Needle Aponeurotomy for Stage IV Dupuytren Contracture: A Wide-Awake First Step Approach in 204 Consecutive Rays

Area of Science:

• Orthopedics
• Hand Surgery
• Minimally Invasive Procedures

Background:

• Severe Dupuytren disease presents significant treatment challenges, often requiring invasive surgery with high complication rates or amputation.
• Current treatment options for advanced Dupuytren contracture have limitations.

Purpose of the Study:

• To evaluate the efficacy and safety of needle fasciotomy (needle aponeurotomy) as a primary treatment for severe (stage IV) Dupuytren disease.
• To assess joint contracture improvement following needle aponeurotomy in patients with severe Dupuytren contracture.

Main Methods:

• Retrospective chart review of 204 rays from 165 patients with severe Dupuytren disease (total passive extension contracture ≥ 135 degrees).
• Patients received needle aponeurotomy as their sole or initial treatment.
• Goniometric measurements of finger joint contractures were recorded pre- and post-procedure over a mean follow-up of 22.3 months.

Main Results:

• Significant improvements were observed in flexion contractures at the metacarpophalangeal (74% gain), proximal interphalangeal (32% gain), and distal interphalangeal (46% gain) joints.
• Overall, total passive digit extension improved by 55% (p < 0.001).
• The procedure demonstrated minimal adverse effects.

Conclusions:

• Needle aponeurotomy is an effective and safe first-line treatment for severe Dupuytren disease.
• It leads to significant improvements in joint contractures across all finger joints.
• This minimally invasive approach can be used as a sole treatment or as a precursor to further interventions if necessary.