A new finger-preserving procedure as an alternative to amputation in recurrent severe Dupuytren contracture of the small finger

Asa Eiriksdottir,Isam Atroshi

doi:10.1186/s12891-019-2701-2

Asa Eiriksdottir, Isam Atroshi

Open Access

https://doi.org/10.1186/s12891-019-2701-2

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Abstract

BackgroundRecurrent severe Dupuytren contracture of the small finger’s proximal interphalangeal (PIP) joint is a difficult problem. Further surgery carries high risk of complications and poor outcome. Patients are often offered finger amputation. We have devised a novel surgical procedure consisting of middle phalanx monoblock resection and ligament reconstruction to create a new functioning interphalangeal joint.MethodsTwo patients requesting small-finger amputation because of severe PIP joint contracture after multiple treatments for Dupuytren contracture were offered and accepted this new procedure. Through a dorsal incision the extensor tendon is incised longitudinally exposing the middle phalanx and interphalangeal joints. The collateral ligaments of both interphalangeal joints are detached from the middle phalanx. The middle phalanx is dissected from soft tissues (including the flexor digitorum superficialis tendon) and removed. The distal phalanx is brought proximally and the ends of the collateral ligaments are sutured with non-absorbable sutures with the joint held in full extension and congruency. The two patients were evaluated at 18 months and 15 months after surgery, respectively.ResultsBoth patients regained good finger posture with almost full extension and had normal sensation and no pain. Active flexion in the new interphalangeal joint was 60 degrees and 35 degrees, respectively. Both patients had full metacarpophalangeal joint flexion and extension, normal 2-point discrimination in the small finger and higher grip strength in the treated than the contralateral hand. Radiographs showed a congruent new interphalangeal joint. Both patients were very satisfied with the outcome.ConclusionsIn patients with Dupuytren disease and severe PIP joint contracture after multiple treatments, this novel procedure consisting of middle-phalanx excision and ligament reconstruction creating a new functioning interphalangeal joint has good short-term outcomes and is a favorable alternative to finger amputation. Longer follow-up will show whether these results are durable.

Highlights

Recurrent severe Dupuytren contracture of the small finger’s proximal interphalangeal (PIP) joint is a difficult problem
It has been estimated that finger amputations constitute approximately 2% of all surgical procedures performed on patients with Dupuytren disease (DD) [7, 8]
Teboul et al has described a procedure, done on a patient with recurrent Dupuytren contracture of the small finger after two previous subtotal fasciectomy procedures, involving simple removal of the middle phalanx but without the ligament reconstruction necessary to create a functioning interphalangeal joint [14]. We have performed this novel finger-preserving procedure of total excision of the middle phalanx and creation of a functioning single interphalangeal joint on two patients with recurrent severe Dupuytren contracture of the small finger. This procedure was offered and carried out as an alternative to amputation on two patients who presented with severe contracture of the small-finger PIP joint after multiple treatments for DD

Summary

Introduction

Recurrent severe Dupuytren contracture of the small finger’s proximal interphalangeal (PIP) joint is a difficult problem. We have devised a novel surgical procedure consisting of middle phalanx monoblock resection and ligament reconstruction to create a new functioning interphalangeal joint. In patients with Dupuytren disease (DD) recurrent contracture of the proximal interphalangeal (PIP) joint of the small finger is a difficult problem. When all surgical and other treatments have failed the only remaining option to offer patients has often been amputation of the affected finger. It has been estimated that finger amputations constitute approximately 2% of all surgical procedures performed on patients with DD [7, 8]. The cosmetic result of finger amputation is troublesome for some patients

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