Collagenase for Dupuytren’s Contractures: A Prospective Case Series
Arran S Goddard-Nash3*, Brendan J Valente1 Arnout JL Faveere1 and Matthew J Lawson-Smith1-4
1Fremantle Department of Hand Surgery, Australia
2Fremantle Department of Orthopaedic Surgery, Australia
3University of Notre Dame Australia (Fremantle), Australia
4University of Western Australia, Australia
*Corresponding Author: Arran S Goddard-Nash, University of Notre Dame
Australia (Fremantle), Australia.
April 28, 2023; Published: May 20, 2023
Background: Dupuytren’s disease (DD) is a fibroproliferative disorder with marked deposition of type I collagen in the palmar fascia of the hand. This causes flexure contractures of the fingers, which can be detrimental to a patient’s hand function and quality of life. Collagenase injections derived from clostridium histolyticum (CCH) have been growing in popularity for the treatment of DD, as such evidence has grown for short and long term outcomes, however there is limited evidence for long term complication rates.
Methods: Prospective cohort study measuring flexion of contracture’s post collagenase injection with follow up at 5-12 weeks and 1-3 years.
Results: Four hundred and eighty seven fingers from 287 patients, 83% were either little or ring finger contracture’s. There was an average of 37° of flexion in the cohort’s metacarpophalangeal joint’s (MCPJ). This was reduced to 18° post stretch, further reduced to 13° at early follow up and maintained at 18° at late follow up. The proximal interphalangeal joint (PIPJ) followed similar patterns reducing from 36° to 23° at early follow up. However did not maintain the improvement at late follow up, as is consistent with surgical outcomes. The complication rate was found to be 27%, with small skin tears reported in 16% of patients, this is again comparable to surgical treatment options.
Conclusions: The study shows collagenase injections are beneficial in the treatment of DD, with comparable results to surgical intervention literature. It remains a promising alternative to surgery due to the potential for high treatment rates, cost effectiveness and resource optimization.
Keywords:Dupuyren’s Disease; Clostridium histolyticum; Collagenase; Joint Contracture; Complications
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