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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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The evaluation of Dupuytren’s contracture with ultrasonography for safety of Collagenase Clostridium Histolyticum injection

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  • presenting/speaker Issei Nagura - Kobe Rosai Hospital, Kobe, Japan
  • Takako Kanatani - Kobe Rosai Hospital, Kobe, Japan
  • Yoshifumi Harada - Kobe Rosai Hospital, Kobe, Japan
  • Atsuyuki Inui - Kobe University Graduate School of Medicine, Kobe, Japan
  • Yutaka Mifune - Kobe Rosai Hospital, Kobe, Japan
  • Ryosuke Kuroda - Kobe University Graduate School of Medicine, Kobe, Japan

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. DocIFSSH19-508

doi: 10.3205/19ifssh0426, urn:nbn:de:0183-19ifssh04264

Published: February 6, 2020

© 2020 Nagura 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

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Objectives/Interrogation: The technical instruction leaflet for Collagenase Clostridium Histolyticum (CCH) injection recommends a "2-3mm depth" of injection, however, there is little supporting evidence. We consider that CCH injection into the middle of the cord is optimal to avoid the possible complications of skin laceration or flexor tendon rupture. This study investigated using the long axis images of ultrasonography as a tool to determine the appropriate injection depth.

Methods: 32 patients with Dupuytren's contracture with a mean age of 71.4 years (range; 57-87 years) were included in this study. All patients showed fixed flexion contracture (FFC) of the MCP joint caused by a palpable cord. The average FFC of the MCP joint was 51.4 degree (range; 20-80). We marked the CCH injection point on the skin above the cord and added two injection points proximally and distally with a 2mm distance. Then we measured the thickness of the skin and the width of the cord, and the distance from the skin to the middle of the cord as "the appropriate injection depth" by high resolution ultrasonography with long axis images (SNiBLE; Konica Minolta, Tokyo, Japan).

Results and Conclusions: The average distance from skin to the cord was 1.1mm (range; 0.5-2.0). The average width of the cord was 2.7mm (range; 1.5-3.8). The average distance from the skin to the middle of the cord was 2.4mm (range; 1.5-3.0). There was no difference of the distance among the three points.

Injection of CCH to an adequate depth is very important not only to obtain the maximum effect of collagenase but also to avoid possible complications. By using ultrasonography, we demonstrated that the distance from the skin to the middle of the cord was comparable to that described in the technical manual for the CCH injection namely "2-3mm depth injection is recommended". Using long axial images was practical for the measurement of the three injection points at one time. CCH injection could be possible safely not only relying on the feeling of resistance at the injection but also recognizing the actual depth by the ultrasonography.