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Dupuytren's contracture

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By Rajesh Purushothaman Additional Professor of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
W A Townley, R Baker, N Sheppard, A O Grobbelaar
No abstract text is available yet for this article.
February 18, 2006: BMJ: British Medical Journal
A Bayat, D A McGrouther
Dupuytren's disease is a progressive fibroproliferative disorder of an unknown origin affecting the hands causing permanent flexion contracture of the digits. Significant risk factors for development of Dupuytren's disease include old age, male sex, white northern European extraction, presence of positive family history of Dupuytren's disease, and diabetes mellitus. The disease also seems to deteriorate rapidly in those cases showing young age of onset and additional fibromatosis affecting the back of the hands, soles of the feet and the penis...
January 2006: Annals of the Royal College of Surgeons of England
M G Hart, G Hooper
Dupuytren's disease (DD) is a common progressive fibrotic condition affecting the palmar and digital fascia. Although its management is undertaken by hand surgeons, it is commonly seen by other doctors as an incidental finding. In many cases it is believed to be associated with other medical conditions, although the evidence for such associations is not always clear. This review considers the evidence behind these associations and discusses the aetiology of DD. By doing so, it is hoped that this review will permit a better understanding of the relevance of DD as a clinical sign...
July 2005: Postgraduate Medical Journal
Roberto Diaz, Catherine Curtin
PNA is one of many treatments available for the treatment of hand contractures resulting from Dupuytren’s disease. It is generally recommended for elderly patients with less severe contractures who desire a less invasive procedure, or as a first stage to delay surgery in those with more aggressive disease. The procedure is safe and easily tolerated by patients, but there is a high rate of recurrence.
February 2014: Hand Clinics
Vincent R Hentz
Palmodigital fasciectomy remains the gold standard. The initial outcome is, in my experience, far more predictable than either NA or enzyme fasciotomy (EF). It is also a more durable treatment. NA and EF can be conceptualized as similar procedures--one uses a needle and the other an enzyme to weaken a cord sufficient to be able to rupture it and thus straighten a contracted joint. Both are less invasive and the hand is quick to recover. Both procedures are equally initially effective. CHH seems to offer greater durability...
February 2014: Hand Clinics
C A Peimer, C A McGoldrick, G J Fiore
BACKGROUND: Collagenase clostridium histolyticum (CCH) is a Food and Drug Administration-approved treatment for adult patients with Dupuytren's contracture with a palpable cord that has been shown efficacious and safe in clinical trials. METHODS: This paper summarizes the most common post-marketing clinical adverse event (AE) reports received by the manufacturer of CCH and sponsor of the US Biologics License Application (Auxilium Pharmaceuticals, Malvern, PA, USA) during the first 12 months after drug approval and commercialization in the USA...
June 2012: Hand: Official Journal of the American Association for Hand Surgery
Scott Gelman, Robert Schlenker, Abdo Bachoura, Sidney M Jacoby, Jeffrey Lipman, Eon K Shin, Randall W Culp
BACKGROUND: Numerous options exist for the treatment of Dupuytren's contracture. This study describes the technique and early results of partial fasciectomy through a mini-incision approach as an additional treatment option for Dupuytren's disease. METHODS: This procedure involves the excision of diseased Dupuytren's tissue with the use of multiple 1 cm transverse incisions. Patient demographics, digit involvement, the number of incisions required to release each digit, and complications were recorded for all patients...
December 2012: Hand: Official Journal of the American Association for Hand Surgery
Lukas A Holzer, Andrej Cör, Gerhard Pfandlsteiner, Gerold Holzer
BACKGROUND AND PURPOSE: Dupuytren's disease (DD) is a benign fibroproliferative process that affects the palmar fascia. The pathology of DD shows similarities with wound healing and tumor growth; hypoxia and angiogenesis play important roles in both. We investigated the role of angiogenic proteins in DD. PATIENTS AND METHODS: The expression of vascular endothelial growth factor (VEGF), its receptors vascular endothelial growth factor receptor 1 (VEGFR1) and vascular endothelial growth factor receptor 2 (VEGFR2), hypoxia-inducible factor alfa (HIF-1α), and alfa-smooth muscle actin (α-SMA) were analyzed immunohistochemically in fragments of excised Dupuytren's tissue from 32 patients...
