Only few reports are available. Larocerie-Salgado and Davidson developed a volar hand-based nighttime extension splint combined with physiotherapy (stretching and massage) on PIP joint flexion contractures. After one year he reported a significant improvement of 15° in mild contractures in 13 patients (Larocerie-Salgado and Davidson 2012). Meinel developed a glove with static insert on the extension site and palmar silicone bed. In contrast to our splinting regime, this glove splint was prescribed after percutaneous needle fasciotomy and is worn at nighttime for 6 months. He mentioned a personal experience with lower recurrence risk and clinical remodeling (Meinel 2011). Glasgow et al. demonstrated that splinting at least 12 h a day reduced traumatic digital contractures in a short period of time (3 months), even without surgery (Glagow et al. 2003).

This idea of treating Dupuytren Disease by compression is today’s golden standard in hypertrophic burn scar management Chang et al. (1995). There is no available clinical research on the effect of compression on Dupuytren nodules. Hypertrophic and keloid scars are similar fibro-proliferative disease processes as Dupuytren Disease (Townley et al. 2006). In normal wound healing, granulation tissue disappears after epithelialization through a massive apoptosis of myofibroblasts. This wave of apoptosis lacks in fibro-proliferative disease (Gabbiani 2003). As mentioned earlier, the activity of myofibroblasts depends on the mechanical environment (Sarrazy et al. 2011). Several nonsurgical treatments have been proposed for hypertrophic and keloid scars, but only 2 have properties that induce mechanical forces on the scar: silicon sheets and compression therapy. The effect of compression therapy has been proven clinical (60–85 % success ratio) and histological, but the mechanisms responsible for hypertrophy remission following compression are not well understood (Fraccalvieri et al. 2012). Pressure therapy creates a localized hypoxia, which results in fibroblast degeneration and collagen breakdown (Worrell 2012, Yigit et al. 2009). An in vitro study on the effect of mechanical compression on hypertrophic scars demonstrated apoptosis in the derma of hypertrophic scars, twofold higher as compared to normal scar tissue (Reno et al. 2003). A prolonged compression can restore the cell organization as in normal scars and trigger myofibroblast apoptosis (Sarrazy et al. 2011).

There is discussion about the optimal amount of pressure. Most authors suggest a minimal interface pressure (pressure between the skin and splint) of 25 mmHg, but this is not evidence based (Macintyre and Baird 2006). The effect of pressure of 20 mmHg on fibroblasts in burn scars during 18 h causes an inhibition of fibroblasts and a decrease of TGF-β1, and a minimum of 20 h pressure splinting a day is advised (Sarrazy et al. 2011).

Silicon sheeting also is an imperative element in scar treatment and is generally well tolerated. The sheet must be worn for at least 12 h per day for 2–3 months to be effective (Berman et al. 2007). The combination of continuous compression with a silicon layer is a good method to manage keloid scarring and may thus be considered in Dupuytren Disease as well (Fraccalvieri et al. 2012). The challenge of traditional compression therapy in managing scarring or Dupuytren Disease is the ability to adequately fit the splint to the impaired area. It is therefore important to see the patient at regular intervals to adjust the splint to fit the achieved extension of the finger. A perfect contact between the skin and splint, especially at the nodules, is extremely important for reliable outcome.

Compression splinting should be considered as nonsurgical treatment in Dupuytren Disease, particularly in the case of palpable, visual, and in some cases even painful nodules. The use of splinting as a noninvasive, low-risk, low-cost treatment in primary or recurrent Dupuytren contractures may be a viable option. Both compression and tension splints can be effective in reducing the finger contractures, but compression therapy is better tolerated. A splinting regime of 20 h a day for 3 months is efficient in both early proliferative untreated hands as aggressive postsurgery recurrence disease. Long-term effects of tension and compression on Dupuytren nodules need more investigation, and the role of splinting in prevention of contractures in the long term is yet unclear.