Collagenase Treatment for Dupuytren Disease of the Thumb and First Web

Marieke M. Dreise*, Martin W. Stenekes, Paul M. N. Werker

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
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Abstract

Purpose To evaluate the short-term effectiveness of collagenase Clostridium histolyticum to treat thumb and first web contractures in Dupuytren disease.

Methods We prospectively included 14 thumbs in 12 patients with a contracture at the metacarpophalangeal or interphalangeal joint of at least 20 degrees with a palpable cord in the thumb (n = 8) or an adduction contracture of the thumb with palpable cords in the first web (n = 6). They received an injection containing 0.58 mg of collagenase Clostridium histolyticum in the fibrous cord divided over 3 spots. The contracture was released by carefully manipulating the thumb under local anesthesia 1 day later. The extension and abduction deficits were measured before and after the intervention (follow-up at 7 and 30 days and 6 months). Wilcoxon signed rank test was used to analyze the data.

Results In the total sample, postintervention extension deficits were statistically significantly lower than preintervention deficits except in one patient who had a recurrence at 6 months compared with the 30-day posttreatment result. Intermetacarpophalangeal head distance (IMD) also improved significantly. In an analysis of subgroups, we compared the separate contributions of treatment of a pretendinous cord and a first web cord on both extension deficit and IMD. Treatment of pretendinous cords significantly affected both extension deficit and IMD. However, treatment of first web contractures did not significantly improve extension or IMD.

Conclusions Collagenase Clostridium histolyticum is a good treatment option for pretendinous cords in thumbs affected with Dupuytren disease because it provides good results, is minimally invasive, and has minor adverse events. (Copyright (C) 2016 by the American Society for Surgery of the Hand. All rights reserved).

Original languageEnglish
Pages (from-to)348-353.e1
Number of pages6
JournalThe Journal of Hand Surgery
Volume41
Issue number3
DOIs
Publication statusPublished - Mar-2016

Keywords

  • Collagenase Clostridium histolyticum
  • Dupuytren disease
  • thumb
  • first webspace
  • CLOSTRIDIUM-HISTOLYTICUM
  • CONTRACTURE
  • DERMOFASCIECTOMY
  • FASCIECTOMY
  • HAND

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