Article
Open palm vs closed technique for treatment of multiple digit involvement with Dupuytren’s contracture: A prospective randomized study
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Authors
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Nash Naam
- Southern Illiniois Hand Center, Southern Illinois University, Effingham, United States
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Abdel Hakim Massoud
- Al Azhar University, Cairo, Egypt
| Published: | February 6, 2020 |
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Outline
Text
Introduction: Dupuytren's contracture is a fibroproliferative disease that affects the palmar aponeurosis resulting initially in nodule formation often with progression to cords with increasing contractures of affected digits. Contractures result in flexion deformities of the metacarpophalangeal (MP) and interphalangeal (PIP and DIP). Frequently multiple digits are involved. The use of collagenase injections has reduced the number of patients in need of surgical intervention. Still some patients would require surgical treatment especially if there is multiple digit involvement.
Open palm technique has been shown to improve the functional outcome especially when used for multiple digit involvement.
Methods: Between 2002 and 2017 a prospective randomized study was conducted comparing the functional outcome of treating multiple digit involvement of Dupuytren's contracture using either open palm technique (Group I) vs. closed technique (Group II). Patients were assigned randomly to either group.
There were 27 patients in group I vs 25 in group II. Both groups were very similar in age, gender, and number of digits involved. The average flexion deformities of MP and PIP joints in group I was 56 and 34 degrees respectfully compared to 62 and 27 in group II. 12 patients in group I (45%) and 17 patients in group II (68%) had excision of the check-rein ligaments of the PIP joints.
Follow up ranged from 14 months to 178 months for both groups with an average of 42 months.
Results: There were 3 complications in group I (transient paresthesia in 2 and digit wound dehiscence in 1) vs. 9 complications in group II (3 CRPS, 2 hematoma formation, 3 wound dehiscence and one nerve injury) (P= 0.001).
Average post-operative flexion deformities of the MP and PIP joints at final evaluation were 12 and 7 degrees respectively in group I vs 18 and 12 in group II. Recurrence was seen in 5 patients (19%) in group I vs. 12 patients (48%) in group II (P=0.002). Recurrence was more in patients who were treated earlier in the study. There were no infections in either group.
Conclusions: When compared to closed technique, open palm technique for multiple digit involvement in Dupuytren's contractures, provides better functional outcome including less complications and less incidence of recurrence.
