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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Collagenase dose related correction of flexion deformity in Dupuytren’s contracture: A prospective randomized study

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  • presenting/speaker Nash Naam - Southern Illinois Hand Center, Southern Illinois University, Effingham, United States
  • Abdel Hakim Massoud - Al Azhar University, Cairo, Egypt

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-480

doi: 10.3205/19ifssh0425, urn:nbn:de:0183-19ifssh04256

Published: February 6, 2020

© 2020 Naam et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation:

Collagenase injections have been used in treatment of Dupuytren's contracture. The recommended dose is 0.58 mg per cord. We hypothesized that increasing the Collagenase dose may increase the likelihood of correcting the flexion deformities.

Methods: A prospective randomized study was conducted comparing 2 groups of patients with Dupuytren's contracture. Patients were selected randomly for either injection of 0.9 mg of Collagenase (group I) or 0.58 mg (group II). The injection technique was the same. Patients were seen after 24 hours for the extension procedures under local anesthesia.

There were 37 digits in 27 patients in group I and 34 digits in 29 patients in group II. Age averaged 58 years in group I and 61 years in group II. There were 23 males in group I and 24 in group II. Isolated Metacarpophalangeal (MP) joints were involved in 21 digits in group I and 18 digits in group II. Isolated Proximal Interphalangeal (PIP) joints were involved in 4 digits in group I compared to 6 in group II. Both MP and PIP joints were involved in 12 digits in group I and 10 digits in group II. Flexion deformities of MP joints averaged 69 degrees in group I compared to 72 in group II while PIP joint flexion deformities averaged 41 in group I compared to 39 in group II.

Results: All patients in both groups exhibited bruising and swelling of the involved hand after injection with no significant difference. Correction of flexion deformities of MP joints to 0-5 degrees was achieved in 26 digits (79%) in group I compared to 17 digits (61%) in group II which was statistically significant (P=0.01). Correction of PIP joints to 0-5 was achieved in 10 digits (63%) in group I compared to 8 digits (50%) in group II (P=0.02). The mean improvement in MP joints was 40 degrees in group I compared to 28 in group II (P=0.02). The mean improvement of PIP joints was 27 in group I compared with 17 in group II (P=0.02). DASH scores were similar in both groups (P=0.3).

Complications: One patient in group I had axillary lymphadenopathy that improved in one week. 4 patients in group I and one patient in group II had skin tears that healed within 2 weeks.

Conclusions: Increasing the dosage of Collagenase injections to 0.9 mg increases the effectiveness of correcting flexion deformities with Dupuytren's contractures.

There is no increase of risk or complications.