Epidemiology of Dupuytren's Disease in Japanese General Population.

Background: Dupuytren's disease (DD) is well known as a fibromatous disorder of the palmar aponeurosis. Although there is a large body of literature on the etiology of DD in Europe, there have been few studies in Japan. The purpose of our study was to investigate the etiology and risk factors of DD in a large population in Japan. Methods: The subjects were voluntary participants from the 2014 Health Promotion Project, and 1,112 individuals were included (421 men and 691 women; mean age = 54.2 ± 15.3 years) in this study. The severity of DD was assessed using the Meyerding classification. All participants completed a questionnaire on age, sex, lifestyle, and occupations. All participants also completed the Short Form Health Survey (SF-36) to investigate the QOL. Fasting venous blood specimens were taken for biochemical analysis. Results: DD was found in 44 participants (3.9%). The prevalence was 8.3% among the men and 1.3% among the women. The prevalence in these older than 60 years was 7.7% (men; 18.5%, women; 2.4%). There were 17 participants that had DD of both hands. Multiple digits were affected in 9 participants. The ring finger was the most affected finger (71.2%), followed by the little finger (16.4%), and middle finger (12.3%). In Meyerding classification, 39 cases were stage 0, one case was stage 1, and four cases were stage 2. The multivariate logistic regression analysis revealed that age, sex, smoking, and occupation were significantly associated with DD. There was no significant association between DD and other parameters. When associations between DD and the SF-36 subscales were analyzed, there were significant associations with physical functioning, physical role functioning, and mental health. Conclusions: Our study is the largest in Japan to date. These results will provide very useful data to aid understanding of DD.

Dupuytren's Contracture: Incidence of Injury-Induced Cases and Specific Clinical Expression.

Background and objectives: Dupuytren's contracture is a chronic fibroproliferative hand disorder with a varying pattern of genetic predisposition across different regions and populations. Traumatic events have been found to have influence on the development of this illness and are likely to trigger different clinical forms of this disease. The aim of this study was to evaluate the phenomenon of development of Dupuytren's contracture (DC) following an acute injury to the hand, and to observe the incidence and clinical diversity of such cases in daily clinical practice. Materials and Methods: We collected data of patients presenting with primary Dupuytren's contracture in the Lithuanian population and evaluated the occurrence and clinical manifestation of this specific type of DC, arising following acute hand trauma. The diagnosis of DC was based on clinical signs and physical examination. Digit contractures were measured by goniometry, and the staging was done according to Tubiana classification. Injury-induced (injury-related) cases were identified using the "Criteria for recognition of Dupuytren's contracture after acute injury" (established by Elliot and Ragoowansi). Results: 29 (22%) of a total of 132 cases were injury-induced DCs. Twenty-six of 29 patients in this group presented with stage I-II contractures. Duration of symptoms was 6 (SD 2.2) and 3.8 (SD 2.2) years in the injury-related and injury-unrelated DC groups, respectively. Mean age on the onset of symptoms in the injury-induced and non-injury-induced groups was 52 (SD 10.7) and 56 (SD 10.9), respectively. Patients from both groups expressed strong predisposition towards development of DC. Conclusions: Around one-fifth of patients seeking treatment for primary Dupuytren's contracture seemed to suffer from injury-induced Dupuytren's contracture. We noted that injury to the wrist and hand seems to trigger the development of less progressive Dupuytren's contracture in younger age. Prospective randomized studies are required to confirm our findings.

Dupuytren's disease: A reality in Black Africa.

Long regarded as a disease exclusively found amongst Northern Europeans, Dupuytren's disease was seldom studied amongst Black Africans. Thus, we sought to study the impact of Dupuytren's disease, its etiological, clinical and evolutionary peculiarities on a segment of the Senegalese population. This study analyzed data derived from clinical observations carried out between January 2006 and December 2018. It involved Senegalese subjects with Dupuytren's disease, the patients' history, profession, habitus, clinical findings, therapeutic modalities and disease staging. The population included 20 men and 6 women averaging 63.5 years of age (range 45-77). None of the patients reported a family of Dupuytren's disease. Twelve patients had diabetes, 11 were smokers and 22 were engaged exclusively in manual labor. The condition was bilateral in 14 cases. Tubiana stages N, I, II, III and IV were found in 31, 15, 9, 5 and 6 rays, respectively. Conservative treatment was done in 11 patients. Surgical treatment was carried out in the other 15 patients: needle fasciotomy (N=10) including two bilateral involvement and open fasciectomy (N=7). Functional outcomes were satisfactory. Lesions were all stable in the short and medium term. Two patients had progressive lesions on a longer-term basis. Dupuytren's disease is real among Afro-descendants from Senegal even though it is seldom studied. Based on the patients' recollection of Dupuytren's disease in their families, heredity is not yet a proven factor. The early forms are more common, and the lesions remain stable for a long time.

