gms | German Medical Science

Objectives/Interrogation: Both needle fasciotomy (PNF) and the extensive needle fasciotomy with skin graft (PNF+) are minimal invasive treatments for severe recurrent Dupuytren's contractures which follow a partial fasciectomy (PF).

It is not always possible to straighten the fingers completely. Sooner or later, depending on the patients individual fibrosis diathesis a further recurrence occurs.

This work presents a completely new dynamic finger splint that can permanently correct a remaining contracture after a PF or PNF/PNF+.

Methods: Two test persons both with a high fibrosis diathesis and both suffering severe recurrences following partial fasciectomy were treated by PNF+ and PNF respectively.

A 56-year-old male patient underwent PNF+ with skin graft.

The contracture in the middle joint of his small finger, left hand, was reduced from 90 degrees (Tubiana 2) to 40 (Tubiana 1, Figure 1).

The contractures in the small finger of his right hand (Tubiana 4) were eased from 50 to 0 degrees in the base joint, and 90 degrees to 50 (Tubiana 2) in the middle joint (Figure 2).

The patient designed and fabricated his own completely new dynamic splint (video 1), which he wore 2-3 times a day for 2-3 hours at a time over a duration of 8 months.

A 32-year-old female patient suffered from a contracture of 90 degrees in the middle joint of her small finger, right hand. PNF released the contracture by a mere 15 degrees and only for the short time of 4-6 weeks (Figure 3a+b). The patient wore the newly developed dynamic splint several times a day for 1-3 hours at a time and during the night she wore a more comfortable dynamic splint (video 2) to prevent fist closure.

Results and Conclusions: After 8 months using his self-designed dynamic splint, the 56-year-old patient achieved a complete release of the contractures on both small fingers to stage 0 on the Tubiana scale (Figure 4+5). This condition has remained constant since October 2017 up until today. To maintain this status, it is essential that the dynamic splint is worn for 2-3 hours every day.

After just 5 months, the 32-year-old patient achieved an almost complete straightening of the finger, 83 degrees, almost Tubiana stage 0 (Figure 6).

She continues to wear both dynamic splints, day and night, but for a shorter duration.

Both fibrous cords and scars resulting from a partial fasciectomy can be stretched.

The newly developed dynamic splints can release severe recurrent Dupuytren's contractures permanently.