Article
A new finger-preserving procedure as an alternative to amputation in recurrent severe Dupuytren’s contracture of the small finger
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Authors
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Isam Atroshi
- Lund University, Department of Orthopedics Hässleholm-Kristianstad, Kristianstad, Sweden
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Ase Eiriksdottir
- Department of Orthopedics, Kristianstad, Sweden
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: Recurrent severe Dupuytren contracture of the small finger proximal interphalangeal (PIP) joint is a difficult problem. Further surgery and joint release carries high risk of neurovascular injuries and residual contracture. Other treatments like PIP arthrodesis or arthroplasty commonly yield poor results. Patients are often offered finger amputation. We have devised a novel surgical procedure consisting of middle phalanx monobloc resection and ligament reconstruction to create a new functional interphalangeal joint.
Methods: Two patients with severe small-finger PIP joint contracture after multiple treatments who requested finger amputation were offered and accepted this new procedure. Through a dorsal incision the extensor tendon is incised longitudinally exposing the middle phalanx and interphalangeal joints. The collateral ligaments of both IP joints are detached from the middle phalanx. The middle phalanx is dissected from soft tissues (including the flexor digitorum superficialis tendon) and removed. The distal phalanx is brought proximally and the ends of the collateral ligaments are sutured with non-absorbable sutures with the joint held in extension and congruency. The two patients were evaluated at 18 months and 15 months after surgery, respectively.
Results and Conclusions: Both patients regained good finger posture with almost full extension and had normal sensation and no pain. The first patient had 60 degrees active flexion in the newly fashioned joint and the second patient had 35 degrees. Both patients had full MCP flexion and extension, normal 2-point discrimination in the small finger and higher grip strength in the treated than the contralateral hand. Radiographs showed a congruent new IP joint. Both patients were very satisfied with the outcome.
In patients with Dupuytren disease and severe recurrent PIP joint contracture after multiple treatments, this novel procedure consisting of middle-phalanx excision and ligament reconstruction creating a new functioning interphalangeal joint has good short-term outcomes and is a favorable alternative to finger amputation. Longer follow-up will show whether these results are durable.