Needle Aponeurotomy for Dupuytren Disease.

Needle aponeurotomy is an effective, minimally invasive treatment for metacarpophalangeal and interphalangeal joint contractures caused by Dupuytren disease. Multiple joints and digits can be safely treated in 1 session. Needle aponeurotomy is more cost-effective and has a significantly lower complication rate compared with open fasciectomy and collagenase injections. Recurrence rates are higher compared with open fasciectomy and collagenase injections. Patient satisfaction rates are high following needle aponeurotomy; the single clinic visit required and the minimal downtime after treatment are advantages unique to this procedure compared with other treatment modalities, including open fasciectomy, dermatofasciectomy, collagenase injections, and lipofilling.

Fasciectomy for Dupuytren Contracture.

This article discusses limited fasciectomy for Dupuytren contracture, reviews the literature to list common complications, addresses the observations that need to be made after surgery, and systematically reviews the literature for 2 clinical questions: (1) regarding leaving wounds open and (2) the use of postoperative splintage.

A post hoc analysis of Dupuytren contracture treated with collagenase Clostridium histolyticum across disease stages.

This post hoc analysis from a multicenter study (NCT01674634) was designed to evaluate the efficacy of collagenase Clostridium histolyticum (CCH) treatment in patients with different stages of Dupuytren contracture. Previously untreated patients who received two concurrent injections of CCH in two affected joints in the same finger were assessed by disease severity (Tubiana stage). The mean (SD) improvement in total fixed flexion contraction (FFC) 31 days post-CCH treatment in 181 patients was: 71.1 (36.5)% for Tubiana I, 77.0 (21.0)% for Tubiana II, 72.0 (20.4)% for Tubiana III and 66.4 (22.2)% for Tubiana IV. Treatment of metacarpophalangeal and proximal interphalangeal joints in the same finger resulted in a mean (SD) improvement of 82.5 (24.8)% and 66.4 (27.9)%, respectively. In conclusion, CCH is an effective treatment alternative for all stages of Dupuytren contracture and it provides a less invasive treatment alternative to surgery with similar short-term efficacy in patients with more severe disease.

Comparative Outcomes of Dupuytren Disease Treatment.

Despite more than a hundred years of publications on Dupuytren disease, there has been a lack of consensus on definitions and outcomes until recently. Staging and classifications systems have an important historical context; however, more recently, outcomes rely on patient-reported outcomes, angular correction, and definitions of recurrence. This article reviews commonly used assessments, classifications, and staging systems for Dupuytren disease.

[Partial Fasciectomy and Options of Reconstruction Using Local Flaps in Cases of Dupuytren's Disease]. / Partielle Fasziektomie und lappenplastische Deckungsoptionen beim Morbus Dupuytren.

Aim: Partial fasciectomy in cases of grade III-IV Dupuytren's contracture and coverage of the defect with local flaps. Indication: Dupuytren's contracture is a progressive disease of the hand associated with the formation of fascial cords, which may result in flexion and adduction contractures of the fingers leading up to complete dysfunction of the hands. Method: If several fingers are affected, partial fasciectomy is the gold standard in the treatment of Dupuytren's contracture. Ideally, the fingers reach the neutral position after the fibres causing the contracture are resected and arthrolysis is performed as needed. The skin deficits resulting from restored extension have to be covered by the use of Z-plasties, local or pedicled flaps of the hand. Conclusion: The resection of contracting cords in advanced cases of Dupuytren's contracture leads to large soft tissue defects. The microsurgical preparation of nerve and vascular structures is often difficult because of the fascial cords surrounding them. Exact preoperative planning of the extent of resection, as well as reconstruction options are essential and determine how incisions are made. To prevent a relapse, it is essential to reverse skin fibre direction using flaps and to insert intact skin with preserved subdermal adipose tissue.

A review of the classification of Dupuytren's disease.

