Abstract
Objective
To assess the long term functional and objective outcomes for 2 stage Dupuytrens contracture correction.
Methods
Patients with severe contracture were offered a 2 stage correction. This involved application of external fixator to distract the contracture over the course of 2 weeks and subsequent partial fasciectomy (in primary contractures) and dermofasciectomy with full thickness skin graft (in recurrent contractures). A series of 54 corrections in 47 patients were identified. Of these, 6 were lost to follow-up, 1 deceased. Pre-operative total range of active movement (TRAM), total flexion contracture and PIP flexion contracture, Tubiana grade and DASH/Michigan Hand Scores were recorded and compared to post-operative data.
Results
Mean age was 61 (range 43–90), 44 male, 10 females. The average duration of follow-up was 32 months (range 6–96).
The mean fixed flexion deformity (FFD) in the PIPJ improved from 84 degrees (range 50–110, SD-12) to 30 degrees (range −5–90, SD-27) (p< 0.0001). Mean total flexion contracture improved from 123 degrees(range 50–210, SD-34) to 46 degrees (range 0–195, SD-50) (p< 0.0001). The mean TRAM improved from 70 degrees (range 10–140, SD-33) to 148 degrees (range 25–135, SD-52) (p< 0.0001).
DASH scores improved from 32.0 to 27.6. Michigan hand scores improved from 68 to 76. There was no statistical difference in pre- and post-op hand scores.
Complications include CRPS (8%), infection (6%), stiffness (4%), graft failure (4%), neurovascular injury (2%), fracture (4%)
Conclusions
Long term follow-up of this two stage technique shows that the correction, range of movement and function is maintained. We consider that the complications rate is acceptable for these very severe deformities where amputation, joint fusions and total collateral ligament and volar plate release are the only other comparable surgical alternatives.
