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Single-Stage Versus Staged Fasciectomy for Severe PIPJ Contractures in Dupuytren Disease: A Retrospective Comparative
Jordan Lachnish1, Katherine Shehadeh1, Devan Patel1
1Stanford University Medical Center, Department of Orthopaedic Surgery, Stanford, CA.
Purpose:
This study compared the clinical effectiveness and safety of single-stage fasciectomy versus a two-stage approach for the treatment of severe proximal interphalangeal joint contractures in Dupuytren disease. The two-stage approach involves first using an external extension torque device (EETD) to correct the deformity, followed by removal of the device and fasciectomy at the second stage. We sought to determine whether the staged approach would (1) improve intraoperative correction and reduce residual contracture, (2) decrease operative time for fasciectomy, and (3) reduce complications in the short to mid-term.
Methods:
We performed a retrospective cohort study of patients with proximal interphalangeal joint contractures of 70° or greater treated at a single center. Fifty-two patients (54 digits) underwent single-stage fasciectomy, whereas 23 patients (23 digits) received a two-stage approach using the EETD for 6-10 weeks followed by fasciectomy. Primary outcomes included immediate postoperative correction and residual flexion contracture, operative time, and perioperative complications. Measurements were taken before surgery, immediately after surgery, and at final follow-up.
Results:
The staged approach provided considerably greater intraoperative correction (86° vs 69°) and lower immediate residual contracture (2° vs 15°) compared with the single-stage procedure. At final follow-up (mean 31 weeks, median 13 weeks, range 10-192), residual contracture did not differ between groups (32° vs 31°). Operative time for fasciectomy was considerably shorter in the two-stage group (80 vs 120 minutes); however, total surgical time was similar. Major complications occurred more frequently in the single-stage group, at roughly twice the rate observed in the two-stage group.
Conclusions:
Staging with the EETD led to improved immediate correction and shorter fasciectomy time. Major complications occurred at roughly half the rate in the staged group, suggesting a potential safety advantage, although the study was underpowered for complication analysis. Final residual contracture did not differ between groups, but this outcome was also underpowered, leaving the long-term effectiveness of the staged approach uncertain.
Type Of Study/Level Of Evidence:
Therapeutic IV.
