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Clinical outcomes following collagenase injections compared to fasciectomy in the
treatment of Dupuytren s contracture
#MMPMID26034441
Muppavarapu RC
; Waters MJ
; Leibman MI
; Belsky MR
; Ruchelsman DE
Hand (N Y)
2015[Jun]; 10
(2
): 260-5
PMID26034441
show ga
INTRODUCTION: The aim of this study is to compare the efficacy of collagenase
injections with that of fasciectomy in the treatment of Dupuytren's contracture.
METHODS: This is a case-control retrospective study. We reviewed the electronic
medical records from January 2009 through January 2013, identifying 142
consecutive patients who underwent either fasciectomy or collagenase injection.
Exclusion criteria for both groups were age <18 years, pregnant women, and
arthroplasty or arthrodesis of the treated joint. Follow-up data beyond 1-year
duration was available for 117 of the patients: 44 patients who had undergone
fasciectomy, and 73 patients who had received collagenase injection. The primary
outcome measure in this study was resolution of joint contracture to 0-5° deficit
of full extension. Data was analyzed using two-sample t tests for continuous data
and chi-square test for categorical data. A significant P value was set at <0.05.
RESULTS: At the latest follow-up, significantly more joints treated with
fasciectomy met the primary outcome measure. Metacarpophalangeal (MP) joints
responded better than the proximal interphalangeal (PIP) joints for both
treatments. At the latest follow-up (14.2 months for collagenase, 16.3 months for
fasciectomy), 46 % of MP joints treated with collagenase and 68 % of MP joints
treated with fasciectomy maintained resolution of joint contracture. Sub-analysis
of the affected joints based on the severity of initial contracture demonstrated
that MP and PIP joints with contractures <45° responded better than more severely
contracted joints (>45°). CONCLUSIONS: Fasciectomy yields a greater mean
magnitude of correction for digital contractures at the latest follow-up when
compared to collagenase. Both treatments were more effective for treatment of MP
joint contracture compared to PIP joint contracture. LEVEL OF EVIDENCE: Level
III, therapeutic.