Proposal for Treatment of Severe Dupuytren Disease in 2 Steps: Progressive Distraction With External Fixator and Collagenase - A Preliminary Case Series.

Abstract

Background: We want to describe a treatment for advanced Dupuytren disease using a spanning external fixator (EF) applied dorsally to produce progressive extension, followed by collagenase injection. Methods: Between October 2014 and September 2016, a total of 22 fingers from 18 patients were treated with an EF. The devices were implanted under local anesthesia, and the patients were instructed to gradually extend the hinge to gain a progressive extension. The EF was removed in an outpatient clinic setting after obtaining a complete extension of the treated joint in a mean of 19 days (range 15-22 days), and a collagenase injection was performed in the residual cord after a mean of 20 days (18-24 days), followed by splinting. Results: All patients were evaluated at an average follow-up of 14 months (range 3-23 months): the total average residual flexion deformity was 9.7° (range 0°-19°) with a correction of 107.2° (range 94°-138°), the average flexion deformity of the proximal interphalangeal joint was 7.4° (range 0°-15°) with a correction of 64.4° (range 46°-92°), and the average flexion deformity of the metatarsophalangeal joint was 2.4° (range 0°-9°) with a correction of 42.8° (range 15°-59°). No complications were reported in relation to EF treatment. Two cases of cutaneous laceration after collagenase injection were observed, neither of which required any additional treatment. Conclusions: All patients obtained a regression from 2 to 3 stages in disease severity only with EF. We had no report of complications due to the device. After collagenase injection and splinting, we obtained further finger extension with a mean total residual flexion deformity of 9.7° at 14-month follow-up.