Severe contractures of the proximal interphalangeal joint in Dupuytren's disease: combined fasciectomy with capsuloligamentous release versus fasciectomy alone

Plastic and Reconstructive Surgery
N WeinzweigE J Fleegler

Abstract

Severe proximal interphalangeal joint contracture in Dupuytren's disease presents a frustrating problem for hand surgeon. Some surgeons argue for fasciectomy alone, avoiding violation of the proximal interphalangeal joint, which may prolong morbidity and result in permanent limitation of flexion; this loss of flexion can be more disabling than a mild flexion contracture. Others favor capsulotomy in addition to fasciectomy, especially for severe contractures, to obtain additional release, arguing that one cannot completely correct secondary contracture by fasciectomy alone. We performed a retrospective review of severe flexion contractures (60 degrees or greater) involving 42 proximal interphalangeal joints in 28 patients with Dupuytren's disease. Twenty-seven joints in 18 patients underwent fasciectomy alone, and 15 joints in 10 demographically similar patients underwent capsulotomy in addition to fasciectomy. In the noncapsulotomy group, preoperative contracture averaged 78.4 degrees. Postoperative contracture averaged 36.6 degrees, with a 53 percent improvement. In the capsulotomy group, preoperative joint contracture averaged 82.5 degrees. Postoperative contracture averaged 36.8 degrees, with a 55 percent improvement. Intrao...Continue Reading

References

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Citations

Feb 5, 2015·Journal of Pediatric Oncology Nursing : Official Journal of the Association of Pediatric Oncology Nurses·Kelly R PeckHui Zhang
May 15, 2004·The Journal of Hand Surgery : Journal of the British Society for Surgery of the Hand·K BeyermannU B Lanz
Oct 4, 2011·The Journal of Hand Surgery, European Volume·J Larocerie-Salgado, J Davidson
Nov 23, 2000·Hand Surgery : an International Journal Devoted to Hand and Upper Limb Surgery and Related Research : Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand·K BeyermannU Lanz
Jan 22, 2004·The Journal of Hand Surgery : Journal of the British Society for Surgery of the Hand·J F S RitchieD H Yanni
Jun 9, 2015·Hand Surgery : an International Journal Devoted to Hand and Upper Limb Surgery and Related Research : Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand·Motohisa Kawakatsu, Susumu Saito
Jan 30, 2007·The Journal of Bone and Joint Surgery. American Volume·Ghazi M Rayan
Feb 27, 2014·Hand : Official Journal of the American Association for Hand Surgery·Mark Henry
Sep 6, 2015·The Journal of Hand Surgery, European Volume·P E BlazarB E Earp

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