Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 6 Issue 6

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.

Received: 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


  1. Arnold DMJ., et al. "Additional Treatment after Collagenase Injections and Needle Fasciotomy for Dupuytren’s Disease: A Retrospective Cohort Study”. Journal of Hand and Microsurgery (2020).
  2. Arora R., et al. "Injectable Collagenase Clostridium Histolyticum as a Nonsurgical Treatment for Dupuytren’s Disease”. Operative Orthopadie und Traumatologie 1 (2016): 30-37.
  3. Badalamente MA and Lawrence CH. "Enzyme Injection as Nonsurgical Treatment of Dupuytren's Disease”. Journal of Hand Surgery (American Volume) 4 (2000): 629-636.
  4. Coleman S., et al. "Multiple Concurrent Collagenase Clostridium Histolyticum Injections to Dupuytren’s Cords: An Exploratory Study”. BMC Musculoskeletal Disorders1 (2012): 1-8.
  5. Elliott D., et al. "Collagenase Injections for Dupuytren’s in Australian Public Hospitals: A Cost Analysis”. Australasian Journal of Plastic Surgery1 (2019): 17-22.
  6. Gaston RG., et al. "The Efficacy and Safety of Concurrent Collagenase Clostridium Histolyticum Injections for 2 Dupuytren Contractures in the Same Hand: A Prospective, Multicenter Study”. Journal of Hand Surgery (American Volume) 10 (2015): 1963-1971.
  7. Gilpin D., et al. "Injectable Collagenase Clostridium Histolyticum: A New Nonsurgical Treatment for Dupuytren's Disease”. Journal of Hand Surgery (American Volume) 12 (2010): 2027-2038. e1.
  8. Grandizio LC., et al. "The Use of Residual Collagenase for Single Digits with Multiple-Joint Dupuytren Contractures”. Journal of Hand Surgery (American Volume) 6 (2017): 472.e1-72.e6.
  9. Hansen KL., et al. "Difference in Success Treating Proximal Interphalangeal and Metacarpophalangeal Joints with Collagenase: Results of 208 Treatments”. Plastic and Reconstructive Surgery Global Open4 (2017).
  10. Hayton MLJ., et al. "Isolated and Spontaneous Correction of Proximal Interphalangeal Joint Contractures in Dupuytren’s Disease: An Exploratory Analysis of the Efficacy and Safety of Collagenase Clostridium Histolyticum”. Clinical Drug Investigation 12 (2013): 905-912.
  11. Hurst LC., et al. "Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture”. New England Journal of Medicine10 (2009): 968-979.
  12. Krefter C., et al. "Complications after Treating Dupuytren's Disease. A Systematic Literature Review”. Hand Surgery and Rehabilitation5 (2017): 322-329.
  13. Martín-Ferrero MÁ., et al. "Treatment of Dupuytren's Disease Using Collagenase from Clostridium Histolyticum”. Revista Española de Cirugía Ortopédica y Traumatología (English Edition)6 (2013): 398-402.
  14. McMahon HA., et al. "Examining the Efficacy and Maintenance of Contracture Correction after Collagenase Clostridium Histolyticum Treatment for Dupuytren's Disease”. HAND3 (2013): 261-266.
  15. Muppavarapu RC., et al. "Clinical Outcomes Following Collagenase Injections Compared to Fasciectomy in the Treatment of Dupuytren's Contracture”. HAND2 (2014): 260-265.
  16. Naam NH. "Functional Outcome of Collagenase Injections Compared with Fasciectomy in Treatment of Dupuytren's Contracture”. HAND4 (2013): 410-416.
  17. Peimer CA., et al. "Dupuytren Contracture Recurrence Following Treatment with Collagenase Clostridium Histolyticum (Cordless [Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-Year Data”. Journal of Hand Surgery (American Volume) 8 (2015): 1597-605.
  18. Sandler AB., et al. "Treatment of Dupuytren’s Contracture with Collagenase: A Systematic Review”. HAND (2021): 1558944720974119.
  19. Sanjuan-Cerveró R., et al. "Adverse Effects Associated with Collagenase Clostridium Histolyticum in Dupuytren Disease: A Prospective Study”. Orthopaedics and Traumatology: Surgery and Research6 (2018): 901-905.
  20. Scherman P., et al. "One-Year Results of Needle Fasciotomy and Collagenase Injection in Treatment of Dupuytren’s Contracture: A Two-Centre Prospective Randomized Clinical Trial”. Journal of Hand Surgery (European Volume)6 (2015): 577-582.
  21. Simón-Pérez C., et al. "Factors Influencing Recurrence and Progression of Dupuytren’s Disease Treated by Collagenase Clostridium Histolitycum”. International Orthopaedics4 (2018): 859-866.
  22. Smeraglia F., et al. "Collagenase Clostridium Histolyticum in Dupuytren's Contracture: A Systematic Review”. British medical bulletin1 (2016): 149-158.
  23. Townley WA., et al. "Dupuytren’s Contracture Unfolded”. BMJ7538 (2006): 397.
  24. Warwick D., et al. "Collagenase Clostridium Histolyticum in Patients with Dupuytren's Contracture: Results from Point X, an Open-Label Study of Clinical and Patient-Reported Outcomes”. Journal of Hand Surgery (European Volume) 2 (2015): 124-132.
  25. Warwick D., et al. "Dupuytren’s Disease: Using Needles More across the World”. Journal of Hand Surgery (European Volume)1 (2021): 80-88.
  26. Watt AJ., et al. "Collagenase Injection as Nonsurgical Treatment of Dupuytren's Disease: 8-Year Follow-Up”. Journal of Hand Surgery (American Volume) 4 (2010): 534-39.e1.
  27. Werlinrud JC., et al. "Five-Year Results after Collagenase Treatment of Dupuytren Disease”. Journal of Hand Surgery (European Volume)8 (2018): 841-847.
  28. Wilburn J., et al. "The Impact of Dupuytren Disease on Patient Activity and Quality of Life”. Journal of Hand Surgery (American Volume) 6 (2013): 1209-1214.
  29. Yi I S., et al. "Etiology of Dupuytren’s Disease”. Hand Clinics 1 (1999): 43-51.


Citation: Arran S Goddard-Nash., et al. “Collagenase for Dupuytren’s Contractures: A Prospective Case Series”.Acta Scientific Orthopaedics 6.6 (2023): 49-53.


Copyright: © 2023 Arran S Goddard-Nash., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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