Collagenase injection versus Partial fasciectomy in the treatment of Dupuytren’s contracture
Filed under Reviews
Rapid Review By: Shruti Jani
Title: Collagenase injection versus partial fasciectomy in the treatment of Dupuytren’s contracture
Reference: Tay, T. K. W., Tien, H., & Lim, E. Y. L. (2015). Comparison between Collagenase Injection and Partial Fasciectomy in the Treatment of Dupuytren’s Contracture. Hand Surgery, 20(3), 386-390. https://doi-org.mwu.idm.oclc.org/10.1142/S0218810415500288
The Skinny: “Comparison between Collagenase Injection and Partial Fasciectomy in the Treatment of Dupuytren’s Contracture” by Tay et al. (2015) is a comparative study that aims to compare collagenase injection and partial fasciectomy for patients with Dupuytren’s disease. The study aims to determine pre-treatment and post-treatment differences among patients in the net degree of passive extension, complication rate, and patient satisfaction. A total of 37 patients were recruited between August 2002 to January 2005 and were followed up for two years.
In the Weeds: A total of 37 patients with 62 metacarpophalangeal joints (MCP) and 44 proximal interphalangeal joints (PIP) were treated by a single surgeon (HT). The average age of the participants was 65 years for the collagenase injection group and 66 years for the open surgery group. Participants for the collagenase treatment were given the Xiaflex, and partial fasciectomy was done for the surgical group. The inclusion criteria included a flexion contracture in the MCP and PIP joints and a palpable pathologic cord in the hand or finger. The exclusion criteria consisted of patients unfit for surgery due to secondary reasons.
Bringing it Home: In the Collagenase group: pre-procedure contracture at MP and PIP joints averaged 38.9 and 59.4 degrees, respectively. Post-collagenase injection MP and PIP joints averaged 6.5 and 40.6 degrees, respectively. Both of these were statistically significant (p-value <0.05). In the surgery group: pre-procedure contracture at MP and PIP joints averaged 44.8 and 50.7 degrees, respectively. Post-partial fasciectomy MP and PIP joints averaged 3.9 and 6.5 degrees, respectively. Both of these were statistically significant (p-value <0.05).
Overall, the study found that the outcomes at the final follow of both treatments effectively reduce the contracture at MCP and PIP joints. Even though open fasciectomy has a greater reduction of the flexion contractures at MCP and PIP joints, most patients were satisfied with their outcome regardless of the treatment they received. The study depicts that collagenase injection is much more effective in the involved MCP joint than in the PIP joint. Collagenase procedure restored normal finger extension in most patients with an average of 83% passive extension correction in the MCP joint and 32% in the PIP joint.
Open surgery improved the degree of correction in both MCP and PIP joints. A reduction of 91% of the extension deficit was recorded in the MCP joint and 87% correction in PIP joints at the final follow-up after two years. Overall, both options remain viable options for patients.
More To Read
Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair
Title: Passive Mobilization With Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair: 5-Year Minimum Follow-Up of a Randomized Controlled Trial Article Review By: Tommi Hintnaus Reference: Chevalley, S., Wangberg, V., Ahlen, M., Stromberg, J., & Bjorkman, A. (2024, October 4). Passive Mobilization With Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair: 5-Year Minimum…
Simple but Effective Ways Hand Therapists Address Psychosocial Impacts of Upper Extremity Injuries
Although psychosocial factors are often not formally assessed during an evaluation in those with upper extremity injuries, the therapist often informally assesses these during and after treatment sessions. Sustaining an upper extremity injury can be a physically and emotionally challenging experience. Beyond the physical pain and limitations, these injuries can profoundly impact an individual’s psychosocial…
Pros and Cons of Cortisone Injections
By: Shruti Jani Patients will often times ask the therapist their opinion on cortisone injections. Cortisone injections can be very helpful and significantly reduce inflammation, however, some therapists feel this can mask the pain not treating the true root cause of the problem. This is often debated among therapists. A short synopsis of the pros…
Increasing Shoulder Range of Motion by improving Scapulohumeral Rhythm
Scapulohumeral rhythm is often the key component when treating shoulder conditions and the reason for the lack of total shoulder range of motion. This may also be a critical component in order to prevent shoulder conditions during rehabilitation of other upper extremity conditions such as distal radius fractures, tendon injuries, and elbow injuries. Scapulohumeral rhythm…
Sign-up to Get Updates Straight to Your Inbox!
Sign up with us and we will send you regular blog posts on everything hand therapy, notices every time we upload new videos and tutorials, along with handout, protocols, and other useful information.