Minimally Invasive Treatment of Dupuytren Contracture: Collagenase Versus PNF

PNF collagenase

Patients

Male: female

39:9

19:4

20:5

Age

72 (54–80)

67 (49–79)

Right: left hand

27:21

11:12

16:9

Table 34.2

Patients at 24 months FU

		PNF	Collagenase
Patients	27	13	14
Male: female	22:5	11: 2	11: 3
Age	69	72 (56–79)	65 (49–79)

34.2.6 Measurements, Recurrence Definition, and Complications

The range of motion/ROM was measured with a goniometer at time 0 (prior to treatment) and 3, 6, and 12 weeks and 6, 12, and 24 months after treatment. The extension deficit was determined for each affected joint as well as the finger-nail-table-distance (stretching the fingers as much as possible and measuring the distance from the finger nail to the table in cm, laying the dorsum of the hand on the table). URAM und Quick-DASH scales were assessed prior to treatment and 6, 12, and 24 months afterward. Clinical success was defined as full stretching of the treated finger or a maximum extension deficit of 10°. The measurement after 3 weeks was the reference for determining recurrence, which was defined as an extension deficit of at least 20° more than at 3 weeks after treatment. This is in agreement with the Rome consensus (Felici et al. 2014). A stable extension deficit, compared to week 3, was not considered recurrence. Complications were recorded 1 and 3 weeks after treatment.

34.3 Results

34.3.1 Treatment Success

Staging of Dupuytren Disease prior to treatment and following Iselin: in the PNF group, there were 21 % in stage 2, 61 % in stage 3, and 18 % in stage 4, whereas in the collagenase group, 40% were in stage 2, 40 % in stage 3, and 20 % in stage 4. The achieved extension deficits and the development of extension deficits for both treatments were very similar (Figs. 34.1 and 34.2). Quick-DASH results were nearly identical scoring 20 prior to treatment, 3 after 12 months, and 2 after 24 months. The URAM scale improved from 15 to 2 in both groups.

Fig. 34.1

Extension deficit before and after 3 weeks, 12 and 24 months for the MCP joint. PNF vs. collagenase

Fig. 34.2

Extension deficit before and after 3 weeks, 12 and 24 months for the PIP joint. PNF vs. collagenase

A clinical case for each treatment with photo documentation is shown in Figs. 34.3 and 34.4, respectively.

Fig. 34.3

Pre-PNF and post-PNF after 6 and 24 months

Fig. 34.4

Pre- and post-collagenase injection after 6, 12, and 24 months

34.3.2 Complications

There were no major complications, like rupture or damage to tendons, blood vessels, or nerves in either group. In the PNF group, 15 % had small skin tears which all healed within a few days. 3 fingers had a slight transient numbing which vanished completely latest within 3 weeks. The collagenase group observed minor complications like swelling and bruising for about 30 % of the patients. The assessment of complications and pain was achieved by subjective answers from the patients one week after the treatment. Pain after treatment was much more frequent (5:1) in the collagenase group than in the PNF group.

34.3.3 Recurrence, Clinical Success, and Persisting Extension Deficit

Recurrent extension deficits in PIP and MCP joints were very similar in both groups (Tables 34.3 and 34.4). The recurrence results in the PNF group were even slightly better considering the more severe cases in the PNF group than in the collagenase group. Recurrence was measured relative to the result after 3 weeks. No treatment of recurrence was required during the 24-month study, but we are now, after three years, eventually starting to have repeated treatments. Clinical success was considered a straight finger with 0° extension deficit (maximum 10°), and the opposite was a persisting extension deficit after treatment at 3 weeks.

Table 34.3

Recurrence for MCP joints

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