Although much has been published about the treatment of Dupuytren's disease, there is no clear consensus regarding the most effective form of treatment. Part of this uncertainty may result from the absence of a universal method of assessing this condition. We undertook a review of the literature in order to summarize the various methods by which Dupuytren's disease has been measured and quantified. We included all articles that offered a classification or assessment system for the disease. We excluded articles that dealt solely with surgical technique (although inevitably there was some overlap). We conclude that there are many methods of assessment, but that none of them is perfect and that further work is needed in the field.

Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence.

The aim of this study was to determine a definition of recurrence of Dupuytren disease that could be utilized for the comparison of the results independently from the treatment used. 24 hand surgeons from 17 countries met in an international consensus conference. The participants used the Delphi method to evaluate a series of statements: (1) the need for defining recurrence, (2) the concept of recurrence applied to the Tubiana staging system, (3) the concept of recurrence applied to each single treated joint, and (4) the concept of recurrence applied to the finger ray. For each item, the possible answer was given on a scale of 1-5: 1=maximum disagreement; 2=disagreement; 3=agreement; 4=strong agreement; 5=absolute agreement. There was consensus on disagreement if 1 and 2 comprised at least 66% of the recorded answers and consensus on agreement if 3, 4 and 5 comprised at least 66% of the recorded answers. If a threshold of 66% was not reached, the related statement was considered "not defined". A need for a definition of recurrence was established. The presence of nodules or cords without finger contracture was not considered an indication of recurrence. The Tubiana staging system was considered inappropriate for reporting recurrence. Recurrence was best determined by the measurement of a specific joint, rather than a total ray. Time 0 occurred between 6 weeks and 3 months. Recurrence was defined as a PED of more than 20° for at least one of treated joint, in the presence of a palpable cord, compared to the result obtained at time 0. This study determined the need for a standard definition of recurrence and reached consensus on that definition, which we should become the standard for the reporting of recurrence. If utilized in subsequent publications, this will allow surgeons to compare different techniques and make is easier to help patients make an informed choice.

[Collagenase-A revolution of Dupuytren's therapy]. / Revolutioniert Kollagenase die Chirurgie?

Up to date, Dupuytren's contracture is a disease without cure. Almost 20 years ago, enzymatic cord degradation with clostridial collagenase was described for the first time. Whereas until recently limited fasciectomy was the treatment of choice for most of the patients, now collagenase offers a minimally invasive treatment in cases with palpable cords. Collagenase is a safe and effective treatment with success rates around 85 % for MCP joint and 65 % for PIP joints and a low complication rate. One point of concern is the recurrence rate which is higher compared to open surgery. A review of the literature is presented, technique and indication for collagenase are discussed.

[Treatment of Dupuytren's disease with collagenase - a 1-year follow-up of 37 patients]. / Behandlung der Dupuytren'schen Kontraktur mit Kollagenase - Ein-Jahres-Follow-up-Analyse anhand von 37 Patienten.

INTRODUCTION: The efficiency of collagenase of Clostridium histolyticum (CCH; Xiapex) in the treatment of Dupuytren's contracture has been proved in phase III studies. This retrospective study aims to evaluate our clinical results after the use of CCH. PATIENTS AND METHODS: The study included 40 Dupuytren's contractures in 37 patients. There were 32 male and 5 female patients; their average age was 66 years. The most affected finger was the ring finger (55%; 22/40), followed by the little finger (30%; 12/40) and the middle finger (15; 6/40). 14 fingers (35%) presented isolated contractures of the metacarpophalangeal joint whereas an isolated contracture of the proximal interphalangeal joint was evident in 8 (20%) fingers. 18 (45%) fingers presented combined MCP and PIP flexion contractures. None of the patients underwent any treatment prior to this study. A retrospective chart review was performed of all patients. Follow-up examinations were performed seven days, fourteen days, three months, six months and one year after the intervention. The follow-up examination included goniometry of each affected finger to assess the range of motion (ROM) before and after cord breaking. Further patient-reported outcome was accessed concerning postinterventional complaints, impairment of sensibility and satisfaction with the treatment. RESULTS: The range of motion improved in all fingers. Full extension of the affected finger without any contracture could be observed in 93% of the MCP contractures, 38% of the PIP contractures and in 28% of the combined MCP and PIP contractures. Incomplete cord breaking could be observed in 9 (22.5%) fingers. In 8 fingers (20%) skin tears occurred after joint manipulation but healed up without any further surgical intervention. The recurrence rate at the latest follow-up was 2.5% (1/40). Patient satisfaction was high and none of the patients reported any complaints at the latest follow-up. CONCLUSION: The best results could be achieved in patients with isolated contractures of the MCP joint. Regarding the good functional results, the low complication rates and the high patient satisfaction, CCH represents a simple and effective treatment for Dupuytren's contracture in selected cases.

