[Isolated fifth digit localization in Dupuytren's disease]
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Published on: April 18, 2015
J N Goubier1, Y Le Bellec, P Cottias
1Service de chirurgie orthopédique et traumatologique, Département de Chirurgie de la Main et du Membre Supérieur, hôpital Bichat, 46, rue Henri Huchard, 75877 Paris, France.
Abstract:
Isolated fifth digit localisation in Dupuytren's disease has a bad reputation. A series of this injury is reported with a special attention on recurrences. This series is composed of 30 cases in 26 patients (four bilateral cases): the majority of patients were male and 53.5 y was the average age. Extension loss of MP and PIP joints were present in 25 cases, MP isolated extension loss in two cases and PIP in three cases. The treatment performed was a percutaneous needle technique in five cases, surgical fasciectomy in 24 cases using a zigzag palmodigital longitudinal fasciectomy approach in 18 cases, an open palm technique in six cases and one isolated laterodigital flap. Assessment of correction was based on Tubiana's classification. Average follow-up was 22 months. Postoperative course was uneventful except for one case of precarious vascularisation which leads to an amputation. For the digitopalmar localisations: 15 stage 0 or 1, 7 stage 2, 1 stage 3 and 1 stage 4. Improvement percentage was 0.60 in combined cases, 0.65 in cases with a MP loss and 0.46 in PIP loss. Five recurrences were noted. Literature on this topic is coherent with the fact that isolated involvement of the fifth digit carry a bad prognosis, mainly due to the high recurrence rate in our series as in other papers. In severe injuries, an imperfect result should be the aim to prevent vasculonervous complications.
Insights
Dupuytren
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Plastic Surgery
Background:
- Dupuytren's disease affecting the fifth digit presents unique challenges.
- Recurrence rates and functional outcomes are significant concerns in isolated fifth digit cases.
- Understanding treatment efficacy is crucial for managing this condition.
Purpose of the Study:
- To evaluate treatment outcomes for isolated fifth digit Dupuytren's disease.
- To analyze recurrence rates and factors influencing them.
- To assess the effectiveness of surgical interventions based on disease severity.
Main Methods:
- Retrospective case series of 30 patients (26 individuals) with isolated fifth digit Dupuytren's disease.
- Treatments included percutaneous needle fasciotomy and surgical fasciectomy with various approaches.
- Outcomes assessed using Tubiana's classification, with an average follow-up of 22 months.
Main Results:
- A high recurrence rate was observed, consistent with existing literature.
- Functional improvement varied, with better outcomes for metacarpophalangeal joint involvement.
- One case resulted in amputation due to vascular complications; otherwise, the postoperative course was largely uneventful.
Conclusions:
- Isolated fifth digit Dupuytren's disease has a poor prognosis, primarily due to high recurrence rates.
- Surgical interventions aim for functional improvement, acknowledging that perfect results may not always be achievable.
- Preventing vasculonervous complications is paramount, especially in severe cases.
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