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Current concepts in Dupuytren’s disease

  • Hand and Wrist (DA Osei, Section editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

The last few years have seen a number of significant studies in Dupuytren’s disease that may result in a paradigm shift in the management of this condition. This review article assesses recent therapeutic studies from January 2010 to August 2012. These were rated for levels of evidence, trial quality using the Jadad and Detsky scales, and graded by strength of recommendation. Significant studies include the success of Phase III trials of injectable collagenase (CORD I and II), that may radically alter the practice of Dupuytren’s. Other highlights include randomized controlled trials that address the ongoing debate on needle fasciotomy vs limited fasciectomy, and also the utility of night-time post-operative splinting. Furthermore, the concept of “clinically important differences” in Dupuytren’s outcomes research is considered in the context of the CORD I trial. The implications of these studies for current practice and future research are discussed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. JBJS (Journal of Bone and Joint Surgery). Instructions for authors. Levels of evidence for primary research question. Available at: http://jbjs.org/public/instructionsauthors.aspx. Accessed on December 10, 2012

  2. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Contr Clin Trials. 1996;17:1–12.

    Article  CAS  Google Scholar 

  3. Detsky AS, Naylor CD, O’Rourke K, McGeer AJ, L’Abbe KA. Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol. 1992;45:255–65.

    Article  PubMed  CAS  Google Scholar 

  4. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323:334e–6.

    Article  Google Scholar 

  5. Bhandari M, Richards RR, Sprague S, Schemitsch EH. The quality of reporting of randomized trials in the Journal of Bone and Joint Surgery from 1988 through 2000. J Bone Joint Surg Am. 2002;84-A:388–96.

    PubMed  Google Scholar 

  6. Chuback JE, Yarascavitch BA, Eaves III F, Thoma A, Bhandari M. Evidence in the aesthetic surgical literature over the past decade: how far have we come? Plast Reconstr Surg. 2012;129:126e–34.

    Article  PubMed  Google Scholar 

  7. Chen NC, Shauver MJ, Chung KC. Cost-effectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture. J Hand Surg Am. 2011;36:1826–34.

    Article  PubMed  Google Scholar 

  8. Degreef I, Tejpar S, De Smet L. Improved postoperative outcome of segmental fasciectomy in Dupuytren disease by insertion of an absorbable cellulose implant. J Plast Surg Hand Surg. 2011;45:157–64.

    Article  PubMed  Google Scholar 

  9. Pess GM, Pess RM, Pess RA. Results of needle aponeurotomy for Dupuytren contracture in over 1000 fingers. J Hand Surg Am. 2012;37:651–6.

    Article  PubMed  Google Scholar 

  10. Agee JM, Goss BC. The use of skeletal extension torque in reversing Dupuytren contractures of the proximal interphalangeal joint. J Hand Surg Am. 2012;37:1467–74.

    Article  PubMed  Google Scholar 

  11. White JW, Kang SN, Nancoo T, Floyd D, Kambhampati SB, McGrouther DA. Management of severe Dupuytren's contracture of the proximal interphalangeal joint with use of a central slip facilitation device. J Hand Surg Eur. 2012;37(8):72–32.

    Google Scholar 

  12. Hovius SE, Kan HJ, Smit X, Selles RW, Cardoso E, Khouri RK. Extensive percutaneous aponeurotomy and lipografting: a new treatment for Dupuytren disease. Plast Reconstr Surg. 2011;128:221–8.

    Article  PubMed  CAS  Google Scholar 

  13. Colditz GA, Miller JN, Mosteller F. How study design affects outcomes in comparisons of therapy. I. Medical Stat Med. 1989;8:411–54.

    Google Scholar 

  14. Engstrand C, Krevers B, Kvist J. Interrater reliability in finger joint goniometer measurement in Dupuytren's disease. Am J Occup Ther. 2012;66:98–103.

    Article  PubMed  Google Scholar 

  15. Tubiana R, Michon J, Thomine JM. Scheme for the assessment of deformities in Dupuytren's disease. Surg Clin North Am. 1968;48:979–84.