Dupuytren disease: on our way to a cure?

Despite its high prevalence, the clinical presentation and severity of Dupuytren disease is extremely variable. The disease features a broad spectrum of symptoms, from simple nodules without the slightest clinical impact towards an extremely disabling form requiring multiple surgical procedures, sometimes even partial hand amputations. Recurrence after surgery is considered a failure for both patient and surgeon, but its definition is vague. The term 'recontracture' was coined by a patient and reflects the disappointment of recurrent disease. Wether or not a treatment option will insure a definite result, may depend more on the severity of the disease, which is patient specific, than on the treatment method itself. If a patient presents with Dupuytren disease, one should not merely evaluate his hands. Different clinical and personal history features may uncover a severe fibrosis diathesis and both correct information to the patient and an individualized treatment plan are needed. In the near future, a simple genetic test may help to identify patients at risk. Similar to the evolving knowledge and treatment modalities seen in rheumatoid arthritis, treatment of Dupuytren disease is likely to advance in the direction of disease control with pharmacotherapy and single shot minimal invasive enzymatic fasciotomy with collagenase to correct established contractures.

Results of surgery treatment of Dupuytren's contracture in 115 patients.

INTRODUCTION: Dupuytren's disease (DD) is a progressive fibroproliferative disorder of the hand causing digital flexion contracture. Treatment goals include removing or releasing the fibrotic cord to allow extension of the affected finger(s) and restoration of hand function. MATERIAL AND METHODS: In study period from 2001 through 2008, evaluation was performed in 115 patients. Limited or extensive fasciectomy was performed in all patients. Tubiana classification sheme to rate severity of DD was used. RESULTS: There were 106 male patients ( mean age 62.6 years) and 9 female patients (mean age 66.3 years). Before the operation, 38% of all patients were at Tubiana stage I, 32% were at stage II, 22% were at stage III and 8% were at stage IV. Of all patients, 43% were diagnosed with Dupuytren's in only one finger, 39% in two fingers and 18% in three fingers. In 23% of patients DD were diagnosed on both hands. Limited fasciectomy was peformed in 90.4% of patients and extensive fasciectomy in 9.6% of patients. The Tubiana stage achived after surgery was lower in 98% of patients. As a final result after surgery, 66% of patients didn't have contracture, stage I was reported in 28% and stage II in 3% of patients. There were no patients with Tubiana stage III or more after surgery. Postoperative complications were noted in 18% of patients. Wound healing problems were present 12% of patients. Haematoma was reported 5% of patients. Of all patients 22% had diabetes mellitus. CONCLUSION: DD is much more common in male than in female patients. Most of the patients are diagnosed at Tubiana stage I and II. Surgical correction has led to an improvement in most patients. Limited fasciectomy is still the gold-standard in DD treatment. Extensive fasciectomy or dermofasciectomy is preformed only in most severe cases.

Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years.

BACKGROUND AND PURPOSE: In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. PATIENTS AND METHODS: Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response. RESULTS: According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy. CONCLUSION: After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a "salvage" operation is still feasible.

Re-visiting Luck's classification: a histological analysis of Dupuytren's disease.

Luck (1959) described a histological staging system for Dupuytren's disease, classifying the disease into three stages. Previous biochemical and immunochemical studies have detailed the decrease in type III/I collagen ratio with disease progression. Herovici (1963) described a histological stain that produced a differential red/purple and blue colour for type I and III collagen respectively. We stained 15 specimens of Dupuytren's disease and quantified the different collagen types in each using computer analysis. We found a corresponding decrease in the amount of type III collagen as a percentage of the total collagen with disease progression: stage I range 35-49% (mean 38%); stage 2 range 21-33% (mean 27%) and stage 3 range 11-19% (mean 14%). We propose a new staging system based on the relative amount of type III collagen, where stage 1: >35%, stage 2: >20% and <35%, and stage 3: <20%.