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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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Actualization results of our prospective study with collagenase clostridium histolyticum: series of 100 cases, 5 years follow-up

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  • presenting/speaker Monica Fernandez Alvarez - Hospital Universitario Marqués de Valdecilla, Santander, Spain
  • Maria de los Angeles De La Red Gallego - Hospital Universitario Marqués de Valdecilla, Santander, Spain
  • Manuel Ruben Sanchez Crespo - Hospital Universitario Marqués de Valdecilla, Santander, Spain
  • Jose Couceiro Otero - Hospital Universitario Marqués de Valdecilla, Santander, Spain
  • Higinio Ayala Gutierrez - Hospital Universitario Marqués de Valdecilla, Santander, Spain
  • Olga Maria Velez Garcia - Hospital Universitario Marqués de Valdecilla, Santander, Spain
  • Fernando Javier Del Canto Alvarez - Hospital Universitario Marqués de Valdecilla, Santander, Spain

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. DocIFSSH19-900

doi: 10.3205/19ifssh0430, urn:nbn:de:0183-19ifssh04307

Published: February 6, 2020

© 2020 Fernandez Alvarez 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: Collagenase injection is a non-surgical option for Dupuytren disease. We ought to analyse the results in our prospective serie of cases at 5 years of follow-up.

Methods: Prospective study collected data was performed from the first 100 CCH injections performed at our institution since 2012. Statistical analysis was made for 18 variables. We'll focuse specially in the recurrence rate and necessity of a new infiltration or surgery. Recurrence was defined as the apparition of a palpable cord with retraction greater than 20º

Results and Conclusions: 89% male, with a mean-age of 64'27. 94% right-handed. Fifth finger was affected in 47%, fourth 27%, both 11% and others 15%. MCP were the most injected joints, 79% of cases, followed by PIP 18%. Complete extension was achieved in the 83'54% of cases (86% of MCP joints and 56% of PIP joints), incomplete extension in 12'66%, and in 3'8% of cases there was no extension. There were statistical significant differences (p= 0,008) between treated joints and extension achieved. Nor statistical significant differences (p=0'462) were found between treated finger and extension achieved, neither between treated joint and complications rate (p; 0'248). In total the rate of recurrences was 16%: 1% at 6 months, 5% at 1 year, 4% at 2 years, 3% at 3 years, 1% at 4 years and 2% at 5 years' follow-up. Recurrence affected the Fifth finger in 75% of cases. In 43,75% of cases, PIP were the affected site, MCP joints in 18,75% and combination of both in the rest of the cases. PIP joint mean recurrence degrees was 42,3º, and 40,5º at MCP. Treatment after recurrence consisted in open surgery procedure for 31,25% of the cases, new collagenase injection for 31,25% and no procedure in other cases.

CCH is effective in the treatment of Dupuytren MCP and PIP joint contractures, in mid-term follow-up. Most studies are short term and there are few data on recurrence, however, recurrence PIP rate are high and we should consider this at long follow-up because the advantage of initial lower cost and quick recovery of CCH comparing to surgery might be dud if those patients need another infiltration or surgery.