gms | German Medical Science

Since May 2011 there is a minimal invasive therapeutic option for Morbus Dupuytren by means of enzymatic lysis of Dupuytren's cord available in Germany. We report about efficacy and adverse effects of injactable collagenase clostridium histolyticum for M. Dupuytren.

Constitution and application were carried out according to the manufacturer's guidelines. The manual cord rupture was done 24 hours after injection of collagenase. Patients received local anesthesia and the finger was pulled into extension. Before and after treatment we measured range of motion in all finger joints with a small goniometer. Patients were given a splint to wear nightly and they did undergo physical therapy.

Since may 2011 we included 44 patients with an average age of 68,3 years (range, 39–83). 35 patients (80%) were male. Overall 55 fingers were treated with 54 injections. We noticed a preponderance of ulnar sided-digits, with 51% (28) ring finger followed by the little finger 36% (20). The immediate correction of 39 MP joint contractures was from an average 48° preprocedure (range, 5°–90°) to an average of 1° (range, 0°–20°) postprocedure. In 34 PIP joints contracture was reduced from 59° (range, 10°–100°) to 19° (range 0°–70°).

In a group of 11 patients enrolled in a 6-month follow-up, contracture was reduced from an average of 34° (range, 20°–80°) before treatment to an average of 12° (range, 0°–30°) 6 months later in the MP joint (n=7). In the PIP joint (n=15) there was reduction from an average contracture of 74° (range, 40°–100°) before therapy to an average of 38° (range, 0°–70°) 6 months later.

Common adverse effects were local edema (n=20), hematoma (n=12) and skin tears (n=9). There were also two small skin lesions of a few millimeter. All those injuries of the skin healed with local wound care. There were no heavy complications such as tendon ruptures or nerve lacerations.

Injectable collagenase clostridium histolyticum is an efficient and safe therapy for Dupuytren’s disease. Low patient burden and performance in an ambulant setting make it an interesting option for patients. It requires good anatomical knowledge and hand surgical skills to be performed successfully and to cope potential complications. Our study shows that it is successful in MP joints as well as in PIP joints.