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Collagenase treatment of Dupuytrens contracture using a modified injection method
Department Orthoped, Sweden; Ystad Hospital, Sweden; Lund University, Sweden.
Department Orthoped, Sweden; Ystad Hospital, Sweden; Lund University, Sweden.
Department Orthoped, Sweden; Ystad Hospital, Sweden.
Department Orthoped, Sweden; Ystad Hospital, Sweden.
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2015 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 86, no 3, 310-315 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose - Treatment of Dupuytrens contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods - We studied 164 consecutive hands with DC, palpable cord, and extension deficit of greater than= 20 degrees in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7-34) days after finger extension. Results - A skin tear occurred in 66 hands (40%). The largest diameter of the tear was less than= 5 mm in 30 hands and greater than 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59 degrees (SD 26) as opposed to 32 degrees (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of greater than= 75 degrees. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55 degrees (SD 28). Interpretation - Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good.

Place, publisher, year, edition, pages
Informa Healthcare: Creative Commons Attribution Non-Commercial / Informa Healthcare , 2015. Vol. 86, no 3, 310-315 p.
National Category
Clinical Medicine
URN: urn:nbn:se:liu:diva-120056DOI: 10.3109/17453674.2015.1019782ISI: 000355976700008PubMedID: 25695745OAI: diva2:839978

Funding Agencies|Hassleholm Hospital

Available from: 2015-07-06 Created: 2015-07-06 Last updated: 2016-04-25

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Waldén, Markus
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