Progression of Dupuytren Contracture: A Randomized Controlled Trial Comparing Surgery, Needle Fasciotomy, and...

Area of Science:

• Orthopedics
• Hand Surgery
• Rheumatology

Background:

• Dupuytren's contracture treatment options include surgery, needle fasciotomy, and collagenase injection.
• Understanding the long-term effects of these treatments on disease progression in both treated and untreated fingers is crucial.

Purpose of the Study:

• To compare the progression of Dupuytren's contracture over two years across surgery, needle fasciotomy, and collagenase injection.
• To identify patient risk factors for disease progression and the need for retreatment.

Main Methods:

• Finger-level analysis of data from the DupuytrEn Treatment EffeCtiveness randomized controlled Trial (DETECT).
• Included 302 participants and 423 initially treated fingers, analyzing progression over two years.
• Linear regression models identified risk factors for progression and retreatment in treated and untreated fingers.

Main Results:

• Surgery showed less progression in treated fingers compared to needle fasciotomy and collagenase injection.
• No significant differences in progression were observed between treatment groups in adjacent or all untreated fingers.
• Younger age, smoking, dominant PIP joint involvement, and little finger involvement were associated with higher progression/retreatment risk.

Conclusions:

• Surgical treatment for Dupuytren's contracture offers more durable outcomes in treated fingers than percutaneous approaches.
• Progression and retreatment rates in untreated fingers were comparable across all evaluated treatment modalities.
• High-risk patients (young smokers with little finger involvement) may benefit most from surgical intervention.