August 2013: Acta Orthopaedica
Patrick I Emelife, Russell E Kling, Ronit Wollstein
Dupuytren's contracture remains a significant clinical challenge due to associated complications and a recurrence rate of up to 60%. Commonly, the operated skin tends to rebuild scar in the area of surgery. Assuming local ischemia as an etiological factor, two cases in which topical nitroglycerin was used following surgical treatment of Dupuytren's disease are presented. In these patients, no raised scar formation developed during healing. At least six months after surgery, disease recurrence was not noted and the patients and surgeon reported improved skin quality...
2012: Canadian Journal of Plastic Surgery, Journal Canadien de Chirurgie Plastique
Lawrence C Hurst, Marie A Badalamente, Vincent R Hentz, Robert N Hotchkiss, F Thomas D Kaplan, Roy A Meals, Theodore M Smith, John Rodzvilla
BACKGROUND: Dupuytren's disease limits hand function, diminishes the quality of life, and may ultimately disable the hand. Surgery followed by hand therapy is standard treatment, but it is associated with serious potential complications. Injection of collagenase clostridium histolyticum, an office-based, nonsurgical option, may reduce joint contractures caused by Dupuytren's disease. METHODS: We enrolled 308 patients with joint contractures of 20 degrees or more in this prospective, randomized, double-blind, placebo-controlled, multicenter trial...
September 3, 2009: New England Journal of Medicine
Shaunak S Desai, Vincent R Hentz
The treatment of progressive Dupuytren contractures has historically been and continues to be largely surgical. Although a number of surgical interventions do exist, limited palmar fasciectomy continues to be the most common and widely accepted treatment option. Until recently, nonsurgical options were limited and clinically ineffective. However, the commercial availability and recent approval of collagenase clostridium histolyticum now provides practitioners with a nonsurgical approach to this disease. This article presents a comprehensive review of the surgical and nonsurgical treatments of Dupuytren disease, with a focus on collagenase...
May 2011: Journal of Hand Surgery
Neal C Chen, Ramesh C Srinivasan, Melissa J Shauver, Kevin C Chung
BACKGROUND: Needle aponeurotomy and collagenase injection are alternative treatments of Dupuytren's contracture to open partial fasciectomy; however, reported data are difficult to interpret without a formal systematic review. METHODS: A Medline, EMBASE, and Cochrane database search was performed, and 277 articles were identified. Articles were stratified by level of evidence, and those of the highest level for each technique were included. Evidence available for needle aponeurotomy was of low quality so only cohorts larger than 100 patients were included...
September 2011: Hand: Official Journal of the American Association for Hand Surgery
Stephen Coleman, David Gilpin, F Thomas D Kaplan, Anthony Houston, Gregory J Kaufman, Brian M Cohen, Nigel Jones, James P Tursi
PURPOSE: To assess the safety and efficacy of 2 concurrent injections of collagenase clostridium histolyticum (CCH) in the same hand to treat multiple Dupuytren flexion contractures. METHODS: In a multicenter, open-label phase IIIb study, 60 patients received two 0.58-mg CCH doses injected into cords affecting 2 joints in the same hand during 1 visit, followed by finger extension approximately 24 hours later. Efficacy at postinjection day 30 (change in flexion contracture and active range of motion, patient satisfaction, physician-rated improvement, and rates of clinical success [flexion contracture 5° or less]) and adverse events were summarized...
January 2014: Journal of Hand Surgery
Scott E Gelman, Robert Schlenker, Sidney M Jacoby, Eon K Shin, Randall W Culp
Treatment options for the Dupuytren contractures vary from percutaneous needle aponeurotomy, open fasciotomy or fasciectomy, dermofasciectomy, and more recently, injectable collagenase. Although utilization of injectable collagenase avoids a formal surgical procedure, not all patients are eligible and some patients do not feel comfortable with an enzyme injection or the associated risks, which may include hematoma, wound dehiscence, or tendon rupture. This study describes the technique and early results of partial fasciectomy through a mini-incision approach as an additional treatment option for Dupuytren contractures...
