of postoperative infection (0.7% vs 1.4%, OR 0.49,
p<0.001), hematoma (4.5% vs 5.2%, OR 0.87,
p=0.049), and nerve injury (6.4% vs 12.2%, OR 0.49,
p<0.001) compared to surgery. However, collagenase was associated with a significantly higher reoperation rate (31.7% vs 16.2%, OR 2.40,
p<0.001). No significant differences were observed in functional outcomes (35.9% vs 36.7%,
p=0.284) or ER utilization (24.6% vs 24.5%,
p=0.915).
Conclusions:Collagenase injection for DC is associated with fewer short-term complications but nearly doubles the risk of reoperation compared to surgical management. These findings highlight a trade-off between safety and long-term procedural durability and should inform shared decision-making between clinicians and patients.
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