Is There a Role for Ultrasound During the Enzymatic Lysis of Dupuytren’s Cord? Our Preliminary Results

Abstract

Objective: The enzymatic lysis of Dupuytren’s cord with collagenase clostridium histolyticum (CCH) was approved for the treatment of adult patients with the Dupuytren disease with one palpable cord. Ultrasound is useful in the assessment of Dupuytren. We present our study comparing two groups of patients using ultrasound guided or not during enzymatic lysis of Dupuytren’s cord. Materials and Methods: We present a retrospective study comparing two groups, ultrasound guided or not. Ultrasound is used in localization and infiltration of Dupuytren’s cord and the contracture extension, using Esaote MyLab One Touch with 5 to 13 MHz linear, placed longitudinal and axial to the cord. Between 2012 and 2015, we treated 115 patients with a single cord treated by enzymatic lysis with CCH: 66 patients guided group and 49 not guided. We analyzed the results according to complications (contusion, hematoma, lymphangitis, infection, tendon rupture, vasculonervous lesion . . .) and clinical success, for every cord and affected joint, defined as flexum 0° to 5° of joint after 30 days. Results: We do not have statistic differences between two groups, according to complications. The clinical success between two groups was significantly higher (20.4%, 10%-30.6% with P value, .00564), and the clinical success in metacarpophalangic joint of annular finger is significantly higher (16.8%, 4%-30% with P value, .04454) for ultrasound-guided group. Conclusion: Ultrasound is able to help enzymatic lysis in the Dupuytren disease to improve clinical success, even more if we have a cord with metacarpophalangeal joint contracture in annular finger. The short-term results of this noninvasive therapy are promising; however, we do not have a long follow-up.