December 2012: Techniques in Hand & Upper Extremity Surgery
Jörg Witthaut, Graeme Jones, Nebojsa Skrepnik, Harvey Kushner, Anthony Houston, Tommy R Lindau
PURPOSE: The JOINT I (United States) and JOINT II (Australia and Europe) studies evaluated the efficacy and safety of collagenase clostridium histolyticum (CCH) injection for the treatment of Dupuytren contracture. METHODS: Both studies used identical open-label protocols. Patients with fixed-flexion contractures of metacarpophalangeal (MCP) (20° to 100°) or proximal interphalangeal (PIP) joints (20° to 80°) could receive up to three 0.58-mg CCH injections per cord (up to 5 total injections per patient)...
January 2013: Journal of Hand Surgery
Clayton A Peimer, Philip Blazar, Stephen Coleman, F Thomas D Kaplan, Ted Smith, James P Tursi, Brian Cohen, Gregory J Kaufman, Tommy Lindau
PURPOSE: To evaluate long-term efficacy and safety of collagenase clostridium histolyticum (CCH) after the third year of a 5-year nontreatment follow-up study, Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study. METHODS: This study enrolled Dupuytren contracture patients from 5 previous clinical studies. Beginning 2 years after their first CCH injection, we re-evaluated patients annually for joint contracture and safety. Recurrence in a previously successfully treated joint (success = 0° to 5° contracture after CCH administration) was defined as 20° or greater worsening in contracture in the presence of a palpable cord or medical/surgical intervention to correct new or worsening contracture...
January 2013: Journal of Hand Surgery
Gary M Pess, Rebecca M Pess, Rachel A Pess
PURPOSE: To critically review the efficacy, recurrence rate, and complications of needle aponeurotomy (NA) for the treatment of Dupuytren contracture. METHODS: This was a retrospective study of the results of NA for the treatment of Dupuytren contracture. We included in the study all patients who had NA performed for metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contracture of 20° or greater between March 2005 and May 2008. There were 474 patients with 1,013 fingers treated...
April 2012: Journal of Hand Surgery
Paul M N Werker, Gary M Pess, Annet L van Rijssen, Keith Denkler
PURPOSE: To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. METHODS: This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English...
October 2012: Journal of Hand Surgery
Keith T Palmer, Stefania D'Angelo, Holly Syddall, Michael J Griffin, Cyrus Cooper, David Coggon
AIMS: The relation between Dupuytren's contracture and occupational exposure to hand-transmitted vibration (HTV) has frequently been debated. We explored associations in a representative national sample of workers with well-characterised exposure to HTV. METHODS: We mailed a questionnaire to 21 201 subjects aged 16-64 years, selected at random from the age-sex registers of 34 general practices in Great Britain and to 993 subjects chosen randomly from military pay records, asking about occupational exposure to 39 sources of HTV and about fixed flexion contracture of the little or ring finger...
April 2014: Occupational and Environmental Medicine
Guido H Dolmans, Paul M Werker, Hans C Hennies, Dominic Furniss, Eleonora A Festen, Lude Franke, Kerstin Becker, Pieter van der Vlies, Bruce H Wolffenbuttel, Sigrid Tinschert, Mohammad R Toliat, Michael Nothnagel, Andre Franke, Norman Klopp, H-Erich Wichmann, Peter Nürnberg, Henk Giele, Roel A Ophoff, Cisca Wijmenga
BACKGROUND: Dupuytren's disease is a benign fibromatosis of the hands and fingers that leads to flexion contractures. We hypothesized that multiple genetic and environmental factors influence susceptibility to this disease and sought to identify susceptibility genes to better understand its pathogenesis. METHODS: We conducted a genomewide association study of 960 Dutch persons with Dupuytren's disease and 3117 controls (the discovery set) to test for association between the disease and genetic markers...
July 28, 2011: New England Journal of Medicine
2014-02-12 03:39:20
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