Article
Needle fasciotomy for Dupuytren’s contracture- a prospective cohort study of 58 fingers with a median follow-up time of 6.5 years
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Authors
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Anna Zachrisson
- Department of Orthopedics, Kungälv Hospital, Kungälv, Sweden
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Allan Ibsen Sörensen
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Joakim Stromberg
- Department of Hand Surgery, Sahlgrenska University Hospital, Department of Orthopedics, Alingsås lasarett, Gothenburg, Sweden
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Needle fasciotomy (NF) is a well-established, minimally invasive treatment option for mild to moderate Dupuytren contractures (DC). The procedure requires limited resources, and multiple contractures can be treated during the same session. However, long-term results have indicated a high recurrence rate. This prospective study was initiated to monitor the safe introduction of NF in a context where limited fasciectomy had been the only treatment option for DC, and to investigate the long-term results.
Methods: The inclusion criterion was a palpable cord with an MCP and/or PIP contracture in one or more fingers. 58 fingers in 43 patients were treated by needle fasciotomy between November 2010 and March 2012, and were followed for a median of 6.5 years. Four patients (with 8 treated fingers) died during the follow-up period, and two patients (with two treated fingers) declined follow-up. At the final follow-up of the remaining 52 patients, 29 fingers had had no further treatment for Dupuytren contracture. Nineteen had undergone another (10) or were scheduled for a secondary procedure of the finger (9).
Results and Conclusions: The median total passive extension deficit (TPED) decreased from 52° (range 20-166°) to 10° (range -25°-119°) postoperatively. No severe adverse events such as nerve or tendon injuries were reported. At final-follow up the median TPED was 20° (range -35°-135°) for all fingers.
A total of 12 fingers (20%) had a recurrence of the contracture defined as an extension deficit of >20° in a previously straightened finger. Six patients had had or were planned for secondary procedures in the same MCP joint, one by partial fasciectomy, five by another NF treatment as preferred by the patients. The median TPED in the remaining 29 fingers was 6° (range -35° - 105°).
Needle fascitomy is a simple and safe procedure for Dupuytren's contracture, with excellent immediate reduction of the joint contracture but with a recurrence rate that has to be taken into account. However, 29 fingers retained a straight finger at the final follow-up, and repeated NF was preferred in all but one of the patients with recurrence.