    PubMed  CAS  Google Scholar 

  16. •• Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA, CORD I Study Group, et al. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med. 2009;361:968–79. The landmark Phase III clinical trial demonstrating an efficacy of 64 % vs 6.8 % in placebo. Although FDA approval followed shortly thereafter, this trial does not compare efficacy against surgical alternatives.

    Article  PubMed  CAS  Google Scholar 

  17. •• van Rijssen AL, ter Linden H, Werker PM. Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy vs limited fasciectomy. Plast Reconstr Surg. 2012;129:469–77. A prospective randomized trial demonstrating the superiority of limited fasciectomy over needle fasciotomy when using initial success and recurrence as key endpoints. There are no other randomized trials in the literature comparing these 2 forms of surgical treatment.

    Article  PubMed  Google Scholar 

  18. Jerosch-Herold C, Shepstone L, Chojnowski A, Larson D. Severity of contracture and self-reported disability in patients with Dupuytren's contracture referred for surgery. J Hand Ther. 2011;24:6–10.

    Article  PubMed  Google Scholar 

  19. Engstrand C, Boren L, Liedberg GM. Evaluation of activity limitation and digital extension in Dupuytren’s contracture 3 months after fasciectomy and hand therapy interventions. J Hand Ther. 2009;22:21–7.

    Article  PubMed  CAS  Google Scholar 

  20. Degreef I, Vererfve P-B, De Smet L. Effect of severity of Dupuytren contracture on disability. Scand J Plast Reconstr Surg Hand Surg. 2009;43:41–2.

    Article  PubMed  Google Scholar 

  21. Budd HR, Larson D, Chojnowski A, Shepstone L. The QuickDASH score: a patient-reported outcome measure for Dupuytren's surgery. J Hand Ther. 2011;24:15–20.

    Article  PubMed  Google Scholar 

  22. • Witthaut J, Bushmakin AG, Gerber RA, Cappelleri JC, Le Graverand-Gastineau MP. Determining clinically important changes in range of motion in patients with Dupuytren's Contracture: secondary analysis of the randomized, double-blind, placebo-controlled CORD I study. Clin Drug Investig. 2011;31:791–8. This study brings the concept of “clinically important differences” into Dupuytren’s outcomes research, correlating objective measurements with patient reported outcomes. It is one of the most important concepts in outcomes research in recent years.

    PubMed  CAS  Google Scholar 

  23. McMillan C, Binhammer P. Steroid injection and needle aponeurotomy for Dupuytren contracture: a randomized, controlled study. J Hand Surg Am. 2012;37:1307–12.

    Article  PubMed  Google Scholar 

  24. Jerosch-Herold C, Shepstone L, Chojnowski AJ, Larson D, Barrett E, Vaughan SP. Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-center, randomized controlled trial. BMC Musculoskelet Disord. 2011;12:136.

    Article  PubMed  Google Scholar 

  25. Bassot J. Traitement de la maladie de Dupuytren par exérèse pharmaco-dynamique bases physio-biologiques technique. Gaz Hop. 1969;16:557.

    Google Scholar 

  26. Gilpin D, Coleman S, Hall S, Houston A, Karrasch J, Jones N. Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren's disease. J Hand Surg Am. 2010;35:2027–38.

    Article  PubMed  Google Scholar 

  27. Watt AJ, Curtin CM, Hentz VR. Collagenase injection as nonsurgical treatment of Dupuytren’s disease: 8-year follow-up. J Hand Surg Am. 2010;35:534–9.

    Article  PubMed  Google Scholar 

  28. BSSH guidelines 2012. Available at: http://www.bssh.ac.uk/education/guidelines/dd_guidelines.pdf. Accessed October 11, 2012.

  29. NICE guidance on radiotherapy. Available at: http://guidance.nice.org.uk/IPG368. Accessed on October, 2012.

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Correspondence to Steven Lo.

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Lo, S., Pickford, M. Current concepts in Dupuytren’s disease. Curr Rev Musculoskelet Med 6, 26–34 (2013). https://doi.org/10.1007/s12178-012-9148-5

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